bluuebunny/crossref_metadata_2025 huggingface dataset:
Electron Microscopic Temporal Bone Histopathology in Experimental Pneumococcal Meningitis
Authors: Rappaport Jamie M. , Bhatt Samir M. , Lauretano Arthur M. , Kimura Robert S. , Levine Robert A.
Published: October 2014

Bacterial meningitis is one of the most common causes of acquired profound sensorineural deafness in children. Measurement of hearing and examination of the cochlea is limited in patients suffering from acute meningitis. A rabbit model of pneumococcal meningitis was developed to identify the temporal bone histopathologic changes that occur in meningogenic labyrinthitis caused by Streptococcus pneumoniae. Light microscopy was previously performed on temporal bones from acutely meningitic rabbits with profound hearing loss as determined electrophysiologically. Extensive inflammation of the cochlea with endolymphatic hydrops was observed. The organ of Corti, however, showed preserved architecture in the majority of these animals. In order to further investigate these findings, a protocol was used to create meningitic rabbits with hearing loss ranging from early high-frequency loss to profound deafness. The temporal bones from 7 rabbits were examined by transmission electron microscopy. In cases of mild hearing loss, partial degeneration of the inner row of outer hair cells, as well as edema of efferent cochlear nerve endings and marginal cells of the stria vascularis, was seen. With increasing degrees of hearing loss, the remainder of the organ of Corti and intermediate cells of the stria showed ultrastructural abnormalities. Spiral ganglion cells and basal cells of the stria vascularis remained intact in all subjects. This study provides unique information regarding the histology and pathophysiology of meningogenic deafness. The clinical implications of these findings are discussed, with an emphasis on potentially reversible changes and therapeutic intervention.
Lipid Peroxides in Middle Ear Fluid after Acute Otitis Media in Guinea Pigs
Authors: Takoudes Thomas G. , Haddad Joseph
Published: October 2014

Oxygen free radical damage has been demonstrated in the middle ear mucosa of a guinea pig model of acute otitis media (AOM). Potential sources of free radicals include both neutrophils responding to infection and Streptococcus pneumoniae, a common AOM pathogen. This project was conducted to examine the middle ear fluid in a guinea pig model of AOM for evidence of elevated lipid peroxide (LPO) as a marker of free radical damage. Twenty-one guinea pigs were injected transtympanically with bacteria into the left (infected) middle ear cavity and sterile saline into the right (control) middle ear. Middle ear fluid was recovered on postoperative day 5. The fluid was weighed and analyzed for quantity of LPO. Results indicated an increased absolute level of LPO, as well as an increased level of LPO divided by the weight of the fluid recovered. Histologic examination confirmed leukocyte infiltration and mucosal edema that were consistent with mucosal damage. While free radical damage to the middle ear mucosa in a guinea pig model of AOM is well documented, this is the first study to demonstrate evidence of free radical damage in middle ear fluid. These results are relevant because they correlate mucosal damage with lipoperoxidation in fluid. Additionally, this serves as an important precursor to human studies, since middle ear fluid is readily available in patients with otitis media.
Abnormal Expression of the Cystic Fibrosis Transmembrane Regulator in Chronic Sinusitis in Cystic Fibrosis and Non-Cystic Fibrosis Patients
Authors: Coltrera Marc D. , Mathison Susan M. , Goodpaster Tracy A. , Gown Allen M.
Published: October 2014

Cystic fibrosis (CF) patients commonly suffer from chronic sinusitis. Mutations of a single gene, the cystic fibrosis transmembrane conductance regulator (CFTR) gene, have been associated with CF. Functional CFTR protein is localized to the apical cell membrane, while dysfunctional CFTR is commonly found in the cytoplasm. We undertook a preliminary immunocytochemical study of CFTR subcellular localization in CF and non-CF pediatric and adult patients using a newly developed murine monoclonal antibody, TAM. Immunostaining was evaluated for subcellular localization (cytoplasmic versus membranous) and for epithelial layer (basal versus luminal). Analysis of the predominant CFTR distribution patterns demonstrated significant differences in adult versus pediatric groups independent of whether the latter were CF or non-CF (p < .0001 and p < .008, respectively), and no significant difference between the 2 pediatric groups (p = .70). This suggests that the pathophysiology of pediatric sinusitis differs from that of adult sinusitis at the level of secretion production.
Effect of Diesel Exhaust on Guinea Pig Nasal Mucosa
Authors: Terada Nobuhisa , Maesako Ken-Ichi , Hiruma Kiyoshi , Hanazawa Toyoyuki , Konno Akiyoshi , Nomoto Minoru , Kobayashi Takahiro
Published: October 2014

In this study using guinea pigs, we investigated the effects of diesel exhaust (DE) containing diesel exhaust particulate (DEP) on 1) vascular permeability induced by histamine, 2) nasal mucosal permeability to horseradish peroxidase (HRP), and 3) eosinophilic epithelial infiltration. The vascular permeability induced by histamine was enhanced significantly and dose-dependently in DE-exposed guinea pigs. The HRP reaction products in epithelial cells and intercellular spaces were significantly and dose-dependently increased in those guinea pigs. Eosinophil infiltration into the epithelial layer was significantly increased in guinea pigs exposed to DE containing 3.2 mg/m3 DEP, and the reactivity of the nasal mucosa to histamine solution applied on the nasal mucosa was significantly enhanced in those guinea pigs. These findings suggest that DE may play an important role not only in promoting nasal hyperreactivity induced by the enhancement of absorption of antigen through the nasal epithelium, but also in inducing eosinophil infiltration in nasal mucosa and enhancing nasal mucosal reactivity.
Laryngeal Long Latency Response Conditioning in Abductor Spasmodic Dysphonia
Authors: Deleyiannis Frederic W.-B. , Gillespie Michael , Yamashita Toshiyuki , Bielamowicz Steven , Ludlow Christy L.
Published: October 2014

