bluuebunny/crossref_metadata_2025 huggingface dataset:
Time Course of Changes in Absorption of Macromolecule through the Nasal Mucosa after Antigen Challenge in Guinea Pig Model of Allergic Rhinitis
Authors: Konno Akiyoshi , Nagata Hiroshi , Numata Tsutomu , Terada Nobuhisa , Motosugi Hideaki , Hanazawa Toyoyuki , Okamoto Yoshitaka
Published: October 2014

The time course of changes in absorption of horseradish peroxidase (HRP) through the nasal mucosa after antigen challenge was evaluated in a guinea pig model of allergic rhinitis immunized with ovalbumin. Before and at 5 minutes, 4 hours, and 24 hours after nasal antigen challenge, both nasal cavities were filled with 5% HRP solution for 30 minutes, and blood was obtained to measure serum HRP levels by enzyme-linked immunosorbent assay. In immunized animals, the serum HRP levels were 2.3 times higher than those of normal controls (p < .05) before antigen challenge, which was performed 7 days after a series of nasal antigenic sensitizations. At 5 to 35 minutes after antigen challenge, the HRP levels decreased to one sixth of the prechallenge levels (p < .05), and they did not show a difference from the control levels. However, they increased markedly at 4 and 24 hours after antigen challenge (p < .01). The present study suggests that the absorption of macromolecules through the allergic nasal mucosa is enhanced markedly, depending upon the time course after antigen challenge, although it shows no apparent difference from normal controls during the dominant exudative process.
Laryngeal Sarcoidosis: Treatment with the Antileprosy Drug Clofazimine
Authors: Ridder Gerd Jürgen , Strohhäcker Helmut , Golz Avishay , Löhle Erwin , Fradis Milo
Published: October 2014

Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the larynx is affected, the symptoms are frequently mild, but severe airway obstruction can occur. Although systemic corticosteroids are helpful, patients may become refractory to further drug administration. The current methods of treatment are here summarized, and the patient literature is reviewed. We also report a case of a young patient suffering from laryngeal sarcoidosis successfully treated by the antileprosy agent clofazimine and propose it as an alternative treatment of laryngeal sarcoidosis in patients refractory to corticosteroids.
Acquired Total (Grade 4) Subglottic Stenosis in Children
Authors: Gustafson L. Mark , Hartley Benjamin E. J. , Cotton Robin T.
Published: October 2014

Pediatric acquired total subglottic stenosis (SGS) is a challenging problem. The management of these patients has evolved at our institution over the past 25 years. We conducted a retrospective study to evaluate the surgical management and outcomes of children with grade 4 SGS. Fifty-six patients have presented with acquired grade 4 SGS since 1981. The causes included previous surgery (34), prolonged intubation (15), burns (1), and unknown causes (6). Of the 56 patients, 44 (79%) were decannulated; 120 total procedures were performed, and 39 patients (70%) required more than 1 procedure for decannulation. The decannulation rate has risen from 67% in the 1980s to 86% in the 1990s. Patients who underwent cricotracheal resection (CTR) had a higher decannulation rate than patients who underwent laryngotracheal reconstruction (LTR) with anterior and posterior costal cartilage grafting (CCG) (92% versus 81%), and were less likely to need additional open procedures to achieve decannulation (18% versus 46%). The decannulation rate for children with grade 4 SGS has improved because of advances in surgical technique. Currently, the principal operations used at our institution are 1) CTR and 2) LTR with anterior and posterior CCG. There was a trend toward a higher decannulation rate in patients who underwent CTR, and they were less likely to require further reconstructive surgery before decannulation.
Inner Ear Fluid Volumes and the Resolving Power of Magnetic Resonance Imaging: Can it Differentiate Endolymphatic Structures?
Authors: Buckingham Richard A. , Valvassori Galdino E.
Published: October 2014

Magnetic resonance imaging (MRI) can accurately recognize minute volumes as small as 1 mm3. The volumes of the utricle and saccule of the inner ear are within the resolving power of MRI, but these structures cannot be recognized because the endolymph and perilymph signals are identical. To clarify the interpretation and description of inner ear structures on MRI, we measured and calculated the volumes of the perilymphatic and endolymphatic spaces of the human ear. We found the total volume of the bony labyrinth to be approximately 192.5 mm3 (endolymph, 34.0 mm3; perilymph, 158.5 mm3).
Comparison of the Microanatomical Distributions of Macrophages and Dendritic Cells in Normal and Diseased Tonsils
Authors: Gorfien Janet L. , Noble Bernice , Brodsky Linda
Published: October 2014

The palatine tonsils play an important role in immunologic surveillance and resistance to infection in the upper aerodigestive tract. Dendritic cells and macrophages function to capture and process antigen and present it to T lymphocytes, a critical step in the early immune response. Few studies have characterized the distribution and phenotype of those antigen-presenting cells in the normal palatine tonsil, or determined how those parameters change with disease. Immunohistochemical analysis was performed to determine the microanatomical distribution, quantity, morphology, and phenotype of macrophages and dendritic cells in both normal and diseased tonsils. Differences were observed in macrophage and dendritic cell distribution, quantity, and phenotype in the surface and crypt epithelium. The number of macrophages was significantly increased in all compartments in all disease groups (p <.05), although the number of macrophages that expressed phenotypes of maturity and/or activation was not concomitantly increased. In the surface epithelium, Langerhans and interdigitating cells decreased significantly with disease (p <.05). Chronic infection may impose an immunosuppressive effect on responses within tonsil tissue, affecting the immunologic factors responsible for macrophage maturation and activation.
Effect of Cigarette Smoking on Gastropharyngeal and Gastroesophageal Reflux
Authors: Smit Conrad F. , Copper Marcel P. , Schoots Ivo G. , van Leeuwen Justin A. M. J. , Stanojcic Laki D.
Published: October 2014

