bluuebunny/crossref_metadata_2025 huggingface dataset:
Cellular Changes in Reissner's Membrane in Endolymphatic Hydrops
Authors: Yoon Tae H. , Schachern Patricia A. , Paparella Michael M. , Le Chap T.
Published: October 2014

A quantitative morphologic study of the cellular changes in human Reissner's membrane (RM) was performed under light microscopy on 30 normal temporal bones from 15 subjects, and on 20 temporal bones from 10 subjects with endolymphatic hydrops. The cellular density of the epithelial and mesothelial layers of normal RMs decreased with increasing age. In endolymphatic hydrops, cellular proliferation and decreased cellular density of a distended RM were observed, and these changes occurred more remarkably in epithelial cells. Decreased cellular density in RM was correlated to the degree of endolymphatic hydrops. These findings indicate an involvement of the epithelial cellular changes in the pathogenesis of endolymphatic hydrops. Our results suggest that cellular changes in RM may cause dysfunction of radial flow leading to ionic disturbance of endolymph, which provides a possible mechanism of hearing loss in endolymphatic hydrops.
Neonatal and Pediatric Microsubglottiscope Set
Authors: Ossoff Robert H. , Tucker John A. , Werkhaven Jay A.
Published: October 2014

A microsubglottiscope for infants and children has been developed for microlaryngeal surgery in the glottic and subglottic regions of the larynx. The universal handle allows selection of several sizes of blades to be used according to the patient's anatomic limitations. The tips of these blades have been designed specifically to give exposure to the subglottis and upper trachea under microscopic magnification. A needle adapter for jet ventilation has been included. The authors have used this instrument in young infants and children for diagnosis and for laser resection of subglottic stenosis, hemangioma, and suprastemal granuloma, and have found the exposure to be superior to that obtained with conventional microlaryngoscopes.
Tinnitus: The Hidden Epidemic a Patient's Perspective
Authors: Neher Andrew
Published: October 2014

The author describes his personal experience with tinnitus as well as various medical practitioners. He also discusses possible avenues for tinnitus research and suggests educational efforts that otolaryngology organizations might initiate.
Globus Pharyngeus: Long-Term Follow-up and Prognostic Factors
Authors: Timon Conrad , Cagney David , O'Dwyer Tadhg , Walsh Michael
Published: October 2014

A prospective trial of 80 patients with globus pharyngeus is reported. An in-depth analysis of the typical history at presentation is given. The average follow-up period was 27 months (range, 21 to 42 months). The asymptomatic rate at this interval was 25%, with a further 35% reporting a significant improvement in symptoms. Three independent factors were found to influence prognosis (p < .05). These were sex, length of history at consultation, and the presence or absence of associated throat symptoms. Male patients having a history of the globus symptom for less than 3 months and not complaining of any associated throat symptoms had the best chance of becoming asymptomatic or symptomatically improved. The presence or absence of heartburn or its treatment had no bearing on outcome.
Effect of Ototoxic Drug Administration to the Endolymphatic SAC
Authors: Lee Kwang Sun , Kimura Robert S.
Published: October 2014

Aminoglycosides were applied to the endolymphatic sac of guinea pigs, and the inner ears were studied by light microscopy, In group 1 gentamicin sulfate application on the lateral surface of the endolymphatic sac produced sensory cell atrophy limited to the macula sacculi. In group 2 gentamicin injection into the sac by extradural and intradural approaches often showed lesions in the maculae sacculi and utriculi, cristae of the three ampullae, and organ of Corti in the basal turn. In group 3 passive instillation of streptomycin sulfate pellets into the sac from a lateral opening resulted in a similar pattern of degeneration but with less severity in comparison to the injection method. Mild to severe endolymphatic hydrops was sometimes observed. The study shows diffusion of drugs taking place against the longitudinal flow of endolymph. This procedure may be applicable for the treatment of Meniere's disease.
In Vitro Ciliogenesis in Respiratory Epithelium of Cystic Fibrosis Patients
Authors: Jorissen Mark , Van der Schueren Bernadette , Van den Berghe Herman , Cassiman Jean-Jacques
Published: October 2014

Nasal epithelial cells, dissociated from nasal polyps of three cystic fibrosis patients, were cultured on collagen gels until all cilia were lost, and then the cells were released in suspension as cell sheaths to form aggregates and vesicles. Cilia reappeared after 1 week. The number of ciliated cells increased progressively and within 1 month large areas of the aggregates were ciliated. These newly formed cilia were ultrastructurally normal. The ciliary activity was well coordinated and resulted in continuous movements of the aggregates in the culture medium. In the supranuclear cytoplasm the different ciliogenetic precursors were found; fibrogranular aggregates with occasionally small tubules, deuterosomes with procentrioles, kinetosomes, basal bodies, and short cilia. Initial stages of ciliary shaft formation, such as elevation of the apical membrane above the basal bodies without axonemal ultrastructure, could be well documented. The results indicate that in cystic fibrosis, ciliogenesis and the resulting ciliary activity in vitro are indistinguishable from those seen in cells from control tissue.
Human in Vitro Nasal and Tracheal Ciliary Beat Frequencies: Comparison of Sampling Sites, Combined Effect of Medication, and Demographic Relationships
Authors: Roth Yehudah , Baum Gerald L. , Aharonson Ephraim F. , Priel Zvi , Teichtahl Harry , Modan Michaela
Published: October 2014

