bluuebunny/crossref_metadata_2025 huggingface dataset:
Uvulopalatopharyngoplasty: Results of a Patient Questionnaire
Authors: Carpenter Janette M. , LaMear William R.
Published: October 2014

Objectives:

This study was performed to evaluate patient satisfaction after uvulopalatopharyngoplasty (UPPP).

Methods:

One hundred forty-five patients returned surveys in an otolaryngology group. The patients had undergone UPPP for snoring, sleep apnea, or both between April 1, 2000, and April 5, 2005.

Results:

Most patients (103; 78%) reported being satisfied with their surgery, and most (96; 71%) stated that they would choose to have the surgery again. Postoperative improvement was reported by 85% of patients who had surgery for snoring alone, 88% of those who had surgery for sleep apnea alone, and 83% of those who had surgery for both. Patients who had a sleep study before surgery had a satisfaction rate of 90.3%, whereas only 62% of those who did not have a sleep study were satisfied. Fifty-three percent of those who had used continuous positive airway pressure still needed it after the operation.

Conclusions:

Most patients who had UPPP were satisfied and would choose to have the surgery again. The most satisfied patients had sleep apnea or sleep apnea and snoring together, as well as a sleep study before surgery. It is important to emphasize that UPPP does not cure everyone of sleep apnea or snoring and that it may not eliminate the need for continuous positive airway pressure.
EP4 Agonist Inhibits Lipopolysaccharide-Induced Mucus Secretion in Airway Epithelial Cells
Authors: Hattori Reiko , Shimizu Shino , Majima Yuichi , Shimizu Takeshi
Published: October 2014

Objectives:

We examined the in vivo effects of agonists for prostaglandin E2 receptors (EP1, EP2, EP3, and EP4) on mucus hypersecretion. We also examined the in vitro effects of EP agonists on airway epithelial cells.

Methods:

For the in vivo study, we induced hypertrophic and metaplastic changes of goblet cells in rat nasal epithelium by intranasal lipopolysaccharide (LPS) instillation. For the in vitro study, we used NCI-H292 cells and cultured human nasal epithelial cells.

Results:

Subcutaneous injection of the EP4 agonist (1 to 100 μg/kg) dose-dependently inhibited LPS-induced mucus production and neutrophil infiltration. The EP3 agonist (100 μg/kg) also had some inhibitory effects on mucus production, whereas the EP1 and EP2 agonists showed no effect. The LPS-induced mucus secretion was significantly inhibited by the EP3 and EP4 agonists at 10−6 mol/L in cultured epithelial cells. The LPS-induced interleukin-8 secretion was also inhibited by the EP3 and EP4 agonists.

Conclusions:

These results indicate that the EP4 agonist inhibited LPS-induced airway mucus hypersecretion directly or indirectly through the suppression of interleukin-8 secretion and neutrophil infiltration.
Effect of Fibroblasts on Epithelial Regeneration on the Surface of a Bioengineered Trachea
Authors: Nomoto Yukio , Kobayashi Ken , Tada Yasuhiro , Wada Ikuo , Nakamura Tatsuo , Omori Koichi
Published: October 2014

Objectives:

Our group applied a tracheal prosthesis, which was composed of polypropylene as the frame and collagenous sponge as the scaffold, to the first human case and had successful results. The objective of this study was to find a way to acquire more rapid re-epithelialization with fibroblasts on this tracheal prosthesis.

Methods:

Tracheal epithelial cells, which were isolated from the trachea of rats, were suspended in a collagenous gel. The collagenous gel with fibroblasts was layered on a collagenous sponge. The grafts of this “bioengineered trachea” were implanted into tracheal defects of rats, and the regenerated epithelium on the grafts was histologically examined.

Results:

Seven days after implantation, stratified squamous epithelium covered almost all of the surface of the gel, and some of the implanted fibroblasts in the gel were lined up just below the epithelium. Fourteen days after implantation, columnar and cuboidal ciliated epithelium covered almost all of the surface of the defects, and the implanted fibroblasts had disappeared. The numbers of regenerated epithelial cells at 14 days after implantation were larger than those of control models without fibroblasts, with statistical significance.

Conclusions:

The results suggested that the grafts of bioengineered trachea composed of collagenous sponge and collagenous gel with tracheal fibroblasts accelerated epithelial differentiation and proliferation in vivo.
Current State of Scanning Micromanipulator Applications with the Carbon Dioxide Laser
Authors: Remacle Marc , Lawson Georges , Nollevaux Marie-Cécile , Delos Monique
Published: October 2014

Objectives:

The development of the scanning system AcuBlade has considerably enhanced carbon dioxide laser energy delivery, improving cutting and ablation modes. The scanning system can be applied with the 2 available high-powered pulsed waves, SuperPulse and UltraPulse. This study was conducted to determine whether there are any differences in phonosurgery between the SuperPulse and UltraPulse lasing applications with regard to thermal diffusion into the surrounding tissues, healing time, and clinical results.

Methods:

Thirteen patients with bilateral and similar vocal fold lesions underwent operation — One side in SuperPulse mode and the other side in UltraPulse mode. The parameters for phonosurgery were depth of 0.2 mm, 10 W, single pulse, and 0.10 second for SuperPulse, and 2 passes, 10 W, single pulse, and 0.10 second for UltraPulse.