Gastropharyngeal reflux appears to be associated with various otolaryngological complaints. Cigarette smoking is known to affect adversely the defense mechanisms against reflux of acid gastric contents into the esophagus. To study the relationship between gastropharyngeal, as well as gastroesophageal, reflux and cigarette smoking, 15 subjects underwent 24-hour double-probe pH monitoring while smoking their daily amount of cigarettes. The percentage of time the pH was below 4 during the smoking period was significantly higher than the percentage of time the pH was below 4 during the nonsmoking period, the level of the upper esophageal sphincter, as well as distal, above the lower esophageal sphincter. These findings demonstrate that smoking increases gastropharyngeal and gastroesophageal reflux. Smokers with complaints and disorders caused by reflux should therefore be advised to stop smoking in order to reduce reflux.
Objective Voice Analysis after Autologous Fat Injection for Unilateral Vocal Fold Paralysis
Authors: Hartl Dana M. , Riquet Marc , Hans Stéphane , Laccourreye Ollivier , Vaissière Jacqueline , Brasnu Daniel F.
Published: October 2014

This study was designed to objectively compare a patient's voice after onset of unilateral vocal fold paralysis (UVFP) to his or her own normal voice, and to compare the results after treatment by intrafold injection of autologous fat. Acoustic recordings were obtained for 2 male patients before thoracic surgery and after the onset of iatrogenic left UVFP. Vocal fold augmentation was performed 10 days after UVFP. The acoustic recordings were repeated within 3 days and at 1 month. The phonation quotient, pitch perturbation quotient, amplitude perturbation quotient, harmonics-to-noise ratio, cepstral peak prominence, and long-term average spectrum were analyzed. All parameters improved after treatment, with a return to preparalytic values for most. During the first month, some deterioration was noted. This is the first study comparing a subject's own normal voice to his or her voice after vocal fold augmentation. We recommend overinjection of fat if vocal fold atrophy is expected.
Enhancement of Submicroscopic Damage of the Nasal Epithelium by Topic Al Allergen Challenge in Patients with Perennial Nasal Allergy
Authors: Motosugi Hideaki , Ohno Kazuto , Nagata Hiroshi , Sanai Akiko , Numata Tsutomu , Suzuki Homare , Konno Akiyoshi
Published: October 2014

The purposes of this study were to clarify whether damage of the nasal epithelium exists in patients with nasal allergy, and how the morphology of the epithelium changes after topical allergen challenge. Electron microscopy revealed 2 characteristic features in the nasal epithelium of patients with perennial nasal allergy — an increase in the number of epithelial cells with cytoplasmic vacuoles, and markedly widened intercellular spaces — although these changes were unclear under light microscopy. The density of vacuolated cells significantly increased 24 hours after allergen challenge. Further, the number of eosinophils that were associated with vacuolated cells was significantly higher in patients with nasal allergy than in controls. These morphological changes, thus, were considered to be types of damage to the nasal epithelium associated with nasal allergy. Such changes may be among the causes of nasal hyperreactivity, which is an important feature of nasal allergy.
Adenoid Cystic Carcinoma of the Base of the Tongue
Authors: Namazie Ali , Alavi Sassan , Calcaterra Thomas C. , Abemayor Elliot , Blackwell Keith E.
Published: October 2014

A retrospective review of 14 patients with adenoid cystic carcinoma of the tongue treated between 1955 and 1997 was performed. Treatment consisted of surgery (n = 2), radiotherapy (n = 2), chemotherapy (n = 1), or combination therapy (n = 9). The 2-, 5-, and 10-year absolute survival rates were 92%, 79%, and 63%, respectively. Seventy-five percent of the patients who died of cancer succumbed to distant metastases. However, long-term survival was common despite a high incidence of local and distant recurrence. The presence of positive surgical margins, the incidence of regional metastases, the incidence of perineural invasion, the initial stage of disease, and the eventual development of locoregional recurrence and distant metastases did not significantly alter the survival rate. Surgical extirpation combined with postoperative radiotherapy is advocated for the treatment of adenoid cystic carcinoma of the tongue. Given the indolent nature of this disease process, surgery should be directed toward conservation of speech and swallowing function.
Hypertrophic Neuropathy of the Facial Nerve
Authors: Cazals-Hatem Dominique , Lisovoski Fabrice , Kania Romain E. , Bouccara Didier , Hénin Dominique , Cyna-Gorse Françoise , Sterkers Olivier
Published: October 2014

Hypertrophic neuropathy is a peripheral nerve lesion that is histologically characterized by onion bulb formations around axons. This histologic picture, which is usually seen in generalized hypertrophic neuropathies, can occasionally be observed in single nerves as localized hypertrophic neuropathy. Cranial involvement of such localized hypertrophic neuropathy represents a very rare entity; only a few cases have been reported in the literature. We report the history of a progressive facial paralysis with a tumorous enlargement of the seventh cranial nerve that was clinically suspected of being a schwannoma. Pathological examination permitted the diagnosis of hypertrophic neuropathy.
Ligand-Gated Purinergic Receptors are Differentially Expressed in the Adult Rat Vestibular Periphery
Authors: Kreindler James L. , Troyanovskaya Marta , Wackym Phillip A.
Published: October 2014