In vitro nasal and tracheal ciliary beat frequencies (CBFs) were measured photometrically in brush samples of 15 patients undergoing bronchoscopy. Tracheal and nasal CBF values in these patients were found to be significantly correlated (r = .74, p < .01), and the latter did not differ significantly from the nasal CBF of 80 subjects serving as controls. Premedication with morphine and atropine and local anesthesia with lidocaine hydrochloride significantly decreased the CBF. Among the control subjects, a significantly higher CBF (13.6 ± 1.5 Hz) was found in the young age group (10 to 19 years) as compared to other groups (12.2 ± 1.7 Hz). Gender and ethnic origin did not influence CBF in any age group. These data support the possible use of the in vitro study of nasal epithelium to reflect the CBF in the lower respiratory tract.
Cochlear Blood Flow under Increased Inner Ear Pressure
Authors: Nakashima Tsutomu , Suzuki Toru , Yanagita Noriyuki
Published: October 2014

The effect of elevation of inner ear pressure on cochlear blood flow in guinea pigs was studied with use of nonradioactive microspheres and a laser-Doppler flowmeter. Hydrostatic pressure was applied to the perilymph through a glass capillary tube inserted into the scala tympani of the basal turn. Because of the elevation of the inner ear pressure, the cochlear blood flow, except to the modiolus, decreased significantly. Above all, the blood flow in the capillaries or microcirculation in the cochlea was most easily impaired by the elevation of inner ear pressure.
Ultrastructural and Cytochemical Evidence for Single Impulse Initiation Zones in Vestibular Macular Nerve Fibers of Rat
Authors: Ross Muriel D. , Chee Oliver , Cutler Lynn , Black Samuel
Published: October 2014

Cupric ion–ferricyanide labeling methods and related ferrocyanide-stained tissues were used to locate and characterize, at the ultrastructural level, presumptive impulse initiation zones in the three types of vestibular macular nerve fibers. Large-diameter, M-type vestibular nerve fibers terminate in a calyx at the heminode, and labeling is coextensive with the base of the calyx. Intermediate, M/U-type nerve fibers have short, unmyelinated preterminal segments that sometimes bifurcate intramacularly, and small-diameter, U-type nerve fibers have long, unmyelinated preterminal axons and up to three branches. Preterminals of these nerve fibers display ultrastructural heterogeneity that is correlated with labeling patterns for sodium channels and/or associated polyanionic sites. They have a nodelike ultrastructure and label heavily from near the heminode to the base of the macula. Their intramacular branches, less organized ultrastructurally, label only slightly. Results indicate that vestibular nerve fibers have one impulse initiation zone, located near the heminode, that varies in length according to nerve fiber type. Structural heterogeneity may favor impulse conduction in the central direction, and length of the impulse initiation zone could influence nerve discharge patterns.
Inhibition of Bacterial Adherence by Nasopharyngeal Secretions
Authors: Kurono Yuichi , Shigemi Hideo , Shimamura Koichiro , Mogi Goro
Published: October 2014

The role of secretory immunoglobulin (Ig) A in nasopharyngeal secretions in the adherence of Streptococcus pneumoniae and Hemophilus influenzae to nasopharyngeal epithelial cells was investigated in vitro. The adherence was remarkably reduced by treating bacteria with nasopharyngeal secretions, and the antiadhesive activity was significantly greater in nasopharyngeal secretions having secretory IgA antibody activity against bacteria than in those having no activity. Noticeable changes were not observed in the antiadhesive activity caused by absorption of IgG from nasopharyngeal secretions. Results suggest that secretory IgA in nasopharyngeal secretions is related to bacterial adherence and adds to the prevention of nasopharyngeal infections.
Hearing and Vestibular Disturbances in Behçet's Syndrome
Authors: Gemignani Gabriele , Berrettini Stefano , Bruschini Paolo , Piragine Franco , Sellari-Franceschini Stefano , Pasero Giampiero , Fusari Pierfrancesco , Olivieri Ignazio
Published: October 2014

In order to evaluate the prevalence of audiovestibular disturbances in Behçet's syndrome, we submitted 20 consecutive patients and 20 control subjects to detailed audiologic and vestibular examination in the last 3 years. A sensorineural hearing loss was found in 12 patients, 2 of whom revealed sudden deafness. Two other patients with neuro-Behçet's syndrome showed a vestibular function deficit, and 3 others exhibited altered caloric stimulation test results. Two of these last patients also revealed a simultaneous bilateral auditory deficit. HLA typing showed the presence of the B51 antigen in 10 of the 14 patients with ear involvement, while only 3 of the 6 patients without ear involvement were HLA-B51-positive. Results suggest that audiovestibular involvement is common in Behçet's syndrome: Sudden deafness may be the first sign of ear disturbance; vestibular lesions may represent an early sign of neuro-Behçet's syndrome; and the HLA-B51 antigen is associated with ear involvement. Otoneurologic study can reveal hidden brain stem lesions in Behçet's patients during flare-ups of the disease, even without obvious signs of neurologic deficits.
Predicting Radioresistance in Early Glottic Squamous Cell Carcinoma by DNA Content
Authors: Walter Margaret A. , Peters Glenn E. , Peiper Stephen C.
Published: October 2014