Previously, we demonstrated that patients with adductor spasmodic dysphonia (ADSD) have a disinhibition of laryngeal responses to sensory input. In this study, sensorimotor responses to stimulation of the superior laryngeal nerve were compared between 10 subjects with abductor spasmodic dysphonia (ABSD) and 15 normal volunteers. The groups had similar latency and frequency characteristics of their unconditioned adductor responses (p > .05). The conditioned R1 (early) responses of the subjects with ABSD were greater and more variable in amplitude than those of the normal volunteers (p ≤ .008). Similar R2 (late) conditioning effects were found in both groups, with a nonsignificant trend toward reduced inhibition of contralateral R2 responses at lower interstimulus intervals (p = .01) in the patient group. Thus, inhibitory mechanisms that modulate the R1 laryngeal sensorimotor pathway in the brain stem may be abnormal in subjects with ABSD. Abnormal modulation of laryngeal sensorimotor responses seems present in both types of spasmodic dysphonia.
Documentation of the Prevalence of Penicillin-Resistant Streptococcus Pneumoniae Isolated from the Middle Ear and Sinus Fluid of Children Undergoing Tympanocentesis or Sinus Lavage
Authors: Shapiro Nina L. , Martin Michelle , Pransky Seth M. , Bradley John S.
Published: October 2014

With increasing pneumococcal resistance to penicillin and other antibiotics, use of antibiotic therapy for children with upper respiratory tract infections such as otitis media and sinusitis has become difficult. Selecting an appropriate treatment regimen has become more challenging due to frequent concomitant microbial resistance to multiple antibiotics. In a prospective, nonrandomized study, we obtained middle ear and sinus aspirate specimens from all children undergoing outpatient tympanocentesis or sinus lavage for any indication at our institution over Two 4-week periods. One hundred fifty-four specimens were obtained. Of these, 12 grew Streptococcus pneumoniae, 7 of which were resistant to penicillin. A 6-month retrospective review of these patients' medical histories evaluated their antibiotic use prior to surgical intervention. An association between penicillin resistance and recent use of 2 or more antibiotics in children with positive S pneumoniae cultures was confirmed, as has been documented in prior reports. Those with penicillin-resistant S pneumoniae also demonstrated a higher incidence of multidrug-resistant organisms.
Resistance to Antimicrobials Used for Therapy of Otitis Media and Sinusitis: Effect of Previous Antimicrobial Therapy and Smoking
Authors: Brook Itzhak , Gober Alan E.
Published: October 2014

We undertook to identify the antimicrobial susceptibility of the pathogens isolated from patients with otitis media or maxillary sinusitis who failed to respond to antimicrobial therapy, and correlate it with previous antimicrobial therapy and smoking. We analyzed isolates recovered from 2 consecutive cultures obtained from middle ear aspirate obtained through an open perforation in 22 children with otitis, and maxillary sinus aspirate collected by endoscopy from 20 patients. Forty-seven isolates were repeatedly recovered from 42 culture-positive individuals. The organisms isolated were Streptococcus pneumoniae (15 isolates), Haemophilus influenzae (14), Staphylococcus aureus (7), Moraxella catarrhalis (6), and Streptococcus pyogenes (5). Resistance of at least 2 tube dilutions to the antimicrobial agents used was found in 23 of the 47 (49%) isolates that were found in 20 (48%) of the patients. These included 10 of 15 (67%) isolates of S pneumoniae, 4 of 14 (29%) H influenzae (all were β-lactamase producers), 4 of 7 (57%) S aureus (all β-lactamase producers), 5 of 6 (83%) M catarrhalis (all β-lactamase producers), and none of 5 S pyogenes. In the 21 patients who failed to respond to amoxicillin, H influenzae and S pneumoniae predominated. Streptococcus pneumoniae was recovered from 4 of the 11 (36%) after trimethoprim-sulfamethoxazole, 4 of 21 (19%) after amoxicillin, 2 of 3 (67%) after azithromycin dihydrate, and 1 of 4 (25%) after cefixime. A statistically significant higher recovery of resistant organisms was noted in those treated 2 to 6 months previously, and in those with sinusitis who smoked. The data illustrate the relationship between resistance to antimicrobials and failure of patients with otitis media and sinusitis to improve.
Spontaneous Cerebrospinal Fluid Otorrhea from a Tegmen Defect: Transmastoid Repair with Minicraniotomy
Authors: Kuhweide Rudolf , Casselman Jan W.
Published: October 2014

Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare condition that presents in 2 clinical categories. In congenital labyrinthine malformations, it leads to bouts of meningitis in a hearing-impaired child. In the adult age group, a spontaneous CSF leak almost always results from a dural and bony defect in the tegmen area. Possible pathogenic mechanisms include progressive sagging and rupture of dura through a congenital tegmen dehiscence and progressive bone erosion by aberrant arachnoid granulations. These patients usually present with a middle ear effusion, resulting in clear discharge after myringotomy with tube insertion. Based on 4 patients with a CSF leak from a tegmen defect, this report reviews the clinical findings and diagnostic approach. The surgical management by a 5-layer closure using a transmastoid approach with minicraniotomy is outlined. This procedure offers a relatively simple and reliable method for repair without the inherent risks of a middle fossa craniotomy.
Intracochlear Schwannoma and Cochlear Implantation
Authors: Kronenberg Jona , Horowitz Zeev , Hildesheimer Minka
Published: October 2014

A case of intracochlear schwannoma in a 58-year-old candidate for cochlear implantation is described. The tumor was located in the basal turn of the cochlea and was discovered only during surgery. Computed tomography and magnetic resonance imaging obtained prior to surgery failed to detect the tumor. Intralabyrinthine schwannomas are rare tumors that grow either in the vestibule, as intravestibular schwannomas, or in the cochlea, as intracochlear schwannomas. Complete removal of this tumor was achieved through a posterior tympanotomy approach. Cochlear implantation, which resulted in good hearing, was successfully performed 3 years later.
Extracapsular Spread and Desmoplastic Pattern in Neck Lymph Nodes: Two Prognostic Factors of Laryngeal Cancer
Authors: Prim Maria P. , Madero Rosario , De Diego Juan I. , Nistal Manuel , Hardisson David , Gavilán Javier
Published: October 2014

The influence of extracapsular spread (ECS) and a desmoplastic pattern (DP) of metastatic cervical lymph nodes in patients with laryngeal cancer is presented. The study includes 128 patients surgically treated between 1984 and 1992 for squamous cell carcinoma of the larynx with pathologically proven lymph node metastasis. The results were studied from 2 major standpoints: survival and recurrence. The 3-year survival rates were as follows: patients without ECS 73.4%, and with ECS 28.9% (p < .001); patients without a DP 76.9%, and with a DP 43.3% (p < .03). Also, the 3-year recurrence rates in the neck showed significant differences: patients without ECS 10.7%, and with ECS 49.6% (p < .001); patients without a DP 10%, and with a DP 31.6% (p = .1142). Postoperative radiotherapy did not appear to improve the outcome.
Pediatric Tracheostomy: A Changing Procedure?
Authors: Wetmore Ralph F. , Marsh Roger R. , Thompson Mary E. , Tom Lawrence W. C.
Published: October 2014

In 1982, the experience with tracheostomy at The Children's Hospital of Philadelphia was reported for 1971 through 1980. We have now reviewed 450 cases for the period from 1981 through 1992, and compared the characteristics of these cases with those in the previous review. Long-term follow-up was available on 83% of cases, and the median follow-up was 2.96 years. Patients received a tracheostomy for airway obstruction (38%), chronic ventilation (53%), or multiple indications (9%). The mean duration of tracheotomy (adjusted for death and loss to follow-up) was 2.13 years. The tracheostomy-related mortality was 0.5%, and the non–tracheostomy-related mortality was 22%. Nineteen percent of patients had complications in the first postoperative week, and 58% had 1 or more late complications. In comparison with the previous study from our institution, there was a great increase in long-term tracheostomy and a continuing trend away from tracheostomy for short-term airway management. Better monitoring and improvements in parental teaching may have contributed to a decrease in tracheostomy-related mortality.
Cautery-Assisted Palatal Stiffening Operation and Nasalance of Speech
Authors: Hoolsema Evanne M.
Published: October 2014

Velopharyngeal competence as indicated by nasalance of speech was tested in 18 men before and after a cautery-assisted palatal stiffening operation for snoring. Nasalance was measured preoperatively and postoperatively, with no significant changes noted following surgery. Although there were no objective or subjective changes in nasality of voice, these findings do not rule out all possible changes in velopharyngeal competence, since there were subjective complaints of nasal regurgitation and dysphagia.
Computed Tomography Diagnosis of Esophageal Bone Impaction: A Prospective Study
Authors: Eliashar Ron , Dano Itzhak , Dangoor Eric , Braverman Itzhak , Sichel Jean-Yves
Published: October 2014

A prospective study was performed on 45 patients for an assessment of the use of computed tomography (CT) in the management of a suspected esophageal fish bone or chicken bone. All patients had negative findings on laryngoscopy; therefore, pharyngeal and hypopharyngeal foreign bodies were excluded from further consideration. The patients underwent radiographic examination with plain films and a cervical CT scan without contrast material. Patients with positive findings were taken to the operating room, where they underwent rigid esophagoscopy under general anesthesia, while those with negative findings remained for observation for 24 hours. Thirty CT scans were positive for an esophageal foreign body, and in all cases but 1, a foreign body was found during the operation. Fourteen of 15 patients with normal CT scan findings managed well with no further intervention. One patient with persistent complaints underwent esophagoscopy, but no foreign body was found. Our conclusion is therefore that CT is a simple and reliable method for diagnosing esophageal bone impaction and may reduce the rate of unnecessary esophagoscopies.
Analysis of the Forces and Position Required for Direct Laryngoscopic Exposure of the Anterior Vocal Folds
Authors: Hochman Ilan I. , Zeitels Steven M. , Heaton James T.
Published: October 2014

