bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Tracheoesophageal Prosthesis Sizing in Office-Based Tracheoesophageal Puncture
Authors: Sidell Douglas , Shamouelian David , Erman Andrew , Gerratt Bruce R. , Chhetri Dinesh
Published: October 2014

Objectives:

Tracheoesophageal puncture (TEP) for postlaryngectomy speech is increasingly being performed as an office-based procedure. We review our experience with office-based TEP and compare outcomes with those of operating room—based TEP. Our hypothesis was that office-based TEP results in improved prosthesis sizing, reducing the number of visits dedicated to prosthesis resizing.

Methods:

A retrospective chart review was performed of all patients who underwent secondary TEP at our institution from 2001 to 2008. The primary dependent measure was the change in the length of the voice prosthesis. We also evaluated the number of visits made to the speech-language pathologist for resizing before a stable prosthesis length was achieved, and the number of days between voice prosthesis placement and the date a stable prosthesis length was observed.

Results:

Thirty-one patients were included in this study. There was a significant difference in prosthesis length change between patients who had office-based TEP and patients who had operating room—based TEP (p < 0.001). In addition, the office-based cohort required fewer visits to the speech-language pathologist for TEP adjustments before a stable TEP length was achieved (p < 0.001).

Conclusions:

Voice prosthesis sizing was better in patients who had office-based TEP than in patients who had operating room—based TEP. This outcome is likely due to the lesser degree of swelling of the tracheoesophageal party wall in the office-based procedure.
Congenital Bilateral Vocal Fold Paralysis and Charcot-Marie-Tooth Disease
Authors: Lewis Andrea F. , Carron Jeffrey D. , Vedanarayanan Vetta
Published: October 2014

We present the case of a patient with Charcot-Marie-Tooth disease (CMT) type 1 with congenital bilateral vocal fold paralysis in order to emphasize the treatment options and long-term outcome. The case is reviewed with regard to presentation, differential diagnosis, and treatment. We also reviewed the literature to determine the frequency of congenital and childhood presentations of bilateral vocal fold paralysis associated with CMT, most specifically CMT type 1. We found only 14 children reported to have bilateral vocal fold paralysis associated with CMT, and only 1 of these cases was associated with CMT type 1. None of these patients had congenital vocal fold paralysis. Because of the degenerative nature of the disease, our patient underwent endoscopic cordotomy to avoid tracheotomy. We conclude that CMT should be included in the differential diagnosis in evaluating neonates with bilateral vocal fold paralysis. If CMT is definitively diagnosed, it could alter the course of treatment.
FEESST in the Rehabilitation of Dysphagia after Partial Laryngectomy
Authors: Schindler Antonio , Ginocchio Daniela , Peri Andrea , Felisati Giovanni , Ottaviani Francesco
Published: October 2014

Objectives:

We describe the role of the laryngeal adductor reflex (LAR) and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in the rehabilitation of patients with oropharyngeal dysphagia after partial laryngectomy.

Methods:

Ten patients with a mean age of 64 years (range, 45 to 72 years) were included in the study. Seven patients underwent supraglottic laryngectomy, and 3 had supracricoid laryngectomy. Six patients underwent additional radiotherapy (RT), and 8 had functional neck dissection (ND). FEESST was performed on each patient in order to establish a swallowing rehabilitation program.

Results:

In 2 patients, not submitted to either ND or RT, the LAR was preserved; in 6 patients, who underwent both procedures, the LAR was delayed or absent. In 2 patients who underwent ND but not RT, the LAR was preserved in 1 case and delayed in the other. The patients with an absent LAR presented severe aspiration, whereas in those with a preserved LAR, no penetration was found. Moderate aspiration was found in the remaining patients. In the patients with a reduced or absent LAR, tactile and chemical sensory stimulation was added to the rehabilitation program.

Conclusions:

FEESST represents a useful tool in everyday clinical practice for the planning of swallowing rehabilitation after partial laryngectomy.
Endoscopic Assessment of the Nasopharynx: An Objective Score of Abnormality to Predict the Likelihood of Malignancy
Authors: Vlantis Alexander C. , Bower Wendy F. , Woo John K. S. , Tong Michael C. F. , van Hasselt C. Andrew
Published: October 2014

Objectives:

We developed an objective endoscopic score of abnormality of the nasopharynx to predict the likelihood of malignancy.

Methods:

A score sheet with 44 variables was developed to objectively quantify the bilateral endoscopic assessment of the nasopharynx. Patients scheduled to undergo nasopharyngeal biopsies were recruited. The nasopharynx was assessed endoscopically, photographed, and scored on 44 variables. The scores were compared to the biopsy results, and predictors of malignancy were modeled with regression analysis. The sensitivity and specificity of the novel scoring system were examined.

Results:

Seventeen patients had carcinoma, and 60 had a benign lesion or no disease. Patients with a nasopharyngeal malignancy scored significantly higher than did patients with a benign lesion or no disease. No patient with a malignant lesion had a score of less than 12. With a receiver operating characteristic curve area of 0.917, the score demonstrated an excellent ability to discriminate between nasopharynges that were likely or unlikely to contain malignant disease. Independent predictors for both malignant disease and a score greater than 12 were modeled.