Nuclear DNA content has been implicated as a prognostic factor in an increasing number of tumor types. Current data on the role of DNA content in head and neck carcinoma are conflicting and incomplete. To evaluate the role of DNA content in predicting radioresistance, 29 patients with T1N0M0 squamous cell carcinoma of the glottic larynx who had undergone uniform curative radiotherapy and whose clinical outcome was known had flow cytometric analysis for DNA content performed on their tumors with paraffin-embedded archival tissues. Five aneuploid lesions and 24 diploid lesions were identified. All aneuploid lesions occurred in radioresistant tumors. The probability of an aneuploid tumor failing radiotherapy was highly significant at p = .016. No DNA discordance was found in a sampling of half of the radioresistant lesions' pretreatment and recurrent specimens, for a 100% predictive value of moderate statistical power. On the basis of these findings, patients with aneuploid T1 glottic lesions should be referred for primary surgical therapy.
Nasopharyngeal Carcinoma: Modes of Presentation
Authors: Skinner Derek W. , Van Hasselt C. Andrew , Tsao S. Y.
Published: October 2014

Nasopharyngeal carcinoma (NPC) is a common malignancy among the southern Chinese people and has a poor prognosis. The aim of this study was to describe in detail the presentation of NPC as found between 1984 and 1988 at Prince of Wales Hospital, Hong Kong. Our study confirmed that patients present with an advanced stage of malignancy; 707% were stage III to V. Eighty-two percent of patients were between 21 and 60 years of age. The symptoms often suggested benign disease and most patients would delay seeking treatment for at least 5 months. We recommend inspection of the nasopharynx with flexible nasoendoscopy for all persons in high-risk areas on a regular basis and advise a policy of active health education for both physicians and the general population to reduce the stage of NPC at first presentation.
Role of Quinsy Tonsillectomy in the Management of Peritonsillar Abscess
Authors: Lockhart Ricky , Parker Gregg S. , Tami Thomas A.
Published: October 2014

Peritonsillar abscess (PTA) is the most frequent complication of acute tonsillitis requiring surgical intervention. Debate continues concerning optimal therapy in terms of patient morbidity and cost-effectiveness. A retrospective study was performed on 45 tonsillectomies for PTA in military personnel from December 1986 through December 1988. Twenty-three quinsy (abscess) tonsillectomies and 22 interval tonsillectomies were identified. Parameters studied were age, sex, abscess location, interval prior to operation, blood loss, operative time, operative experience, and combined hospital and convalescent days for the two groups. Significant differences were noted between the quinsy and interval tonsillectomy groups concerning the average number of days hospitalized (3.0 versus 4.5) and their respective convalescent periods (10.3 versus 17.3). We conclude that quinsy tonsillectomy is the best management for PTA in a young work force when the optimal treatment choice is between interval or acute tonsillectomy.
Effects on Cochlear Morphology of Repeated Insults to the Stria Vascularis
Authors: Duvall Arndt J. , Robinson Karen S.
Published: October 2014

The interrelationship of stria vascularis and organ of Corti integrity was investigated. Strial morphology was altered by repeated injections of ethacrynic acid in the chinchilla. Although prolonged temporary strial damage was created, neither strial atrophy nor organ of Corti damage resulted.
Arachidonic Acid Metabolites in Middle Ear Effusions of Children
Authors: Faden Howard , DeCastro Giovanna , Brodsky Linda , Bernstein Joel , Volovitz Benjamin , Stanievich John , Ogra Pearay L.
Published: October 2014

Middle ear effusions (MEEs) from 78 children (98 ears) with otitis media were examined for products of arachidonic acid (AA) metabolism, including leukotrienes B4, C4, D4, and E4 and prostaglandins D2 and E2, by high-performance liquid chromatography. Leukotrienes B4 and D4 were recovered most frequently: 59% and 54%, respectively. Leukotriene B4 was found in highest concentration, 1.29 ± 3.46 ng/0.1 mL. The concentrations of leukotrienes B4 (p < .03), C4 (p < .01), and E4 (p< .02) were significantly higher in culture-positive than in culture-negative MEEs. Neither the concentration nor the type of AA metabolite correlated with bacterial species isolated, chronicity of effusion, age of subject, or consistency of MEE. These data suggest that the AA metabolites are synthesized relatively frequently during otitis media of childhood. Leukotriene B4 is the most frequently detected AA metabolite in MEEs and is highly associated with the presence of viable bacteria.
Familial Sensorineural Hearing Loss: A Correlative Study of Audiologic, Radiographic, and Vestibular Findings
Authors: Chan Kenny H. , Furman Joseph M. R. , Eelkema Elizabeth A. , Kamerer Donald B.
Published: October 2014

A multidisciplinary approach to the study of a family with autosomal dominant sensorineural hearing loss is presented. The affected family members underwent extensive clinical and laboratory evaluation. They were found to have various degrees of bilateral congenital inner ear anomalies as imaged by computed tomography. The degree of structural abnormalities in the inner ears correlated with the severity of hearing impairment. Vestibular testing revealed nonspecific abnormalities generally correlating with audiologic and radiographic findings. This report presents a unique form of sensorineural hearing loss not previously described and is the first in-depth clinical study of nonsyndromal “Mondini dysplasia” occurring in a family.
Oral Ofloxacin Therapy for Invasive External Otitis
Authors: Rapoport Yoram , Shalit Itamar , Zikk Daniel , Redianu Chaim , Himmelfarb Mordechai Z.
Published: October 2014

The clinical efficacy and safety of orally administered ofloxacin (400 mg twice daily) were evaluated in 24 adult patients (17 men and 7 women; mean age, 65.8 years) with pseudomonal invasive external otitis (IEO). The patients were divided into two groups: Group A, (n = 9) suffering from a mild form of IEO, and group B (n = 15), suffering from a more severe form of the disease. Diabetes mellitus was the main underlying disease in these patients. Pseudomonas aeruginosa was the only pathogen in 18 infected ears and part of the polymicrobial flora in an additional 6. Cure was observed in 83.3 % of the patients. Two of the cured patients required more than one course of ofloxacin treatment. Development of P aeruginosa resistant to ofloxacin (n = 3) and severe allergic reaction (n = 1) required the discontinuation of ofloxacin therapy. Other side effects such as nausea, arthralgia, and vaginal itching were minimal. Oral administration of ofloxacin seems to be an effective, convenient, relatively safe, and economical therapy of IEO caused by the susceptible organism.
Ultrastructure of Cat Superior Vestibular Commissural Neurons
Authors: Lyon Michael J. , Guyot Jean-Philippe , Gacek Richard R.
Published: October 2014