Results:

Incisions were sharper with UltraPulse, making the surgery easier, but at the first postoperative follow-up visit, after 8 to 10 days, no differences were observed in the presentation, the healing, or the vibration of the 2 vocal folds. Coagulation along the incision line was 25 μm for SuperPulse and 15 μm for UltraPulse (median values).

Conclusions:

In comparison with SuperPulse, the UltraPulse carbon dioxide laser made the procedure easier, but did not improve the clinical outcome.
Multicenter Registry of Balloon Catheter Sinusotomy Outcomes for 1,036 Patients
Authors: Levine Howard L. , Sertich Anthony P. , Hoisington Douglas R. , Weiss Raymond L. , Pritikin Jordan ,   for the PatiENT Registry Study Group
Published: October 2014

Objectives:

This study assesses the safety and effectiveness of balloon catheters used as instruments in sinus surgery in a “real-world” multicenter registry of 1,036 patients across 27 US otolaryngology practices.

Methods:

Data were collected by standardized chart review with centralized database administration for all consecutive functional endoscopic sinus surgeries that included the use of balloon catheters across the 18-month time period from December 2005 to May 2007.

Results:

Balloon catheters were used in 3,276 peripheral (maxillary, frontal, and sphenoid) sinuses, for an average of 3.2 sinuses per patient. There were no major adverse events related to the use of balloon catheter instruments. The revision rate was 1.3% of sinuses treated with a balloon catheter after an average follow-up of 40.2 weeks. Sinus symptoms were improved in 95.2%, unchanged in 3.8%, and worse in 1.0% of patients. Postoperative sinus infections were significantly less frequent and less severe compared to infections before surgery. The results were consistent across all patient categories, including balloon-only patients and revision patients.

Conclusions:

Use of balloon catheters as instruments in sinus surgery appears to be relatively safe and effective and to improve the patient's quality of life. The results are consistent and generalizable across a wide range of sinusitis patients and physician practices. The complication rates, revision rates, and patient symptom improvement rates all compare favorably with previously reported results of functional endoscopic sinus surgery.
Role of Sialoscopy in the Treatment of Stensen's Duct Strictures
Authors: Koch Michael , Iro Heinrich , Zenk Johannes
Published: October 2014

Objectives:

The origin of strictures of Stensen's duct often remains unclear, but chronic recurrent parotitis may be one associated disease. Failure of conservative therapy leads to a recommendation of parotidectomy in a high percentage of cases. Nowadays, development of new, minimally invasive methods may lead to a fundamental change in the treatment regimen.

Methods:

We retrospectively evaluated 39 patients who presented with symptomatic strictures of Stensen's duct from 2002 to 2005. Sialoscopy was performed with semirigid endoscopes. Therapy consisted of irrigation and intraductal infusion of cortisone. If possible, interventional sialoscopy was carried out as the first-line procedure. If indicated, operative procedures of the duct were performed.

Results:

After irrigation and intraductal medication, 17.9% of the patients were free of symptoms. Interventional sialoscopy was carried out in 74.4%, with a success rate of 75.9%. Operative duct procedures (extended papillotomy or resection of papilla stricture with duct reinsertion) were carried out in 23% of cases. In 5.1% of the total cases, parotidectomy was unavoidable.

Conclusions:

Sialoscopy-based methods play a central role in gland-preserving treatment of strictures of Stensen's duct. Sialoscopy has proven to be a fast, useful, and relatively safe therapeutic tool with a high success rate. Parotidectomy is the last choice in symptomatic cases.
Acute Myopericarditis Complicating Acute Tonsillitis: Beware the Young Male Patient with Tonsillitis Complaining of Chest Pain
Authors: Talmon Yoav , Gilbey Peter , Fridman Nancy , Wishniak Alice , Roguin Nathan
Published: October 2014

Objectives:

We describe 11 cases of myopericarditis complicating bacterial tonsillitis.

Methods:

We performed a retrospective study of all cases of myopericarditis treated at one hospital during the years 2005 and 2006.

Results:

The patients were all young men. The average latency from the onset of throat pain to the onset of chest pain was 4.6 days. All patients complained of chest pain. The most common electrocardiographic finding was transient ST segment elevations. The levels of cardiac enzymes and troponin were elevated in all cases.

Conclusions:

Otolaryngologists should be aware of this rare entity. Additional studies are indicated to evaluate the exact incidence of myopericarditis associated with acute streptococcal tonsillitis.
Concurrent Influenza A and Group A Beta-Hemolytic Streptococcal Pharyngotonsillitis
Authors: Brook Itzhak , Gober Alan E.
Published: October 2014

Objectives:

A concurrent group A β-hemolytic Streptococcus (GABHS)–influenza virus pharyngotonsillitis (PT) is generally not considered in diagnoses, even though mixed bacterial-viral infections are common in other respiratory tract infections. This report describes our experience in diagnosing a potential mixed GABHS–influenza virus PT in children.

Methods:

Acute and convalescent antistreptolysin O (ASO) and anti-DNase B titers were obtained from 12 children with acute PT and clinical presentation that suggested viral infection, and in whom both rapid influenza A virus and rapid GABHS tests were positive.