Conclusions:

A cutoff score above 12 on the novel objective endoscopic assessment of the nasopharynx measure was highly predictive of possible malignancy.
Migration of Ingested Foreign Bodies into the Thyroid Gland: Literature Review and Case Report
Authors: Hohman Marc H. , Harsha Wayne J. , Peterson K. Linnea
Published: October 2014

Objectives:

We review the literature on the migration of ingested foreign bodies into the thyroid gland to analyze trends in patient presentation, evaluation, and management. Additionally, we present a case of an intrathyroidal foreign body from our own experience.

Methods:

We searched the Medline database using key words “foreign bodies” and “thyroid gland,” and present a new case report of an ingested foreign body that migrated to the thyroid gland.

Results:

Our search generated 11 relevant articles with 15 total patients. All patients were female; 10 foreign bodies were fish bones, 2 were chicken bones, and 3 were wire bristles. The most common presenting symptoms were throat pain (67%) and dysphagia (47%). Computed tomography was the most sensitive test (100%), although cervical radiography also had high sensitivity (79%). Endoscopy was substantially less sensitive (38%). All patients required neck exploration.

Conclusions:

Radiographic evaluation has a high likelihood of detecting foreign bodies in the thyroid gland, and a computed tomographic scan is doubly useful because it assists in preoperative planning. Endoscopy has limited utility in cases of extraluminal migration, but should still be performed to evaluate soft tissue that is poorly visualized on a computed tomographic scan. Unless the foreign body can be removed endoscopically and there are no complications from migration or perforation, the definitive treatment is surgical.
Transoral Excision of a Retropharyngeal Lymph Node under Rigid Endoscopic Control
Authors: Buttà Laura , Lombardi Davide , Marconi Anna , Nicolai Piero
Published: October 2014

Different traditional surgical approaches, such as transcervical, transparotid, and mandible-splitting procedures, have been described to expose the retropharyngeal space. The introduction of the transoral approach, in selected patients, provided a direct and adequate access to the retropharyngeal space, permitting a feasible and minimally invasive procedure to remove retropharyngeal lymph nodes. We report a case of a transoral video-assisted approach for the excision of a retropharyngeal lymph node in a young man who had previously been treated at another institution by surgery and radiotherapy for oral tongue cancer. The endoscopic magnification allowed us to perform a meticulous and relatively bloodless dissection of the lesion from the surrounding tissues with a clear identification of the anatomic structures, and therefore may represent a valid alternative to the use of a microscope or loupes to enhance vision. A clear understanding of the anatomy of the retropharyngeal space and a high degree of surgical expertise are required to perform a safe dissection of the lesion.
Videolaryngoscopic Transoral En Bloc Resection of Supraglottic and Hypopharyngeal Cancers Using Laparoscopic Surgical Instruments
Authors: Shiotani Akihiro , Tomifuji Masayuki , Araki Koji , Yamashita Taku , Saito Koichiro
Published: October 2014

Objectives:

We assessed the outcome of en bloc transoral resection of supraglottic and hypopharyngeal cancer using a distending laryngoscope with rigid videoendoscopic and laparoscopic surgical instruments.

Methods:

We enrolled 30 patients with T1, T2, or selected T3 supraglottic and hypopharyngeal cancer in the study; 9 patients had undergone radiotherapy. Neck dissections were performed for node-positive patients. Postoperative radiotherapy was administered to patients with multiple lymph node metastases or positive surgical margins.

Results:

This surgical environment provided a wide view of the operative field, facilitating bimanual manipulation of laparoscopic surgical instruments, and enabled us to perform en bloc transoral resection. In 21 cases with a minimum follow-up period of 1 year (average, 33 months; range, 15 to 56 months), the 3-year disease-specific survival rate and the laryngeal preservation rate were each 95%. Normal food intake was eventually possible in all cases. Tracheostomy was performed for 2 patients as a prophylactic measure and for 1 patient because of a postoperative hemorrhage.

Conclusions:

These results indicate that videolaryngoscopic transoral en bloc resection using laparoscopic surgical instruments can be one of the minimally invasive treatment options for supraglottic and hypopharyngeal cancers with satisfactory oncological outcome and postoperative laryngeal function.
Use of Double Electrode Pads for Intraoperative Monitoring of the Recurrent Laryngeal Nerve
Authors: Choby Garret , Trojanowski Andrzej , Johnson Samuel , Goldenberg David
Published: October 2014

We describe a novel technique using double electrode pads for intraoperative neuromonitoring of the recurrent laryngeal nerve. This is a novel setup of intraoperative neuromonitoring that helps protect against faulty readings due to tube migration during surgery and allows for the recording of “side-specific” recurrent laryngeal nerve information. This method has not been previously described in the literature. This original approach to neuromonitoring helps guard against tube migration, simplifies the intubation process, allows for the acquisition of side-specific information, and is less expensive than use of commercially available integrated endotracheal tubes.
Diagnosis and Management of Type I Posterior Laryngeal Clefts
Authors: Bakthavachalam Sivi , Schroeder James W. , Holinger Lauren D.
Published: October 2014

Objectives:

We review the diagnosis and management of type I posterior laryngeal clefts (PLCs).

Methods:

We performed a retrospective study at a tertiary-care children's hospital of children who were diagnosed with a PLC between January 2003 and August 2008. We studied concurrent airway anomalies, comorbidities, presenting symptoms, age at the time of aspiration resolution, and rate of aspiration resolution.