The ultrastructure of the feline superior vestibular commissural neurons (CNs) was studied after labeling by contralateral injection of horseradish peroxidase. These small spindle-shaped cells are found in clusters oriented in a rostrocaudal, dorsoventral, or lateromedial direction. The CNs have a cleft nucleus, with the majority of nerve terminals contacting the CN near the emergence of polar dendrites. Polarization of the afferent synaptic profiles suggests a bidirectional nature of inputs to CNs by the vestibular nerve, contralateral CNs, and/or cerebellar systems. One type of labeled cell does not conform to this pattern, instead resembling a vestibulo-ocular neuron. Hence, it may function as a commissural and a vestibulo-ocular neuron. Characterization of different types of synapses, based on the size and eccentricity of their synaptic vesicles, indicates a continuum rather than separate populations. Volume fraction of intracellular organelles showed a larger volume fraction percent of polyribosomes in larger cells. Since this organelle is involved with protein synthesis, this finding may indicate that larger CNs have a more extensive dendritic tree.
Choanal Atresia and Lymphedema
Authors: Borderon Marie L. , Har-El Gady , Weiss Michael H.
Published: October 2014

The coexistence of bilateral bony choanal atresia and lower-extremity lymphedema was observed in a family with several consanguineous marriages. The combination of these two rare anomalies, in a hereditary form, has not been described before.
Immunohistochemical Localization of Spleen-Type Prostaglandin D Synthetase in Rat Nasal Mucosa
Authors: Iwata Shigenobu , Nagatsu Ikuko , Miwa Masato , Niwa Kazushi , Urade Yoshihiro
Published: October 2014

Using the specific antibody of spleen-type prostaglandin D synthetase, we investigated the immunohistochemical localization of this enzyme in rat nasal mucosa. The excised tissues were fixed with 4% paraformaldehyde and immunohistochemically stained by the peroxidase-antiperoxidase method. Formalin-resistant connective tissue mast cells were positive for spleen-type prostaglandin D synthetase.
Basaloid Monomorphic Adenomas
Authors: Luna Mario A. , Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Monomorphic adenomas can be divided into basaloid and nonbasaloid types. With the exception of the canalicular adenoma, the basaloid monomorphic adenomas are preponderantly tumors of the major salivary glands, most often the parotid gland. The dermal analogue monomorphic adenomas, so named because of their histologic similarity to eccrine tumors of the skin, are a unique subset of the basaloid adenomas. They are often multifocal, recur frequently, may undergo malignant change, and can be part of a salivary-cutaneous tumor diathesis
Head and Neck Surveillance Program for Factory Personnel Exposed to Asbestos
Authors: Parnes Steven M. , Sherman Malcolm
Published: October 2014

Personnel at a local factory that manufactures brake linings and discs in which asbestos is a major component were requested to participate in an on-site surveillance program to detect head and neck abnormalities, specifically cancer. Demographic data included smoking histories and job descriptions that could be delineated into high– and low–asbestos exposure groups. In the first year, 322 factory workers had no cancer identified but 15% had laryngeal abnormalities, mostly laryngitis. Ninety-seven percent of those workers with abnormal findings were smokers, but there were a significant number in the high-asbestos group irrespective of smoking histories. From this report, high-risk individuals were identified and requested to continue in the program for monitoring. In the subsequent 3 years, these individuals and new personnel were examined. Similar results were obtained in that laryngitis was noted in 24% (95% of whom were smokers) with a stronger statistical association with the high-asbestos group. More important, one person previously identified as high-risk was noted to have stage I squamous cell carcinoma and was treated with radiotherapy. The results of this program suggest that individuals at high risk for the development of head and neck cancer can be identified and that such surveillance programs should be implemented in similar arenas.
Massive Orofacial Abscesses of Dental Origin
Authors: Welsh John J. , Welsh Louis W. , Kelly John J.
Published: October 2014

Massive cervicofacial abscesses of dental origin are relatively rare, and may be associated with serious and grave morbidity. In extreme cases, an occasional fatality may result from regional complications. Three cases are presented that describe the clinical and radiographic evaluation and the surgical approaches for abscess drainage. Specific attention is directed toward 1) the management of imminent airway obstruction, 2) the application of computed tomographic technology for localization and surgical planning, and 3) current antibiotic therapy.
Basaloid Salivary Carcinoma
Authors: Batsakis John G. , Luna Mario A.
Published: October 2014

The basaloid salivary carcinoma is proposed as the malignant counterpart of the basal cell or basaloid monomorphic adenoma. The carcinoma can arise de novo or by evolution from a maternal monomorphic adenoma. Particularly at risk for the latter sequence is the dermal analogue monomorphic adenoma. Preponderantly a parotid gland neoplasm, the basaloid carcinoma appears to be a biologically low-grade carcinoma with a low mortality but with a respectable local aggressiveness and recurrence rate
Laryngeal Synkinesis following Reinnervation in the Rat: Neuroanatomic and Physiologic Study Using Retrograde Fluorescent Tracers and Electromyography
Authors: Flint Paul W. , Downs Daniel H. , Coltrera Marc D.
Published: October 2014

