bluuebunny/crossref_metadata_2025 huggingface dataset:
Epiglottic Tuberculosis: Differential Diagnosis and Treatment
Authors: Richter Bernhard , Fradis Milo , Köhler Gabriele , Ridder Gerd Jürgen
Published: October 2014

A case of a 40-year-old man with tuberculous involvement of the epiglottis suffering from unsuspected pulmonary tuberculosis is described. The laryngeal lesions were primarily considered to be highly suspicious for a neoplastic process rather than an infectious one. After diagnosis, the patient was treated according a standard protocol and followed up for a period of 2 years. He is still free of disease. The clinical presentation, diagnosis, pathological findings, and therapy of the condition are described. The differential diagnosis and management of epiglottic tuberculosis are reviewed and discussed. Even though these cases are rare, otorhinolaryngologists should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors, as the incidence of tuberculosis in developed countries is steadily increasing.
Arytenoid Prolapse as a Consequence of Cricotracheal Resection in Children
Authors: Rutter Michael J. , Hartley Benjamin E. J. , Link Dana Thompson , Cotton Robin T.
Published: October 2014

Cricotracheal resection (CTR) is a technique introduced comparatively recently for treating severe laryngotracheal stenosis in children. The recognized complications of CTR include recurrent laryngeal nerve damage, anastomotic dehiscence, and restenosis. We describe a further complication of CTR, namely, prolapse of the arytenoid cartilage. The presentation may be late, with symptoms of shortness of breath on exertion and nocturnal stertor with a poor sleep pattern, or the prolapse may be an asymptomatic incidental finding. The diagnosis is performed with flexible nasopharyngoscopy with the patient unanesthetized, or with rigid endoscopy with the patient lightly anesthetized and spontaneously ventilating. The affected arytenoid cartilage is noted to prolapse anteriorly and medially with inspiration, partly obstructing the airway. If treatment is required, endoscopic laser partial arytenoidectomy is effective. In a series of 44 children who underwent CTR, 20 were noted to develop arytenoid prolapse after operation. Twelve were asymptomatic, and 8 required laser arytenoidectomy, 2 of whom now require continuous positive airway pressure for moderate supraglottic collapse.
Molecular Markers in Head and Neck Squamous Cell Carcinoma: Their Biological Function and Prognostic Significance
Authors: Smith Benjamin D. , Haffty Bruce G. , Sasaki Clarence T.
Published: October 2014

Head and neck squamous cell carcinoma affects more than 500,000 people worldwide each year. Despite optimal treatment with surgery, irradiation, and chemotherapy, disease recurrence and progression remains a common and challenging oncological problem. Recently, interest has developed in identifying novel molecular markers that allow identification of those patients at increased risk for locoregional recurrence and death. This article reviews several such molecular markers studied in head and neck cancer, including p53, angiogenesis-related markers, cyclin D1, and epidermal growth factor receptor. The biological function of these markers and the potential clinical implications are discussed. The purpose of this review is to update the otolaryngologist on a rapidly emerging segment of applied translational research in our field.
Is Pressure Dressing Necessary after Ear Surgery?
Authors: Castelli Marco L. , Tavormina Paolo , Lisi Diego Di , Cappellaro Elena , Marcato Paolo , Sartoris Alberto
Published: October 2014

Compressive bandages carry intrinsic risks and complications. The purpose of this study was to assess whether compressive head bandages are necessary after ear surgery to prevent complications such as hematoma or wound infection. A prospective, randomized, controlled study was conducted from August 1, 1993, to June 1, 1999. We randomly assigned 420 consecutive middle ear or mastoid operations to either a pressure bandage group or to a no—pressure bandage group. A careful follow-up was planned, and complications were recorded. In the pressure bandage group, 3 patients had bruising over the pinna and 70 patients had minor skin erythema when the dressing was removed. No patient had bruising or erythema in the no—pressure bandage group. No patient had hematoma, wound infection, or any other wound complication in either group. As a result of this study, we have decided to abandon the use of compression bandages after uncomplicated ear surgery.
Tracheal Length of Infants under Three Months Old
Authors: Lee Kuo-Sheng , Yang Cheng-Chien
Published: October 2014

The measurement of tracheal length in infants is difficult to perform in vivo. In adults, tracheal length may be consistent with age, but in infants, tracheal length may vary much more with age and other factors. This study used video rigid ventilation bronchoscopy to evaluate the length of the airway, concentrating on the population younger than 3 months old. There were 34 infants in this study: 14 boys and 20 girls. The mean length from the superior border of the vocal fold to the carina was 5.04 cm, and the mean tracheal length (from the ridge of the first tracheal ring to the carina) was 4.12 cm. There was no significant difference between boys and girls in the length from the vocal fold to the carina or in the tracheal length. The length from the vocal fold to the carina is best correlated to body weight, followed by body height and age.
Stroboscopic Assessment of Vocal Fold Keratosis and Glottic Cancer
Authors: Colden Darryl , Jarboe John , Zeitels Steven M. , Bunting Glenn , Hillman Robert E. , Spanou Konstantina
Published: October 2014

