bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chondromyxoid Fibroma of the Temporal Bone: Case Report and Review of the Literature
Authors: Otto Bradley A. , Jacob Abraham , Klein Michael J. , Welling D. Bradley 
Published: October 2014

Objectives: We describe the clinical presentation, imaging, and pathology results of a patient with chondromyxoid fibroma (CMF) involving the mastoid portion of the temporal bone. The literature covering CMF of the head and neck is reviewed. Methods: The patient chart, including imaging and pathology results, was analyzed. An English-language literature review of skull base CMF was performed. Results: Eighty-seven cases of CMF involving the head and neck have been reported in the scientific literature. Sixty-two cases involved the skull base, temporal bone, nasal cavity, or paranasal sinuses. Including this patient, only 8 cases of CMF isolated to the temporal bone have been reported. Most patients experience insidious onset of symptoms such as hearing loss or headache. A computed tomographic scan best shows the relationship of the tumor to surrounding bone and may show intratumoral calcification. Surgical removal was the treatment most commonly used. Although irradiation has been used in selected cases, it is usually avoided because of the potential risk for malignant transformation. Conclusions: Chondromyxoid fibroma, a slow-growing bone tumor, is exceedingly rare within the mastoid. Its differential diagnosis includes chordoma, chondroid chordoma, and low-grade myxoid chondrosarcoma. Surgical excision is the treatment of choice.
Endoscopic Management of Sphenoid Sinus Cerebrospinal Fluid Leaks
Authors: Sautter Nathan B. , Batra Pete S. , Citardi Martin J. 
Published: October 2014

Objectives: Cerebrospinal fluid (CSF) leaks that originate within the sphenoid sinus pose a unique surgical challenge due to difficulties with access and visualization. The objective of this report is to illustrate concepts for the successful management of sphenoid sinus CSF leaks. Methods: Retrospective data analysis was performed on 9 patients who presented to a tertiary care medical center for endoscopic repair of a sphenoid sinus CSF leak from January 2002 to January 2006. Results: The patient cohort included 7 women and 2 men with a mean age of 51.7 years. In 5 cases the CSF leak was caused by a previous neurosurgical procedure; the other 4 cases were idiopathic. An endoscopic pterygomaxillary fossa approach was required in 4 cases. A layered reconstruction of the sphenoid sinus wall with collagen allografts (cadaveric acellular dermal allograft, 8 patients; bovine collagen membrane, 1 patient) and mucosa under endoscopic visualization with intraoperative surgical navigation was performed in all cases. The reconstruction was buttressed with autologous bone in 2 cases and with cartilage in 2 cases. Fibrin sealant was used in 7 cases. Two patients developed transient diabetes insipidus after the repair. Two patients developed a recurrent CSF leak necessitating revision repair 2 and 15 months, respectively, after the initial repair procedure. The average hospital stay was 6.5 days. The mean length of follow-up was 21.1 months. Conclusions: This series demonstrates that minimally invasive endoscopic repair of sphenoid sinus CSF leaks may be accomplished with an acceptable rate of morbidity and excellent outcomes. Extended endoscopic approaches, including the pterygomaxillary fossa approach, may be useful in selected instances.
Institutional and Comprehensive Review of Laryngeal Leukoplakia
Authors: Isenberg Jason S. , Crozier Daniel L. , Dailey Seth H. 
Published: October 2014