The functional organization of laryngeal motoneurons in the nucleus ambiguus (NA) was evaluated in adult male rats before and after recurrent laryngeal nerve section and reinnervation. Using retrograde double labeling techniques with fluorescent probes, we obtained the number and position of labeled neurons by using the Bioquant 3-D imaging system. Reinnervation was documented by electromyography. In nine control animals vector analysis revealed significant (p < .05) separation of the posterior cricoarytenoid (PCA) muscle motoneurons and the thyroarytenoid and lateral cricoarytenoid (TA/LCA) muscle motoneurons. The PCA motoneurons were positioned ventromedially in the NA, and TA/LCA motoneurons were found dorsolaterally in the NA. Rostral-caudal separation was not significant. Electromyography revealed phasic electrical activity synchronous with respiration in the PCA, and activity synchronous with deglutition in the TA/LCA. In four animals surviving 15 weeks following recurrent laryngeal nerve section and primary neurorrhaphy, functional organization within the NA was lost and phasic motor unit activity synchronous with respiration was seen in the TA/LCA muscle as well as the PCA. Vector analysis revealed the reinnervating motoneurons for both the PCA and TA/LCA to be positioned dorsolaterally, similar to the control group TA/LCA motoneurons. These findings demonstrate a shift in the topographic organization of laryngeal motoneurons within the NA following reinnervation, with random organization occurring at the neurorrhaphy site.
Rosai-Dorfman Disease Involving the Premaxilla
Authors: Shemen Larry , D'Anton Michael , Toth Ilona , Klijian Ara , Galantich Peter
Published: October 2014

Sinus histiocytosis with massive lymphadenopathy (SHML), introduced in 1969 by Rosai and Dorfman, is a benign and self-limited (albeit often relapsing) pseudolymphomatous entity with characteristic histopathologic features. Although the presence of massive cervical lymphadenopathy often aids in the diagnosis of SHML, the disease may present in the absence of detectable nodal involvement (Rosai-Dorfman disease). Therefore, the physician must be aware of such extranodal presentations. A recent review of the 365 cases in the SHML registry has revealed a preponderance of eyelid and/or orbital involvement; only 26 cases were found with subcutaneous or soft tissue involvement in areas other than the eyelid and/or orbit. This is a case report of one such atypical presentation of SHML without clinically apparent lymphadenopathy or eyelid or orbital involvement.
Traction Diverticulum of the Hypopharynx following Anterior Cervical Spine Surgery
Authors: Goffart Yves , Lenelle Jacques , Moreau Pierre , Boverie Jean
Published: October 2014

Pharyngeal complications due to anterior cervical spine surgery (ACSS) are not rare. We describe the case of a traction diverticulum of the hypopharynx after ACSS, a complication that has not yet been reported. We discuss the possible mechanism. A review of the complications of ACSS that are of interest to the otolaryngologist is included.
Tracheomalacia and Bronchopulmonary Dysplasia
Authors: Duncan Scott , Eid Nemr
Published: October 2014

Wheezing in the infant with bronchopulmonary dysplasia results from various pathophysiologic mechanisms, including upper or central airway obstruction. We report an infant with bronchopulmonary dysplasia who presented with episodic wheezing associated with hypoxia and bradycardia without evidence of stridor. Bronchoscopy revealed the presence of tracheomalacia. Upper or central airway obstruction, if undiagnosed, may be life-threatening. We suggest that wheezing with hypoxia and bradycardia in neonates should alert the physician to the possibility of tracheomalacia, even in the absence of audible stridor. Infants presenting with these symptoms should undergo bronchoscopy to confirm the diagnosis.
Salivary Gland Tumors in Children
Authors: Luna Mario A. , Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Fewer than 5% of all primary salivary gland neoplasms occur in children, but if benign supporting tissue tumors are excluded, a higher proportion than in adults are malignant. The first decade of life, and particularly the first 2 years of life, has a preponderance of benign neoplasms. Commencing with the second decade, carcinomas rise in incidence and are most often mucoepidermoid and acinic cell carcinomas. The pleomorphic adenoma is the most common epithelial salivary tumor throughout childhood. The embryoma may be a uniquely childhood epithelial salivary gland tumor.
Causes of Childhood Deafness at a Dutch School for the Hearing Impaired
Authors: van Rijn Peter M. , Cremers W. R. J.
Published: October 2014

This study was conducted on 162 hearing-impaired school pupils who were investigated as to the cause of their hearing loss. In 64 pupils (40%) a hereditary cause was recognized, and in 43 (27%), an acquired cause; in 55 (34%) the cause remained unknown, according to the criteria we used for defining a cause. Special attention was paid to the differences between the hereditary and acquired forms of deafness in relation to the degree of hearing loss. The study population therefore was divided into groups per 10 dB of hearing loss. Using this method we found that an autosomal dominant hearing loss occurred significantly more frequently among the less severe hearing disorders. This finding, which has not been seen in the literature, is important in genetic counseling for the deaf. Another remarkable finding was that Usher's syndrome, especially type 2 with a moderate hearing loss, was more frequent among the hearing-impaired subjects than we had expected.
Congenital Conductive or Mixed Deafness, Preauricular Sinus, External Ear Anomaly, and Commissural Lip Pits: An Autosomal Dominant Inherited Syndrome
Authors: Marres Henri A. M. , Cremers W. R. J.
Published: October 2014