The sniffing position is traditionally considered optimal for direct laryngoscopic examination of the vocal folds. This study examined head and neck positions associated with ideal exposure of the anterior glottal commissure with a variety of laryngoscopes. A prospective investigation was done in 20 patients by comparing the force required to expose the anterior vocal folds by utilizing 3 head and neck positions with 3 different-sized tubular laryngoscopes. The completeness of anterior glottal exposure was rated and the force required to achieve this exposure was measured with a strain gauge. Three positions relating the atlanto-occipital and cervicothoracic vertebrae were analyzed: 1) extension-extension, 2) sniffing: extension-flexion, and 3) flexion-flexion. Head and neck position and laryngoscope size were both statistically significant factors for achieving complete anterior vocal fold exposure. Regardless of the laryngoscope, the number of patients in whom complete exposure could be achieved increased gradually when the position was changed from extension-extension to extension-flexion to flexion-flexion. Complete exposure was inversely related to larger laryngoscope size. According to the data herein, the flexion-flexion position provides the best glottal exposure for endotracheal intubation in those patients who are anatomically predisposed to difficulty in direct examination of the glottis. Because this places the laryngoscope lumen in a vertical position, this position is inappropriate for microlaryngoscopy. The study reinforced the concept that the sniffing position is the optimal position for microlaryngoscopy because it enables the use of the largest-lumened laryngoscope. This facilitates ideal exposure of the anterior vocal folds, which is necessary for phonomicrosurgery.
Laryngopharyngeal Sensory Discrimination Testing and the Laryngeal Adductor Reflex
Authors: Martin John H. , Thomson Jeanne E. , Aviv Jonathan E. , Kim Ted , Diamond Beverly , Sacco Ralph L. , Close Lanny G.
Published: October 2014

Laryngopharyngeal sensory capacity has been determined by endoscopically administering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve and asking the patient if he or she feels the stimulus. A potential shortcoming of this psychophysical testing (PT) procedure is that it is a subjective test, and patients with impaired cognition may not be able to perform the required task. In the search for an objective measure of laryngeal sensory function, we have observed that the laryngeal adductor reflex (LAR) is evoked at stimulus intensities similar to those capable of eliciting the psychophysical, or perceptual, response. The purpose of this study is to determine if the threshold for eliciting the LAR is the same as that of the sensory threshold. A specially designed endoscope was used to present air pulse stimuli (range 0.0 to 10 mm Hg) to the laryngopharynx in 20 healthy subjects and in 80 patients with dysphagia, using both PT and the LAR. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 65). In the control group and in the group of patients with dysphagia, there was no statistically significant difference between the median laryngopharyngeal sensory thresholds whether we used PT or the LAR (p > .05, Wilcoxon signed-rank test). The intraclass correlation for the total sample was .999 (U = .999, L = .998). Since psychophysical and sensorimotor reflex thresholds were not statistically significantly different and the intraclass correlation was close to a perfect correlation, we conclude that the LAR can be used as an objective and accurate clinical method of endoscopically assessing laryngopharyngeal sensory capacity.
Ankle-Arm Index as a Screening Examination for Fibula Free Tissue Transfer
Authors: Futran Neal D. , Stack Brendan C. , Zachariah Ajay P.
Published: October 2014

The frequent use of the fibula free flap for mandibular reconstruction has served as an impetus to develop a screening test for this flap. This would detect lower leg vascular disease that could jeopardize the flap or donor extremity. Data would allow a decision whether to pursue further lower leg imaging versus consideration of an alternative donor site. The ankle-arm index (AAI) was determined on a prospective series of 62 patients being considered for fibula free flap transfer. An AAI of less than 1.0 was found to be predictive of a high rate of lower leg vascular disease (by color flow Doppler imaging) that would jeopardize the flap or donor extremity. The AAI did not detect anomalous vasculature of the lower leg (N = 2). If the AAI is less than 1, an alternative donor site to the fibula should be considered, and if it is greater than 1, a color flow Doppler examination of the donor extremity is recommended.
Minimally Invasive Device to Effect Vocal Fold Lateralization
Authors: Cummings Charles W. , Westra William H. , Redd Elizabeth E. , Flint Paul W.
Published: October 2014

Despite many operative procedures focused on vocal fold lateralization, none has achieved an acceptable level of dependability. Bilateral vocal fold abductor paralysis is treated by arytenoidectomy, cordotomy, suture lateralization, or partial cordectomy. Tracheotomy remains the gold standard for maximizing the airway and preserving phonatory function. We have developed a device that is minimally invasive, tunable, and reversible, with the potential for lateralization or medialization of the vocal process. The device consists of a polyethylene collar, a Vitallium cam, and a double-helix core for engaging soft tissue. It is introduced through a circular opening in the thyroid cartilage by a modified thyroplasty approach. Both the first and second iterations of this device have been evaluated for clinical effectiveness in 9 sheep by means of photographic and video documentation. Effectiveness in humans is currently being assessed. The results of the animal study permit us to have substantial optimism with respect to the clinical application of this device.
Montgomery® Salivary Bypass Tube in the Reconstruction of the Hypopharynx Cost-Benefit Study
Authors: León Xavier , Quer Miquel , Burgués Joaquim
Published: October 2014

