bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients with Phantogeusia Show Increased Expression of T2R Taste Receptor Genes in Their Tongues
Authors: Hirai Ryoji , Takao Kyoichi , Onoda Keiko , Kokubun Shinichiro , Ikeda Minoru
Published: October 2014

Objectives:

The taste receptor gene family T2R has been implicated in the sensation of bitter taste. Phantogeusia is a spontaneous abnormal taste with no external stimulus. We analyzed the expression of T2R taste receptor genes in the tongues of patients with phantogeusia to assess their role in the pathogenesis of phantogeusia.

Methods:

We obtained specimens from 43 patients with phantogeusia and 24 normal volunteers by scraping the foliate papillae and examined these specimens for the expression of 10 T2R taste receptor genes using reverse transcription–polymerase chain reaction and electrophoresis.

Results:

The expression rate (subjects with detectable expression) of the 10 taste receptor genes in the healthy subjects ranged from 16.7% to 100%; 3 receptor genes were found in 50% or fewer of these subjects. In the patients with phantogeusia, the expression rate was increased significantly compared to that in the healthy control subjects for 3 of the 10 receptor genes examined.

Conclusions:

Our results show that the expression rate of some of the T2R taste receptor genes was increased significantly in patients with phantogeusia. These results suggest that increased expression of taste receptor genes is involved in the pathogenesis of phantogeusia; this finding may contribute to elucidation of the mechanism of this disorder.
Oval Window Transport of Gd-DOTA from Rat Middle Ear to Vestibulum and Scala Vestibuli Visualized by in vivo Magnetic Resonance Imaging
Authors: Zou Jing , Poe Dennis , Ramadan Usama Abo , Pyykkö Ilmari
Published: October 2014

Objectives:

We tested our hypothesis that the oval window (OW) potentially functions as a route to carry substances from the middle ear to the vestibulum and then the scala vestibuli through the annular ligament across the stapediovestibular joint.

Methods:

Gd-DOTA was either injected into the lateral attic compartment of rats with a high-performance polyimide tube in a selective OW delivery group, or administered to the middle ear cavity of two groups of rats in which the OW was either sealed or not sealed. The dynamic uptake of Gd-DOTA in the inner ear was visualized with a 4.7-T magnetic resonance imaging machine.

Results:

In the selective OW delivery group, Gd-DOTA appeared in the vestibulum and in the basal turn of the scala vestibuli but not in the scala tympani on T1-weighted images acquired at 10 minutes after Gd-DOTA administration (the earliest available time point of magnetic resonance imaging). In the sealed-OW group, immediate uptake of Gd-DOTA was absent in the vestibulum and scala vestibuli. Measurement of the signal ratio of the vestibulum to that of the scala tympani showed that selective OW delivery induced the greatest signal ratio and that sealing of the OW induced the lowest signal ratio.

Conclusions:

The OW is a genuine and efficient pathway to transport Gd-DOTA from the middle ear to the vestibulum.
Decellularized Rabbit Cricoarytenoid Dorsalis Muscle for Laryngeal Regeneration
Authors: Fishman Jonathan M. , Ansari Tahera , Sibbons Paul , De Coppi Paolo , Birchall Martin A.
Published: October 2014

Objectives:

Although considerable progress has been made in regenerative medicine, a quantum step would be the replacement and/or regeneration of functional muscle tissue. For example, although patients' airways can now be successfully replaced with stem cell–based techniques, a much greater patient need would be addressed by regeneration of the muscles required for engineering a functional larynx, in which active movement is critical. The rabbit cricoarytenoid dorsalis muscle was chosen for the present study because it is equivalent to the posterior cricoarytenoid muscle, the only significant abductor muscle in human larynges.

Methods:

Rabbit cricoarytenoid dorsalis muscles were harvested, and different decellularization methods were compared by use of a combination of histologic, immunohistochemical, and molecular techniques. Decellularized scaffolds were implanted into Sprague-Dawley rats as part of a 2-week biocompatibility study to assess immunogenicity.

Results:

Decellularization with a combination of latrunculin B, potassium iodide, potassium chloride, and deoxyribonuclease resulted in total DNA clearance and reduced levels of major histocompatibility complex class II expression, with relative preservation of the scaffold's structural integrity (collagen, elastin, and glycosaminoglycan content). The scaffolds showed minimal signs of rejection at 2 weeks in a cross-species (xenotransplantation) study.

Conclusions:

Decellularized laryngeal muscles, which are nonimmunogenic, may provide the optimal scaffold source for the generation of a fully functional tissue-engineered larynx.
Variability of Postoperative Esophagrams after Endoscopic Cricopharyngeal Myotomy: Technique Dependence
Authors: Berzofsky Craig E. , Holiday Roy A. , Pitman Michael J.
Published: October 2014

Objectives:

We illustrate the dependence of postoperative day (POD) 1 esophagram findings on the closure technique used after endoscopic cricopharyngeal myotomy (ECPM).

Methods:

We performed a retrospective chart review of POD 1 fluoroscopic examinations of the cervical esophagus utilizing contrast dye after ECPM to assess radiologic findings associated with three different techniques of addressing the exposed buccopharyngeal fascia (BPF).