Results:

Sixty-seven children with PLCs were identified (41 boys and 26 girls). Fifty-nine had type I clefts, 6 had type II, and 2 had type III. Of the 59 type I cases, 15 (25.4%) were surgically repaired by endoscopy. Eleven of these 15 children (73.3%) have had symptomatic improvement since the surgery, and 7 of those 11 (63.6%) are tolerating thin liquids by mouth. Two of the 15 (13.3%) displayed no improvement with surgery, and 2 of the 15 (13.3%) were lost to follow-up. Forty-four of the 59 type I clefts (74.6%) were managed nonsurgically. Twenty of these 44 children (45.5%) did not present with aspiration. Twenty-four of the 44 (54.5%) presented with aspiration, and 16 of the 24 (66.7%) are now tolerating thin liquids by mouth. Seven of these 24 patients (29.2%) are still aspirating, and 1 has died. The average time to resolution of aspiration was 7.8 months for the surgical group and 13.6 months for the nonsurgical group (p = 0.19). In the surgical group, the average age at resolution of aspiration for patients who received their diagnosis at 0 to 6 months of age was 21.5 months; that for those with a diagnosis at 6 to 12 months was 27.3 months; and that for those with a diagnosis at older than 12 months was 27.3 months (p = 0.31). In the nonsurgical group, the average age at resolution of aspiration for patients who received their diagnosis at 0 to 12 months of age was 15.8 months; that for those with a diagnosis at 12 to 24 months was 27.3 months; and that for those with a diagnosis at older than 24 months was 77.3 months (p = 0.0015).

Conclusions:

We found that 1) the reported incidence of type I PLCs is increasing; 2) type I PLCs can often present without clinical aspiration; 3) aspiration caused by type I PLCs can be managed medically or surgically; and 4) operative intervention is advantageous for patients who have severe symptoms or who have persistent aspiration after 2 years of age.
Endoscopic Removal of Esophageal Impacted Dentures
Authors: Fang Rui , Sun Jingwu , Hu Yanming , Yao Kun , Hu Wei
Published: October 2014

Objectives:

A retrospective study was conducted on 6 patients with esophageal impacted dentures removed via rigid esophagoscopy.

Methods:

Six patients with esophageal impacted dentures were treated in our department, and the following technique was successfully performed. With the patients under general anesthesia, we inserted the endoscope to visualize the impacted dentures, fixed them with forceps, and then stuffed several cotton slivers soaked in saline solution into the esophagus around the dentures with another forceps. Then we extracted the dentures from the esophagus.

Results:

All dentures were extracted through esophagoscopy, and there were no severe complications except for 1 case of esophageal hematoma.

Conclusions:

The dilation method using saline solution—soaked cotton slivers is relatively safe and effective in removing impacted dentures from the esophagus, avoiding open surgery and possible perforation.
Successful Decannulation of T-Tubes According to Type of Tracheal Stenosis
Authors: Kim Sang Cheol , Kim Se-Heon , Kim Benjamin Youngho
Published: October 2014

Objectives:

Although the T-tube has been widely used as a therapeutic method for treatment of tracheal stenosis, predictors for success have not been much studied. The authors analyzed several factors to search for a factor that would be useful as a prognostic indicator for successful decannulation.

Methods:

A total of 41 patients who underwent T-tube insertion from 1995 to 2004 at Yonsei University Health System were included. The medical records were reviewed retrospectively, and several factors regarding the type of stenosis were evaluated.

Results:

Age, sex, and multiplicity and severity of stenoses (p = 0.860) were not significantly related to successful decannulation. The longitudinal extent of stenosis had a significant influence on success (p = 0.035), and cases with a greater circumferential involvement tended to result in decannulation failure (p = 0.084).

Conclusions:

The severity of stenosis did not have a statistically significant relationship to the decannulation rate, although it was closely related to the patient's symptoms. The longitudinal extent and the circumferential involvement of stenosis were found to be correlated to the success rate and represented the extent of the damaged mucosal area. Therefore, it was assumed that the extent of the damaged mucosal area could be more important than the area of the granulation tissue or the patients' symptoms in predicting the decannulation of T-tubes.
Role of Dexamethasone in Reducing Pain after Endoscopic Sinus Surgery in Adults: A Double-Blind Prospective Randomized Trial
Authors: Al-Qudah Mohannad , Rashdan Yasser
Published: October 2014

Objectives:

We sought to study postoperative pain after endoscopic sinus surgery and to evaluate the efficacy of dexamethasone sodium phosphate in reducing pain and rescue analgesic requirements.

Methods:

In a prospective, double-blind, placebo-controlled clinical trial, 62 patients with chronic rhinosinusitis who were undergoing general anesthesia for endoscopic sinus surgery were randomized to receive either 8 mg (2 mL) of intravenous dexamethasone sodium phosphate or 2 mL of saline solution at the time of induction of anesthesia. After surgery, the patients were observed for 24 hours and were given 1 g of acetaminophen every 6 hours. Pain severity was reported immediately and 6 and 24 hours after surgery on a 10-cm visual analog scale. The need for rescue analgesia with tramadol hydrochloride was recorded and compared between the two groups.

Results:

The two groups were matched by demographic data, clinical indications, and intraoperative details. The average postoperative pain severity scores at the 3 time intervals were 3.6, 2, and 1 in the dexamethasone group and 3.6, 2.5, and 1.6 in the saline solution group. These differences were not statistically significant. Ten patients in the dexamethasone group required rescue analgesia, compared to 12 in the saline solution group. The average patient required 0.53 doses of rescue analgesic in the dexamethasone group, versus 0.67 doses in the saline solution group. Again, these differences were not statistically significant.