To further characterize the pattern of expression of the ligand-gated purinergic P2X receptors in the peripheral vestibular system, we conducted reverse transcription—polymerase chain reaction amplification of P2X1 and P2X2 messenger RNA extracted from adult rat vestibular ganglia (Scarpa's ganglia) and vestibular end organs. Transcripts encoding P2X1 were found in both Scarpa's ganglia and the end organs, but transcripts encoding P2X2 were found only in the vestibular end organs. These results support previous electrophysiological data, and they provide a more complete understanding of the specific role of purinergic (adenosine-5′-triphosphate) transmission in the vestibular periphery.
Effect of Furosemide on Basal Lamina Anionic Sites in
Authors: Labyrinth Guinea Pig , Suzuki Mitsuya , Raga Kimitaka
Published: October 2014

The authors studied the effects of acute furosemide administration on the basal lamina (BL) anionic sites in the stria vascularis, ampullar crista, and endolymphatic sac by using cationic polyethyleneimine (PEI). Furosemide was intravenously administered to albino guinea pigs with normal Preyer's reflexes. After 20 minutes, the bony labyrinth was removed and processed for histologic evaluation. Under a transmission electron microscope, a marked enlargement of the intercellular spaces was observed in the stria vascularis. The PEI distribution decreased significantly on the capillary BL in the stria vascularis and on the subepithelial BL in the sensory, transitional, and dark cell areas. However, no significant change was observed on the capillary BL or the subepithelial BL in the endolymphatic sac. These findings suggest that acute furosemide administration severely alters the distribution of the anionic sites in the striai capillary BL and in the subepithelial BL in the ampullar crista, but not in the capillary BL or the subepithelial BL of the endolymphatic sac.
Epidemiological Studies on Hearing Impairment with Reference to Genetic Factors in Sichuan, China
Authors: Liu Xue Zhong , Xu Li Rong , Sismanis Aristides , Hu Ying , Zhang Si Ling , Nance Walter E. , Xu Ying
Published: October 2014

Hearing impairment is the most common disorder of sensorineural function and is an economically and socially important cause of human morbidity, A large-scale epidemiological survey of hearing loss was conducted with 126,876 unselected subjects (63,741 male and 63,135 female) from Sichuan, China. The overall prevalence of hearing loss was 3.28% (4,164 of 126,876), and the prevalence increased with age, reaching 12.8% (1,465 of 11,421) at 60 years of age. In 73.03% of all cases (3,041 of 4,164), the hearing loss was sensorineural, and in 20.39% (849 of 4,164), it was conductive; the remaining cases (6%) were mixed hearing loss. Bilateral loss was found in 74.5% of cases (3,103 of 4,164). In 63.79% of cases (2,656 of 4,164), the degree of hearing loss was less than 55 dB hearing level (HL), and in 5.67% of cases (236 of 4,164), it was greater than 90 dB HL. The prevalence of hearing loss in childhood (<15 years of age) was 0.67% (227 of 34,157), of which 57.7% of cases were conductive and 38.8% were sensorineural. The prevalence of genetic hearing loss was 0.28% (349 of 126,876). Persons who lived in the flatlands appeared to have a higher prevalence than those who lived in the hills. Several ethnic groups, including Tibetans, the Yi, and the Lisu, had a higher prevalence of hearing loss. Presbycusis, otitis media, and genetic factors were the most commonly recognized causes of hearing impairment overall, but otitis media and genetic factors were the main causes of hearing loss in children. Causes for the observed differences in prevalence and etiologic factors between China and industrialized countries will be discussed. In China, infections and genetic factors appear to be of major importance as causes of hearing loss.
Fungal Malignant Otitis Externa Due to Scedosporium Apiospermum
Authors: Yao Mike , Messner Anna H.
Published: October 2014

Malignant otitis externa (MOE) is an infection of the external auditory canal that invades the skull base. Aspergillus species fungi were the pathological organism in 21 of 23 reported cases of fungal MOE. We report on a 21-year-old man with end-stage acquired immunodeficiency syndrome (AIDS) and fungal MOE caused by Scedosporium apiospermum. Fungal MOE is most common in patients with end-stage AIDS and hematologic malignancies. Granulation tissue is not a common finding in these patients, and the infectious process often starts in the mastoid air cells or middle ear space, as opposed to the external auditory canal. Surgical debridement and amphotericin B are the mainstays of therapy; resolution of the infection depends greatly on the severity of the underlying disease.
Detection of Intracytoplasmic Cytokines by Flow Cytometry in Adenoids and Peripheral Blood Lymphocytes of Children
Authors: Bernstein Joel M. , Ballow Mark , Rich Gary
Published: October 2014

Cytokine flow cytometry at the single-cell level has never been utilized in the study of adenoidal lymphocytes. We describe the multiparameter capability of flow cytometry to simultaneously detect an antigen on the surface of the adenoidal and peripheral blood lymphocytes and detect Th1 and Th2 cytokines within the cytoplasm of these lymphocytes. The data suggest that the percentage of cells producing interferon (IFN)-γ are decreased in adenoidal as compared to peripheral blood lymphocytes, confirming our previous studies. The new findings show that the CD8 subset of adenoidal lymphocytes produces lower amounts of IFN-γ as compared to peripheral blood CD8 cells. The intracytoplasmic synthesis of interleukin (IL)–2, however, appears to be similar in both adenoidal and peripheral blood lymphocytes. The CD4 subset of lymphocytes in the adenoid produces more IL-2, whereas the CD8 subset produces more IFN-γ. Finally, as shown in our previous studies, the Th2 cytokines appear to be produced in similar quantities in both adenoidal and peripheral blood lymphocytes.
Aerodynamic Profiles of a Hemilarynx with a Vocal Tract
Authors: Alipour Fariborz , Montequin Douglas , Tayama Niro
Published: October 2014