Disruption of the normal viscoelastic properties of the superficial lamina propria (SLP) results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to determine whether stroboscopy is a reliable method for 1) differentiating invasive glottic carcinoma from intraepithelial atypia or 2) determining the depth of cancer invasion. An analysis was done on the preoperative vocal fold vibration characteristics of 62 keratotic (intraepithelial, 45; cancer, 17) lesions that were subsequently resected by means of microlaryngoscopy. Histopathology and intraoperative mapping were used to specify the depth of invasion. A panel of 4 blinded judges was used to assess the amplitude of vocal fold vibration and the magnitude of mucosal wave activity in the region of the lesion from videostroboscopic recordings. The final comparative data set comprised only those ratings that achieved at least 75% interjudge agreement. Of the 28 intraepithelial lesions that could be reliably evaluated for amplitude of vocal fold vibration, only 2 were normal, with the amplitude reduced in 24 and absent in 2. Of the 30 intraepithelial lesions in which mucosal wave activity could be reliably assessed, only 2 were normal, with the wave reduced in 24 and absent in 4. Furthermore, amplitude of vocal fold vibration and magnitude of mucosal wave propagation were absent in 2 of 4 carcinomas in which the depth of microinvasion did not reach the vocal ligament. According to the findings herein, reduced amplitude of vocal fold vibration and/or mucosal wave propagation associated with keratosis did not reliably predict the presence of cancer or the depth of cancer invasion into the laminae propriae. However, the presence of a flexible mucosal wave probably indicates that there is not extensive vocal ligament invasion. Reductions in the amplitude of vocal fold vibration and in mucosal wave magnitude were usually noted in intraepithelial atypia, despite the fact that there was no invasion into the SLP. The reduced epithelial pliability could be due to bulky keratosis and/or alteration of the SLP occurring as a result of inflammation or fibrovascular scarring.
Critical Role of Central Facilitation in the Glottic Closure Reflex
Authors: Sasaki Clarence T. , Ho Steven , Kim Young-Ho
Published: October 2014

The sphincteric function of the larynx, essential to lower airway protection, is most efficiently achieved through strong reflex adduction by both vocal cords. We hypothesize that central facilitation is an essential component of a bilateral adductor reflex and that its disturbance could result in weakened sphincteric closure. Six adult 50-kg pigs underwent evoked response laryngeal electromyography under 0.5 to 1.0 minimal alveolar concentration (MAC) isoflurane anesthesia. The internal branch of the superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. Consistent threshold responses were obtained ipsilaterally from 0.5 to 1.0 MAC anesthesia. However, the contralateral reflex responses approached 0% in successive trials as anesthetic levels approached 1.0 MAC. Alteration of central facilitation by deepening anesthesia abolishes the crossed adductor reflex, predisposing to a weakened glottic closure response. A precise understanding of this effect may improve the prevention of aspiration in patients emerging from prolonged sedation or under heavy psychotropic control.
Presence of Autoantibodies in the Sera of Meniere's Disease
Authors: Yoo T. J. , Ge Xianxi , Sener Osman , Mora Massimilliano , Kwon Soon Seog , Mora Francesco , Barbieri Marco , Shea John , Yazawa Yoshiro , Mora Renzo , Du Xiaoping
Published: October 2014

We examined the sera of patients with Meniere's disease for the presence of antibodies against 8 inner ear antigens by enzyme-linked immunosorbent assay (ELISA). One hundred eight patients with Meniere's disease and 28 control subjects were studied. The antibodies against chicken type II collagen, bovine type II collagen, the cyanogen bromide cleaved peptide 11 (CB11) of each, type IX and XI collagens, C-Raf, and tubulin were measured by ELISA. The sensitivity of each antigen was between 37% and 60% individually, and was 91% when all 8 inner ear antigens were combined. These results showed that 91% of Meniere's disease sera have antibody activities to 1 or more of these inner ear antigens. The results suggest that performing ELISA for these 8 inner ear antigens was useful as a diagnostic tool for Meniere's disease. Further study is required for elucidating the role of these antigens in the pathogenesis of Meniere's disease, which might eventually result in better therapy.
Effect of Macrolides on the Expression of HLA-DR and Costimulatory Molecules on Antigen-Presenting Cells in Nasal Polyps
Authors: Iino Yukiko , Kojima Chie , Sasaki Yukako , Miyazawa Tetsuo
Published: October 2014

To clarify the basis of macrolide therapy for improvement of chronic sinusitis, we investigated the effect of macrolides on the expression of HLA-DR and costimulatory molecules such as CD54 and CD80 on macrophages in nasal polyps. Nasal polyps taken from 54 patients who had or had not been treated with macrolides were immunohistochemically studied. The percentages of CD68-positive macrophages expressing HLA-DR or CD54 were not significantly different between patients treated with macrolides and those not treated with macrolides. However, among patients exhibiting no atopic predisposition, the number of CD80-positive macrophages was higher in patients treated with macrolides than in those not treated. In addition, the percentage of CD80-positive macrophages was negatively correlated with the percentage of infiltrating eosinophils in the polyps. These results demonstrate that macrophages act as antigen-presenting cells, expressing both major histocompatibility complex II and costimulators, and that the expression of CD80 may play a key role in the immune responses occurring in a nasal polyp. Macrolides may modulate the mucosal immune responses through CD80 expression.
Isolated Vestibular Areflexia after Blunt Head Trauma
Authors: Guyot Jean-Philippe , Thielen Kristina , Liard Pierre , Kos Izabel
Published: October 2014