Conclusions:

Dexamethasone injection at the time of induction of general anesthesia is not superior to placebo in controlling early postoperative pain in patients who undergo endoscopic sinus surgery.
Partial Characterization of Normal and Haemophilus Influenzae—Infected Mucosal Complementary DNA Libraries in Chinchilla Middle Ear Mucosa
Authors: Kerschner Joseph E. , Erdos Geza , Hu Fen Ze , Burrows Amy , Cioffi Joseph , Khampang Pawjai , Dahlgren Margaret , Hayes Jay , Keefe Randy , Janto Benjamin , Post J. Christopher , Ehrlich Garth D.
Published: October 2014

Objectives:

We sought to construct and partially characterize complementary DNA (cDNA) libraries prepared from the middle ear mucosa (MEM) of chinchillas to better understand pathogenic aspects of infection and inflammation, particularly with respect to leukotriene biogenesis and response.

Methods:

Chinchilla MEM was harvested from controls and after middle ear inoculation with nontypeable Haemophilus influenzae. RNA was extracted to generate cDNA libraries. Randomly selected clones were subjected to sequence analysis to characterize the libraries and to provide DNA sequence for phylogenetic analyses. Reverse transcription—polymerase chain reaction of the RNA pools was used to generate cDNA sequences corresponding to genes associated with leukotriene biosynthesis and metabolism.

Results:

Sequence analysis of 921 randomly selected clones from the uninfected MEM cDNA library produced approximately 250,000 nucleotides of almost entirely novel sequence data. Searches of the GenBank database with the Basic Local Alignment Search Tool provided for identification of 515 unique genes expressed in the MEM and not previously described in chinchillas. In almost all cases, the chinchilla cDNA sequences displayed much greater homology to human or other primate genes than with rodent species. Genes associated with leukotriene metabolism were present in both normal and infected MEM.

Conclusions:

Based on both phylogenetic comparisons and gene expression similarities with humans, chinchilla MEM appears to be an excellent model for the study of middle ear inflammation and infection. The higher degree of sequence similarity between chinchillas and humans compared to chinchillas and rodents was unexpected. The cDNA libraries from normal and infected chinchilla MEM will serve as useful molecular tools in the study of otitis media and should yield important information with respect to middle ear pathogenesis.
Initial Clinical Experience with Balloon Dilation in Revision Frontal Sinus Surgery
Authors: Wycherly Benjamin J. , Manes R. Peter , Mikula Suzette K.
Published: October 2014

Objectives

The purpose of this study was to determine whether balloon dilation is effective in revision frontal sinus surgery.

Methods

We retrospectively reviewed all patients who had previously undergone endoscopic frontal sinus surgery and had persistent sinusitis. AH patients then underwent balloon dilation of the frontal ostium. Outcome measurements included endoscopic patency of the frontal ostium, Lund-Mackay scores, culture-positive postoperative infections, and subjective persistence of symptoms.

Results

Twenty-four frontal ostia and recesses were dilated in 13 patients. The mean follow-up was 13 months (range, 7 to 19 months). During follow-up, 21 of 24 ostia (86%) remained patent and 3 required additional procedures. Postoperative computed tomography scans were performed an average of 12 months after dilation (range, 6 to 18 months) in 9 patients (17 sinuses). The average Lund-Mackay score was 1.35 before dilation and 0.87 at follow-up (p = 0.0076), with 41 % of sinuses (7 of 17) displaying radiographic improvement. The average number of postoperative infections was 2.07 (range, 0 to 7). Frontal headaches persisted in 38% of patients (5 of 13) at follow-up.

Conclusions

Balloon dilation of the frontal ostia has a posttreatment patency rate comparable to those of other endoscopic revision techniques. Although it may not fully address the frontal sinus disease of all patients, it is a less invasive technique that may be helpful for some patients.
Carotid Blowout in Patients with Head and Neck Cancer
Authors: Powitzky Rosser , Vasan Nilesh , Krempl Greg , Medina Jesus
Published: October 2014

Objectives

The objective was to review the clinicopathologic features of carotid blowout syndrome (CBS) in patients with head and neck cancer (HNC) and present a management algorithm.

Methods

We reviewed all HNC patients with a diagnosis of CBS seen at our tertiary cancer hospital from 1994 to 2009 and performed a retrospective review of all English-language studies documenting CBS cases within the past 15 years.

Results

Eight patients with HNC developed CBS at our institution, and another 132 HNC patients were presented in 21 studies. Patients with CBS typically have a history of radiotherapy (89%), nodal metastasis (69%), and neck dissection (63%). This disease usually occurs proximal to the carotid bifurcation and is commonly associated with soft tissue necrosis in the neck (55%) and mucocutaneous fistulas (40%). Half of CBS patients present with sentinel bleeding, but 60% of patients will develop a life-threatening hemorrhage requiring emergent intervention. Over 90% of patients with CBS were treated with endovascular therapy, and surgical ligation was rarely indicated. The morbidity and mortality rates of patients with CBS are significant; only 23% have survived without evidence of disease.