Results:

Each technique resulted in specific and different findings on the POD 1 esophagram. When the BPF was untreated, the esophagram demonstrated a pseudodiverticulum with free flow of contrast dye. When a fibrin glue seal was used, the esophagram demonstrated a curvilinear focus of contrast dye projected over the retropharyngeal soft tissue persisting after the swallow, similar to a leak. When fibrin glue application was combined with single-suture reapproximation of the mucosal incision, the pattern was similar to esophagrams performed 6 weeks after myotomy.

Conclusions:

Different techniques used to address the exposed BPF following ECPM result in specific findings on the POD 1 esophagram. Recognition of these imaging differences and open communication with the fluoroscopist will avoid a misdiagnosis of a pharyngeal leak, which might cause an unnecessary delay of oral feeding and hospital discharge.
Reducing Fistula Rates following Laryngotracheal Separation
Authors: Francis David O. , Blumin Joel , Merati Albert
Published: October 2014

Objectives:

Laryngotracheal separation (LTS) is an uncommonly performed but highly effective procedure for intractable aspiration in patients with amyotrophic lateral sclerosis and other neurodegenerative conditions. Previously published series have noted rates of postoperative tracheocutaneous fistula formation as high as 1 in 3 patients. This report details the use of a muscle flap–reinforced imbrication technique to reduce the incidence of fistula formation after LTS surgery.

Methods:

All patients who underwent LTS surgery at the reporting institutions between 2004 and 2010 were identified. The principal diagnosis, patient characteristics, the presence of a preexisting tracheotomy, and postoperative complications were recorded. We describe the technique for imbrication closure of the proximal stump with strap muscle reinforcement.

Results:

Thirteen patients (10 male, 3 female; median age, 53 years; interquartile range, 45 to 66 years) underwent the LTS procedure; amyotrophic lateral sclerosis was the principal diagnosis in 8 of the 13 patients. Six patients had a preexisting tracheotomy. None developed tracheocutaneous fistula, hematoma, or wound infection. Two patients required stomaplasty at a later date.

Conclusions:

Strap muscle flap–reinforced imbrication closure of the proximal tracheal stump after LTS surgery allows for a low incidence of postoperative fistula formation.
Rate of Recurrent Vestibular Schwannoma after Total Removal via Different Surgical Approaches
Authors: Ahmad Raja Ahmad R. Lope , Sivalingam Shailendra , Topsakal Vedat , Russo Alessandra , Taibah Abdelkader , Sanna Mario
Published: October 2014

Objectives:

The objective of this study was to assess the differences in the recurrence rates of vestibular schwannoma (VS) after total tumor removal through enlarged translabyrinthine (ETL), retrosigmoid (RS), and middle cranial fossa (MCF) approaches. Our results were compared with previously published data, and literature reviews were done to identify the possible causes for the recurrence of VS.

Methods:

We performed a retrospective analysis of 2,400 cases of VS that underwent removal at the Gruppo Otologico, Piacenza, Italy, from 1983 until 2010. The minimum postoperative follow-up was 12 months. We also reviewed the previously published data on recurrence rates of VS after ETL, RS, and MCF approaches.

Results:

Total tumor removal was achieved in 2,252 cases (93.8%). The recurrence rate was 0.05% for the ETL approach, 0.7% for the RS approach, and 1.8% for the MCF approach. Literature reviews of 3 previously published case series utilizing the translabyrinthine approach showed that none of the primary tumors were less than 2.0 cm in size. Recurrences were seen between 1 and 13 years after the initial surgery.

Conclusions:

The rate of VS recurrence after total removal is exceptionally low in experienced hands. Undetected microscopic deposits left on crucial points such as the facial nerve, the preserved cochlea nerve, or the fundus of the internal auditory canal could be possible causes for the recurrence. A definite advantage of an ETL approach is the excellent internal auditory canal exposure, resulting in an extremely low rate of VS recurrence. The patients should be followed up to 15 years with gadolinium-enhanced magnetic resonance imaging (with fat suppression sequence in ETL approach cases). Recurrent VS may exhibit a faster growth rate than primary VS.
Long-Term Postoperative Vocal Function after Thyroplasty Type I and Fat Injection Laryngoplasty
Authors: Umeno Hirohito , Chitose Shun-Ichi , Sato Kiminori , Ueda Yoshihisa , Nakashima Tadashi
Published: October 2014

Objectives:

We evaluated the differences in the long-term functional results of medialization thyroplasty type I (MT) and autologous fat injection laryngoplasty (FIL) in patients with unilateral vocal fold paralysis.

Methods:

Forty-one patients underwent MT, and 73 patients underwent FIL. The voice functions before and after both surgeries were examined by aerodynamic, pitch and intensity, and acoustic analyses. The postoperative voice examinations were performed 12 months (median) after the MT, and 4 years (median) after the FIL. The differences between the preoperative and postoperative parameters were examined with a paired t-test for each group separately. For each variable, a comparison of the effects of surgery was conducted with an analysis of covariance model, with the change between the preoperative and postoperative values as the dependent variable and the preoperative value as the covariate.

Results:

In both groups, all parameters significantly improved after surgery. In particular, there was a significant difference for the postoperative acoustic analyses. However, the aerodynamic analysis after FIL improved more significantly in comparison to that after MT because of the respiratory handicap.

Conclusions:

We found that MT and FIL provided almost the same effectiveness, and that both surgeries were reliable in improving the vocal function in patients with vocal fold paralysis.
Distribution of Gentamicin in Inner Ear after Local Administration via a Chitosan Glycerophosphate Hydrogel Delivery System
Authors: Luo Jianfen , Xu Lei
Published: October 2014

Objectives:

We examined the distribution of gentamicin sulfate in the inner ear after delivery via a chitosan glycerophosphate (CGP) hydrogel system and examined the change in morphology of the hair cells so as to determine how gentamicin affected the function of the inner ear.