The sudden unilateral loss of vestibular function is a frequent cause of vertigo. This condition is called vestibular neuronitis or vestibular neuritis. Its cause remains unknown, but many authors consider it to be a sequel of vestibular viral infection. We report the history and clinical findings of 5 patients in whom a unilateral vestibular loss occurred after head trauma. None of these patients complained of hearing loss. In all cases, the vertigo gradually subsided over days or weeks. The follow-up showed the partial recovery of vestibular function in 2 cases, while vestibular areflexia persisted in 3. The clinical course and findings were similar in every respect to those in patients with classic idiopathic vestibular neuronitis.
Cochlear Microphonic Potentials: A New Recording Technique
Authors: Carricondo Francisco , Sanjuán-Juaristi Julio , Gil-Loyzaga Pablo , Poch-Broto Joaquín
Published: October 2014

A new instrumentation and a particular method for detecting and recording cochlear microphonic potentials (CMPs) are described here. The CMPs were recorded in rats by means of pure tones (4,000, 2,000, 1,000, 500, and 250 Hz) and intraepidermic electrodes; the electrocochleography technique was avoided. An experimental design that included the use of a glutamatergic agonist (kainic acid [KA]) and an aminoglycoside antibiotic (kanamycin [KANA]) was carried out to demonstrate the origin of the recorded potential. Morphological studies showed that KA selectively eliminated the afferent type I dendrites of the spiral ganglion, while the administration of KANA resulted in the absence of outer hair cells. When CMPs were recorded after KA administration, no alterations were detected. In contrast, KANA administration resulted in the absence of any selective electrophysiological activity corresponding to CMPs. All these results were compared with the recording of the compound action potential of the eighth nerve obtained by electrocochleography. These findings and the great specificity of the reproduction of the sound stimulus confirm that the CMPs can be recorded by the new equipment.
Association of Laryngopharyngeal Reflux Disease and Subglottic Stenosis
Authors: Maronian Nicole C. , Waugh Patricia , Azadeh Hafez , Hillel Allen
Published: October 2014

Laryngopharyngeal reflux (LPR) disease and extraesophageal manifestations of gastroesophageal reflux have been recognized to have dramatic effects in the upper airways. Patient-reported symptoms alone underestimate the presence of LPR, making accurate clinical diagnosis difficult. Many previous studies examine populations with only standard dual-probe pH testing that does not include a test probe in the pharynx. Therefore, documentation of acid exposure at the laryngeal inlet is lacking. In adult patients with subglottic stenosis (SGS), whether due to granulomatous disease or presumed idiopathic causes, LPR is often a contributing or causative factor. a retrospective chart review from 1991 to 1999 identified 19 patients with SGS. Ten of the 19 patients had concomitant disease states, including sarcoidosis (3), Wegener's granulomatosis (3), laryngeal trauma (3), and a history of intubation (1). Fourteen patients underwent 24-hour ambulatory pH probe testing with 3- or 4-port probes. The proximal port in either catheter was positioned by manometric guidance directly behind the laryngeal inlet. Measurements of pH of less than 4 were recorded at the level of the larynx in 12 of the 14 patients tested (86%). This finding was noted in half of the patients despite empirical therapy with proton pump inhibitors at the time of the testing. Seven of 10 patients with underlying disease were studied, and all demonstrated acid reflux in the hypopharynx. In 9 patients, the stenosis was presumed to be idiopathic. Five of the 7 patients (71%) with idiopathic SGS tested had positive pH probe studies (pH below 4 in the pharyngeal probe). Our results demonstrate a strong association of LPR and SGS. In the idiopathic group, reflux is the probable cause of their stenosis. In the group of patients with underlying disease states, reflux was involved in all tested patients and likely acts as a synergistic factor that stimulates their granulomatous disease to react and subsequently result in the development of stenosis. Evaluation for LPR with pharyngeal pH testing should be performed in all patients with SGS.
Bronchial Intraepithelial Neoplastic Lesions in Head and Neck Cancer Patients: Results of Autofluorescence Bronchoscopy
Authors: Venmans Ben J. W. , Van Boxem Ton J. M. , Smit Egbert F. , Postmus Pieter E. , Sutedja Tom G.
Published: October 2014

To determine the efficacy of autofluorescence bronchoscopy for detection of bronchial intraepithelial neoplastic lesions in head and neck cancer patients, we analyzed data from head and neck cancer patients who underwent both white light bronchoscopy and autofluorescence bronchoscopy for the rates of detection of intraepithelial neoplastic lesions. The results of the histopathologic examination were compared with the bronchoscopic findings. The sensitivity for detection of intraepithelial neoplastic lesions was calculated. Eleven moderate dysplasias and 3 severe dysplasias were detected during 8 of the 42 bronchoscopic examinations (19%) in 6 of the 24 patients (25%). The sensitivities for white light bronchoscopy alone and for white light bronchoscopy combined with autofluorescence bronchoscopy for detection of intraepithelial neoplastic lesions were, respectively, 21% (3 of 14) and 57% (8 of 14). In short, bronchial intraepithelial neoplastic lesions were found in a considerable percentage of head and neck cancer patients. Use of autofluorescence bronchoscopy improved the detection of these lesions.
Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Multicenter Review and an Algorithm for Airway Management
Authors: Chiu Alexander G. , Burningham Alan R. , Newkirk Kenneth A. , Krowiak Edward J. , Davidson Bruce J. , Deeb Ziad E.
Published: October 2014