The pressure-flow relationship was examined in excised canine and human larynges with and without a vocal tract. Canine and human larynges were prepared and cut in the midsagittal plane from the top to about 10 mm below the vocal folds. The right half was removed and replaced with an acrylic plate. The vocal tract was simulated initially with a 15-cm plastic tube and later with a vocal tract model with an area function resembling “ah.” Simultaneous recordings were made of the glottal pressure, mean subglottal pressure, and average airflow at various levels of adduction. Preliminary data indicated that the pressure-flow relationships were similar to those of a full larynx and were almost linear. The addition of the vocal tract increased the glottal resistance by moving these pressure-flow lines to the lower-flow and higher-pressure region. The human larynx appears to phonate more easily than the canine larynx on the laboratory bench and has lower phonation threshold pressures.
Topical Ascorbic Acid Reduces Myringosclerosis in Perforated Tympanic Membranes a Study in the Rat
Authors: Spratley Jorge E. , Hellström Sten O. , Mattsson Cecilia K. , Pais-Clemente Manuel
Published: October 2014

Myringosclerosis, a common finding after myringotomy, has been recently associated with an increased production of oxygen free radicals. Ascorbic acid's proposed actions include collagen synthesis, antioxidation, and free radical scavenging. The effects of topical ascorbic acid on healing tympanic membranes were studied. Particular attention was given to detecting the presence of myringosclerosis. Twelve Sprague-Dawley rats were bilaterally myringotomized. Their ears were randomized into group A, which received topical ascorbic acid in Gelfoam, group B, which received topical saline solution in Gelfoam, and group C, which received no treatment. The tympanic membranes were harvested on day 13, after routine otomicroscopy. Under light microscopy, the connective tissue layer of the untouched side of the pars tensa was distinctly thicker in group A than in group B or group C. At this level, the extent of sclerotic lesions was significantly less in the ascorbic acid—treated group. It is inferred that topical ascorbic acid reduces the occurrence of myringosclerosis following tympanic membrane perforations in the rat.
Acute Otitis Media in Brazilian Children: Analysis of Microbiology and Antimicrobial Susceptibility
Authors: Sih Tania Maria
Published: October 2014

Between 1990 and 1995, a total of 300 children, ages 2 months to 5 years, received diagnoses of acute otitis media (AOM) in a hospital emergency room in Săo Paulo, Brazil, and were recruited for this study. The investigation was undertaken, first, to identify microorganisms and antimicrobial susceptibilities of pathogens from AOM in Brazilian children; next, to ascertain, by comparison, whether the isolates of Streptococcus pneumoniae have the same serotypes as those included in the new conjugated heptavalent pneumococcal vaccine; and last, to determine whether additional and/or different serotypes are needed in the vaccine to ensure an immunogenic response against pneumococcal pathogens for the indigenous children in this study. Microorganisms were isolated from ear fluid of 192 patients (64%). The 5 most prevalent pathogens were S pneumoniae (48 isolates; 16%), Haemophilus influenzae (21 isolates; 7%), Moraxella catarrhalis (15 isolates; 5%), Pseudomonas aeruginosa (6 isolates; 2%), and Staphylococcus aureus (3 isolates; 1%). These 5 represented 93 of the 192 total isolates. Resistance to antibiotics was found in the 3 primary pathogens. No high-level resistance of S pneumoniae to penicillin was found; instead, there was high-level resistance to trimethoprim-sulfamethoxazole. Ten serotypes of S pneumoniae were isolated: 6B, 9V, 11A, 16, 18C, 19A, 19F, 23A, 23B, and 23F Only 5 of the 10 serotypes isolated were included in the conjugated heptavalent pneumococcal vaccine. Therefore, the other 5 serotypes (24 of 48 strains) should be considered in selecting antigens for the new vaccine.
Paranasal Sinus Ventilation in Healthy Subjects and in Patients with Sinus Disease Evaluated with the 133-Xenon Washout Technique
Authors: Paulsson Bo , Dolata Jan , Ohlin Per , Larsson Ingemar , Lindberg Sven
Published: October 2014

Ventilation of the paranasal sinuses is of great importance in sinus pathophysiology. Therefore, methods of measuring sinus ventilation are important for the evaluation of patients with sinus disease. In the present study, a 133-xenon washout technique was used to evaluate the ventilation of the paranasal sinuses in 34 healthy subjects and in 13 subjects with sinus disease (5 patients with nasal polyposis and 8 patients with chronic sinusitis). For this purpose, a 133-xenon-air mixture was insufflated in each nostril and the washout of the radioactive gas from the paranasal sinuses was monitored with a dynamic single-photon-emission computed tomography camera. The half-time (±SD) was found to be 18 ± 18 minutes for the maxillary sinus, 10 ± 8 minutes for the frontal sinus, and 18 ± 23 minutes for the posterior ethmoid and sphenoid sinuses in the healthy subjects. Repeated measurements in 18 of the healthy subjects indicated that the method had acceptable reproducibility according to a Bland-Altman plot. The 133-xenon washout was not influenced by insufflation pressure, nasal patency, or body position. The subjects with sinus disease exhibited half-times of 77 ± 101 minutes for the maxillary sinus, 91 ± 124 minutes for the frontal sinus, and 60 ± 60 minutes for the posterior ethmoid and sphenoid sinuses. For patients with nasal polyposis, the half-time was significantly longer than that in healthy subjects, while patients with chronic sinusitis did not differ from healthy subjects in this respect.
Laryngeal Mask versus Endotracheal Tube in a Ferret Model
Authors: Brietzke Scott E. , Mair Eric A.
Published: October 2014