Methods:

A matrix of CGP hydrogel loaded with gentamicin conjugated with Texas Red (GTTR) was injected into the round window niche of the left ear of C57/BL6 mice. The mice were painlessly killed on day 1 or day 7 after injection. Confocal fluorescence microscopy was used to locate the gentamicin in the cochlear and vestibular systems.

Results:

In the vestibule, the intensity of GTTR staining in the hair cells of the macula of the saccule on day 1 was significantly stronger than that on day 7, and the number of hair cell bundles on top of the cuticular plate on day 7 was obviously decreased in comparison to that on day 1. In the cochlea, the intensity of GTTR staining in the basal turn was significantly stronger than that in the medial turn on both day 1 and day 7. Negligible fluorescence was observed in the apical turn on both day 1 and day 7. Less-intense GTTR staining was detected on day 7 than on day 1 in both the basal turn and the medial turn. There was some outer hair cell loss in the basal turn on day 7, and no hair cell loss in the medial and apical turns at any time point.

Conclusions:

Gentamicin is distributed in the inner ear via the CGP hydrogel delivery system in a time-dependent and basal-to-apical manner. This finding implies that the vestibule and the basal turn may retain more gentamicin for a longer period than do other sites in the inner ear. These two characteristics may account for the high-frequency hearing loss and vestibular dysfunction seen with use of this system to deliver gentamicin into the inner ear.
Assessment Package for Language Development in Japanese Hearing-Impaired Children (ALADJIN) as a Test Battery for the Development of Practical Communication
Authors: Fukushima Kunihiro , Kasai Norio , Omori Kana , Sugaya Akiko , Fujiyoshi Akie , Taguchi Tomoko , Konishi Takayuki , Sugishita Syuuhei , Takei Wataru , Fujino Hiroshi , Ojima Toshiyuki , Nishizaki Kazunori
Published: October 2014

Objectives:

The measurement of language development in hearing-impaired children is an important step in assessing the appropriateness of an intervention. We proposed a set of language tests (the Assessment Package for Language Development in Japanese Hearing-Impaired Children [ALADJIN]) to evaluate the development of practical communication skills. This package consisted of communication skills (TQAID), comprehensive (PVT-R and SCTAW) and productive vocabulary (WFT), comprehensive and productive syntax (STA), and the STRAW.

Methods:

A total of 638 children with greater than 70-dB hearing impairment were subjected to this set of language tests. Additional tests, including the PARS, the RCPM, and parental questionnaires, were administered to assess the backgrounds of the children.

Results:

A trimodal distribution was observed among hearing-impaired children by the histogram-based analysis of each test.

Conclusions:

The ALADJIN is a useful Japanese-language evaluation kit for hearing-impaired children.
Syntactic Development in Japanese Hearing-Impaired Children
Authors: Fujiyoshi Akie , Fukushima Kunihiro , Taguchi Tomoko , Omori Kana , Kasai Norio , Nishio Shinya , Sugaya Akiko , Nagayasu Rie , Konishi Takayuki , Sugishita Syuuhei , Fujita Jyunpei , Nishizaki Kazunori , Shiroma Masae
Published: October 2014

Objectives:

This study examined syntactic development of auditory comprehension of sentences in Japanese-speaking school-age children with and without hearing impairment.

Methods:

In total, 592 preschool and school-age children (421 normal-hearing and 171 hearing-impaired) were included in this cross-sectional observation study conducted using the Syntactic Processing Test for Aphasia for Japanese language users. Linear regression analysis was used to determine the estimated age at which each syntactic structure was acquired.

Results:

Acquisition of syntactic structures was observed in hearing-impaired and normal-hearing children. Basic word order sentences of agent-object-verb and the goal benefactive construction were acquired at preschool age (earlier group), whereas reverse word order sentences of object-agent-verb, source benefactive construction, passive voice, and relative clauses were acquired at school age (later group). The results showed that many hearing-impaired children may not acquire Japanese grammatical structures until the age of 12 years.

Conclusions:

Adequate screening for language development for school-age hearing-impaired children is required for an effective intervention.
Method for Studying Gas Composition in the Human Mastoid Cavity by Use of Laser Spectroscopy
Authors: Lindberg Sven , Lewander Märta , Svensson Tomas , Siemund Roger , Svanberg Katarina , Svanberg Sune
Published: October 2014

Objectives:

We evaluated a method for gas monitoring in the mastoid cavity using tunable diode laser spectroscopy by comparing it to simultaneously obtained computed tomographic (CT) scans.

Methods:

The presented optical technique measures free gases, oxygen (O2), and water vapor (H2O) within human tissue by use of low-power diode lasers. Laser light was sent into the tip of the mastoid process, and the emerging light at the level of the antrum was captured with a detector placed on the skin. The absorption of H2O was used to monitor the probed gas volume of the mastoid cavity, and it was compared to the CT scan–measured volume. The ratio between O2 absorption and H2O absorption estimated the O2 content in the mastoid cavity and thus the ventilation. The parameters were compared to the grading of mastoid cavities based on the CT scans (n = 31). The reproducibility of the technique was investigated by measuring each mastoid cavity 4 times.