Angioedema is a nonpitting edema of which the presentation ranges from benign facial swelling to airway obstruction managed by intubation or tracheotomy. The presentation of this disease is reviewed, and a treatment algorithm based on initial signs and symptoms is proposed for proper airway management. We performed a retrospective review of 108 patients treated in 2 tertiary care centers in the Washington, DC, area over a 5-year period. Ninety-eight patients (90.7%) were African-American, and 81 (75%) were female. Seventy-four patients (68.5%) were taking angiotensin-converting enzyme inhibitors (ACEIs). A classification system was developed based on the location of the edema at initial presentation: 1) isolated facial swelling and oral cavity edema, excluding the floor of the mouth; 2) floor of mouth and/or oropharyngeal edema, and 3) oropharyngeal edema with glottic and/or supraglottic involvement. Fourteen patients (13%) needed airway intervention, 2 of whom underwent a cricothyrotomy after a failed intubation attempt. Eleven (78.6%) were taking ACEIs. The indication for each intubation was massive tongue and floor of mouth edema. The patients were extubated 48 to 72 hours later. No patient demonstrated symptom progression after medical treatment was initiated. Therapy included discontinuation of the ACEI or other inciting agent, a high-humidity face tent, an initial dose of intravenous antihistamines, and a continued course of intravenous steroids. Within 48 hours, most patients had a resolution of their edema. Only cases of significant tongue and oropharyngeal edema took longer than 48 hours to resolve. The ACEIs are a common cause of angioedema. Left untreated, angioedema may progress to involve the oropharynx and supraglottis, resulting in a life-threatening airway compromise. Marked floor of mouth and tongue edema are the indications for airway intervention. An algorithm based on the initial presentation is essential for proper airway and patient management. Once treatment has begun, angioedema is nonprogressive and often resolves within 24 to 48 hours.
Central Incisor Width as a Predictor of Appropriate Curette Size in Adenoidectomy
Authors: Hohn Darren J. , Deschler Daniel G. , Tucker John A.
Published: October 2014

As inadvertent eustachian tube injury during adenoidectomy can have serious short- and long-term implications, a simple anatomic correlate that could predict the optimal curette choice for adenoidectomy, especially in severely hypertrophic cases, is beneficial. This study evaluates the correlation of the distance between the lateral borders of the upper central incisors and the distance between the tori tubarius in the nasopharynx. One hundred one consecutive patients undergoing adenoidectomy at a pediatric tertiary care hospital were enrolled in this study. The patients ranged in age from 7 months to 15 years. No complications were noted in any of the procedures. During the operation, the distance between the central upper incisors was measured in millimeters, as was the inter-tubarius width (ITW). A multiple regression analysis was completed to assess the correlation between central incisor width and ITW. Age and inter-incisor width were positively correlated with ITW in a statistically significant manner (p = .007 and p = .006, respectively). The distance between the lateral borders of the upper central incisors predicts the distance between the tori tubarius in the nasopharynx. Therefore, an adenoid curette the window of which does not overlap the lateral aspects of the central upper incisors can be used relatively safely, even in fields with poor visualization.
Prefabrication of Composite Tissue for Improved Tracheal Reconstruction
Authors: Delaere Pierre R. , Hermans Robert , Hardillo Jose , Van Den Hof Bert
Published: October 2014

Tracheal repair tissues were evaluated experimentally to provide an evidence-based choice for decision-making in clinical tracheal reconstruction. Tracheal reconstructive tissue was characterized as providing for vascularization, support, and/or lining. A tissue equivalent was developed in the rabbit for each of the individual tissues. The individual tissues consisted of nonepithelialized soft tissue (vascularized fascia), epithelialized tissue (vascularized fascia grafted with buccal mucosa), and supportive tissue (ear cartilage). The 3 reconstructive tissues were evaluated in 30 rabbits after repair of an anterior laryngotracheal defect. Morphometric and histologic analysis was applied to the reconstructions. After a 1-month follow-up period, defects repaired with nonepithelialized soft tissue showed healing by secondary intention and a wound that was contracted to 44% of the initial surface area of the defect. Mucosa-lined soft tissue flaps and cartilage grafts showed a less than 10% wound contraction. Compared to cartilage grafts, mucosa-lined soft tissue (vascularized fascia grafted with buccal mucosa) seemed preferable for clinical use, because it showed healing by primary intention. A mucosa-lined radial forearm fascia flap was used successfully in cases of restenosis after tracheal resection. One deficiency of the mucosa-lined soft tissue was the absence of supportive tissue. In cases of extensive stenosis, it might be useful to obtain additional expansion of the airway lumen by creating a convexity at the site of reconstruction. In a second set of experiments, we attempted to improve the mucosa-lined soft tissue concept by adding elastic cartilage. A composite tissue consisting of vascularized fascia, buccal mucosa, and auricular cartilage was developed. Heterotopic prefabrication of the composite tissue was essential for survival of the cartilaginous component. Additional airway lumen expansion could be obtained after heterotopic flap prefabrication. After experimental evaluation, the concept of the prefabricated composite tissue was successfully applied in a clinical case of long-segment stenosis. Experimental and clinical evidence suggests that the combination of buccal mucosa and fascia form an optimized tissue combination for tracheal reconstruction. This combination can be improved by adding strips of autologous ear cartilage.
Persistent Measles Virus Infection and Otosclerosis
Authors: Arnold Wolfgang , Niedermeyer Hans P. , Schuster Maria , Neubert Wolfgang J. , Baumann Christa , Sedlmeier Reinhard
Published: October 2014