Results:

The children did not receive any antimicrobial therapy, and all recovered from their acute PT within 2 to 5 days and were all asymptomatic upon their return visit 3 to 4 weeks later. GABHS was recovered from 2 of the children on their return visit. However, ASO and anti-DNase B titers were not elevated in these individuals. The ASO and anti-DNase B titers determined in the first serum samples were less than the age-adjusted normal values for all of the children. However, these titers rose by at least two-dilution (0.2 logarithm) in the convalescent sera as compared with the acute ones in 4 of the 12 children (33%). One of the 8 children who had no increase in ASO and anti-DNase B titers had an acute GABHS PT 5 months later. One-year follow-up of all of the children showed no anomalies.

Conclusions:

This report is the first to describe a concomitant GABHS and influenza A virus PT, as evident by increased ASO and anti-DNase B titers in a third of the patients who had both of these organisms detected in their upper airways.
Management of Neurologic Disorders of the Larynx
Authors: Woodson Gayle
Published: October 2014

Objectives:

I review the literature on management of neurologic disorders of the larynx.

Methods:

I reviewed the literature on laryngeal physiology, clinical evaluation of laryngeal function, and the clinical presentation and treatment of neurologic disorders that frequently affect the larynx.

Results:

Laryngeal function is complex, as this organ is important in breathing, speech, and swallowing. Coordination of these roles is very susceptible to disruption by neurologic disorders. Diagnosis of neurologic disease is primarily based on history and physical examination; however, the diagnosis of laryngeal dysfunction is frequently overlooked, because the larynx is not easily accessible to examination by non-otolaryngologists. Evaluation of laryngeal function includes listening to the voice, systematic observation of the larynx during speech and nonspeech tasks, and, sometimes, ancillary tests. Neurologic disorders that affect laryngeal function include Parkinson's disease, essential tremor, stroke, amyotrophic lateral sclerosis, multiple sclerosis, and dystonia. The otolaryngologist can sometimes provide treatment to specifically improve symptoms of laryngeal involvement.

Conclusions:

Otolaryngology consultation is important in the diagnosis and treatment of neurologic disorders that affect laryngeal function. The otolaryngologist should be able to perform a systematic evaluation of laryngeal and pharyngeal function, and should be aware of the clinical presentation of neurologic disorders that affect the larynx.
Optical Coherence Tomography Imaging of the Inner Ear: A Feasibility Study with Implications for Cochlear Implantation
Authors: Lin James , Staecker Hinrich , Jafri M. Samir
Published: October 2014

Cochlear implantation is now being performed in ears with residual hearing. Those implant recipients who keep residual hearing may benefit from improved pitch resolution through both electrical and acoustic hearing. Preservation of cochlear function after implantation is a challenging task for the surgeon. Current topics of hearing preservation research include electrode design and surgical technique. To maintain hearing, surgeons strive to create a cochleostomy and place the electrode in a minimally traumatic fashion. In this study, we examine a novel catheter-based real-time imaging modality with 10- to 15-μm resolution, optical coherence tomography (OCT), on the inner ear. We demonstrate the capability of OCT to allow visualization of inner ear structures through bone in live mice. We additionally used OCT to image the inner ear in a human temporal bone. Optical coherence tomography was able to delineate soft tissue structures within the cochlea and may be useful as an adjunct to cochlear implantation. Other potential otologic applications of OCT are discussed.
Should a Hearing Aid in the Contralateral Ear Be Recommended for Children with a Unilateral Cochlear Implant?
Authors: Beijen Jan-Willem , Mylanus Emmanuel A. M. , Leeuw A. Rens , Snik Ad F. M.
Published: October 2014

Objectives:

To predict bimodal benefit before cochlear implantation, we compared the performances of participants with bimodal fitting and with a cochlear implant alone on speech perception tests.

Methods:

Twenty-two children with a cochlear implant in one ear and a hearing aid in the other (bimodal fitting) were included. Several aided and unaided average hearing thresholds and the aided word recognition score of the hearing aid ear were related to the bimodal benefit on a phoneme recognition test in quiet and in noise. Results with bimodal fitting were compared to results with the cochlear implant alone on a phoneme recognition test in quiet and in noise.

Results:

No relationship was found between any of the hearing thresholds or the aided phoneme recognition score of the hearing aid ear and the bimodal benefit on the phoneme recognition tests. At the group level, the bimodal scores on the phoneme recognition tests in quiet and in noise were significantly better than the scores with the cochlear implant alone.

Conclusions:

Preoperatively available audiometric parameters are not reliable predictors of bimodal benefit in candidates for cochlear implantation. Children with unilateral implants benefit from bimodal fitting on speech tests. This improvement in performance warrants the recommendation of bimodal fitting even when bimodal benefit cannot be predicted.
Clinical Experience with Gray's Minithyrotomy Procedure
Authors: Paniello Randal C. , Sulica Lucian , Khosla Siddarth M. , Smith Marshall E.
Published: October 2014

Objectives:

Endoscopic approaches for submucosal vocal fold surgery may limit the surgeon's ability to release scars or to precisely implant filler material such as fat. In 1999, Gray et al described the “minithyrotomy” approach to this region. Technical aspects of this important new technique, clinical indications, and early results are reviewed.

Methods:

We performed a retrospective review and compiled the data of the office records, clinical notes, and videostroboscopic examinations of all of the four authors' patients who underwent this procedure.