Conclusions

Carotid blowout syndrome is uncommon and can be rapidly fatal without prompt diagnosis and intervention. Although endovascular treatment within the carotid system can have a significant risk of mortality and neurologic morbidity, it has become the treatment of choice for CBS.
Effect of Burow's Solution on the Guinea Pig Inner Ear
Authors: Suzuki Mitsuya , Kashio Akinori , Sakamoto Takashi , Yamasoba Tatsuya
Published: October 2014

Objectives

We examined the changes in the inner ear hair cells following intratympanic injection of Burow's solution.

Methods

Thirty-one albino guinea pigs with a normal Preyer's reflex were used. Burow's solution was applied and allowed to remain on the round window membrane for 30 minutes (30-minute group), 1 hour (1-hour group), or 2 hours (2-hour group). Seven days later, the left temporal bone was removed. Auditory brain stem responses were recorded at 4, 8, and 20 kHz before application of Burow's solution and again immediately before decapitation. The cochlea and utricle were dissected, stained with rhodamine-phalloidin, and examined under a fluorescence microscope.

Results

The postoperative auditory brain stem response thresholds at 20 kHz in the 1-hour group and those at 8 and 20 kHz in the 2-hour group were increased significantly compared to the baseline thresholds. Surface preparations of the organ of Corti revealed no hair cell loss in the 30-minute group, loss of outer hair cells in the lower half of the basal turn in half of the animals in the 1-hour group, and loss of outer hair cells in the basal turn in almost all animals in the 2-hour group. In the 2-hour group, the microthin sections of the round window membrane showed degeneration of the outer epithelium.

Conclusions

The retention of Burow's solution on the round window membrane for 2 hours induces degeneration of the outer epithelium and damage to the cochlear outer hair cells.
Management of Complex Cases of Petrous Bone Cholesteatoma
Authors: Pandya Yash , Piccirillo Enrico , Mancini Fernando , Sanna Mario
Published: October 2014

Objectives:

In a retrospective analysis of a quaternary referral neuro-otologic private practice, we identify complex cases of petrous bone cholesteatoma (ie, cases with encasement of vital structures such as the internal carotid artery, jugular bulb, and sigmoid sinus, with further extension to the clivus, sphenoid sinus, or rhinopharynx), review surgical approaches and techniques of management of vital structures, and propose the ideal surgical management.

Methods:

We performed a retrospective case study of 130 cases of petrous bone cholesteatoma submitted to surgery between 1979 and 2009 to identify the complex cases and their classification, approach used, outcomes, and recurrences.

Results:

Of 130 cases, 13 were complex. Facial palsy was the presenting feature in 11 cases, 7 of which presented with grade VI palsy. A long duration of facial palsy (more than 3 years) was seen in 5 cases. Clival involvement was seen in 6 cases; 1 case extended to the sphenoid sinus, and 1 to the rhinopharynx. The internal carotid artery was encased in 11 cases in the vertical and the horizontal parts. The jugular bulb was involved in 7 cases. Modified transcochlear approaches or infratemporal fossa approaches were used in all cases. There were no recurrences.

Conclusions:

Classification is fundamental to choosing the right surgical approach. Transotic and modified transcochlear approaches hold the key to treating complex cases. Infratemporal fossa approach type B has to be used for extension into the clivus, sphenoid sinus, or rhinopharynx. Internal carotid artery, jugular bulb, and sigmoid sinus involvement should be identified before operation.
Rationale for Targeting Pepsin in the Treatment of Reflux Disease
Authors: Johnston Nikki , Wells Clive W. , Samuels Tina L. , Blumin Joel H.
Published: October 2014

Objectives:

We undertook to 1) obtain unequivocal evidence to confirm or rebut our initial observations that pepsin is taken up by hypopharyngeal epithelial cells by receptor-mediated endocytosis, 2) investigate whether uptake of pepsin at pH 7, in nonacidic refluxate, is of pathological significance, and 3) test our hypothesis that inactive but stable pepsin (<pH 8) taken up by hypopharyngeal epithelial cells causes damage by becoming reactivated inside the cell.

Methods:

Human posterior cricoid biopsy specimens and cultured hypopharyngeal FaDu epithelial cells were used to perform competitive binding studies and to investigate colocalization of pepsin with clathrin, Rab-9, and TRG-46. FaDu cells were exposed to pepsin (both irreversibly and reversibly inactivated) in the presence and absence of wortmannin and dimethyl amiloride and analyzed by electron microscopy, MTT cytotoxicity assay, and Stress and Toxicity SuperArray.

Results:

Pepsin is unequivocally taken up by hypopharyngeal epithelial cells by receptor-mediated endocytosis. Uptake of pepsin at pH 7, in nonacidic refluxate, causes mitochondrial damage and changes the expression of several genes implicated in stress and toxicity. Irreversible, but not reversible, inhibition of peptic activity prevents these changes.

Conclusions:

Pepsin, at pH 7, in nonacidic refluxate, causes damage by becoming reactivated inside the cell. Irreversible inhibitors of peptic activity hold promise as a new therapy for reflux.
In vitro and in vivo Effects of D-Allose: Up-Regulation of Thioredoxin-Interacting Protein in Head and Neck Cancer Cells
Authors: Hoshikawa Hiroshi , Mori Terushige , Mori Nozomu
Published: October 2014

Objectives:

This study was aimed to investigate the relationship between the antiproliferative effects of D-allose and the up-regulation of thioredoxin-interacting protein (TXNIP) in head and neck cancer cells.