Results:

Both O2 and H2O were detected with good reproducibility. The H2O absorption and the CT volume correlated (r = 0.69). The average ratio between the normalized O2 absorption and the H2O absorption signals was 0.7, indicating a lower O2 content than in surrounding air (expected ratio, 1.0), which is consistent with previous findings made by invasive techniques. All mastoid cavities with radiologic signs of disease were detected.

Conclusions:

Laser spectroscopy monitoring appears to be a usable tool for noninvasive investigations of gas composition in the mastoid cavity, providing important clinical information regarding size and ventilation.
Quantitative Evaluation of Facial Movement and Morphology
Authors: Vimercati Sara Laura , Rigoldi Chiara , Albertini Giorgio , Crivellini Marcello , Galli Manuela
Published: October 2014

Objectives:

The aim of our study was to quantitatively analyze facial motion kinematics by means of an optoelectronic system. In particular, we defined a set of easily recognizable reference points for markerization, and tested the applicability of our markerization method for an exhaustive characterization of the subjects' facial motion through the definition of some kinematic parameters.

Methods:

Thirty healthy subjects (mean age, 24.6 ± 1.0 years; 15 female and 15 male) participated in the study. A set of markers (diameter, 3 mm) was positioned on several reference points of the face, and some parameters were computed for the characterization of facial morphology and movement, such as ranges of motion, angles, times, and distances.

Results:

The protocol was tested for inter-rater and intra-rater reliability by use of intraclass correlation, of which the results were good (between 0.4 and 0.75) to excellent (greater than 0.75). The parameters were useful for characterizing the resting position, mimicry, and speaking movements, and highlighted some distinctions between men and women in facial morphology.

Conclusions:

The protocol can be applied to a variety of facial movements, including speaking. Future works could address the use of the protocol in subjects with disorders and the integrated analysis of kinematic parameters and voice spectrography.
Congenital Ossicular Chain Anomalies Associated with a Mobile Stapes Footplate: Surgical Results for 23 Ears
Authors: Thomeer Henricus G. X. M. , Kunst Henricus P. M. , Cremers W. R. J.
Published: October 2014

Objectives:

We describe the audiometric results following surgery in a consecutive series of patients with a congenital ossicular middle ear disorder that was associated with a mobile stapes footplate.

Methods:

We performed a retrospective analysis of patient charts from a tertiary referral center. A total of 23 patients (23 ears) underwent exploratory tympanotomy and ossicular reconstruction between 1986 and 2001. The main outcome measure was the audiometric results.

Results:

Overall, we observed a mean gain in air conduction pure tone average of 17 dB (from 47 dB to 30 dB), a sensorineural deterioration of 3 dB, and a mean postoperative air-bone gap of 19 dB (mean preoperative air-bone gap of 38 dB). The air-bone gap closure was 20 dB or less in 15 of the 23 cases (65%), in agreement with the few results reported in the literature. Moreover, the audiometric results remained stable. In the syndromic group, the mean gain in air conduction was only 13 dB, which was worse than that observed for the nonsyndromic ears.

Conclusions:

Surgery for congenital ossicular chain anomalies with a concomitant mobile stapes footplate provides positive audiometric outcomes. Most ears had some sensorineural impairment (10 to 20 dB), which influenced the final hearing level attained after surgery. Preoperative assessment is mandatory to search for syndromal diagnoses, which might be important for patient counseling and prognosis.
Recurrent Posttransplant Lymphoproliferative Disorder Involving the Larynx and Trachea: Case Report and Review of the Literature
Authors: Banks Caroline A. , Meier Jeremy D. , Stallworth Christina R. , White David R.
Published: October 2014

Objectives:

Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of solid organ transplantation and commonly affects upper airway lymphoid tissue. Tracheal and laryngeal involvement in patients with PTLD, however, is rare. We present one such case.

Methods:

We report the case of a patient with recurrent PTLD involving the larynx and trachea and describe the presentation, evaluation, management, and outcome.

Results:

An 11-year-old boy who underwent bilateral nephrectomy and renal transplantation as an infant was admitted to the hospital with chronic cough, fever, stridor, and dyspnea. His post-transplantation course was complicated by PTLD in cervical lymph nodes at 9 years of age that was successfully treated with chemotherapy. A computed tomographic scan during his present admission revealed supraglottic swelling, a distal tracheal mass, and paratracheal lymph node enlargement. The patient underwent laryngoscopy and bronchoscopy with biopsy specimens taken from the right laryngeal ventricle and distal trachea. Pathologic examination yielded a diagnosis of Epstein-Barr virus–positive PTLD. The patient was treated with chemotherapy, which resulted in resolution of the airway lesions, as seen on repeat bronchoscopy.

Conclusions:

This is the first report, to our knowledge, of recurrent PTLD involving simultaneous lesions in the larynx and the trachea. PTLD in the head and neck can present as lymphoid hypertrophy, airway obstruction, stridor, or cough. A high degree of clinical suspicion is essential for prompt diagnosis of this life-threatening complication.
Aortic Homograft Reconstruction of Partial Laryngectomy Defects: A New Technique
Authors: Zeitels Steven M. , Wain John C. , Barbu Anca M. , Bryson Paul C. , Burns James A.
Published: October 2014

Objectives:

Wide-field transcervical partial laryngectomy often precludes tracheotomy decannulation. It is done infrequently today, primarily because of the popularity of chemotherapy-radiotherapy treatment regimens and limited enthusiasm for using transcervical partial laryngectomy after failed radiotherapy. We sought to identify a new reconstructive technique that would provide an alternative to total laryngectomy in as many patients as possible.