Acquired subglottic stenosis in infants is a difficult iatrogenic problem with notable morbidity, primarily caused by prolonged endotracheal intubation. The laryngeal mask airway (LMA) is a recently developed, alternative airway device that does not contact the subglottis. To explore the possibility of preventing subglottic stenosis, we compared the endotracheal tube (ETT) and the LMA in terms of the incidence and severity of glottic and subglottic injury resulting from prolonged intubation in the adult ferret model of the infant airway. Ten adult ferrets were randomly intubated under inhalational anesthesia with either a 4.0 cuffless ETT or a size 1 LMA for a 24- to 48-hour period. Rigid laryngeal endoscopy was used to detect pharyngeal or glottic injury during the period of intubation and on a routine basis for 3 months after extubation. All 5 ferrets in the ETT group developed endoscopically evident glottic and subglottic injury; 2 of the 5 developed a symptomatic, mature subglottic stenosis. The 5 ferrets in the LMA group had endoscopically normal larynges. However, all ferrets in the LMA group developed significant tongue edema and cyanosis during the first 24 hours of intubation, and 3 of the 5 died of respiratory failure due to airway obstruction. In the 2 LMA survivors, evidence of oropharyngeal injury persisted until 6 weeks after extubation. We conclude that the LMA does not cause subglottic injury in this model. However. its prolonged use results in significant pharyngeal morbidity that raises serious doubt as to its potential routine use in infants requiring prolonged ventilatory support.
Bacteriology of Adenoids and Tonsils in Children with Recurrent Adenotonsillitis
Authors: Brook Itzhak , Shah Kiran
Published: October 2014

Adenoids and tonsils electively removed from 25 children with a history of recurrent group A β-hemolytic streptococci (GABHS) adenotonsillitis were cultured for aerobic and anaerobic bacteria. Two hundred twenty-four organisms (112 aerobes and facultatives, 110 anaerobes, and 2 Candida albicans) were isolated from the tonsils, and 229 (111 aerobes and facultatives and 118 anaerobes) were isolated from the adenoids. Mixed infection was present in all instances, with an average of 9.1 isolates per specimen. The predominant aerobes were Streptococcus sp, Haemophilus influenzae, and GABHS, and the prevalent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. β-Lactamase-producing bacteria were detected in 72 isolates recovered from 22 tonsils (88%) and in 74 isolates recovered from 21 adenoids (84%). Discrepancies in the organisms recovered were found between the tonsils and adenoids. Of the aerobic isolates, 20% were isolated only in tonsils and 18% only in adenoids. Of the anaerobes, 20% were found only in tonsils and 26% only in adenoids. This study demonstrates a polymicrobial aerobic-anaerobic flora in both adenoids and tonsils, and discrepancies in recovery of pathogens such as GABHS. The adenoids may serve as a potential source of tonsillitis caused by GABHS.
Otopathology in a Case of Type I Waardenburg's Syndrome
Authors: Merchant Saumil N. , McKenna Michael J. , Milunsky Aubrey , Baldwin Clinton T. , Nadol Joseph B.
Published: October 2014

We report a case of type I Waardenburg's syndrome that provides insight into the etiopathogenesis of sensorineural hearing loss (SNHL) in this syndrome. The subject, a 76-year-old woman with type I Waardenburg's syndrome (dystopia canthorum, heterochromia irides, and white hair), had congenital low-frequency SNHL in her right ear only, which had remained relatively stable throughout her life. Blood leukocyte DNA studies revealed a PAX-3 mutation with a 1 base pair C-to-A substitution in exon 5 at base 602. Light microscopic studies of the right cochlea showed intact neurosensory structures in only the lower basal turn, with the remainder of the cochlea showing absence of melanocytes, absence of stria vascularis, missing hair cells, dysmorphogenesis of the tectorial membrane, and lack of peripheral processes of the spiral ganglion cells. There was pathological alteration of the vestibular dark cells with marked reduction of melanocytes associated with these dark cells. The left inner ear was normal, with a full complement of neurosensory structures, including melanocytes. Because the PAX-3 gene is involved in neural crest development and melanocytes migrate from the neural crest to the ear, the findings in this case are consistent with the hypothesis that defective melanocyte migration or defective melanocyte function results in defective development of the stria vascularis (and perhaps other structures of the ear). leading to SNHL.
Neuromuscular Disorders Presenting as Congenital Bilateral Vocal Cord Paralysis
Authors: Lapeña Jose F. , Berkowitz Robert G.
Published: October 2014