The cause of otosclerosis is still unknown. Recently, measles virus involvement has been implicated. The aim of this study was to analyze the presence of measles virus RNA within the otosclerotic focus and to evaluate the perilymphatic antibody pattern. Bone and perilymph specimens from 40 patients with the spontaneous form of otosclerosis and from control patients were investigated by reverse transcription polymerase chain reaction (RT-PCR), Western blot techniques, and cell culture. By the use of RT-PCR, measles virus RNA could be detected in 32 patients, but not in controls. Analysis of perilymph revealed the presence of antibodies to N, F1, and M measles virus proteins in all cases, and antibodies against H protein in 2 additional cases. In preosteoblasts cultured from otosclerotic bone chips, no measles virus RNA could be amplified. We conclude that the spontaneous form of otosclerosis is, in the vast majority of cases, a measles virus-associated disease of the otic capsule.
Short- and Long-Term Results of Stapedotomy and Stapedectomy with a Teflon-Wire Piston Prosthesis
Authors: Kos Maria Izabel , Montandon Pierre B. , Guyot Jean-Philippe
Published: October 2014

We analyzed the results of 604 cases of primary stapes surgery performed between 1974 and 1997 with replacement of the stapes by a 0.6- or 0.8-mm Schuknecht Teflon-wire piston. At long-term follow-up (1 to 21 years; mean, 7 years), the residual air-bone gap was 10 dB or less in 79% of the cases. The hearing results and postoperative complications were comparable to those reported by authors who used the same evaluation criteria. Although the aim of the surgery was to perform a small stapedotomy with a narrow footplate perforation (0.8 mm), a large stapedotomy or a stapedectomy was performed in 134 cases (22.2%) because of surgical or anatomic conditions. Our results show that the larger footplate perforations allowed a better correction of the air-bone gap at the lower frequencies. The ears with larger perforations did not show a higher incidence of sensorineural hearing loss.
Total Implantation of the Active Hearing Implant Tica for Middle Ear Disease: A Temporal Bone Study
Authors: Maassen Marcus M. , Lehner Rolf , Baumann I. , Leysieffer Hans , Zenner Hans P.
Published: October 2014

A subpopulation of hearing-impaired patients has conductive hearing loss that cannot be improved by classic tympanoplasty. Other patients have a mixed hearing loss and cannot be helped by present forms of ear surgery or by hearing aids. Possible help for some patients may come from current implantable hearing devices if these are modified for the patient's specific anatomic situation. The TICA LZ 3001 is a hearing implant for total implantation used to treat moderate to severe sensorineural hearing loss. Most patients who use it have a normal ossicular chain that allows coupling of the implant to the incus. The present temporal bone study demonstrates that the TICA can also be used in patients with an interrupted ossicular chain. If the incus long process shows a defect, the TICA may be coupled to the incus body, and connection between the stapes and the long process of the incus can be achieved with a commercially available titanium-angle prosthesis or liquid ionomeric cement. In cases of an absent incus, the coupling axis of the transducer may be coupled to the stapes head via a modified coupling element. With an absent stapes, the coupling axis may be coupled directly to the perilymph by a coupling element similar to a gold stapes prosthesis.
Biofilm Formation on Voice Prostheses: In vitro Influence of Probiotics
Authors: Free Rolien H. , Elving G. Jolanda , van Weissenbruch Ranny , Busscher Henk J. , vander Mei Henny C. , Albers Frans W. J.
Published: October 2014

In order to determine the influence of probiotic bacteria on biofilm formation on Groningen and Provox 2 voice prostheses in an artificial throat, we grew biofilms on both types of voice prostheses and exposed them 3 times daily to a probiotic bacterial suspension. As a control, we perfused an artificial throat with phosphate-buffered saline solution. Perfusion with Lactococcus lactis 53 suspension reduced the percentage numbers of bacteria and yeasts, respectively, on the Groningen prostheses to 17% and 22% and on the Provox 2 prostheses to 19% and 45%, compared to the number of colony-forming units on the control prosthesis, which was set at 100%. A suspension of Streptococcus thermophilus b reduced the percentage numbers of bacteria and yeasts, respectively, on the Groningen prostheses to 53% and 33% and on the Provox 2 prostheses to 14% and 0%, as compared to the control prosthesis. All other probiotic strains tested caused some reduction in the percentages of bacteria or yeasts, but strong differences between the types of prostheses were observed. In conclusion, L lactis 53 and S thermophilus b strongly reduce the occurrence of yeasts and bacteria in voice prosthetic biofilms.
Age Dependence of Laryngeal Chemoreflex in Puppies
Authors: Park Han-Q , Hong Won-Pyo , Kim Kwang-Moon , Kim Myung-Sang , Kim Young-Ho , Kim Dong-Young
Published: October 2014