Methods:

We performed a retrospective examination of 15 patients who underwent single-stage wide-field transcervical partial laryngectomy with cryopreserved aortic homograft reconstruction. Eight of the 15 patients had previously undergone failed radiotherapy. At least 40% of the cricoid circumference was resected in 8 patients.

Results:

All 15 patients had their tracheotomy tube removed and have laryngeal phonation, and 14 of the 15 resumed oral intake. There were no major surgical complications.

Conclusions:

Use of aortic homografts is a new, reliable, and versatile reconstructive option for performing conservation laryngeal cancer surgery that allows for airway, swallowing, and voice preservation.
High-Speed Videoendoscopic Analysis of Relationships between Cepstral-Based Acoustic Measures and Voice Production Mechanisms in Patients Undergoing Phonomicrosurgery
Authors: Mehta Daryush D. , Zeitels Steven M. , Burns James A. , Friedman Aaron D. , Deliyski Dimitar D. , Hillman Robert E.
Published: October 2014

Objectives:

There is increased interest in using cepstral-based acoustic measures for objective clinical voice assessment because of their apparent advantages over more time-honored methods, but there is a paucity of information about how these newer measures relate to underlying phonatory mechanisms.

Methods:

We investigated the relationships between the acoustic cepstral peak magnitude (CPM) and high-speed videoendoscopy (HSV)–based measures of vocal fold phonatory function in 20 subjects who underwent phonomicrosurgery for vocal fold lesions. Acoustic and imaging data were acquired during sustained vowel phonation before and after surgery.

Results:

The changes in the measures between presurgical and postsurgical assessments showed that the CPM correlated significantly with an HSV-based measure combining fundamental frequency deviation and average speed quotient (r = 0.70; p < 0.001) in a multiple linear regression, and that the variation in the CPM could also be attributed to trading relationships between the HSV-based measures of vibratory phase asymmetry and glottal closure.

Conclusions:

These initial results demonstrate that the clinical utility of cepstral-based measures can be enhanced by a better understanding of how these acoustic measures relate to underlying phonatory mechanisms. The CPM seems to integrate information about aperiodicity in vocal fold vibration, the relative speed of glottal closure, and estimates of glottal noise generation.
Dysphagia Due to Adenoid Cystic Carcinoma of the Base of the Tongue
Authors: Hoekzema Craig R. , Massey Becky L. , Blumin Joel H. , Hunt Bryan C. , Bock Jonathan M.
Published: October 2014

Objectives:

Although oropharyngeal neoplasia can often lead to dysphagia, salivary gland tumors rarely grow within the tongue base. We present the case of a 75-year-old man with adenoid cystic carcinoma of the base of the tongue causing profound dysphagia and weight loss, and provide a current literature review and update on the management of these rare tumors.

Methods:

We present a case report and a literature review.

Results:

Physical examination performed at the initial visit revealed a firm right base-of-tongue mass with no palpable lymphadenopathy. Flexible fiberoptic laryngoscopy confirmed a large submucosal mass at the right base of the tongue that obscured the right vallecula. Histopathologic analysis of the operative biopsy specimens revealed the classic features of adenoid cystic carcinoma. Treatment included radical pharyngotomy with wide local excision and primary closure, followed by postoperative radiation treatment.

Conclusions:

We demonstrate the clinical examination findings and histopathologic characteristics of this disease, and review the literature for clinical treatment recommendations for this rare cause of dysphagia.
Multidimensional Evaluation of Vocal Function after Supracricoid Laryngectomy with Cricohyoidopexy
Authors: Topaloğlu İlhan , Koçak İsmail , Saltürk Ziya
Published: October 2014

Objectives:

The aim of this study was to assess the vocal outcome and the impact of arytenoid resection on vocal function following supracricoid laryngectomy with cricohyoidopexy.

Methods:

Twenty-eight male patients who had undergone supracricoid laryngectomy with cricohyoidopexy were included in the study. In 7 patients, one arytenoid cartilage had been totally resected; in 11, both arytenoid cartilages had been preserved; and in 10, one arytenoid cartilage had been partially resected. The maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were assessed and analyzed. Perceptual analysis was performed with the grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Abduction-adduction and anteroposterior squeezing actions were analyzed from videoendoscopic records. The Voice Handicap Index–10 (VHI-10) was used for self-assessment.

Results:

The acoustic and aerodynamic parameters and GRBAS score showed severe impairment. The self-assessment revealed that patients were relatively satisfied with their voice quality. There were no statistically significant differences in the acoustic and aerodynamic parameters, the GRBAS score, or the VHI-10 score according to the level of arytenoid resection.

Conclusions:

Supracricoid laryngectomy with cricohyoidopexy caused deterioration of acoustic and aerodynamic voice parameters and the GRBAS score. Statistically, the level of arytenoid resection had no apparent effect on the objective, perceptual, or subjective voice parameters.
Alpha-Defensin Overexpression in Patients with Bell's Palsy and Ramsay Hunt Syndrome
Authors: Furuta Yasushi , Oridate Nobuhiko , Takeichi Norihito , Fukuda Satoshi , Sawa Hirofumi
Published: October 2014

Objectives:

To investigate the biological factors related to the onset of Bell's palsy, we sought to identify differentially expressed genes in peripheral blood mononuclear cells (PBMCs) and plasma of patients with Bell's palsy and Ramsay Hunt syndrome (RHS).