Methods:

For the in vitro study, 5 oral squamous cell carcinoma cell lines (Ca9–22, HSC-3, HSC-4, SAS, and KON) were treated with 25 mmol/L D-allose. For the in vivo study, HSC-3 cells were used in a xenograft model with female athymic nude mice (BALB/c nu/nu; 5 to 6 weeks old).

Results:

Inhibition of cell growth by D-allose was noted in HSC-3 and Ca9–22 cells, along with significant induction of TXNIP. Although TXNIP up-regulation was also evident, albeit to a lesser extent, in the remaining cell lines, D-allose did not inhibit their growth. With the HSC-3 line, the cell survival fractions decreased and TXNIP expression increased in a D-allose dose—dependent manner. The antiproliferative effects were partially suppressed by concomitant D-glucose treatment, which also reduced TXNIP expression. In the in vivo experiment, the tumor volume at day 15 after D-allose treatment was reduced to 61% of that of the control group.

Conclusions:

This study showed that D-allose exerts growth inhibitory effects on head and neck cancer cells in vitro and in vivo. The sugar may act as an antiproliferative agent via TXNIP induction and thus may be useful as a novel anticancer drug.
Expression and Distribution of Hyaluronic Acid and CD44 in Unphonated Human Vocal Fold Mucosa
Authors: Sato Kiminori , Umeno Hirohito , Nakashima Tadashi , Nonaka Satoshi , Harabuchi Yasuaki
Published: October 2014

Objectives:

The tension caused by phonation (vocal fold vibration) is hypothesized to stimulate vocal fold stellate cells (VFSCs) in the maculae flavae (MFe) to accelerate production of extracellular matrices. The distribution of hyaluronic acid (HA) and expression of CD44 (a cell surface receptor for HA) were examined in human vocal fold mucosae (VFMe) that had remained unphonated since birth.

Methods:

Five specimens of VFMe (3 adults, 2 children) that had remained unphonated since birth were investigated with Alcian blue staining, hyaluronidase digestion, and immunohistochemistry for CD44.

Results:

The VFMe containing MFe were hypoplastic and rudimentary. The VFMe did not have a vocal ligament, Reinke's space, or a layered structure, and the lamina propria appeared as a uniform structure. In the children, HA was distributed in the VFMe containing MFe. In the adults, HA had decreased in the VFMe containing MFe. In both groups, the VFSCs in the MFe and the fibroblasts in the lamina propria expressed little CD44.

Conclusions:

This study supports the hypothesis that the tensions caused by vocal fold vibration stimulate the VFSCs in the MFe to accelerate production of extracellular matrices and form the layered structure. Phonation after birth is one of the important factors in the growth and development of the human VFMe.
Postoperative Morbidity in Traditional versus Coblation Tonsillectomy
Authors: Gustavii Nils , Bove Mogens , Dahlin Christer
Published: October 2014

Objectives

The aim of this study was to compare levels of postoperative pain after traditional (cold steel with bipolar cautery) and Coblation tonsillectomies.

Methods

Patients with recurrent or chronic tonsillitis, including tonsillar hyperplasia, were randomized to undergo tonsillectomies using either a traditional cutting technique or the Coblation technique. Patients and staff on the relevant wards were blinded regarding patient allocation. Pain, odynophagia, and activity limitations were recorded on a visual analog scale. Analgesics were self-administered, and daily analgesic consumption by patients was reported. All complications were also registered.

Results

Fifty-seven patients (between 6 and 57 years of age) completed the study. No significant difference was found between the two techniques with regard to reported pain, odynophagia, activity limitations, or use of analgesics. A slight tendency toward decreased pain and decreased use of analgesics in the Coblation group reached statistical significance only when the adult patients were analyzed separately. Two cases of hospital readmission occurred because of postoperative bleeding following Coblation tonsillectomies.

Conclusions

Overall, the two methods are equivalent in terms of postoperative pain, including the use of analgesics. The risk of postoperative bleeding after the Coblation method requires further evaluation with specifically designed studies.
Midline Cervical Cleft: A Rare Congenital Anomaly
Authors: Renukaswamy Gayathri Mandya , Soma Marlene A. , Hartley Benjamin E. J.
Published: October 2014

Objectives:

A midline cervical cleft (MCC) is a rare congenital anomaly due to failure of fusion of the first and second branchial arches during embryogenesis. It may present as a midline defect of the anterior neck skin with a skin projection or sinus, or as a subcutaneous fibrous cord. This report evaluates the clinical features and surgical management of an MCC.

Methods:

We analyzed a series of 4 patients with an MCC successfully treated at Great Ormond Street Hospital for Children in London.

Results:

Three male patients and 1 female patient between 4 and 11 months of age were found to have an MCC. Each patient presented with an erythematous, fibrous band of tissue extending between the chin and the suprasternal notch. Treatment comprised surgical excision of the lesion and Z-plasty repair. We present the embryology, common clinical presentation, investigations, differential diagnosis, and histology, along with a literature review, of this uncommon malformation of the anterior neck.

Conclusions:

An MCC is a differential diagnosis to consider when assessing a child with a midline cervical lesion. Early surgical excision with Z-plasty repair of the soft tissue defect is the treatment of choice to prevent long-term complications.
Bioengineered Trachea with Fibroblasts in a Rabbit Model
Authors: Okano Wataru , Nomoto Yukio , Wada Ikuo , Kobayashi Ken , Miyake Masao , Nakamura Tatsuo , Omori Koichi
Published: October 2014

Objectives:

Although our group has had mostly successful results with clinical application of a tracheal prosthesis, delayed epithelial regeneration remains a problem. In our previous studies using rats, it was demonstrated that tracheal fibroblasts accelerated proliferation and differentiation of the tracheal epithelium in vitro and in vivo. The purpose of this study was to evaluate the effects of fibroblasts on epithelial regeneration in larger tracheal defects in rabbits.