Branchiogenic syndromes such as branchio-oto-renal syndrome, Treacher Collins syndrome, and hemifacial microsomia are well delineated. From a clinical study in a large family spanning three generations, it can be concluded that the association of conductive deafness, commissural lip pits, preauricular sinuses, and external ear anomalies can be differentiated from the above-mentioned syndromes and is a separate autosomal dominant syndrome.
Afferent Activity in the External Branch of the Superior Laryngeal and Recurrent Laryngeal Nerves
Authors: Sant'Ambrogio Franca B. , Mathew Oommen P. , Tsubone Hirokazu , Sant'Ambrogio Giuseppe
Published: October 2014

We investigated the presence of respiratory-modulated receptors in the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (ExtSLN) in anesthetized, spontaneously breathing dogs. Of 39 receptors recorded from the ExtSLN, the vast majority responded with a slowly adapting discharge to compression of the cricothyroid muscle, and only 1 responded to probing of the laryngeal mucosa. Ten receptors showed a respiratory modulation. All 30 receptors recorded from the RLN responded to probing of the laryngeal lumen, most of them (60%) with a rapidly adapting response. Seven of the slowly adapting receptors exhibited a respiratory modulation; 38% of the receptors tested were stimulated by water, and only 15% by smoke. No receptors stimulated by laryngeal cooling were identified in either nerve. Our study indicates that in the RLN and the ExtSLN there are relatively few afferents responding to changes in transmural pressure and mechanical irritation, as compared to the internal branch of the SLN. The relative scarcity of receptors responding to transmural pressure and irritant stimuli is consistent with previous observations in dogs that indicate a preponderant role for afferents in the internal branch of the SLN in the reflex responses to laryngeal stimulation.
Plasma Cell Granuloma of the Middle Ear and Mastoid
Authors: Benton Nick C. , Korol Harold W. , Smyth Lawrence T.
Published: October 2014

We present the case of a 37-year-old man with plasma cell granuloma affecting the middle ear and mastoid. At magnetic resonance imaging scan, the lesion appeared as a homogeneously enhancing mass of soft tissue replacing the majority of the mastoid bone and causing vascular compression. After surgical resection, microscopic examination showed predominantly plasmacytes, and histochemical studies confirmed a polyclonal origin consistent with nonneoplastic plasma cell granuloma. We believe this is the first case report of plasma cell granuloma affecting the middle ear and mastoid.
“Adenocarcinoma, not otherwise Specified”: A Diminishing Group of Salivary Carcinomas
Authors: Batsakis John G. , El-Naggar Adel K. , Luna Mario A.
Published: October 2014

As refinements in classification with clinicopathologic correlations proceed, the “adenocarcinomas, not otherwise specified” (NOS) of salivary tissue are reduced in number. Clinicopathologic entities such as salivary duct carcinoma, terminal duct carcinoma, and epimyoepithelial carcinoma, formerly in the NOS category, are examples of this process. There remain, however, adenocarcinomas of salivary tissues that cannot be accommodated in conventional classifications. They are the least common of salivary carcinomas and manifest a cytoarchitecture ranging from a well-differentiated, low-grade appearance to high-grade, invasive lesions. This report addresses this group of carcinomas for which the NOS designation is still applicable.
Voice Analysis of Patients with Endoscopically Treated Early Laryngeal Carcinoma
Authors: McGuirt W. Frederick , Koufman James A. , Blalock David , Feehs Robert S.
Published: October 2014

Endoscopic laser resection of early (T1) laryngeal carcinoma has been advocated as an alternative to radiotherapy. Heretofore, the voice characteristics following this procedure have been addressed in only one review, which included patients treated by irradiation and laser resection. We present the first review of voice findings in 22 patients treated only by endoscopic laser resection of their vocal cord carcinomas. Laser resection of selected vocal cord carcinomas produced voice function results acceptable to the patients and was rated by them to be normal to almost normal. Speech pathologists rated the voices to be near-normal to mildly abnormal. Voices after laser resection of vocal carcinoma exhibited a slightly higher fundamental frequency, a decrease in intensity and phonatory duration, and markedly higher laryngeal airway resistance. The percentage of voicing showed little deviation from normal, as did mean percentage of perturbations.
Histopathologic Correlates of Acute Laryngeal Allograft Rejection in a Rat Model
Authors: Strome Scott , Brodsky Gilbert , Wu Justin , Darrell Judith , Strome Marshall
Published: October 2014

This study used both clinical and histopathologic criteria to define the sequence and time parameters of rejection in histoincompatible vascularized rat laryngeal allografts. Clinical onset of rejection was characterized at 1 week by graft edema. Pathologic examination at this time revealed arterial wall thickening and a diffuse lymphocytic and macrophage mucosal infiltrate. At 14 days, the graft was encased in an inflammatory exudate with no visible cartilaginous structure. This correlated microscopically with a lymphocytic infiltrate of the lamina propria, loss of minor salivary glands, and squamous metaplasia of the surface respiratory epithelium. Arterial thrombosis was always correlated with tissue necrosis, but venous occlusion, occurring more than 2 days after transplantation, was not an independent determinant of graft viability. Definition of the time sequence and histopathology of rejection will allow future determination of the efficacy of various immunosuppressive regimens.
Cochlear Blood Flow and Microvascular Resistance Changes in Response to Hypertonic Glycerol, Urea, and Mannitol Infusions
Authors: Baldwin David L. , Miller Josef M. , Ohlsén K. Agnetha , Nuttall Alfred L.
Published: October 2014