Results:

Twenty-one patients underwent 22 minithyrotomy procedures for vocal fold scarring (6), lateralizing scar following polytetrafluoroethylene removal or trauma (5), scar with radiation fibrosis (2), sulcus vocalis (2), or presbylarynx or bowing (6) — Bilaterally in 14 operations and unilaterally in 8. There were 13 male patients and 8 female patients, with a mean age of 58.3 years (range, 22 to 87 years). The mean follow-up was 9.1 months (range, 1 to 46 months). After submucosal vocal fold exploration, autologous fat was implanted in 20 of the 21 patients. Postoperative videostroboscopy demonstrated improved mucosal pliability in 19 cases and improved glottal closure in 20 cases. Most patients noted voice improvement. Complications were minimal.

Conclusions:

Gray's minithyrotomy is a highly effective approach for treating vocal fold scar processes, bowing, sulcus vocalis, and, potentially, other conditions.
Cidofovir Efficacy in Recurrent Respiratory Papillomatosis: A Randomized, Double-Blind, Placebo-Controlled Study
Authors: McMurray J. Scott , Connor Nadine , Ford Charles N.
Published: October 2014

Objectives:

We performed a prospective, double-blind, placebo-controlled, longitudinal adjuvant therapy trial to determine the efficacy of cidofovir in the treatment of severe recurrent respiratory papillomatosis (RRP). Although results of case series suggest that cidofovir may decrease the frequency and rapidity of papilloma regrowth, no blinded placebo-controlled studies have demonstrated efficacy.

Methods:

Adults and children (n = 19) with aggressive RRP received either active drug (cidofovir) or placebo. When surgical intervention was needed, drug or placebo was injected into affected areas after surgical removal of disease. The following measures were made at baseline and at 2-month intervals for the course of 12 months: Derkay papilloma severity grading scale, Voice Handicap Index, Health-Related Quality of Life, and total number of procedures performed over 12 months.

Results:

At 2- and 12-month follow-ups, there was a significant (p < .05) improvement in the Derkay Severity Score within the cidofovir and placebo groups, but no difference between groups, and no difference between groups in the number of procedures performed. Significant improvement was found in Voice Handicap Index scores in the cidofovir group at the 12-month follow-up. No differences were seen in Health-Related Quality of Life.

Conclusions:

A randomized, blinded, placebo-controlled trial is necessary in the study of RRP, because the natural history of the disease can include remissions and reactivations. We found a significant improvement in the Derkay Severity Score 12 months after the baseline assessment in patients treated with cidofovir. This effect, however, was also seen in the placebo group. Accordingly, we were unable to provide proof of efficacy of cidofovir in the treatment of RRP.
Effect of Changing Airway Pressure on the Ability of the Human Nose to Warm and Humidify Air
Authors: Sahin-Yilmaz Asli , Baroody Fuad M. , deTineo Marcy , Cuttance Georgina , Makinson Doug , Pinto Jayant M. , Naureckas Edward T. , Naclerio Robert M.
Published: October 2014

Objectives:

Nasal continuous positive airway pressure (CPAP) treatment causes nasal symptoms that are believed to result from the drying effects of the air on the nasal mucosa, and these symptoms affect compliance with therapy. We hypothesized that the increased air pressure on the nasal mucosa caused by positive pressure from CPAP would decrease the ability of the nose to warm and humidify inspired air, explaining these symptoms.

Methods:

We performed a 4-way crossover trial using CPAP pressures of −5, 0, +5, and +10 cm H2O in 10 subjects. The ability to warm and humidify inspired air was determined by measurement of the temperature of a fixed volume of cold, dry air entering and exiting the nostril and calculation of the amount of water supplied to the airstream by the nose.

Results:

The water content of air was unaffected at the pressures studied.

Conclusions:

The pressure of delivered CPAP does not affect the ability of the nose to warm and humidify inspired air.
Unilateral Blindness following Septoplasty
Authors: Shihada Rabia , Fradis Milo , Vardizer Yoav , Braun Jacob , Luntz Michal
Published: October 2014

Visual loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to orbital apex syndrome following septoplasty. We also review the literature and discuss probable causes. To the best of our knowledge, this is only the second published report of this complication.
Observations on Bilateral Symmetry of the Stapedial Footplate Lesion and Narrowing of the Oval Window Niche in Otosclerosis
Authors: Gristwood Ronald Edward , Bedson Janet
Published: October 2014

Objectives:

We consider whether patients with bilateral otosclerosis who have surgery on their second ear show symmetry in the degree of severity of their footplate otosclerosis.

Methods:

The severity of the stapedial otosclerotic lesion and the degree of narrowing of the oval window niche by exostoses were recorded for each ear of 269 patients who elected to undergo operation on the second ear. The severities and similarities of the otosclerotic lesion affecting the oval window niche were compared between the ears.

Results:

The majority of oval window niches were normal in width in both ears. A niche narrowed to less than 0.8 mm in diameter was rare and tended to affect both ears (5.6% first ears and 5.95% second ears; χ2 = 134.6 on 4 df; p < .0001). The degree of footplate otosclerosis was classified and amalgamated into 3 broad categories: Minor (47.2%), moderate (21.6%), and severe (31.2%). A high degree of bilateral symmetry of the stapedial footplate lesion was found (χ2 = 162.2 on 4 df; significant at .0001 level).