Objectives: The nature and interpretation of vocal fold leukoplakia has been limited by small study sizes. The present study reviewed institutional data and the published literature to better characterize vocal fold leukoplakia. Methods: At our institution, the histopathology, age, and malignant conversion rates of 136 patients (208 biopsies) with vocal fold leukoplakia from 1990 to 2005 were reviewed. Results: No dysplasia (ND), mild and/or moderate dysplasia (MM), and severe dysplasia and/or squamous cell carcinoma in situ (SS) was identified in, respectively, 110 of 208 (53%), 38 of 208 (18%), and 31 of 208 (15%) biopsies. After 30 months (range, 1 to 134 months), malignant transformation was observed in 8 patients on subsequent biopsies. Additionally, a literature search was performed from 1960 to 2005 for the medical subject headings (MeSH) premalignant laryngeal lesions, laryngeal dysplasia, laryngeal leukoplakia, vocal cord dysplasia, and hyperkeratosis of the larynx. Fifteen reports were included for review. When these were combined with our institutional data, 1,173 of 2,188 biopsies (53.6%) revealed ND. Mild and/or moderate dysplasia and SS were present in 717 of 2,140 (33.5%) and 375 of 2,471 (15.2%) biopsies, respectively. Squamous cell carcinoma developed in 52 of 1,388 (3.7%), 83 of 824 (10.1%), and 56 of 310 (18.1%) patients whose initial biopsies demonstrated ND, MM, or SS. Conclusions: More than half of the reported leukoplakia lesions with biopsies showed ND. However, even lesions characterized as ND were associated with an increased risk of development of squamous cell carcinoma. Importantly, the risk of developing malignancy appears to correlate with the severity of dysplasia present on initial biopsy. Because clinical examination does not accurately predict the risk of malignancy, future studies, including genomic evaluation of this lesion, may be necessary to further characterize its biologic behavior.
Office Pulsed Dye Laser Treatment for Benign Laryngeal Vascular Polyps: A Preliminary Study
Authors: Ivey Chandra M. , Woo Peak , Altman Kenneth W. , Shapshay Stanley M. 
Published: October 2014

Objectives: The 585-nm pulsed dye laser (PDL) was recently deemed relatively safe and effective for treatment of laryngeal papilloma, dysplasia, and granuloma. We report on in-office PDL treatment of laryngeal vascular polyps. Methods: Retrospective case results from 29 consecutive cases of laryngeal polyps were evaluated to determine the percent change in polyps after PDL treatment. Preoperative and postoperative measurements of polyp size, total power delivered to the site, and whether patients opted for postprocedure phonomicrosurgery were analyzed. Results: After PDL treatment, the results varied from complete to partial resolution of the polyp. Four patients requested conventional phonomicrosurgery, and the rest had enough improvement to defer surgery. Almost 40% of patients with larger polyps desired operative intervention after laser treatment, whereas only 13% of those with small polyps opted for phonomicrosurgery. Thirty-eight percent (11 of 29) of the lesions had greater than 70% improvement after 1 or 2 laser treatments (average of 1.1 procedures). Smaller lesions responded better. Thirty-nine percent of small polyps resolved by greater than 70%, whereas only 20% of larger lesions improved by the same amount. There were no adverse events from the office procedure. Conclusions: In-office use of the PDL for treatment of vascular polyps may be a safe alternative to phonomicrosurgery. Small polyps seem to show a better response.
Qualification of a Quantitative Laryngeal Imaging System Using Videostroboscopy and Videokymography
Authors: Popolo Peter S. , Titze Ingo R. 
Published: October 2014

Objectives: We sought to determine whether full-cycle glottal width measurements could be obtained with a quantitative laryngeal imaging system using videostroboscopy, and whether glottal width and vocal fold length measurements were repeatable and reliable. Methods: Synthetic vocal folds were phonated on a laboratory bench, and dynamic images were obtained in repeated trials by use of videostroboscopy and videokymography (VKG) with an imaging system equipped with a 2-point laser projection device for measuring absolute dimensions. Video images were also obtained with an industrial videoscope system with a built-in laser measurement capability. Maximum glottal width and vocal fold length were compared among these 3 methods. Results: The average variation in maximum glottal width measurements between stroboscopic data and VKG data was 3.10%. The average variations in width measurements between the clinical system and the industrial system were 1.93% (stroboscopy) and 3.49% (VKG). The variations in vocal fold length were similarly small. The standard deviations across trials were 0.29 mm for width and 0.48 mm for length (stroboscopy), 0.18 mm for width (VKG), and 0.25 mm for width and 0.84 mm for length (industrial). Conclusions: For stable, periodic vibration, the full extent of the glottal width can be reliably measured with the quantitative videostroboscopy system.
Obstruction of the Eustachian Tube Orifice and Pressure Changes in the Middle Ear: Are They Correlated?
Authors: Kindermann Christine Aparecida , Roithmann Renato , Neto José Faibes Lubianca 
Published: October 2014