Methods:

We carried out DNA microarray analyses using PBMCs taken from patients with Bell's palsy at their initial visit and 2 to 4 weeks later. To validate these analyses, we measured the relative messenger RNA levels of α-defensin in paired PBMCs by reverse transcription–polymerase chain reaction. The plasma concentrations of α-defensin in patients and healthy volunteers were quantified by enzyme-linked immunosorbent assay.

Results:

The DNA microarray analysis identified α-defensin as a candidate gene related to the onset of Bell's palsy. Reverse transcription–polymerase chain reaction analysis showed that the relative α-defensin messenger RNA levels in PBMCs from the later visit were increased at least twofold in 9 of 13 patients (69%) with Bell's palsy and in 4 of 6 patients (67%) with RHS. The plasma α-defensin concentrations in the patients with RHS were significantly higher than those in healthy volunteers (p = 0.0013) and in the patients with Bell's palsy (p = 0.0306). Elevations of plasma α-defensin were observed in 5 of the 9 patients with Bell's palsy who demonstrated α-defensin overexpression in PBMCs.

Conclusions:

α-Defensin may be one of the biological factors related to the onset of Bell's palsy and RHS.
Dysphagia in Severe Anorexia Nervosa and Potential Therapeutic Intervention: A Case Series
Authors: Holmes Samantha R. M. , Gudridge Tricia A. , Gaudiani Jennifer L. , Mehler Philip S.
Published: October 2014

Objectives:

In severe anorexia nervosa, there are a litany of medical complications that affect virtually every body system, and severe weakness is a typical characteristic. To our knowledge, aspiration risk, dysphagia recognition, and dysphagia management and intervention have not been well described in the literature in regard to severe anorexia nervosa. The purpose of this case series is to increase awareness among clinicians of possible oropharyngeal dysphagia symptoms that may present in patients with severe anorexia nervosa.

Methods:

We describe the cases of 3 patients with severe anorexia nervosa who presented with symptoms of dysphagia. The speech-language pathology team administered dysphagia therapy to the 3 patients utilizing neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy tasks that included strengthening exercises and compensatory strategies.

Results:

After the course of dysphagia treatment intervention, the 3 patients were able to tolerate an oral diet with improved swallowing function and no ongoing aspiration.

Conclusions:

The use of NMES in conjunction with traditional swallowing exercises in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeding and prolonged hospitalization. In regard to dysphagia intervention and management within this population and across other populations, rigorous randomized controlled studies are necessary for determining the efficacy of NMES and traditional swallowing therapy implementation.
Cross-Sectional Vestibular Nerve Analysis in Vestibular Neuritis
Authors: Fundakowski Christopher E. , Anderson Joshua , Angeli Simon
Published: October 2014

Objectives:

We examined the association between the size and cross-sectional area of the superior vestibular nerve as measured on constructive interference in steady-state (CISS) parasagittal magnetic resonance imaging (MRI) and the vestibular nerve function as measured by electronystagmography.

Methods:

The retrospective observational cohort study took place at an academic tertiary referral center. Twenty-six patients who met established clinical and electronystagmographic criteria for vestibular neuritis and who underwent parasagittal CISS MRI were identified. Two blinded investigators measured vestibular nerve height and width bilaterally at the level of the fundus of the internal auditory canal and calculated the cross-sectional nerve areas. The inter-rater reliability and agreement were analyzed. Symptom duration, age, and gender were also examined.

Results:

A statistically significant decrease was observed in both vestibular nerve cross-sectional area and height as compared to the contralateral vestibular nerve. A non–statistically significant trend was observed for a relative decreased cross-sectional nerve area with increased age, as well as a decrease in nerve area with an increase in symptom duration.

Conclusions:

Decreases in both vestibular nerve cross-sectional area and height are observed in patients with unilateral vestibular neuritis as measured on parasagittal CISS MRI.
Quality of Life of Patients with Bilateral Vestibulopathy
Authors: Guinand Nils , Boselie Frans , Guyot Jean-Philippe , Kingma Herman
Published: October 2014

Objectives:

Currently, there is no evidence of an effective treatment for patients with bilateral vestibulopathy (BV). Their main complaints are oscillopsia and imbalance. Opinions about the impact of BV on their quality of life are controversial, and their handicap is not always recognized, even among otoneurologists. The aim of this study was to objectively assess the health status of BV patients in order to evaluate the need for pursuing efforts toward the development of new treatments.

Methods:

The Short-Form Health Survey (SF-36), the Dizziness Handicap Inventory (DHI), the Short Falls Efficacy Scale–International (Short FES-I), and an oscillopsia severity questionnaire were submitted to 39 BV patients. The SF-36 scores were compared to the scores of a general Dutch population. The DHI scores were correlated to the oscillopsia severity scores. The Short FES-I scores were compared to scores in an elderly population. Residual otolithic function was correlated to all scores, and hearing to SF-36 scores.

Results:

Compared to the general Dutch population, the BV patients scored significantly worse on the “physical functioning,” “role physical,” “general health,” “vitality,” and “social functioning” SF-36 variables (p < 0.05). The DHI scores were strongly correlated with the oscillopsia severity scores (r = 0.75; p < 0.000001). The Short FES-I scores indicated a slight to moderate increase in the patients' fear of falling. No significant score differences were found between BV patients with residual otolithic function and patients with complete BV. There was no correlation between hearing status and SF-36 scores.