Conclusions:

The findings at the oval window of the first ear in regard to the severity of otosclerotic involvement of the stapes footplate and narrowing of the niche by exostoses do allow a fair prediction of the pathological findings in the second ear, if that ear is suitable for stapes surgery and the patient elects to have an operation. The surgeon is forewarned of possible difficulties and technical challenges if an operation has been performed on the first ear.
Long-Term Results of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy as Treatment for Life-Threatening Aspiration
Authors: Kos Martijn P. , David Eric F. L. , Aalders IJke J. , Smit C. Frits , Mahieu Hans F.
Published: October 2014

Objectives:

We evaluated the long-term results of laryngeal suspension and upper esophageal sphincter (UES) myotomy in patients with life-threatening aspiration.

Methods:

In the period 1995 to 2004, 17 patients with severe aspiration caused by insufficient laryngeal elevation and absent or negligible pharyngeal constrictor muscle activity during deglutition resulting in aspiration pneumonia were surgically treated with a laryngeal suspension procedure and UES myotomy. Preoperative and postoperative videofluoroscopy was performed to assess swallowing and aspiration.

Results:

In 9 of the 17 patients, long-term (more than 1 year) full oral intake without aspiration was achieved. Three other patients demonstrated improvement of deglutition with partial restoration of oral intake with adjusted food consistency, but remained partly dependent on gastrostomy feeding for adequate nutrition. Two patients no longer had cases of aspiration pneumonia, but were unable to achieve even modified oral intake. Three patients finally underwent total laryngectomy — 2 of them after initial successful full oral intake without aspiration but with recurrent aspiration as a result of progression of neuromuscular disease. None of the patients succumbed to aspiration pneumonia.

Conclusions:

In most of our patients, life-threatening aspiration was successfully treated by UES myotomy and laryngeal suspension with restoration of oral intake.
Pedicled Temporoparietal Galeal Flap for Reconstruction of Intraoral Defects
Authors: Pinto Fábio Roberto , de Magalhães Roberto Pereira , de Aquino Capelli Fábio , Brandão Lenine Garcia , Kanda Jossi Ledo
Published: October 2014

Objectives:

In this report we aim to describe the surgical technique required to utilize the pedicled temporoparietal galeal flap for repair of selected intraoral defects and to report our experience with this type of reconstructive procedure.

Methods:

The charts of 6 consecutive patients submitted to reconstruction of intraoral defects using the pedicled temporoparietal galeal flap were reviewed. All of the defects were located in the posterior oral cavity and oropharynx. After resection of the oral cancer, the temporoparietal galeal flap, based on the superficial temporal vessels, was raised and transposed to the mouth through a tunnel under the zygomatic arch. The oral defect was repaired, and no skin graft was applied over the flap.

Results:

There were no flap losses, and the reconstructive goal was achieved in all cases. The patients' deglutition and phonation abilities were restored, and the donor site scars were well hidden by hair growth.

Conclusions:

The pedicled temporoparietal galeal flap is another option for selected cases of reconstruction of intraoral defects — Mainly those located in the posterior oral cavity and oropharynx, in which thin and pliable tissues are usually required.
Extracellular Matrix Gene Expression after Vocal Fold Injury in a Rabbit Model
Authors: Rousseau Bernard , Ge Ping Jiang , Ohno Tsunehisa , French Lesley C. , Thibeault Susan L.
Published: October 2014

Objectives:

We determined the expression of matrix metalloproteinase (MMP)–1, MMP-9, collagen types I and III, and fibronectin from rabbit vocal folds after injury.

Methods:

Thirty rabbits were involved in this study. Five animals were assigned to each time period. Noninjured vocal fold specimens were collected as a control. Gene expression was analyzed at 2, 4, 8, 24, 48, and 72 hours after injury by use of real-time polymerase chain reaction.

Results:

Compared to 2 hours after injury, MMP-1 expression was increased at 4, 8, 24, 48, and 72 hours. Compared to 4 hours, MMP-1 expression was increased at 8, 24, 48, and 72 hours. Compared to the control specimens, MMP-9 expression was increased at 4, 8, 24, 48, and 72 hours. Compared to 2 hours, MMP-9 expression was increased at 4, 8, 24, 48, and 72 hours. Compared to 2 and 4 hours, collagen type I expression was increased at 72 hours. Collagen type III expression was increased at 72 hours compared to 2, 4, and 8 hours. Compared to 2 hours, fibronectin expression was increased at 24, 48, and 72 hours.

Conclusions:

Results revealed time-dependent changes in expression of MMP-1, MMP-9, collagen types I and III, and fibronectin from rabbit vocal folds after injury. Future experiments are planned to investigate the effects of phonation on expression of these genes after injury.
High-Speed Imaging Used to Detect Vocal Fold Paresis: A Case Report
Authors: Mortensen Melissa , Woo Peak
Published: October 2014