Objectives: We performed a cross-sectional study to investigate whether the obstruction of the eustachian tube orifice due to adenoid hyperplasia changes the pressures in the middle ear. Method: Fifty consecutive children 2 to 12 years of age with nasal obstruction were examined from May to October 2005. Adenoid size and status of the eustachian tube orifice were assessed with nasal flexible fiberoptic endoscopy. Tympanometry was used to evaluate the middle ear. Results: In children with occlusion of the eustachian tube orifice by adenoid tissue, 87% had abnormal pressure in the middle ear according to tympanograms. When orifices were not occluded, 86% of the tympanograms were normal (p < .001). Conclusions: Obstruction of the eustachian tube orifice by adenoid tissue was associated with tympanograms suggestive of abnormal pressure in the middle ear. Future studies with a larger sample size are necessary to clarify this association.
Correlating the Clinical Course of Recurrent Croup with Endoscopic Findings: A Retrospective Observational Study
Authors: Hoa Michael , Kingsley Emily L. , Coticchia James M. 
Published: October 2014

Objectives: We sought to correlate endoscopic findings with the clinical course of recurrent croup. Methods: Children were classified as having recurrent croup if they had had 2 or more episodes of barky cough, inspiratory stridor, and hoarseness. All study participants underwent direct laryngoscopy and bronchoscopy and were started on an antireflux regimen. A telephone questionnaire assessed the child's symptoms and treatment response. Results: Forty-seven children with recurrent croup were seen in our otolaryngology outpatient clinic. Demographics included a male-to-female ratio of 1.6 to 1 and an age range of 1 month to 11 years (median, 20 months). Thirty patients (63.8%) had a medical history of asthma, and 10 (21.3%) came with a prior diagnosis of gastroesophageal reflux. Gastroesophageal reflux–related laryngopharyngeal changes were seen during direct laryngoscopy and bronchoscopy in 87.2%. Of those with survey follow-up, 87.5% had improvement of respiratory symptoms after a 6- to 9-month course of antireflux medications. This finding was further reflected in a decreased number and duration of episodes (p < .0001). Conclusions: The underlying narrowing process of recurrent croup can be attributed to gastroesophageal reflux and should be considered in any child with persistent barky cough, inspiratory stridor, and hoarseness. To confirm the diagnosis, diagnostic methods should be correlated with symptom progression after treatment initiation.
Preliminary Study on the Quantitative Analysis of Vocal Loading Effects on Vocal Fold Dynamics Using Phonovibrograms
Authors: Lohscheller Joerg , Doellinger Michael , McWhorter Andrew J. , Kunduk Melda 
Published: October 2014

Objectives: The purpose of the present study was to determine whether high-speed digital imaging with phonovibrogram (PVG) analysis would identify changes in vocal fold vibratory characteristics following prolonged reading (vocal fatigue) in subjects with normal voice to evaluate the voice effects of vocal loading. Methods: Three healthy subjects' larynges were examined with an endoscopic high-speed imaging system at 4 different levels of vocal load. Vocal fold dynamics were segmented and processed by PVGs. The PVG images were quantitatively described by a parameter set enabling an individual characterization of vocal fold dynamics. To reveal differences between the subjects, we performed a linear discrimination analysis. Within each subject, the identification of vocal loading effects was performed by statistical analysis (1-way analysis of variance), and 2-tailed paired t-tests were used as a consistency check between left and right vocal fold sides. Results: For each subject, the PVG analysis enabled a precise quantification of the entire range of vocal fold dynamics. Independently of the high-speed videos (vocal loads), each subject could be identified by his or her PVG parameters on linear discrimination analysis. In all subjects, the effect of vocal loading was reflected by alterations of PVG parameters representing the posterior opening and closing dynamics. Evaluation within subjects revealed slight asymmetric vibratory behavior between the left and right vocal folds, confirming earlier assumptions. Conclusions: Within the investigated subjects, vocal loading does affect the vibratory characteristics of the vocal folds. Left-right vocal fold vibratory asymmetries do occur in healthy voices and can be identified by PVGs. High-speed digital imaging in combination with PVG analysis seems to be a promising tool for investigation of vocal fold fatigue and disorders resulting even from small dynamic changes.
Microendoscopy of Reinke's Space
Authors: Hoffman Henry T. , Bock Jonathan M. , Karnell Lucy Hynds , Ahlrichs-Hanson Janice 
Published: October 2014