Methods:

We developed a bioengineered scaffold, the luminal surface of which was coated with fibroblasts. This scaffold was implanted into tracheal defects in 12 rabbits (bioengineered group), and scaffolds without fibroblasts were implanted in 12 rabbits (control group). The regenerated epithelium was histologically examined by light microscopy, scanning electron microscopy, and immunohistochemical studies.

Results:

In the bioengineered group, a stratified squamous epithelium was observed on the surface 7 days after transplantation. However, in the control group, the scaffolds were exposed. Fourteen days after implantation, a columnar ciliated epithelium was observed in the bioengineered group. The average thickness of the regenerated epithelium in the bioengineered group was significantly greater than that in the control group.

Conclusions:

This study indicated that fibroblasts had a stimulatory effect that hastened regeneration of the epithelium in large tracheal defects.
Laryngeal Features of External Superior Laryngeal Nerve Denervation: Revisiting a Century-Old Controversy
Authors: Roy Nelson , Smith Marshall E. , Houtz Daniel R.
Published: October 2014

A long-standing controversy exists regarding the laryngoscopic features associated with unilateral denervation of the external superior laryngeal nerve (ESLN). Recently, we modeled acute unilateral cricothyroid muscle paralysis by blocking the ipsilateral ESLN with lidocaine hydrochloride, and identified epiglottic petiole deviation to the side of paralysis during high-pitched voice production as a possible diagnostic sign. This study provides preliminary clinical evidence supporting the presence of petiole deviation in cases of ESLN denervation. Epiglottic petiole deviation to the side of weakness was present in electromyographically confirmed cases of unilateral partial or complete ESLN denervation, in isolation or in combination with denervation of other branches of the vagus nerve. In addition, a case of complete ESLN and recurrent laryngeal nerve (RLN) denervation showed return of the petiole to the midline 6 months after surgical reinnervation of the ESLN and RLN. Finally, petiole deviation was not present in isolated RLN paralysis — A finding suggesting that the diagnostic sign is uniquely associated with ESLN denervation. We concluded that deviation of the petiole to the side of cricothyroid muscle weakness during high-pitched voice production represents a potential diagnostic sign of unilateral ESLN denervation. Further research is necessary to determine factors that influence the expression and detection of this sign, as well as its diagnostic precision.
Temporomandibular Joint Osteochondromatosis: An Unusual Cause of Preauricular Swelling
Authors: Phelan Eimear , Griffin John , Timon Conn
Published: October 2014

We report an unusual and rare cause of preauricular swelling and review the most recent literature concerning synovial osteochondromatosis of the temporomandibular joint. We report the clinical and radiologic findings of a case of synovial osteochondromatosis of the temporomandibular joint that presented as preauricular swelling in a female patient. This disease typically affects large joints; fewer than 100 cases reported in the literature affect the temporomandibular joint. This case illustrates that disorders of the temporomandibular joint should also be included in the differential diagnosis of patients who present with a preauricular mass.
Posterior Glottic Diastasis: Mechanically Deceptive and Often Overlooked
Authors: Zeitels Steven M. , de Alarcon Alessandro , Burns James A. , Lopez-Guerra Gerardo , Hillman Robert E.
Published: October 2014

Dysphonia secondary to posterior glottic aerodynamic incompetence can often be recognizable acoustically, but difficult to document visually. This mechanical impairment in posterior glottic closure is the result of injury caused by airway instrumentation. The difficulty of recognition of this entity is due to posterior supraglottic soft tissue that obscures the complete view during posterior glottic adduction, the lack of a structural organization of the cricoarytenoid region injury that leads to this disorder, and the lack of nomenclature. A retrospective assessment was done on 3 patients who underwent surgical reconstruction to correct posterior phonatory incompetence subsequent to laryngotracheal intubation. All 3 had sustained an injury to the cricoarytenoid joints, and 2 of the 3 had undergone paraglottic space medialization laryngoplasty that failed to solve the posterior glottic insufficiency. New procedures were designed and performed in these patients to correct the posterior glottic incompetence and are described: Laryngofissure and partial posterior cricoid resection, endoscopic pharyngoepiglottic-aryepiglottic fold advancement-rotation flap with interarytenoid interposition, and interarytenoid submucosal implant augmentation. Although the academic literature is replete with reports describing stenosis resulting from impaired cricoarytenoid joint abduction, the term glottic diastasis provides nomenclature for the inability to normally adduct the arytenoid cartilages. The initial experience with surgical reconstruction is preliminary, but encouraging.
Eye Movements in Response to Electrical Stimulation of the Lateral and Superior Ampullary Nerves
Authors: Guyot Jean-Philippe , Sigrist Alain , Pelizzone Marco , Feigl Georg C. , Kos Maria Izabel
Published: October 2014

Objectives:

Recently, we demonstrated that it was possible to elicit vertical eye movements in response to electrical stimulation of the posterior ampullary nerve. In order to develop a vestibular implant, a second site of stimulation is required to encode the horizontal movements.