Previously collected data have indicated that the laryngeal chemoreflex (lcr) response is exaggerated during a critical period of postnatal development in several experimental animals. These animals had fewer anatomic and physiological similarities to humans than do puppies. This investigation of the lcr in 14 anesthetized puppies was undertaken to determine age-related differences in the response to stimulation of the supraglottic laryngeal mucosa by saline solution, distilled water, cow's milk, and acid at pH 1.0. The dogs were divided into 3 age groups: group 1 consisted of 4 dogs that were 2 weeks old, and in groups 2 and 3 there were 5 puppies each, of 4 and 6 weeks of age, respectively. The lcr response (laryngospasm, apnea, respiratory depression, and bradycardia) was found in the puppies only after stimulation of the laryngeal mucosa with acid at pH 1.0, and it was more easily achieved in the 4- and 6-week age groups than in the 2-week group. These findings suggest that the lcr is an age-dependent response that appears in dogs only after 2 weeks of age. The important implication of this finding is that postnatal neural maturation may influence the laryngeal reflex in humans to some extent.
Three-Dimensional Analysis of Morphological Aspects of the Human Saccular Macula
Authors: Naganuma Hideaki , Tokumasu Koji , Hashimoto Shinichiro , Okamoto Makito , Yamashina Shohei
Published: October 2014

The 3-dimensional shape of the human saccular macula and its orientation in the skull were quantitated in this study. The semicircular canals and saccular maculae were reconstructed 3-dimensionally on a computer from 3 human temporal bones. The 380 to 522 triangles in the entire area of the saccular macula were made by drawing lines between 2 adjacent points every 100-μm width of the saccular macula in each section. The angles between each triangle and each estimated standard axis in the skull obtained were calculated. This information will provide standard data regarding the 3-dimensional morphological aspects of the saccular macula for further investigations of the function of the sacculus. It was determined that the 3-dimensional shape of the saccular macula was not a plane, but was a curved surface like that of an ellipsoid. It is thought that this shape is necessary in order for the saccular macula to detect wide-range linear acceleration.
Facial Nerve Schwannoma: Surgical Excision versus Conservative Management
Authors: Liu Richard , Fagan Paul
Published: October 2014

Facial nerve schwannomas are slow-growing tumors that may involve any part of the facial nerve. When they present with moderate to total facial palsy, complete resection is clearly indicated. However, in cases with mild or no facial dysfunction, the best course of treatment is less obvious. A series of 22 patients with facial nerve schwannoma is presented, of whom 12 underwent definitive excision and 10 were managed more conservatively. The best postoperative facial function in the group who had tumor removal was a House-Brackmann grade III, while 8 of the conservatively treated group had normal facial function up to 10 years after presentation. As well, no significant tumor growth was noted on serial radiologic imaging of those being observed. Delaying surgical resection of facial nerve schwannomas may allow patients to retain normal facial function indefinitely.
Vocal Fold Paresis of Charcot-Marie-Tooth Disease
Authors: Sulica Lucian , Lovelace Robert E. , Blitzer Andrew , Kaufmann Petra
Published: October 2014

No cohesive overview of vocal fold abnormalities associated with Charcot-Marie-Tooth disease (CMT) has been presented in the literature. This study examines a patient in depth and compares the findings with those of published reports to characterize the features of vocal fold paresis in CMT. The affected patient was investigated with nerve conduction testing, laryngeal electromyography, endoscopy, and laryngeal sensory testing. Ten published cases were reviewed for similarities and differences. Vocal fold paresis has been observed in 11 CMT patients ranging in age from 8 to 80 years. Two cases have occurred in the context of CMT type 1, and 9 in CMT type 2. Seven of the 11 cases (64%) were clearly bilateral; only 2 of the 7 cases (29%) required tracheotomy, and both were in children. The electromyographic findings were typical of reinnervation. Sensory findings were present, but did not represent significant disability in the 1 patient so studied. We conclude that CMT does not spare the cranial nerves, as has been previously thought. Furthermore, vocal fold paresis is not restricted to CMT type 2 and should not be considered a hallmark of that category. The available evidence suggests that the neural deficit evolves gradually, may exhibit partial recovery, and often escapes notice for a time. Vocal fold abnormalities are most often bilateral. Because the deficit is generally well tolerated in adults, many cases have probably been overlooked, and no conclusion regarding incidence is possible. Nevertheless, the potential for airway compromise exists, especially in children. Respiratory complaints of CMT patients should be thoroughly investigated.
Revision Thyroplasty
Authors: Maragos Nicolas E.
Published: October 2014