Congenital bilateral vocal cord paralysis (BVCP) can be associated with an underlying neuromuscular disorder, and may present before other features of the neuromuscular disorder become apparent. All infants less than 12 months of age presenting with BVCP between July 1987 and July 1999 at the Royal Children's Hospital, Melbourne, in whom a neuromuscular disorder was subsequently diagnosed were followed. Three children in whom BVCP was diagnosed soon after birth and before recognition of an underlying neuromuscular disorder were identified. All presented with upper airway obstructive symptoms at birth, had a diagnosis of bilateral abductor vocal cord paralysis made at awake flexible laryngoscopy, and had no underlying structural laryngeal abnormality on microlaryngoscopy and bronchoscopy. Two children required a tracheostomy, and 1 child was weaned from nasopharyngeal continuous positive airway pressure after 3 weeks. Subsequent neuromuscular symptoms were recognized between 4 months and 7 years later, leading to diagnoses of facioscapulohumeral myopathy, spinal muscular atrophy, and congenital myasthenia gravis. In each case, the prognosis for recovery from symptoms related to BVCP reflected that of the underlying neuromuscular disorder. This experience suggests that congenital BVCP may be a feature of an unrecognized neuromuscular condition. This possibility should be considered particularly in the presence of associated neurodevelopmental or neuromuscular dysfunction, or in cases in which BVCP is progressive.
Evaluation of Poly-L-Lactic Acid and Polyglycolic Acid Resorbable Stents for Repair of Tracheomalacia in a Porcine Model
Authors: Nalwa Sarvi S. , Hartig Gregory K. , Connor Nadine P. , Warner Thomas , Thielman Michael J.
Published: October 2014

Poly-L-lactic acid and polyglycolic acid (PLPG) resorbable stents may offer a potential solution to the problem of tracheomalacia. Advantages of this material include its strength, its versatile shaping characteristics, and its resorbability, which would preclude surgical removal and allow for airway growth. The purpose of this pilot study was to examine the usefulness of PLPG stents for temporary external airway stenting of tracheomalacia in a porcine model. A severe tracheomalacia was created in 6 pigs by submucosal resection of segments of tracheal cartilage from 6 consecutive rings. The PLPG stent was then shaped to recreate the tracheal contour and sutured to the underlying airway. Endoscopic photodocumentation during spontaneous ventilation was obtained before and after reconstruction. After creation of the malacic tracheal segment, all animals developed stridor, retractions, and cyanosis during spontaneous ventilation. After repair, all animals were extubated without complication. All animals survived the follow-up period of 9 to 12 weeks without evidence of respiratory distress and with rapid weight gain. Repeat bronchoscopy showed no evidence of airway collapse during spontaneous ventilation. Tracheal measurements revealed growth of the stented segment with a mild narrowing within the repaired region. Histologic examination showed preservation of respiratory epithelium. These preliminary findings suggest that PLPG stents may serve a useful role in the surgical management of tracheomalacia.
Relationship between Transglottal Pressure and Fundamental Frequency of Phonation, with Effects of Dehydration Produced by Atropine, in Healthy Volunteers
Authors: Tanaka Kazunari , Kitajima Kazutomo , Tanaka Hiroko
Published: October 2014

We investigated the effects of the intravenous injection of atropine sulfate on the relationship between the fundamental frequency of phonation (F0) and the magnitude of F0 change per unit change in transglottal pressure (dF/dP) in 4 healthy male volunteers. Before the injection of atropine, we observed a nonlinear or V-shaped relationship between dF/dP and F0. After the injection, the values for dF/dP were reduced at a lower F0, whereas the values were unchanged at a higher F0. The results support our hypothesis that the relationship between dF/dP and F0 reflects adjustments in the length and depth of the vocal folds in controlling F0.
Morphometric Analysis of Age-Related Changes in the Human Basilar Membrane
Authors: Bhatt Kirit A. , Liberman M. Charles , Nadol Joseph B.
Published: October 2014

The histopathologic correlates of presbycusis suggest several categories, including degeneration of sensory cells, neurons, or the stria vascularis. Lack of clear-cut histopathologic changes in some cases has suggested an “indeterminate category”; however, several studies have suggested that a disorder of the basilar membrane (BM) may underlie indeterminate presbycusis. The objective of the present study was to quantify age-related changes in the human BM and correlate them with audiometric patterns. Under high-resolution light microscopy, BM thickness was calculated, and the number of tympanic mesothelial cells (TMCs) lining the BM was counted, at 4 cochlear locations in 92 temporal bones. The control group (n = 80) included subjects from 10 decades of age with normal hearing and/or histopathologic findings. The indeterminate group (n = 12) consisted of elderly patients (ages 64 to 91 years) with hearing loss and no apparent histopathologic changes. Age-related BM thickening was seen in both groups, but only in the most basal cochlear region. The BM thickness in the indeterminate group was not significantly different from that of age-matched controls. Counts of TMCs showed age-related decreases in all cochlear regions in both groups; however, TMC counts in the indeterminate group were not different from those of age-matched controls. The results suggest that BM histopathology is not a common cause of presbycusis. Although age-related BM thickening, seen in both groups, could contribute to hearing loss, the extreme basal region, to which the thickening was confined, is not tested in routine audiometry.
Age-Related Changes of Collagenous Fibers in the Human Vocal Fold Mucosa
Authors: Sato Kiminori , Hirano Minoru , Nakashima Tadashi
Published: October 2014

The viscoelastic properties of the vocal fold mucosa depend on the extracellular matrices. Collagenous fibers provide tensile strength and resilience and serve as a stabilizing scaffold in the extracellular matrices. Light and electron microscopic investigations of age-related changes of collagenous fibers in vocal fold mucosa were carried out on excised normal human adult larynges. Twelve human vocal fold mucosae were examined (10 from older adults with ages ranging from 70 to 97 years, and 2 from younger adults for comparison). The results for the aged mucosae can be summarized as follows. 1) Especially in men, collagenous fibers had increased and reticular fibers had decreased. 2) Collagenous fibers had formed bundles, and their density was high. 3) The spaces between collagenous fibers and the interstitial spaces for other extracellular matrices had decreased. 4) The collagenous fibril diameters differed, and their outline was irregular. 5) Twisted collagenous fibrils were present. 6) Occasionally, masses of dense collagenous fibers and fibrous tissue could be seen in the mucosa. 7) Occasionally, the collagenous fibers were increased all the way from the deep layer to the superficial layer of the mucosa, and consequently, there was no layered structure. Not only changes in the 3-dimensional structure of the collagenous fibers, but also their qualitative and quantitative changes, have an effect on the 3-dimensional structure of the extracellular matrices. Thus, the viscoelasticity must change to ensure normal phonation, and this change in viscoelasticity would explain one component of aging of the voice.
Local Anesthesia with Emla Cream for Maxillary Sinus Puncture
Authors: Joki-Erkkilä Veli-Pekka , Kääriäinen Janne , Penttilä Matti , Rautiainen Markus
Published: October 2014