Conclusions:

The results correlate with our clinical impression that BV has a strong negative impact on physical and social functioning, leading to a quality-of-life deterioration. There is a clear need for a therapeutic solution. Efforts toward the development of a vestibular implant are justified.
Voice Outcomes following the Gray Minithyrotomy
Authors: Mallur Pavan S. , Gartner-Schmidt Jacqueline , Rosen Clark A.
Published: October 2014

Objectives:

Most practitioners have limited treatment options for vocal fold scar and sulcus vocalis. The Gray minithyrotomy (GMT) is a surgical procedure for the treatment of these conditions, although limited objective data exist regarding voice outcomes. This study compares the quantified subjective and visual perceptual outcomes following GMT for the treatment of vocal fold scar and sulcus vocalis.

Methods:

We performed a retrospective review of patients who underwent GMT in a single institution. Patient-reported satisfaction, Voice Handicap Index–10 scores, results of video perceptual analysis, and complications were recorded.

Results:

Sixteen patients underwent GMT for phonotraumatic or postoperative scar (11), radiation-induced scar (3), or sulcus vocalis (2). Seven underwent bilateral operations. Follow-up data were available for 12 patients. Eight patients had 2 or more failed surgical interventions before GMT. Seven of the 13 procedures resulted in a self-reported improvement. Although the mean preoperative Voice Handicap Index–10 score (30.6) across all patients did not decrease after the operation, 6 of the 13 GMT procedures resulted in improvement (mean decrease, 7.5). Complications, encountered in 5 patients, included ecchymosis, neck abscess, tongue numbness, wound dehiscence, and aspiration pneumonia.

Conclusions:

The GMT is a viable treatment for severe vocal fold scar and sulcus vocalis. Our results show improvement in half of a cohort that was marked by previous failures at improving voice. These results point to the recalcitrant nature of voice difficulties in treating vocal fold scar and sulcus, and may properly guide clinicians and patients in their expectations following this infrequently used technique.
Free-Flap Reconstruction of Large Full-Thickness Lip and Chin Defects
Authors: Godefroy Willem P. , Klop Willem M. C. , Smeele Ludi E. , Lohuis Peter J. F. M.
Published: October 2014

Objectives:

We describe our experience in the reconstruction of large 3-layer lip defects using free revascularized lower-arm and fibula flaps.

Methods:

Between 2005 and 2009, nine patients underwent free-flap reconstruction after oncological surgery involving the lip and chin with or without mandibular involvement. The flap techniques are described, and postoperative functional and aesthetic results were recorded.

Results:

There were no flap failures. All patients showed intact oral function and good aesthetic results. Two patients died of distant metastases, 8 months and 17 months after surgery.

Conclusions:

Three-layer defects of the lip ideally require free-flap reconstruction, which has a high probability of achieving good functional and aesthetic results.
Middle Ear Effusion and Fungi
Authors: Murakami Atsushi , Tutumi Takesi , Watanabe Kensuke
Published: October 2014

Objectives:

Bacteria and viruses are rarely isolated from the middle ear fluid in cases of otitis media with effusion (OME). However, since endotoxins are often detected in such effusions, it is suspected that patients with OME have a previous history of gram-negative infection. Recently, fungi have drawn attention as microorganisms that cause chronic sinusitis. We investigated the involvement of fungi in the formation of middle ear effusions of patients with OME and eosinophilic otitis media, in which patients have viscous middle ear effusions and a history of adult bronchial asthma indicating definite involvement of eosinophils.

Methods:

Middle ear effusions and nasal secretions were collected from patients with eosinophilic otitis media (7 patients) or OME (12 patients), and smears were prepared for methenamine silver staining. The remaining specimens were embedded in Epon and stained with toluidine blue for observation under a light microscope, and ultrathin sections were prepared for examination under an electron microscope.

Results:

Fungal hyphae were detected in the middle ear fluid in all of the patients with eosinophilic otitis media or OME. Charcot-Leyden crystals (CLCs) were observed in 6 of the 7 patients with eosinophilic otitis media. In regard to the findings in the nasal secretions, fungal hyphae were also detected in the nasal secretions of all patients, whereas CLCs were detected in only 1 patient with eosinophilic otitis media.

Conclusions:

It was clarified by use of the methenamine silver staining method that fungi were present in the middle ear fluid in 100% of the studied cases of eosinophilic otitis media or OME. Whether fungi are also present in the middle ear cavity of normal persons is unknown, but the possibility that they may contribute as a cause of both diseases cannot be excluded. Particularly in eosinophilic otitis media, the observation of numerous CLCs in the middle ear fluid suggests that many eosinophils have degenerated. The eosinophil granule proteins released from the degenerated eosinophils can cause epithelial injury of the middle ear. The possibility that fungi induce the eosinophils in the middle ear also cannot be excluded.
Transoral Robot-Assisted Lingual Tonsillectomy and Uvulopalatopharyngoplasty for Obstructive Sleep Apnea
Authors: Lee Jonathan M. , Weinstein Gregory S. , O'Malley Bert W. , Thaler Erica R.
Published: October 2014

Objectives:

We assessed the use of transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for the surgical management of tongue base obstruction in patients with obstructive sleep apnea.