This study analyzes the postoperative complications and the functional results in 61 patients who underwent total laryngectomy with partial or total (circumferential) pharyngectomy reconstructed with a pectoralis major myocutaneous flap, in relation to the use of the Montgomery® Salivary Bypass Tube (MSBPT). There were no significant differences regarding frequency of postoperative cervical complications in relation to the use of the MSBPT. The median hospital stay for patients without the MSBPT (36 days) was significantly higher than that for patients with the MSBPT (25 days). Although the MSBPT did not modify the rate of complications at the cervical level, it did reduce their severity. A financial study showed the cost-effectiveness of using the MSBPT. Systematic use of the MSBPT is recommended after total laryngectomy with partial or total pharyngectomy reconstructed with a pectoralis major myocutaneous flap.
Histochemical and Immunocytochemical Study of Nitrergic Innervation in Human Nasal Mucosa
Authors: Riederer Andreas , Mayer Bernd , Held Birgit , Wörl Jürgen
Published: October 2014

Nitric oxide (NO) is a free radical gas that has been found to be produced in neuronal cells by the action of the enzyme brain nitric oxide synthase (bNOS). The aim of this study was to identify NO-containing nerve structures in the human nasal mucosa by localizing bNOS and to find out whether NO production is attached to the parasympathetic system. For this purpose, immunocytochemistry with antibodies to bNOS and neurofilament was performed. Additionally, nicotinamide-adenine dinucleotide phosphate diaphorase (NADPH-d), an enzyme that correlates with the localization of NO synthase, and acetylcholinesterase were visualized in a histochemical double staining technique on frozen sections. The NADPH-d and bNOS reactions were found in axons of nerve bundles and in subepithelial, glandular, and vascular nerve fibers. Arteries showed a distinctly developed nitric innervation, whereas no activity was found in nerve fibers supplying veins. A high coexistence of NADPH-d in parasympathetic nerves could be detected. These findings suggest that NO takes part in the nerve control functions of the human nasal mucosa.
Management of Persistent Tracheocutaneous Fistula in the Pediatric Age Group
Authors: Stern Yoram , Walner David L. , Cosenza Matthew , Cotton Robin T.
Published: October 2014

Different surgical methods have been advocated for closure of persistent tracheocutaneous fistula (TCF) in children. The objective of this study was to compare different methods of repair and postoperative care that were used for management of TCF in children. The charts of 98 children with persistent TCF who were surgically managed in our department between January 1990 and April 1997 were reviewed retrospectively. Excision of the fistulous tract and healing by secondary intention was employed in 18 patients. Eighty patients were managed by tract excision followed by primary closure. Sixty-three patients remained intubated for 18 to 24 hours postoperatively, while 17 patients were extubated in the recovery room. One patient had a large tracheal granuloma on follow-up endoscopy. Three patients needed a second procedure. No significant correlation was found between the method of surgical repair or the length of postoperative intubation and outcome. In our experience, TCF repair, either by primary closure or secondary intention, is a relatively safe and effective procedure in the pediatric age group. Preoperative evaluation and possible indications for selecting the method of repair are discussed.
Discovering Diagnostic Rules from a Neurotologic Database with Genetic Algorithms
Authors: Kentala Erna , Pyykkö Ilmari , Laurikkala Jorma , Juhola Martti
Published: October 2014

Data on patients with Meniere's disease, vestibular schwannoma, traumatic vertigo, sudden deafness, benign paroxysmal positional vertigo, or vestibular neuritis were retrieved from the database of otoneurologic expert system ONE for the development and testing of a genetic algorithm (GA). The accuracy of the diagnostic rules in solving the test cases was 81%, 91%, 92%, 95%, 96%, and 98% for the respective diseases. The best rules retrieved from the GA were described by a set of questions with the most likely answers. The most important questions concerned the duration of hearing loss and the occurrence of head injury. The validity and structure of the rules created with a GA can be analyzed in detail. For rare diseases, some other reasoning process can be used, for example, case-based reasoning.
Cochlear Function of Guinea Pigs with Experimental Chronic Renal Failure
Authors: Ohashi Toru , Kenmochi Mutsumi , Kinoshita Hirotsugu , Ochi Kentaro , Kikuchi Hitoshi
Published: October 2014

This study aimed to evaluate electrophysiologically the cochlear function of guinea pigs that underwent a five-sixths nephrectomy and, additionally, to explore the synergistic action between chronic renal failure (CRF) and noise. Cochlear potentials were recorded at 1, 2, and 3 months postoperatively. Slight changes in compound action potential and cochlear microphonics were seen at 1 month postoperative, while moderate and profound changes were seen at 2 and 3 months. Endocochlear potential showed no significant reduction. The results indicate that CRF may be an etiologic factor for cochlear dysfunction and that the hair cells seem likely to be a main site of the lesion. One-month-postoperative animals were exposed to a broadband noise. In contrast to control animals, the test animals demonstrated no recovery from the decrease in compound action potential and cochlear microphonics that occurred immediately after noise exposure. This suggests a synergistic interaction between CRF and noise.
Distribution of Psammoma Bodies in the Internal Auditory Canal and its Extended Areas in the Human Temporal Bone
Authors: Kitagawa Miwa , Suzuki Chiaki , Sando Isamu , Balaban Carey
Published: October 2014