Maxillary sinus puncture is traditionally carried out through the lateral wall of the inferior nasal meatus under local anesthesia. One problem with it is that the insertion of a cotton-tipped applicator soaked in local anesthetic is painful. Patients also dislike waiting for the anesthetic effect with the metallic applicators in the nose. In this study, we present a new, well-tolerated method of topical anesthesia for maxillary sinus puncture via the inferior meatus of the nose. Twenty adult patients with maxillary sinus infection who were undergoing bilateral maxillary sinus puncture were studied. One side of each patient's nose was anesthetized with a cotton-tipped applicator moistened with a lidocaine-adrenaline solution (LA), and the other side was anesthetized with EMLA cream instilled with a suction needle and syringe; the sides were chosen randomly. The mean “application of anesthesia” pain score on a 100-mm visual analog scale was 39.2 for the LA side and 9.1 for the EMLA side (p <.01). The anesthesia required for puncture was reached more quickly on the EMLA side than on the LA side (p =.02). The mean puncture pain score was 25.1 with LA and 8.6 with EMLA (p =.01). Fourteen patients out of the 20 (70%) found EMLA more tolerable, 3 patients (15%) found no difference, and 3 patients (15%) preferred LA (p <.01). We conclude that EMLA is better-tolerated and quicker-acting than LA for local anesthesia in maxillary sinus puncture.
Waveform Changes in Antidromic Facial Nerve Responses in Patients with Bell's Palsy
Authors: Nakatani Hiroaki , Hamada Masashi , Iwai Mitsuru , Takeda Taizo , Kakigi Akinobu , Nakahira Mitsuhiko
Published: October 2014

We repeatedly tested the antidromic facial nerve response within 7 days after onset of paralysis in patients with Bell's palsy. None of 109 patients showed the triphasic waveform that reflects normal conduction of the facial nerve action potential. The waves recorded from patients showed biphasic, monophasic, or flat waveforms. Eighty-two of 88 patients with complete recovery showed biphasic waves, whereas half of the patients with nerve degeneration had monophasic or flat waves. Most patients with complete recovery maintained biphasic waves, but in patients with incomplete recovery, the waveforms changed to monophasic or flat, except in 1 case. The presence of monophasic or flat waves with a low facial score strongly suggests nerve degeneration. The antidromic facial nerve response is recommended as a method of diagnosing paralysis and monitoring the progression of intratemporal facial nerve damage during its early stages.
Revision Functional Endoscopic Sinus Surgery
Authors: Jiang Rong-San , Hsu Chen-Yi
Published: October 2014

Functional endoscopic sinus surgery (FESS) has recently become a popular procedure for treating chronic sinusitis. However, there is a 2% to 24% rate of primary FESS failure. Revision functional endoscopic sinus surgery (RESS) is indicated for patients who remain symptomatic after primary FESS and optimal medical therapy have failed. A retrospective study was conducted on all patients who underwent RESS in our department between April 1988 and March 1998. During this period, FESS was performed 1,227 times to treat chronic sinusitis; among those procedures, 142 were RESS. Complications occurred in 14 RESS procedures (9.9%). After RESS, 65% patients had improved. In this study, we concluded that although RESS is more difficult than primary FESS because of distorted or missing anatomic landmarks, complications did not increase with RESS if meticulous surgical procedures were performed. However, the 65% improvement rate with RESS was lower than that of primary FESS.
Clinical Study of Acute Low-Tone Sensorineural Hearing Loss: Survey and Analysis of Glycerol Test and Orthostatic Test
Authors: Nozawa Izuru , Imamura shun-Ichi , Honda Hideyuki , Mizukoshi Akihito , Okamoto Yoshitaka
Published: October 2014

Fifty patients (14 men and 36 women ranging in age from 16 to 66 years) with acute low-tone sensorineural hearing loss (ALHL) were retrospectively analyzed in this study. The glycerol test and the orthostatic test were performed. On the glycerol test, 43.8% of 16 ears of the 14 men and 33.3% of 39 ears of the 36 women with ALHL had a positive result. On the orthostatic test, 42.9% of the 14 men and 52.7% of the 36 women with ALHL had a positive result. In addition, 28.6% of the 14 men and 33.3% of the 36 women had hypotension with a systolic blood pressure of 100 mm Hg or less. Our results suggest that endolymphatic hydrops as shown by the glycerol test and an underlying autonomic imbalance and/or insufficient blood circulation as shown by the orthostatic test may be important factors in the causation of ALHL.
Occurrence of Familial Meniere's Syndrome and Migraine in Brasilia
Authors: Oliveira Carlos A. , Messias Christiane I. , Ferrari Iris
Published: October 2014