High-speed imaging has been used to study vocal fold vibration and has been shown to provide additional information in aid of our understanding of pathologic vocal fold vibration. This is the first case report of vocal fold paresis diagnosed by high-speed imaging. An 18-year-old girl presented with intermittent voice loss that had been present for 4 years. The patient had been seen by other otolaryngologists and had been given proton pump inhibitors without any improvement in her voice. Her voice was diplophonic. The patient was examined by rigid stroboscopy and was found to have a predominantly open phase pattern but a normal vibratory pattern. High-speed photography showed a distinct vibratory frequency for each vocal fold, suggestive of a paresis pattern. Laryngeal electromyography confirmed the diagnosis of vocal fold paresis. A computed tomographic scan of the larynx and chest showed a thymoma. After thymectomy, the patient recovered full voice function. High-speed imaging is useful for the clinical evaluation of pathologic vocal fold vibration and can detect subtle features of paralysis that may not be detected on fiberoptic endoscopy and rigid stroboscopy. The additional information from high-speed imaging helped to make the diagnosis of vocal fold paresis in this patient.
Imaging Case Study of the Month Traumatic Pneumolabyrinth
Authors: de Negreiros Jacinto , Sampaio André L. L. , Sesana Wilson E. , Oliveira Carlos A.
Published: October 2014

Pneumolabyrinth is a condition in which air is present in the vestibule and/or in the cochlea. Air inside the inner ear structures is uncommon, and is not detected even in otic capsule–violating fractures or in transverse fractures of the temporal bone. It is rarely described in the literature. We present a longitudinal computed tomography (CT) study of a significant pneumolabyrinth due to temporal bone trauma in a 31-year-old man. Routine CT of the cranium performed 3 hours after the accident showed air inside the vestibule (pneumolabyrinth). Two days later, a new CT study was performed. The air in the vestibule was partially resorbed. There was opacity over the oval window niche and the promontory. Thirteen months after the initial head trauma, another CT examination showed a fracture line running from the vestibule to the posterior wall of the petrous bone. The patient had profound sensorineural hearing loss after the trauma, and the pneumolabyrinth cleared over a few months. Surgical treatment was not indicated.
Recovery of Potential Pathogens in the Nasopharynx of Healthy and Otitis Media—Prone Children and Their Smoking and Nonsmoking Parents
Authors: Brook Itzhak , Gober Alan E.
Published: October 2014

Objectives:

Exposure to smoking is associated with colonization with pathogenic bacteria. This study investigated the frequency of isolation of potential pathogens in the nasopharynx of healthy and otitis media–prone (OMP) children and their smoking or nonsmoking parents.

Methods:

Posterior nasopharynx cultures were taken from 40 healthy and 40 OMP children and one of their parents. Twenty parents in each group were smokers. Potential pathogenic organisms were identified.

Results:

In the healthy children whose parents smoked, 15 potential pathogens were isolated from the parents and 13 were recovered from their children. Among the healthy children whose parents were nonsmokers, 3 potential pathogens were isolated from 2 parents (p < 0.005, compared to the parents and children in the smoking group) and 7 were recovered from their children. In the OMP children whose parents smoked, 16 potential pathogens were isolated from the parents and 19 were found in their children. Among the OMP children with nonsmoking parents, 3 potential pathogens were isolated from the parents (p < 0.001, compared to the parents and children in the OMP smoking group and the healthy children in the nonsmoking parents group) and 17 were recovered from their children.

Conclusions:

Parents who smoke are more often colonized with pathogens than those who do not smoke. The nasopharynx of healthy children of smokers harbors a high number of pathogens that are similar to the flora found in their parents and OMP children. Pathogenic organisms were found more often in OMP children of both smoking and nonsmoking parents, as compared to healthy children whose parents were nonsmokers. Concordance with pathogens in the parent was high among the OMP children of smoking parents, but this was not observed in the OMP children of nonsmokers.
Effect of Irradiation on the Human Laryngeal Glands
Authors: Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

The present study was conducted to determine the effects of irradiation on the human laryngeal glands.

Methods:

Light and transmission electron microscopic observations were made.

Results:

Granular endoplasmic reticula and Golgi apparatuses were sparse in the cytoplasm of serous and mucous cells in cases with a short duration after radiotherapy. The secretory granules in serous cells had decreased in number. The secretory granules were less electron-dense compared to those in non-irradiated specimens, but were electron-lucent. The mucigen droplets in mucous cells were not as numerous as those in non-irradiated specimens. The discharge of secretory granules and mucigen droplets had decreased. In cases with a long duration after radiotherapy, there were some granular endoplasmic reticula and Golgi apparatuses in the cytoplasm. However, the transmission electron microscopy findings of secretory granules and mucigen droplets were the same as those in the irradiated glands with a short duration after radiotherapy.

Conclusions:

Morphological changes in the irradiated laryngeal glands influenced not only the amount but also the quality of secretions. The above changes lessened the lubrication of the vocal folds, thus causing a voice disorder to some extent. Local immunity and mucociliary transport were also affected. The effects of irradiation on the laryngeal glands partially altered the laryngeal functions.
Sinocutaneous Fistula Secondary to Chronic Frontal Rhinosinusitis: Case Series and Literature Review
Authors: Wu Vivian F. , Smith Timothy L. , Poetker David M.
Published: October 2014

Objectives:

The purpose of this study was to describe the clinical features of a series of patients in whom sinocutaneous fistula developed in the setting of chronic frontal sinusitis.

Methods:

We performed a retrospective case review of patients with sinocutaneous fistula. Clinical records, imaging, and operative reports were carefully examined. A complete literature review for relevant studies was performed to examine similar cases and possible pathophysiology.