The internal auditory canal (IAC) and its extended areas of 27 normal human temporal bone specimens were investigated histologically for the distribution of psammoma bodies. A total of 145 ± 25 (mean ± SE) psammoma bodies were counted in series of every tenth 30-μm-thick section. Psammoma bodies were observed in the IAC and around the labyrinthine portion of the facial nerve (FN), the geniculate ganglion of the FN, and the posterior ampullary nerve in the singular canal. The number of psammoma bodies increases with age. We believe that psammoma bodies are a normal finding of aging in the IAC. The compression of the FN by psammoma bodies in the labyrinthine portion of the facial canal and the distribution of numerous psammoma bodies surrounding the posterior ampullary nerve in the narrow singular canal raise the questions of the involvement of psammoma bodies in the FN and in vestibular dysfunction and the presence of psammoma bodies in the subarachnoid space.
Mineralocorticoid Receptors in the Mammalian Olfactory Mucosa
Authors: Robinson Alan M. , Kern Robert C. , Krozowski Zygmunt S. , Foster James D. , Pitovski Dimitri Z.
Published: October 2014

Mineralocorticoid hormones regulate secretion and absorption in a wide variety of epithelial tissues, although specific mechanisms in the olfactory mucosa are currently unknown. Utilizing reverse transcription—polymerase chain reaction (RT-PCR) analysis, we have demonstrated the expression of mineralocorticoid (type I) receptor messenger RNA in the rodent olfactory mucosa. Amplification products of predicted size were obtained with nucleotide sequences corresponding to respective mineralocorticoid receptor (MR) kidney transcripts. Immunocytochemistry, using an antibody with known specificity for MRs, was then utilized in order to localize the cellular site(s) of MR protein expression in the olfactory mucosa. The highest levels of MR immunoreactivity were localized to the supranuclear region of sustentacular cells, as well as the acinar cells of the Bowman's glands. The respiratory regions of the nasal cavity were devoid of appreciable MR immunoreactivity. This study demonstrates both MR transcript and protein expression in the olfactory mucosa. We hypothesize that the mineralocorticoid hormones may have a role in modulation of olfactory secretion and/or sensory transduction in the peripheral olfactory system.
Psychosocial Adjustment after Laryngeal Cancer Surgery
Authors: Herranz Jesús , Gavilán Javier
Published: October 2014

The objective of the study was to assess the psychosocial adjustment of 111 patients, and 87 partners, after laryngeal cancer surgery. Sixty-nine patients were grouped as having had radical surgery (total or near-total laryngectomy), and 30 as having had functional surgery (horizontal supraglottic laryngectomy or cordectomy). The Psychosocial Adjustment to Illness Scale Self Report questionnaire was used as the primary outcome. No significant differences were found between groups when global adjustment or domain adjustment was compared. Patient and partner responses were almost identical. Work and family relationships were the domains with poorest adjustment for both patients and partners. Information about treatment expectations was negatively rated by functional surgery patients, especially by those who underwent a cordectomy. We conclude that patient perspectives should be considered and consulted to 1) evaluate patient opinion about treatment results, 2) identify patients with special support needs, and 3) inform patients according to other patients' priorities, based on their experience.
Complications of Pediatric Laryngotracheal Reconstruction: Prevention Strategies
Authors: Ludemann Jeffrey P. , Noah Zehava , Hughes C. Anthony , Holinger Lauren D.
Published: October 2014

A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pediatric LTR and CTR. We propose strategies to prevent these infections. We also advocate the treatment of GERD during the healing phase of LTR.
Identification of Posterior Cricoarytenoid Motoneurons in the Rat
Authors: Berkowitz Robert G. , Chalmers John , Sun Qi-Jian , Pilowsky Paul
Published: October 2014

The posterior cricoarytenoid (PCA) muscle is the sole abductor of the larynx and is controlled by motoneurons located in the nucleus ambiguus. These motoneurons receive inputs from a variety of interneurons, including those that impart respiratory modulation, and are responsible for the phasic inspiratory activity of the PCA muscle. Identification of PCA motoneurons is therefore an essential initial step in understanding the mechanisms responsible for coordinated vocal cord abduction. We identified PCA motoneurons in the rat model by retrograde labeling, and following antidromic activation. A total of 194 neurons were identified by retrograde labeling with cholera toxin B subunit (CTB). Labeling was exclusively ipsilateral where the contralateral vagus and superior laryngeal nerves had been divided. The neurons were multipolar, with dimensions of 33.2 ± 6.4 μm (mean ± standard deviation) in length and 22.4 ±3.4 μm in width. The neurons were located within a range of 0.6 to 2.4 mm caudal to the caudal pole of the facial nerve, 1.2 to 1.7 mm lateral to the midline, and 1.5 to 2.3 mm deep to the dorsal surface of the medulla. The PCA motoneurons were antidromically activated by focal stimulation of the PCA muscle. The extracellular field was recorded in 5 rats, and the PCA motoneurons were found within a range of 0.8 to 1.7 mm caudal to the caudal pole of the facial nerve, 1.5 to 2.0 mm lateral to the midline, and 1.9 to 2.4 mm deep to the dorsal surface of the medulla. The mean conduction velocity ranged from 37.0 ± 5.8 to 68.6 ± 5.0 m/s. An extracellular antidromic field potential, which corresponds to the distribution of the PCA motoneuron pool demonstrated by retrograde labeling with CTB, can be reliably obtained in a rat model following focal PCA muscle stimulation.
The Otolaryngologist as a Role Model
Authors: Holinger Lauren D.
Published: October 2014