Since 1941, many families with several members affected by Meniere's syndrome have been described. “Migraine-like” headache was always mentioned. In 1997, we described a large family with Meniere's syndrome and migraine, both transmitted in an autosomal dominant mode. Recently, a gene that could be responsible for Meniere's symptoms has been identified. However, the incidence of familial Meniere's syndrome is still unknown. A. W. Morrison et al estimated this incidence as between 2.9% and 12%. During the years 1997 and 1998, we saw 8 new patients with typical Meniere's syndrome in our outpatient department. They were referred to Dr Messias, who did a careful search for other affected family members. Six of them had relatives with Meniere's syndrome and migraine transmitted in an autosomal dominant mode. The familial incidence of Meniere's syndrome and migraine in Brasilia seems to be higher than the figures of Morrison et al for the United Kingdom. The 6 families are described herein.
Effects of Frequency, Instrumental Family, and Cochlear Implant Type on Timbre Recognition and Appraisal
Authors: Gfeller Kate , Witt Shelley , Mehr Maureen A. , Woodworth George , Knutson John
Published: October 2014

The purpose of this study was to compare postlingually deafened cochlear implant recipients and normal-hearing adults on timbre (tone quality) recognition and appraisal of 8 musical instruments representing 3 frequency ranges and 4 instrumental families. The implant recipients were significantly less accurate than the normal-hearing adults on timbre recognition. The implant recipients gave significantly poorer ratings than did the normal-hearing adults to those instruments played in the higher frequency range and to those from the string family. The timbre measures were weakly correlated with speech perception measures, but were significantly correlated with 3 cognitive measures of sequential processing.
Cartilage Interposition in Ossiculoplasty with Hydroxylapatite Prostheses: A Histopathologic Study in the Guinea Pig
Authors: Meijer Astrid G. W. , Albers Frans W. J. , Verheul Jolanda , Segenhout Hans M.
Published: October 2014

In this experimental animal study, a cartilage disk was interposed between a synthetic middle ear prosthesis and the tympanic membrane in guinea pigs to investigate its effect on the extrusion process of the implant. Two groups of guinea pigs were studied. One group consisted of animals in which the prosthesis was directly in contact with the tympanic membrane, and the other group consisted of animals in which a cartilage disk had been inserted between the head of the prosthesis and the tympanic membrane. Before histologic processing, in situ inspection was performed with an operating microscope. After fixation and embedding, light microscopic and transmission electron microscopic examination were performed. We studied the histopathologic aspects of the tympanic membrane with regard to the protrusion and extrusion processes of the middle ear implant. In this experimental model, protrusion and extrusion of a hydroxylapatite middle ear prosthesis was greatly reduced by interposition of a cartilage disk. Further clinical evaluation of these experimental results is needed in the human middle ear.
Averaged Electrode Voltages in Users of the Clarion Cochlear Implant Device
Authors: Mens Lucas H. M. , Mulder Jef J. S.
Published: October 2014

Averaged electrode voltages (AEVs) are of secondary importance for integrity testing of cochlear implant devices featuring back-telemetry. However, AEVs are device-independent and may show intermittent failures and deviant stimulation patterns unnoticed by telemetry. We collected AEVs from 18 users of the Clarion 1.2 system and 6 users of the HiFocus system in order to establish norms for evaluating AEVs in difficult cases. The stimuli were presented with the standard clinical software. Monopolar stimulation at about 16 μA showed large AEVs (mean, 173 μV) suitable for integrity testing. No electrode failures were found. The AEV amplitudes from neighboring electrodes differed by less than 30% (2 SD). The AEVs from subjects with the Clarion HiFocus electrode and/or the Clarion electrode positioner were within the normal range. The AEV amplitudes from bipolar stimulation were much more variable. Inversion of phases between electrodes was found in patients with an altered state of the cochlea (otosclerosis and osteogenesis imperfecta) and in a patient with a curled electrode tip. There was no correlation across subjects between AEVs and electrode impedances. Therefore, impedances are dominated by the electrode-tissue interface, in contrast to AEVs, which are determined by the volume conduction in the body.
Surgical Voice Rehabilitation after Laser Surgery for Glottic Carcinoma
Authors: Sittel Christian , Zorowka Patrick , Friedrich Gerhard , Eckel Hans-Edmund
Published: October 2014

Transoral laser surgery today is the mainstay of treatment for T1 and T2 glottic carcinoma. The vocal ability remains sufficient in the majority of patients. However, in some cases, a significant glottic gap may persist, leading to poor voice quality. We report a special technique of medialization thyroplasty using autologous cartilage specifically adapted for vocal rehabilitation after laser resection. Six patients with a significant glottic gap following laser surgery were treated. For vocal rehabilitation, a special medialization technique was performed. The superior rim of the thyroid cartilage of the resected side was exposed. A 1 × 2-cm piece of cartilage was harvested and reimplanted into a subperichondrial pouch created on the inner side of the thyroid cartilage. When phonation was optimal, this cartilaginous strut was sutured and/or glued in place. In all 6 cases, the vocal function improved significantly. The dysphonia index (0 = normal, 3 = aphonia), which includes objective parameters as well as expert voice ratings and the patient's perception, increased by 1.1 on average (range, 0.4 to 1.6). The results have been lasting. The established medialization techniques are of limited value in a larynx scarred by laser surgery. Injection augmentation is often futile because the tight scar tissue does not lend itself to augmentation. Implantation of nonorganic material may cause problems if revision surgery for tumor recurrence should become necessary or if the implant protrudes into the scarred endolarynx. The technique reported avoids these pitfalls and leads to voice quality improvement comparable to that of established medialization procedures.