Methods:

In a prospective, nonrandomized trial using historical controls, patients underwent drug-induced sleep endoscopy, transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty, and preoperative and postoperative polysomnography.

Results:

Twenty patients have completed the study to date. The rate of surgical success was 45%, and the rate of surgical response was 65%. The mean preoperative apnea-hypopnea index of 55.6 decreased by 56.7%, to a mean postoperative value of 24.1 (p < 0.001), and the minimum arterial oxygen saturation increased from the mean preoperative value of 75.8% to the mean postoperative value of 81.7% (p = 0.013). The mean Epworth Sleepiness Scale score improved from 13.4 to 5.9 (p = 0.003). One patient had postoperative bleeding that required cauterization, resulting in a major complication rate of 4.2%.

Conclusions:

Transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty is a novel technique for the surgical management of obstructive sleep apnea that results in a significant decrease in the apnea-hypopnea index, a significant improvement in minimum arterial oxygen saturation, and a significant improvement in the Epworth Sleepiness Scale score and has an acceptable complication rate.
Selective Vestibular Neurolabyrinthitis of the Lateral and Superior Semicircular Canal Ampulla and Ampullary Nerves
Authors: Magliulo Giuseppe , Gagliardi Silvia , Appiani Mario Ciniglio , Iannella Giannicola , Gagliardi Mario
Published: October 2014

Objectives:

The diagnosis of vestibular neurolabyrinthitis is based on the sudden appearance of vertigo that lasts for hours or days without associated cochlear or central nervous system signs or symptoms. The advent of the video head impulse test, cervical vestibular evoked myogenic potential testing, and ocular vestibular evoked myogenic potential testing has provided interesting clinical evidence for evaluating and monitoring the damage to specific compartments of the vestibular apparatus. These various methods of testing individual end-organ functions may have a clinical impact on the vestibular workup of neurolabyrinthitis.

Methods:

This report describes 3 patients with acute vestibular neurolabyrinthitis in whom caloric tests, cervical vestibular evoked myogenic potentials, ocular vestibular evoked myogenic potentials, and the video head impulse test led to a suspicion of peripheral vestibular deficits of the lateral or superior semicircular canal ampulla or ampullary nerves.

Results:

In our patients, the examination results (normal hearing, absence of responses on caloric testing, and bilateral preservation of cervical and ocular vestibular evoked myogenic potentials) disclosed an acute partial superior vestibular neurolabyrinthitis.

Conclusions:

To our knowledge, these are the first reported cases in which selective damage to the lateral and superior semicircular canals and their nerves caused by neurolabyrinthitis was demonstrated clinically. Our clinical results indicate that the damage can be selective for specific vestibular end organs.
Oral Frostbite Due to Dry Ice
Authors: Ohki Masafumi , Ishikawa Jyunichi , Kikuchi Shigeru
Published: October 2014

Objectives:

Dry ice is a commercially available cryogen that is used worldwide. It may cause frostbite if misused. However, frostbite of the oral cavity due to dry ice has not been previously reported. Here, we describe the first case of dry ice–induced frostbite of the oral cavity.

Methods:

We present a case of oral frostbite due to dry ice and subsequent swelling of the submandibular area and lower lip. We discuss the clinical features of oral frostbite due to volatile substance abuse.

Results:

Oral frostbite not only may result in the impairment of the affected mucosae directly, but also may adversely affect the tissues in the vicinity of the oral cavity floor indirectly. Oral frostbite may cause edema of the upper airway tract. In case of severe pharyngolaryngeal edema, either tracheal intubation or tracheostomy is necessary. Steroids and antibiotics may be effective in preventing the development of pharyngolaryngeal edema.

Conclusions:

It is important to bear in mind that volatile substance abuse may possibly induce unusual events. In particular, special attention should be paid to delayed unusual events.
Efficacy of Computed Tomographic Scans in the Evaluation of Patients with Esophageal Foreign Bodies
Authors: Loh Woei-Shyang , Eu Donovan K. C. , Loh Shaun R. H. , Chao Siew-Shuen
Published: October 2014

Objectives:

This study aimed to determine whether computed tomographic (CT) scans on which foreign body impaction cannot be detected can be relied upon to decide whether a patient requires further investigation by esophagoscopy. This information might minimize unnecessary esophagoscopy without incurring the risk of a missed impacted foreign body.

Methods:

In a retrospective chart review of all patients admitted to National University Hospital, Singapore, over the period 2004 to 2011 for an ingested foreign body, case files of patients who underwent preoperative CT scanning followed by esophagoscopy were identified and reviewed. The results of the CT scan and the findings of esophagoscopy in these patients were analyzed.

Results:

A total of 376 patients underwent rigid esophagoscopy for an ingested foreign body during this period. Of these, 119 patients had CT scans performed before the endoscopy. Based on our analysis, the sensitivity of CT scanning was 100%, and the specificity was 70.6%. The positive predictive value was 89.5%, and the negative predictive value was 100%. None of the patients who had CT scans with no detectable foreign body had complications on follow-up.

Conclusions:

CT scanning appeared to be sensitive and specific in investigation of patients with an ingested foreign body. It also has a high negative predictive value, which may allow it to be the only preliminary investigation in these patients. Based on these data, a prospective study with close monitoring of patients who have CT scans with no detectable foreign body can be designed to accrue more patients to answer this query.