Throughout our daily interactions with medical students and residents, each of us, whether we like it or not, functions as a role model. Since role modeling is primarily a passive function — teaching by example — we may not be acutely aware of this role and its importance. In what respect is the concept of the role model important to otolaryngology—head and neck surgery? In addition to the function of specific training — teaching the trade — most of the literature on role modeling cites 2 major areas of significance: 1) influencing medical students' career choices and 2) facilitating socialization into the world of medicine with the establishment of an appropriate professional identity. This brief article reviews some of the current literature, catalogs those attributes that have been identified as those of excellent role models, and offers some thoughts as to what our specialty might consider in response to the challenges to medical education in the changing health care environment.
Videolaryngostroboscopy following Vertical Partial Laryngectomy
Authors: Woo Peak , Minasian Amy , Mandell David L. , Behin Daniel S. , Urken Mark L. , Mojica Jacqueline , Biller Hugh F.
Published: October 2014

Phonation after partial laryngeal ablative surgery has not often been examined. Videolaryngostroboscopic recordings made after vertical partial laryngectomy (VPL) were retrospectively reviewed and correlated with patient historical and operative factors. Among VPL patients (n = 42), the most common site of vibration during phonation was the contralateral false vocal fold (17/42 patients or 40.5%), followed by the contralateral arytenoid mucosa (10/42 or 23.8%) and the contralateral true vocal fold (8/42 patients or 19.0%). There was no overall difference in vocal quality judgment with respect to site of vibration (ANOVA, p = .373). Vocal quality scores were similar with use of the pyriform mucosal flap versus other reconstructive methods (Student's t-test, p = .568). This study highlights the fact that reconstruction of a new vibratory source after VPL is important for voice production. Because VPL patients infrequently demonstrated true vocal fold vibration, alternative sites (ie, false vocal fold, arytenoid mucosa) must be considered as new phonatory sources after VPL.
Ten-Year Experience with Cervical Miniesophagostomy
Authors: Har-El Gady
Published: October 2014

This report describes our experience with 35 patients who underwent intraoperative transcutaneous cervical miniesophagostomy (TCME) during conservation laryngeal and/or hypopharyngeal surgery. The TCME was designed to provide enteral alimentation without the need for a nasogastric tube. Nasogastric tubes may cause posterior laryngeal inflammation, granulations, muscle damage, and vocal cord immobility. Friction between nasogastric and tracheotomy tubes may result in damage to the remaining posterior larynx and may delay healing, oral feeding, and decannulation. Percutaneous endoscopic or radiologically assisted gastrostomy is a possible solution. However, it requires time, special expertise, and coordination with other specialties. In addition, immediate and delayed abdominal complications may occur. The TCME is a relatively simple and quick procedure that is performed during the primary cancer surgery by the head and neck surgeon. It requires no special equipment. It takes about 5 minutes to perform and, if done correctly with tunneling under the skin flaps, is associated with minimal or no postoperative morbidity. It is useful after supraglottic laryngectomy, partial laryngectomy, partial laryngopharyngectomy, and base of tongue resection, and in selected cases of vertical hemilaryngectomy and anterolateral laryngectomy. In the last group, we found that TCME is required if the arytenoid cartilage is removed and the posterior aspect of the larynx is disrupted. There were only minor complications related to TCME. Leakage from the miniesophagostomy did not occur, primarily because of the superior-to-inferior orientation of the tube and the long subplatysmal tunneling before esophageal entrance.
Cricothyroid Subluxation: A New Innovation for Enhancing the Voice with Laryngoplastic Phonosurgery
Authors: Zeitels Steven M. , Desloge Rosemary B. , Hillman Robert E. , Bunting Glen A.
Published: October 2014

Laryngoplastic phonosurgery has evolved to become a dominant treatment modality for paralytic dysphonia. Current surgical procedures have addressed primarily the position of the musculomembranous vocal fold and the arytenoid in the axial and vertical planes. However, dynamic range capabilities and vocal flexibility have been limited secondary to the flaccid, denervated vocal fold tissue. Therefore, a new procedure was conceived to enhance the acoustic vocal outcome from operations that reposition the vocal edge. Cricothyroid (CT) subluxation was designed as a technique to increase the distance between the cricoarytenoid joint and the insertion of the anterior commissure ligament. Cricothyroid subluxation was done without complication in 9 patients who underwent combined adduction arytenopexy and medialization laryngoplasty, and in 4 patients with medialization laryngoplasty alone. Postoperative stroboscopic assessment was done in all of the 13 patients, while complete analysis of vocal function was available in 10 of the 13 patients; this revealed improvement (as a group) on almost all objective measures over the preoperative state. All patients who underwent CT subluxation had a normal maximum frequency range (pitch variation of more than 2 octaves), as compared with 22% of a prior similar cohort of patients who did not undergo CT subluxation. All patients who underwent CT subluxation had normal glottal airflow and a normal noise-to-harmonics ratio. Cricothyroid subluxation is a relatively easily adjustable procedure that increases the length and viscoelastic tension of the denervated vocal fold. The modified biomechanical properties resulted in improved vocal outcome in all of our patients, which was most remarkable in terms of maximal range capabilities. Cricothyroid subluxation enhanced the postoperative voice of patients regardless of whether they required medialization laryngoplasty alone or whether they also required adduction arytenopexy.
Laryngeal Chemodenervation: Effects of Injection Site, Dose, and Volume
Authors: Lee Patty , Paniello Randal C.
Published: October 2014