Methods:

Three patients with disabling Meniere's disease were included in the study. Before a labyrinthectomy via a standard transcanal approach was performed, their lateral and anterior ampullary nerves were surgically exposed under local anesthesia through a procedure we recently developed. The attic was opened, the incus and malleus head were removed, and a small well was drilled above the horizontal portion of the facial nerve canal to place an electrode. This electrode was used to deliver balanced biphasic trains of electrical pulses.

Results:

The electrical stimuli elicited mainly horizontal nystagmus without simultaneous stimulation of the facial nerve.

Conclusions:

It is possible to stimulate electrically the lateral and superior ampullary nerves without simultaneous stimulation of the facial nerve. Because the nerves run close to each other, electrical stimulation provoked eye movements that were not purely horizontal, but also had some vertical components. Nevertheless, this site can be used to encode horizontal movements, because central adaptation may correct unnatural afferent vestibular cues delivered by a prosthetic sensor. The range of stimulus intensities that produced a response was broad enough for us to envision the possibility of encoding eye movements of various speeds.
Neurologic Variant Laryngomalacia Associated with Chiari Malformation and Cervicomedullary Compression: Case Reports
Authors: Petersson Rajanya S. , Wetjen Nicholas M. , Thompson Dana M.
Published: October 2014

Two infants presented with intermittent stridor and evidence of laryngomalacia on flexible laryngoscopy. The first was a 10-month-old girl who had undergone 3 supraglottoplasty surgeries at an outside institution, without long-term resolution of symptoms. She was found during our evaluation to have a Chiari malformation. Laryngomalacia symptoms resolved after suboccipital decompression and C1 laminectomy, and the patient remained symptom-free at 6-month follow-up. The second infant was a 24-day-old boy with velocardiofacial syndrome who was found to have posterior cervicomedullary junction compression at the level of C1. He underwent C1 laminectomy for decompression of the brain stem, which resulted in immediate resolution of symptoms, and he remained symptom-free at 12-month follow-up. Neurologic abnormalities have been reported in up to 50% of infants with laryngomalacia. As such, brain stem dysfunction should be considered among the causes of laryngomalacia during evaluation, especially in patients with failure of supraglottoplasty. Both of these infants had resolution of symptoms after their neurosurgical procedures.
Systematic Review of Endoscopic Airway Findings in Children with Gastroesophageal Reflux Disease
Authors: May Jason Glenn , Shah Priyanka , Lemonnier Lori , Bhatti Gaurav , Koscica Jovana , Coticchia James M.
Published: October 2014

Objectives:

We performed a systematic review of published literature correlating findings on endoscopic evaluation of the larynx and trachea in the pediatric population with the incidence of gastroesophageal reflux disease.

Methods:

Eight articles were identified through a structured PubMed search of English-language literature using the key terms laryngopharyngeal reflux, extraesophageal reflux, and gastroesophageal reflux. A systematic review was performed relating the presence of reflux in the pediatric population to findings on endoscopic airway evaluation. A covariant analysis was performed, and each study was weighted according to the number of available samples in that study as a fraction of the total. Overall odds ratios and confidence intervals were computed for each endoscopic finding on the basis of the documented absence or presence of gastroesophageal reflux disease.

Results:

A correlation was seen between the endoscopic findings and the presence of reflux.

Conclusions:

Arytenoid, postglottic, and vocal fold edema and erythema, lingual tonsil hypertrophy, laryngomalacia, and subglottic stenosis are among the endoscopic findings most frequently identified in patients with gastroesophageal reflux disease. Certain findings commonly encountered on endoscopic evaluation of the larynx and trachea in children who present with respiratory symptoms do indeed demonstrate a correlation with the presence of laryngopharyngeal reflux disease and may indicate the need for antireflux therapy.
Use of Intraoperative Laryngeal Electromyography to Evaluate Stridor in Children with Arthrogryposis
Authors: Scott Andrew R. , Kudak Brent A. H. , Skinner Stanley , Sidman James D.
Published: October 2014

Objectives:

Arthrogryposis is a rare, congenital condition characterized by joint contractures of the extremities with muscle weakness and fibrosis. The otolaryngological manifestations of this disorder may include stridor, chronic aspiration, and Pierre Robin sequence, among others. Prior reports of vocal fold immobility associated with arthrogryposis have attributed it to recurrent laryngeal nerve paralysis, rather than to cricoarytenoid joint restriction. The objective of this study was to determine whether children with arthrogryposis and vocal fold immobility demonstrated laryngeal electromyography (L-EMG) findings consistent with recurrent laryngeal nerve paralysis or with cricoarytenoid joint restriction.

Methods:

A retrospective, institutional chart review of children with otolaryngological manifestations of arthrogryposis was performed; 6 children were identified. Three patients had vocal fold immobility documented by flexible laryngoscopy. These 3 children were prospectively evaluated with direct laryngoscopy and intraoperative L-EMG.

Results:

The 3 children with arthrogryposis and vocal fold dysfunction had laryngoscopy-confirmed vocal fold immobility or significant restriction of motion. The intraoperative L-EMG tracings obtained from all 3 patients demonstrated motor unit action potentials without evidence of denervation.

Conclusions:

This series, albeit small, suggests that the vocal fold dysfunction related to arthrogryposis may be attributable to cricoarytenoid joint restriction or poor laryngeal coordination, rather than to nerve paralysis, as originally postulated.