To document surgical techniques for performing a revision thyroplasty operation and to describe the subjective and objective results of these operations, I undertook a retrospective review of all patients who have undergone thyroplasty in my practice. I identified patients who required revision of a previous thyroplasty and evaluated preoperative and postoperative video and audio analyses of the voice. I identified the surgical steps necessary for successful completion of a revision operation and noted any special findings made at surgery. Charts were reviewed and tabulated for reasons for failure of the first operation, efficacy of the second surgical approach, specific anatomic findings made at revision surgery, and types of surgery available for revision. Of 625 total thyroplasties in 331 patients, revision operations accounted for 61 operations in 48 patients. All thyroplasty operations were found to be revisable or reversible. Objective voice analysis for 35 operations in 32 patients revealed a statistically significant improvement in shimmer in women, and in harmonics-to-noise ratio in all patients. Subjective voice improvement occurred in 80% of patients after revision surgery. I conclude that revision thyroplasty is possible with all thyroplasty types, giving significant improvement in both shimmer (women) and harmonics-to-noise ratio (all patients). Although most voices are still abnormal on postoperative objective voice analysis, 80% of patients are subjectively improved.
Effects of Gum Chewing on Pharyngeal and Esophageal pH
Authors: Smoak Benjamin R. , Koufman James A.
Published: October 2014

We investigated the effects of gum chewing on pharyngeal and esophageal pH levels in patients with laryngopharyngeal reflux (LPR) who were undergoing reflux testing. Forty consecutive, unselected, adult patients who were undergoing ambulatory double-probe (simultaneous pharyngeal and esophageal) pH monitoring for diagnosis of LPR were asked to chew 2 sticks of gum 4 times during their pH studies. Twenty subjects chewed regular sugarless gum, and 20 subjects chewed a sugarless gum containing bicarbonate. The subjects recorded the beginning and end of each gum-chewing period. The mean pH values for the gum-chewing intervals and for comparable pre-gum-chewing intervals were analyzed statistically for both the pharyngeal and esophageal probe data. The regular gum group and the bicarbonate gum group were analyzed separately. In addition, the gum-chewing pH data were compared to controls, ie, normal postcibal buffering effects. The data show that gum chewing consistently increases esophageal and pharyngeal pH, and that bicarbonate gum causes greater increases than regular gum. For patients with LPR, gum chewing appears to be a useful adjunctive antireflux therapy.
Superselectiye Embolization as Palliative Treatment of Recurrent Hemorrhage in Advanced Carcinoma of the Head and Neck
Authors: Sittel Christian , Jungehülsing Markus , Gossmann Axel , Zähringer Markus
Published: October 2014

We report a case of recurrent major hemorrhage in a patient with advanced head and neck squamous cell carcinoma. Before and between the bleeding episodes, the functional level of the patient was remarkably high. Therefore, an attempt at bleeding control with superselective embolization with Ethibloc was made. Because of its specific characteristics, this substance is almost ideal for the purpose of palliative embolization. The material used and the technique of application are described in detail. After the procedure, no hemorrhage occurred for more than 4 months. We recommend superselective embolization, preferably with Ethibloc, for minimally invasive control of recurrent bleeding as palliative treatment in selected patients with advanced head and neck carcinoma, since significant benefit in terms of the quality of life may result.
Virtual Laryngotracheal Endoscopy Based on Geometric Surface Modeling Using Spiral Computed Tomography Data
Authors: Triglia Jean-Michel , Marciano Sandrine , Nazarian Bruno , Moulin Guy , Sudre-Levillain Isabelle , Giovanni Antoine
Published: October 2014

This prospective study describes the clinical utility of virtual endoscopy based on geometric surface modeling of the laryngotracheal lumen. Eighteen children with dyspnea related to either subglottic angioma (n = 5) or laryngotracheal stenosis (n = 13) were included. All patients underwent video-recorded operative endoscopy, spiral computed tomography, and 3-dimensional reconstruction of the laryngotracheal lumen. Modeling was achieved by contour detection on spiral computed tomographic images and reconstruction using a geometric shape-recognition algorithm. The generated surface was used for diagnosis and measurement using interactive and automatic tools. Findings of virtual endoscopy and operative endoscopy were compared. Virtual endoscopy confirmed narrowing of the airway in all cases. In 9 cases, high-grade stenosis prevented complete operative endoscopy, but virtual endoscopy allowed accurate assessment and measurement of the stenosis. The findings of operative and virtual endoscopy were concordant in 9 cases. We conclude that surface modeling provides valuable information for preoperative evaluation of laryngotracheal narrowing. The ability to assess extraluminal anatomy provides a clearer picture of overall disease involvement. In the future, virtual endoscopy will probably be used in conjunction with operative endoscopy for therapeutic decision-making. Noninvasive virtual endoscopy could become an alternative to traditional endoscopy under general anesthesia for therapeutic follow-up.
Effect of Ketamine, Dextromethorphan, and MK-801 on Cochlear Dysfunction Induced by Transient Ischemia
Authors: Tabuchi Keiji , Ito Zenya , Tsuji Shigeki , Hara Akira , Wada Tetsuro , Kusakari Jun
Published: October 2014

Overstimulation of the A'-methyl-d-aspartate (NMDA) glutamate receptor has been implicated as a factor in the pathogenesis of hypoxic-ischemic injury in the central nervous system. To evaluate the role played by NMDA antagonists in ischemia-reperfusion injury of the cochlea, 3 noncompetitive NMDA antagonists — ketamine, dextromethorphan, and MK-801 — were administered to 53 albino guinea pigs subjected to transient ischemia of 30 minutes' duration, and the threshold shifts of the compound action potential were compared with those of nontreated animals 4 hours after the onset of recirculation. Ketamine and dextromethorphan moderately ameliorated the compound action potential threshold shifts, whereas MK-801, the most potent NMDA receptor antagonist among these 3 agents, did not show any protective effect. These results indicate that the action antagonizing the NMDA receptor has no protective effect against ischemia-reperfusion injury of the cochlea, and that ketamine and dextromethorphan act as protective agents for the cochlea via other pathways.
Functional Definitions of Vocal Fold Geometry for Laryngeal Biomechanical Modeling
Authors: Tayama Niro , Kaga Kimitaka , Chan Roger W. , Titze Ingo R.
Published: October 2014