A canine model was used to measure changes in laryngeal adductory pressure (LAP) following injections of vecuronium bromide, a short-acting neuromuscular blocking agent. At a constant volume, LAP was inversely related to the dose (and concentration) of vecuronium injected. At a constant dose (0.05 mg), LAP did not vary significantly over a wide range of injection volumes, from 0.05 to 0.50 mL. At a constant dose and volume, the site of injection was varied among the anterior, middle, and posterior vocal fold, the interarytenoid region, and the anterior contralateral vocal fold. Reduction in LAP was greatest (p < .05) for the posterior vocal fold injection site (78% reduction); less reduction was seen for the middle (54%) and anterior (52%) vocal fold and interarytenoid (43%) injection sites. These results have implications for laryngeal botulinum toxin injections, which are discussed.
T Cells Infiltrating from the Systemic Circulation Proliferate in the Endolymphatic Sac
Authors: Iwai Hiroshi , Inaba Muneo , Tomoda Koichi , Ikehara Susumu , Sugiura Kikuya , Yamashita Toshio
Published: October 2014

It has been reported that autoimmune mechanisms are involved in the development of inner ear disorders such as Meniere's disease and steroid-responsive sensorineural hearing loss. In the present study, using an animal model for graft-versus-host disease, we investigated the immune regulatory mechanism in the endolymphatic sac and demonstrated that donor T cells injected into the systemic circulation of recipients infiltrate and proliferate in the perisaccular region. These findings suggest that immunocompetent cells are supplied from the systemic circulation through blood-labyrinth and blood-endolymph barriers into the endolymphatic sac, and that the endolymphatic sac allows these cells to proliferate locally as a local immune defense. It therefore seems likely that the endolymphatic sac plays a crucial role in not only graft-versus-host disease but also autoimmune inner ear disorders.
Orbital Blowout Fracture with Persistent Mobility Deficit Due to Fibrosis of the Inferior Rectus Muscle and Perimuscular Tissue
Authors: Okinaka Yoshihiko , Hara Jun , Takahashi Masahiro
Published: October 2014

A case of orbital blowout fracture accompanied by fibrosis of the inferior rectus muscle resulting in an irreversible orbital mobility deficit is reported. An 8-year-old girl with an orbital blowout fracture was treated with steroids for 10 days, as with other cases in our department. She exhibited a disturbance of vertical eye movement and a positive forced duction test result. Although surgery was performed on day 13, and on day 27 due to poor recovery after the first operation, almost no improvement of the ocular movement was noted. The results of a traction test, performed during the second operation, suggested that the inferior rectus muscle had adhered to the periosteum. Magnetic resonance imaging performed 3 days after the second operation revealed fibrosis of the inferior rectus muscle and perimuscular tissue, resulting in an irreversible disturbance of the vertical ocular movement. The present findings suggest that the need for and timing of surgery in patients with blowout fractures should be determined on an individual basis.
A study on the generalised space of urban–rural integration in Beijing suburbs during the present day
Authors: Song Zhijun , Yu Linjun
Published: October 2014

Urban–rural integration is a complex process in the giant urban–rural system of the Beijing suburbs with various evolutions in modern suburban functions. Therefore, the functions and processes of the whole Beijing suburb system cannot be treated in isolation. Based on the theory of generalised space proposed by Chen (2008), the urban–rural integration process in the Beijing suburbs was analysed in real space (R-space), phase space (P-space) and order space (O-space). The results show that the macro urban–rural gap is the dominant factor in the O-space. A multifunctional policy at the meso-level will promote the scientific evolution of the P-space. These factors in turn influence the evolution of the urban–rural integration in Beijing suburbs at various levels in the R-space. Finally, new features of spatial organisation, for example, fractals, are generalised from the interactions of those three spaces. Therefore, the perspective of the R-P-O space fusion can provide theoretical guidance to investigators for the urban–rural integration of Beijing suburbs.
Improving the Meta-Analytic Assessment of Effect Size Variance With an Informed Bayesian Prior
Authors: Steel Piers , Kammeyer-Mueller John , Paterson Ted A.
Published: October 2014

Meta-analytic estimation of effect size variance is critical for determining the degree to which a relationship or finding generalizes across contexts. In most meta-analyses, population effect size variability is estimated by subtracting expected sampling error variance from observed variance, using only information from a limited set of available studies. We propose an improved Bayesian variance estimation technique that incorporates findings from previous meta-analytic research through an informed prior distribution of likely levels of effect size variance. The logic of exchangeability as a conceptual foundation for using an informed prior is explicated. On the basis of Monte Carlo simulations, we find the traditional method of meta-analytic variance estimation the most biased and least accurate technique across all sizes of meta-analyses considered. The Bayesian methodology incorporating an informed prior proved to be the most accurate and overall least biased of all estimation methods. Conceptual advantages and limitations that must be taken into account when incorporating an informed prior to estimate variability of effect sizes in a meta-analysis are also discussed.