Results:

Three patients with sinocutaneous fistula secondary to frontal sinusitis were identified. All patients underwent successful endoscopic sinus surgery with computer-assisted stereotactic localization and closure of the fistula.

Conclusions:

Development of sinocutaneous fistula secondary to frontal sinusitis is rare, but still occurs in the modern antibiotic era. Definitive management of this disease process requires 1) a frontal sinusotomy ensuring patency of the outflow tract and 2) fistula excision and multilayer closure.
Clinical Assessment of Gustatory Function before and after Middle Ear Surgery: A Prospective Study with a Two-Year Follow-up Period
Authors: Mueller Christian A. , Khatib Saher , Naka Asami , Temmel Andreas F. P. , Hummel Thomas
Published: October 2014

Objectives:

Middle ear surgery can affect gustatory function because of the course of the chorda tympani nerve (CTN) close to the tympanic membrane. The aim of the study was to evaluate the sense of taste before and after middle ear surgery with a test suitable for clinical routine. Moreover, subjective complaints were assessed over a relatively long period of time.

Methods:

Forty-seven patients (26 female, 21 male; mean age, 42 years) were investigated before and 4 days after surgery on both sides of the anterior part of the tongue. Self-assessment of taste function was performed by visual analog scales.

Results:

The mean (±SD) taste scores significantly decreased on the side ipsilateral to the operated ear in patients with major manipulation of the CTN (12.0 ± 4.5 before surgery and 6.9 ± 4.5 after surgery; p < 0.001), whereas no significant changes were measured in patients with minor manipulation of the CTN (12.5 ± 3.1 before surgery and 11.2 ± 3.9 after surgery; p = 0.14). Self-assessed ratings of taste function significantly decreased after surgery in all patients (p < 0.001). Reassessment of subjective taste function after 2 years indicated no persisting complaints.

Conclusions:

Depending on the amount of manipulation of the CTN, taste function is decreased after surgery. However, long-lasting changes of gustatory function seem to be rare.
Treatment of Tinnitus with a Customized, Dynamic Acoustic Neural Stimulus: Clinical Outcomes in General Private Practice
Authors: Hanley Peter J. , Davis Paul B. , Paki Bardia , Quinn Shaunine A. , Bellekom Sandra R.
Published: October 2014

Objectives:

We evaluate the relative effectiveness of a newly available tinnitus treatment approach for different categories of patients in general private practice.

Methods:

This was a cohort study, sponsored by Neuromonics, involving the first 470 patients to undertake the Neuromonics Tinnitus Treatment in 7 Neuromonics tinnitus clinics. All patients were provided with a dynamic acoustic neural stimulus, customized to each patient's audiometric profile, for daily use as part of a structured rehabilitation program. Tinnitus disturbance was assessed before, during, and after treatment with the Tinnitus Reaction Questionnaire.

Results:

The outcomes displayed a relation with patients' suitability according to predefined criteria: Among the most suitable patients (tier 1 cohort), 92% exceeded the threshold for success (defined as a reduction in tinnitus-related disturbance of at least 40%), and the mean improvement in tinnitus disturbance was 72%; the discontinuance rate was 4%. For other suitability categories, the success rates and mean improvements were somewhat lower, and the discontinuance rates higher (tier 2: 60%, 49%, and 16%, respectively; tier 3: 39%, 32%, and 17%, respectively).

Conclusions:

The results showed that the treatment is effective for suitable patients in the private practice setting, and they provide health-care professionals with guidance as to what patients might expect from treatment, depending on their degree of suitability.
Vestibular Evoked Periocular Potentials in Meniere's Disease after Glycerol Testing
Authors: Magliulo Giuseppe , Parrotto Donato , Gagliardi Silvia , Cuiuli Giuseppe , Novello Concetta
Published: October 2014

Objectives:

The present investigation was specifically designed to evaluate the clinical application of vestibular evoked periocular potentials (VEPPs) in the diagnosis of endolymphatic hydrops.

Methods:

We compared the results of the traditional pure tone audiometry glycerol test with those of the vestibular evoked myogenic potential (VEMP) glycerol test and the VEPP glycerol test in 22 patients affected by unilateral endolymphatic hydrops.

Results:

Some patients had positive depletive tests with both VEMPs and VEPPs, and other patients had positive tests with either VEMPs or VEPPs.

Conclusions:

Our outcomes confirmed that vestibular evoked potentials represent a useful additional diagnostic tool in the diagnosis of endolymphatic hydrops. The role of VEPPs in this particular issue was not inferior to that of VEMPs. The outcomes also suggested that not only the saccule, but also the utriculus, may be involved in the genesis of VEPPs.
Computer-Aided Technique for Automatic Determination of the Relationship between Transglottal Pressure Change and Voice Fundamental Frequency
Authors: Deguchi Shinji , Kawashima Kazutaka , Washio Seiichi
Published: October 2014

Objectives:

The effect of artificially altered transglottal pressures on the voice fundamental frequency (F0) is known to be associated with vocal fold stiffness. Its measurement, though useful as a potential diagnostic tool for noncontact assessment of vocal fold stiffness, often requires manual and painstaking determination of an unstable F0 of voice. Here, we provide a computer-aided technique that enables one to carry out the determination easily and accurately.