Precise geometric data on vocal fold dimensions are necessary for defining the vocal fold boundaries with respect to the laryngeal framework in physiological and biomechanical models of the larynx (eg, finite-element models). In the mid-membranous coronal section, vocal fold depth can be defined as the horizontal distance from the vocal fold medial surface to the thyroid cartilage, whereas vocal fold thickness can be defined as the vertical distance from the inferior border of the thyroarytenoid muscle to the vocal fold superior surface. Traditionally, such geometric data have been obtained from measurements made on histologic tissue sections. Unfortunately, it is very difficult to obtain reliable data by this method, unless the effects of sample preparation on vocal fold geometry are quantified. Significant tissue deformations are often induced by histologic processes such as fixation and dehydration, sometimes producing shrinkages as large as 30%. In this study, reliable geometric data of the canine vocal fold were obtained by the alternative method of quick-freezing for sample preparation, using liquid nitrogen. Coronal sections of quick-frozen larynges were thawed gradually in saline solution. Images of the mid-membranous coronal sections at various thawing stages were captured by a digital camera. Measurements of operationally defined vocal fold dimensions (depth and thickness) useful for biomechanical modeling were made with a graphics software package. The results showed that geometric changes of the vocal fold induced by freezing are likely reversed by thawing, such that the measurements made on thawed larynges are reliable approximations of the actual vocal fold dimensions.
Unloaded Shortening Velocity and Myosin Heavy Chain Variations in Human Laryngeal Muscle Fibers
Authors: Sciote James J. , Morris Terence J. , Horton Michael J. , Brandon Carla A. , Rosen Clark
Published: October 2014

Myosin description in human laryngeal muscles is incomplete, but evidence suggests the presence of type I, IIA, IIX, and tonic myosin heavy chain (MHC) fibers. This study describes the unloaded shortening velocity (V0) of chemically skinned laryngeal muscle fibers measured by the slack test method in relation to MHC content. Skeletal fibers from human laryngeal and limb muscle biopsy specimens were obtained for determination of V0, and subsequently, glycerol–sodium dodecyl sulfate–polyacrylamide gel electrophoresis was used to determine the MHC isoform content. The fibers from human limb muscle had shortening speeds similar to those in previous reports on human skeletal fibers. Type I, IIA, and IIX fibers of laryngeal muscle had shortening speeds similar to those of fibers from limb muscle, but laryngeal fibers with heterogeneous MHC expression had a wide range of shortening speeds, some being nearly twice as fast as limb fibers. In addition, MHC isoform bands from human extraocular muscle comigrated with some bands from laryngeal muscle — a finding suggesting that extraocular myosin may also be expressed.
Similar COL1A1 Expression in Fibroblasts from Some Patients with Clinical Otosclerosis and Those with Type I Osteogenesis Imperfecta
Authors: McKenna Michael J. , Kristiansen Arthur G. , Tropitzsch Anke S.
Published: October 2014

Because of the clinical and histopathologic similarities between otosclerosis and type I osteogenesis imperfecta, we examined COL1A1 messenger RNA (mRNA) expression in cultured fibroblasts from patients with clinical otosclerosis to determine whether abnormalities of expression of COL1A1 were present, as has been reported in type I osteogenesis imperfecta. Type I osteogenesis imperfecta has been found to result from mutations in the COL1A1 gene that result in null expression of the mutant allele. Patients with clinical otosclerosis were genotyped for the presence of an expressed 4 base-pair insertion polymorphism in the 3′ region of the COL1A1 gene. Skin biopsies were performed, and cultured fibroblast cell lines were established from patients who were heterozygous for the polymorphism. Allelic expression was examined by reverse transcription–polymerase chain reaction and silver-stained Polyacrylamide gel electrophoresis. Two of 9 patients with clinical otosclerosis demonstrated null or reduced expression of one COL1A1 allele. The differential expression of the Two COL1A1 alleles in all subjects was also examined by a semiquantitative method using an ABI Prism 7700 Sequence Detection System (Taqman). We did this examination to determine whether milder abnormalities in COL1A1 expression might account for the development of otosclerosis in the 7 clinical cases that did not reveal evidence of null expression by the gel technique. Of the same 2 cases of otosclerosis that demonstrated evidence of null expression by gel electrophoresis, both were found to have significant differences in COL1A1 mRNA expression by the Taqman analysis. The remaining 7 cases revealed equal expression of the Two COL1A1 alleles similar to that seen in controls. These results suggest that mutations in COL1A1 that are similar to those that occur in type I osteogenesis imperfecta may account for a small percentage of cases of otosclerosis, and that the majority of cases of clinical otosclerosis are related to other genetic abnormalities that have yet to be identified.