The effect of hyperosmotic agents on cochlear blood flow (CBF) was tested in normal guinea pigs and in guinea pigs having prior unilateral operations to ablate the endolymphatic duct. Laser-Doppler-measured CBF was normalized to remove apparent changes related directly to systemic blood pressure. Hyperosmotic fluids were given via venous infusion: glycerol (20% and 40% solutions), urea (10%, 30%, and 40% solutions), and mannitol (40% solution). All agents were dissolved in 0.9% saline and the mixtures were given at a rate of 0.3 to 0.6 mL/min for 5 minutes. Control infusions were of 0.9% saline and isotonic dextran 70 (Pharmacia). All hyperosmotic infusions resulted in similar increases in normalized cochlear blood flow (nCBF) that extended to a maximum of 300 % of the baseline value in a dose-dependent way during the infusion time period. Within approximately 30 minutes following infusions, nCBF had returned to baseline levels. Saline infusion alone had little effect on nCBF, but isotonic dextran 70 gave a sustained increase to 122% of the baseline levels. There was no difference between the responses of nCBF in hydropic and normal cochleas for either control or hyperosmotic solutions. Measurements of systemic hematocrit at time intervals during and following the infusions showed that transient reductions of up to approximately 8% (for the maximum osmotic challenge) occurred during the infusion. It is concluded that the hyperosmotic treatments tested here are equally effective for short-term enhancements of nCBF in both normal and hydropic cochleas. The basis of the flow increase is partially rheologic and partially due to a local vasodilation.
Fine-Needle Aspiration of Salivary Glands: Its Utility and Tissue Effects
Authors: Batsakis John G. , Sneige Nour , El-Naggar Adel K.
Published: October 2014

Any diagnostic procedure requires a circumspect decision on its clinical utility. Otherwise, it risks being only an additional evaluation that is not cost-effective. In the case of fine-needle aspiration biopsy of lesions of salivary glands, there are unquestioned clinical indications; none, however, merit its inclusion as part of a systematic evaluation. Attention is also called to the possible negation of a histopathologic diagnosis because of the tissue effects of the fine-needle aspiration.
Slow Cumulative Eye Position to Quantify Optokinetic Afternystagmus
Authors: Hain Timothy C. , Patel Gaurang
Published: October 2014

In 30 normal subjects we computed the slow cumulative eye position (SCEP) of optokinetic afternystagmus (OKAN) that followed 60 seconds of full-field optokinetic stimulation at 60°/s. The mean SCEP was 112.8° ± 65.0°. The lower and upper fifth percentile limits for directional preponderance of the SCEP were −38.8% and 44.3%, respectively. The time constant, which we calculated by dividing the SCEP by the initial velocity, was 12.0 ± 7.4 seconds. This value is nearly identical to the time constant obtained from semilogarithmic regression of the decay of OKAN slow-phase velocity versus time. We conclude that the SCEP is a good measure of OKAN and that it reflects the substantial amount of variability and directional asymmetry observed in the optokinetic responses of normal subjects.
Necrotizing Sialometaplasia
Authors: Sneige Nour , Batsakis John G.
Published: October 2014

Necrotizing sialometaplasia of salivary tissues is a vascular-based (lobular infarct), benign, and often self-limited disorder. Preponderantly a lesion of palatal salivary glands, it can involve any salivary gland, and it may be mistaken for carcinoma. Adherence to histopathologic criteria should obviate this mistake.
Thyroid Paraganglioma
Authors: Brownlee Richard E. , Shockley William W.
Published: October 2014

Paraganglioma of the thyroid gland is a rare neoplasm. Only eight cases have previously been reported. The neoplasm was confined to the thyroid in all but two patients; laryngeal involvement was seen in one and tracheal involvement in another. A review of these previously reported cases is presented along with the details of an additional case with laryngeal involvement. Laryngeal and thyroid paragangliomas are compared and contrasted. The anatomic and embryologic basis of these tumors and the diagnosis and treatment are discussed. We suggest changing the nomenclature and reporting of these lesions on the basis of their apparent common origin. Surgery remains the treatment of choice in most paragangliomas, including those involving the larynx and thyroid. Although the number of reported cases is small, there have been no cases of distant metastases or local recurrence after adequate surgical removal.
Physiologic Assessment of Arytenoid Adduction
Authors: Slavit David H. , Maragos Nicolas E.
Published: October 2014

Arytenoid adduction as described by Isshiki is a surgical technique used to improve vocal quality by adducting the arytenoid cartilage of a paralyzed vocal fold, medializing the fold, and closing the posterior glottic aperture. Surgical results of this operation were evaluated by preoperative and postoperative voice recordings, laryngoscopy, and stroboscopy. Objective measurements of vocal jitter, shimmer, and signal to noise ratio were done to assess changes in the vibratory patterns, and analysis of data from 12 patients revealed improved glottic function postoperatively. Often an anterior medialization procedure, primarily a type I thyroplasty, was used to supplement the posterior medialization achieved by adduction of the arytenoid. Arytenoid adduction is recommended as an effective and reliable treatment for posterior glottic insufficiency.
Membranous Cytoplasmic Bodies in the Lateral Wall of the Cat Cochlea
Authors: Watanabe Kensuke , Komatsuzaki Atsushi
Published: October 2014

Membranous cytoplasmic bodies (MCBs) were observed both in the intermediate cells of the stria vascularis and in the fibrocytes of the spiral ligament in normal cats. The MCBs in the intermediate cells were round or ovoid, ranged from 1 to 5 μm in diameter, and consisted of 2 to 40 or more layers disposed concentrically about a core. The core was composed of not only cytoplasm but also of mitochondria in various stages of disintegration, empty vacuoles, and many kinds of dense bodies similar to lysosomes. The MCBs in the fibrocytes were similar to those in the intermediate cells, but they were a little smaller in diameter and consisted of fewer than 10 layers. Both in the intermediate cells and in the fibrocytes, MCBs seem to have a phagocytic function.
Minuscule Submucous Cleft Palate
Authors: Todd N. Wendell , Krueger Barbara L.
Published: October 2014