Objectives: Contemporary surgical treatment of the superficial layer of the lamina propria or Reinke's space is most commonly performed through an incision in the overlying vocal fold epithelium. This approach may disrupt normal tissue, induce scarring, and allow extrusion of implanted materials. Previously reported external approaches to Reinke's space required either a laryngofissure or a “minithyrotomy” for access. These surgical approaches were performed without direct imaging of Reinke's space. Instruments placed below the vocal fold epithelium via this external approach were visualized through the translucent vocal fold epithelium. We designed this study to identify the feasibility of limited-access surgery of the lamina propria using microendoscopes placed into Reinke's space through an external approach. Methods: A cadaveric human larynx was dissected, and microendoscopes were directly advanced into Reinke's space through a subepithelial puncture of the cricothyroid membrane, as well as lateral fenestration through the thyroid cartilage. Results: Photodocumentation of the undersurface of vocal fold epithelium, the opposing surface of the vocal ligament, and the intervening Reinke's space was successfully accomplished. Conclusions: Advances in both microendoscopes and accompanying instrumentation permit access to the superficial layer of the lamina propria without disrupting the overlying epithelium. This approach to microendoscopy of Reinke's space may allow for more effective surgical treatment of cysts, chronic edema, vascular abnormalities, atrophy, scarring, and sulcus vocalis.
Relationship between Mucosal Inflammation, Computed Tomography, and Symptomatology in Chronic Rhinosinusitis without Polyposis
Authors: Bhattacharyya Neil 
Published: October 2014

Objectives: This study was an attempt to determine whether sinus mucosal inflammation is related to computed tomographic findings and patients' reported symptoms in chronic rhinosinusitis (CRS) without polyposis. Methods: I retrospectively reviewed the clinical symptom scores according to the Rhinosinusitis Symptom Inventory (RSI), the radiographic findings, and the histopathologic findings in the paranasal sinus mucosa for a consecutive series of adult patients who underwent endoscopic sinus surgery for CRS. Linear regression analysis was conducted for the relationship between tissue pathology inflammatory severity score graded on a 5-point Likert scale and the RSI symptom domains. A similar analysis was conducted for the relationship between the pathology inflammatory score and the total Lund score. Results: The study cohort consisted of 115 adult patients (mean age, 40.2 years). The mean Lund score for the cohort was 8.8 (95% confidence interval, 7.9 to 9.7), and the mean pathology severity score was 2.1 (median, 2.0). The mean total symptom score for the overall cohort was 41.3; the mean total symptom scores for pathology severity grades 0, 1, 2, 3, and 4 were 25.0, 43.8, 41.8, 42.4, and 32.8, respectively. No significant association could be identified between pathology severity and any of the 5 RSI symptom domains (nasal, facial, oropharyngeal, systemic, and total symptoms; all p > .436, linear regression). A statistically significant relationship between total Lund score and pathology severity was identified (p < .001). Conclusions: Poor correlation exists between the histopathologic severity of sinonasal inflammation and self-reported symptom scores in CRS. Histopathologic inflammatory grade alone fails to stratify CRS cases according to disease symptom severity. Histopathologic inflammation and computed tomographic findings correlate strongly.
Evaluation of a Deep Brain Stimulation Electrode for Laryngeal Pacing
Authors: Katada Akihiro , Van Himbergen Daniel , Kunibe Isamu , Nonaka Satoshi , Harabuchi Yasuaki , Huang Shan , Billante Cheryl R. , Zealear David L. 
Published: October 2014