Methods:

Human subjects vocalized in accordance with a series of reference sounds from a speaker controlled by a computer. Transglottal pressures were altered by means of a valve embedded in a mouthpiece. Time-varying vocal F0 was extracted, without manual procedures, from a specific range of the voice spectrum determined on the basis of the controlled reference sounds.

Results:

The validity of the proposed technique was assessed for 11 healthy subjects. Fluctuating voice F0 was tracked automatically during experiments, providing the relationship between transglottal pressure change and F0 on the computer.

Conclusions:

The proposed technique overcomes the difficulty in automatic determination of the voice F0, which tends to be transient both in normal voice and in some types of pathological voice.
Endoscopic KTP Laser Photocoagulation Therapy for Pharyngolaryngeal Venous Malformations in Adults
Authors: Kishimoto Yo , Hirano Shigeru , Kato Naomi , Suehiro Atsushi , Kanemaru Shin-Ichi , Ito Juichi
Published: October 2014

Objectives:

Venous malformations are benign lesions with thin, fragile mucosa overlying a vascular stroma. Vascular anomalies often manifest as subglottic lesions in infants, but venous malformations in adults are rare in the pharyngolaryngeal region. The treatments include open and endoscopic surgery; intraoperative bleeding is often troublesome. Angiolytic lasers such as the potassium titanyl phosphate (KTP) laser enable photocoagulation for such hemorrhagic lesions without bleeding; we report findings from a series of adult patients.

Methods:

Seven adults were treated with a KTP laser set at a low power of 1.5 W in continuous mode. Photocoagulation was easily performed for shallow lesions; however, laser irradiation of bulky venous malformations resulted only in surface photocoagulation. In such cases, the crust remaining after photocoagulation was removed, and laser energy was repeatedly delivered until no remnant lesion was seen. An office procedure using flexible endoscopy was performed under topical anesthesia for 1 patient with a limited lesion.

Results:

The lesions were well controlled in all cases without major complications. A patient with a large obstructing lesion had a relapse. Because the recurrent lesion is small and the patient does not desire additional treatment at this time, she is being observed carefully.

Conclusions:

Photocoagulation using the KTP laser is a feasible and relatively safe treatment for pharyngolaryngeal venous malformations in adults.
Transnasal Esophagoscopy: White-Light versus Narrowband Imaging
Authors: O'Brien Timothy J. , Parham Kourosh
Published: October 2014

Objectives:

Transnasal esophagoscopy (TNE) is rapidly becoming integrated into otolaryngological practice. A recent report has shown an incongruence between an endoscopic diagnosis of Barrett's esophagus and biopsy-proven Barrett's esophagus in patients with laryngopharyngeal reflux (LPR). The goal of this study was to determine whether performing TNE with narrowband imaging (NBI) improves on the diagnostic yield in the otolaryngologist's hands. Narrowband imaging involves the use of filtered light to enhance the mucosal microvasculature pattern and has been shown to be highly sensitive to detecting Barrett's esophagus under conventional esophagoscopy.

Methods:

A retrospective chart review of 111 patients with LPR who underwent TNE by the same otolaryngologist was carried out. Pentax EE-1580K (white light only) and Olympus GIF-N180 (with NBI) endoscopes were used in 58 and 53 patients, respectively. Microcup biopsy of the squamocolumnar junction was obtained when Barrett's esophagus was suspected.

Results:

Biopsy-proven Barrett's esophagus was found in 13.5% of the patients. According to white light only and NBI, 7 of 58 (12.1%) and 8 of 53 (15.1%), respectively, had biopsy-proven Barrett's esophagus. Three patients had dysplasia on biopsy (2.7%), and all of these cases were detected under NBI (5.7%).

Conclusions:

Narrowband imaging may be a useful adjunct in increasing the diagnostic sensitivity of TNE in the hands of the otolaryngologist.
Microbiology and Antimicrobial Susceptibility Patterns of Commensal Flora in the Middle Nasal Meatus
Authors: Kirtsreesakul Virat , Tuntaraworasin Jompon , Thamjarungwong Benjamas
Published: October 2014

Objectives:

We examined the microbiology and antimicrobial susceptibility patterns of commensal flora in the middle nasal meatus of normal subjects who were free of health care–associated risks and sinonasal disease.

Methods:

A prospective study was performed on 70 healthy volunteers without health care–associated risks or sinonasal disease. Middle meatal specimens were carefully taken by an endoscopically guided swab technique. The specimens were cultured for aerobic and anaerobic bacteria. Antimicrobial susceptibility testing was performed by the broth disc method.

Results:

Bacterial growths were recovered in 66 of the 70 specimens (94.3%). Coagulase-negative staphylococci (CNS) were the most common isolates (61.6%), followed by Staphylococcus aureus (11.6%) and Corynebacterium sp (9.3%). All growths were quantified as very rare (73.3%), rare (13.9%), or few (12.8%). Obligate anaerobic bacteria were not identified. The samples positive for CNS showed multiple resistances to antibiotics, including erythromycin stearate (30.2%), clindamycin hydrochloride (28.3%), oxacillin sodium (a clinical substitute for methicillin sodium; 18.9%), and sulfamethoxazole-trimethoprim (9.4%).

Conclusions:

A small amount of CNS with or without multiple antibiotic resistances and/or S aureus cultured from the middle meatus can be considered contaminants in middle meatal culture during an episode of rhinosinusitis.