Otitis media is almost universal in cleft palate patients, at least during infancy. A lesser cleft manifestation, the occult submucous cleft palate, is identifiable in living patients by surgical dissection or flexible fiberoptic nasopharyngoscopy. We addressed the hypothesis that an even more subtle form of submucous cleft palate, involving both an abnormal musculus levator veli palatini and an abnormal musculus uvulae, is associated with otitis media. We studied 35 adult human cadaver specimens for histologic and infrared photographic transillumination evidence of what we have identified as the minuscule submucous cleft palate. None of the specimens had evidence of clinical otitis media, or clinical abnormality of the palate. Approximately one fifth of the specimens had evidence of minuscule submucous cleft palate: minimal bulk of the musculus uvulae and haphazard organization of the fibers of the musculus levator veli palatini. These data support the nasopharyngoscopic inference that in occult submucous cleft palate, there is both hypoplasia of the musculus uvulae and abnormal orientation of the fibers of the musculus levator veli palatini. Although not significant statistically, a trend was suggested for minuscule submucous cleft palate to be associated with indicators of prior otitis media.
Inner Ear Damage and Passage through the round Window Membrane of Pseudomonas Aeruginosa Exotoxin a in a Chinchilla Model
Authors: Lundman Lars , Harada Teruhiko , Santi Peter A. , Juhn Steven K. , Morizono Tetsuo , Bagger-Sjöbäck Dan
Published: October 2014

By the use of computer-assisted morphometric analysis of the organ of Corti and/or measurements of action potential threshold changes, inner ear changes in chinchillas were evaluated 4 weeks after application on the round window membrane of a Pseudomonas aeruginosa exotoxin A solution. Severe inner ear damage was detected after application of 50 ng (5 μL at a concentration of 10 μg/mL) exotoxin A, whereas application of 5 ng exotoxin did not cause measurable inner ear damage. Perilymph concentrations of exotoxin A were measured with an enzyme-linked immunosorbent assay 1.5 to 19 hours after 50 ng, 0.5 μg, or 5 μg of exotoxin A was applied on the round window membrane. Only the highest concentration produced measurable levels of exotoxin in the inner ear fluids. It is concluded that exotoxin A present on the round window membrane of the chinchilla has the ability to penetrate into the inner ear and cause irreversible inner ear changes.
Pull-through Branchial Fistulectomy: A Technique for the Otolaryngologist
Authors: Talaat Mohammad
Published: October 2014

The complete second branchial fistula consists of a superficial infrahyoid portion and a deep parapharyngeal portion. Through the present technique, the infrahyoid portion is dissected from the neck while the parapharyngeal segment is dissected through the mouth with or without tonsillectomy. Eventually, the whole fistula is pulled out through the mouth. This technique ensures complete fistulectomy and a low recurrence rate, is more cosmetic than the traditional technique, and allows simultaneous tonsillectomy. It may not be satisfactory if the fistula was the seat of repeated infections. This technique is suitable for the otolaryngologist, who is naturally well acquainted with microsurgery and tonsillectomy.
Heterogeneity in Epidermal Growth Factor Responsiveness and Tumor Growth of Human Maxillary Cancer Cell Lines
Authors: Komiyama Sohtaro , Kudoh Shohji , Matsui Katsuko , Mizoguchi Hiromoto , Miyazaki Hiroshi , Shimizu Nobuyoshi
Published: October 2014

We have established three cell lines (IMC-2, IMC-3, and IMC-4) from a human maxillary tumor, which exhibited different sensitivities to epidermal growth factor (ECF). It was inhibitory to colony-forming abilities of IMC-3 and IMC-4 cells in culture, while it affected that of IMC-2 cells slightly if at all. The differential sensitivities to EGF among the three cell lines were reproducibly observed when several cell sublines were further established from tumors appearing in nude mice. Saturation-binding kinetics with 125I-EGF showed similar levels of EGF-binding activities among the three cell lines. However, IMC-2, IMC-3, and IMC-4 showed almost similar sensitivities to cisplatin. Autophosphorylation of EGF receptor in the presence of EGF proceeded at similar levels among the three cell lines. Tumor growth was followed in nude mice when IMC-2, IMC-3, and IMC-4 at 1 × 107 cells were inoculated. The IMC-2 tumors enlarged at much faster rates than the other two cell lines. The IMC-4 tumors showed very slow growth rates, and IMC-3 tumors enlarged at an intermediate rate. These data suggest that the maxillary tumor used comprised cell populations that differed in their growth behaviors in response to EGF.
Pediatric Airway Reconstruction at Great Ormond Street: A Ten-Year Review
Authors: Evans John N. G. , Ochi James W. , Bailey C. Martin
Published: October 2014

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. Thirty-two patients required revisional airway reconstruction in an attempt to achieve decannulation. Patients underwent from one to four revisional airway reconstructions, most often laryngotracheal reconstruction with costal cartilage grafting. In the Cotton grading scheme of preoperative stenosis, those patients requiring revisional airway surgery tended to come from the more severely affected categories. Twenty-two patients of 32 (69%) achieved decannulation with revisional airway reconstruction. Thus, revisional airway reconstruction is indicated if the first attempt fails.