Objectives: The purpose of the present study was to evaluate the suitability of a deep brain stimulation electrode for laryngeal pacing. Of interest was whether the smaller and more closely spaced channels could provide sufficient channel redundancy, controlled current distribution, and discrete activation of the posterior cricoarytenoid (PCA) muscle. Methods: A study was conducted in dogs under differing states of PCA muscle innervation representing complete denervation to complete synkinetic reinnervation. In 3 animals, stimulated glottal opening was assessed in the innervated state and after chemical denervation by pancuronium bromide. In 3 additional dogs, the left side of the larynx was surgically denervated and compared to the innervated, right side to study an anatomic model of clinical paralysis. Results: The thresholds were lower and the maximum level of abduction was greater for the innervated state. The stimulated glottal opening equaled that of a spontaneously breathing animal. Abductory responses were obtained across all channels in the array, demonstrating its anatomic and physiological compatibility for this application. In the denervated state, responses were only 20% of that of the innervated state with a pulse duration of 0.5 ms. The response could be enhanced to 40% and 60% by increasing the pulse duration to 1 and 2 ms. Conclusions: A deep brain stimulation electrode could effectively reanimate the PCA muscle to a normal level in a case of synkinetic reinnervation and to as much as 60% of the normal level in a case of complete denervation.
Mucin Gene Expression in Human Laryngeal Epithelia: Effect of Laryngopharyngeal Reflux
Authors: Samuels Tina L. , Handler Ethan , Syring Michael L. , Pajewski Nicholas M. , Blumin Joel H. , Kerschner Joseph E. , Johnston Nikki 
Published: October 2014

Objectives: We sought to document the mucin gene profile in normal human laryngeal epithelium and compare it with that in patients with reflux-attributed laryngeal injury or disease. We also investigated the effect of low pH with or without pepsin on mucin messenger RNA levels in vitro. Methods: Laryngeal biopsy specimens were obtained from 3 patients with clinically diagnosed laryngopharyngeal reflux and from 2 control subjects who had no signs or symptoms of reflux. Signs and symptoms were assessed by the Reflux Finding Score and the Reflux Symptom Index, respectively. Reverse transcription–polymerase chain reaction (RT-PCR) was performed to establish the mucin gene profile. Human hypopharyngeal epithelial cells were exposed to pH 7, 5, 4, and 2 with and without pepsin (0.1 mg/mL) for 20 minutes at 37°C, and expression of selected mucins was analyzed via real-time RT-PCR. Results: Mucin 1–5, 7, 9, 13, 15, 16, and 18–20 transcripts were detected in normal laryngeal epithelium, whereas mucin 6, 8, and 17 transcripts were not. Mucins 2, 3, and 5 were expressed at reduced levels in patients with reflux-attributed laryngeal injury or disease. These mucin genes were up-regulated after exposure to low pH in vitro (p < 0.005). Pepsin inhibited this up-regulation (p < 0.001). Conclusions: Reflux laryngitis is associated with down-regulation of mucin gene expression.
Auditory Skills Development among Children with Developmental Delays and Cochlear Implants
Authors: Wiley Susan , Meinzen-Derr Jareen , Choo Daniel 
Published: October 2014

Objectives: We sought to understand auditory skills outcomes in young children with cochlear implants and developmental delay. Methods: Children who received cochlear implants at less than 36 months of age were identified via chart review. Their postimplant auditory skills outcomes were measured with the Auditory Skills Checklist. Results: Of 35 children who received cochlear implants before the age of 36 months, 14 children (40%) had additional disabilities or some form of developmental delay. The 12-month postimplant data indicated progress in all groups of children. Children with additional disabilities had the same rate of auditory skills progress as children with no additional disabilities (β = 9.3 versus 9.3; p = 0.5). However, the children with additional disabilities tended to start at a lower baseline skills set (approximately 6 points lower) on the Auditory Skills Checklist. For children with average developmental quotients (at least 80), the rate of progress was twice that of children with a developmental quotient of less than 80, irrespective of a developmental disability (β = 9.9 versus 4.8; p = 0.03). Children with a developmental quotient of less than 80 were less likely to gain skills in discrimination and identification after the first postimplant year. Conclusions: Children with additional disabilities make progress in auditory skills, but may not develop higher auditory skills of identification and comprehension within the first 6 months after implantation. Categorizing children according to a cognitive developmental quotient may provide more predictive ability than does categorizing them by disability type.