bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cell Density of the Lamina Propria of Neonatal Vocal Folds
Authors: Rosenberg Tara L. , Schweinfurth John M. 
Published: October 2014

Objectives: We undertook 1) to measure the cell density within the lamina propria of the neonatal vocal folds and 2) to examine changes in cell density in the lamina propria with increasing gestational age of the neonatal vocal folds. Methods: Intact neonatal larynges were obtained from fresh cadaveric specimens. Hematoxylin and eosin–stained slides were used to visualize the laryngeal structures, and photomicrographs of the vocal folds were taken at 100× magnification. The cell density of the lamina propria was calculated by counting the cells within each of five 100-μm2 regions within the study area, and the totals were then averaged for each area. Results: A total of 62 sections from 14 larynges with gestational ages of 19 to 36 weeks were examined. Histologic analysis revealed a uniform appearance of the vocal fold without apparent layers. The cell density of the lamina propria was 30 or more cells per 100 μm2 for 51.2% of larynges with less than 27 weeks of gestation. However, only 14.3% of the larynges with 27 or more weeks of gestation had an average cell density of 30 or more cells per region (p < 0.005). Conclusions: As described by previous studies, the lamina propria of the neonatal vocal folds is a hypercellular monolayer. The process of vocal fold maturation appears to occur earlier than previously thought, with decreasing cell density in the lamina propria by 27 weeks' gestation.
Clinical Outcomes of Bedside Percutaneous Dilatational Tracheostomy with Suspension Laryngoscopy for Airway Control
Authors: Sharp Dawn B. , Castellanos Paul F. 
Published: October 2014

Objectives: We sought to describe outcomes of a new technique blending suspension laryngoscopy (SL) with percutaneous dilatational tracheostomy (PDT), addressing concerns of airway control and risks of dire complications. Methods: A retrospective review of 67 cases included “all comers,” in that if the patient could undergo any type of tracheostomy, SL-PDT was offered, and it was performed in all but 1 patient. Patient demographics, intubation time, time from consultation to procedure, and perioperative complications were reviewed. Results: Sixty-six patients underwent SL-PDT; 54 procedures were performed bedside in the intensive care unit, and 12 in the operating room. Use of the operating room was due to lack of intensivist availability or possible need for an emergent surgical airway. Early in the series, 1 patient required open tracheostomy because of unfavorable anatomy. Two major complications occurred: 1 perioperative airway obstruction and 1 severe bradycardic event. The 2 patients were resuscitated without significant sequelae. Three minor complications occurred: 2 cases of endotracheal bleeding and 1 transient bradycardic event. Conclusions: Bedside SL-PDT is relatively safe and effective, and offers advantages over traditional PDT and open tracheostomy. This novel technique may encourage a concerted multidisciplinary effort, including otolaryngologists, to continue to improve bedside airway management in critically ill patients.
Flexible Endoscopic Evaluation of Swallowing in Healthy Young and Older Adults
Authors: Butler Susan G. , Stuart Andrew , Kemp Shannon 
Published: October 2014

Objectives: Scant data exist on normal swallowing as assessed endoscopically. A lack of understanding for the range of normal swallowing may lead to inaccurate diagnoses and overly aggressive management of patients with dysphagia. Accordingly, the purpose of this study was to determine the effects of age (ie, young versus older), gender, bolus volume (ie, 5 versus 10 mL), and bolus condition (ie, water versus milk) on Penetration-Aspiration Scale scores, bolus dwell time, pharyngeal closure duration, and residue in healthy adults. Methods: Twenty-three young adults (mean, 30.0 years of age) and 21 older adults (mean, 75.0 years of age) participated. Measurements were acquired during manoendoscopic swallowing assessments. The participants contributed 8 swallows, affording a study total of 352 swallows for analysis. Results: The older adults demonstrated penetration on 19 swallows and aspiration on 11 swallows out of 168 swallows. There was a significant difference in the proportion of Penetration-Aspiration Scale scores across age and gender groups. Longer bolus dwell times were seen in older adults and with milk boluses, whereas residue severity was less in young adults and with water boluses. Conclusions: Endoscopic data on normal swallowing physiology were generated. These data may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.
Balloon Dilation of the Frontal Recess in Patients with Chronic Frontal Sinusitis and Advanced Sinus Disease: An Initial Report
Authors: Catalano Peter J. , Payne Spencer C. 
Published: October 2014

Objectives: Balloon dilation of the sinus ostia and transition spaces is a relatively new tool in the management of chronic rhinosinusitis. Although studies of its safety and application have been reported, its efficacy in specific indications has yet to be clearly defined. The purpose of this study was to evaluate the use of balloon dilation of the frontal recess for the treatment of chronic frontal sinusitis in patients with advanced sinus disease. Methods: This was a prospective study of 20 patients who presented with chronic frontal sinusitis that had failed medical therapy and required operative intervention. Balloon dilation of the frontal recess was performed to improve drainage and ventilation of the frontal sinus. Preoperative and postoperative computed tomography scans were compared for change in the radiologic stage of disease based both on the Lund-Mackay staging system and on the Lund grade (extent of mucosal thickening). Results: Twenty patients met the inclusion criteria during the study period and were followed for several months after operation. All patients underwent a frontal sinus procedure with balloon dilation either alone or in concert with other minimally invasive techniques. A total of 29 sinuses were available for analysis. No significant complications resulted from the procedure. Pretreatment and posttreatment Lund-Mackay scores showed significant improvement in patients with certain subsets of chronic rhinosinusitis. Conclusions: Balloon dilation of the frontal recess is a relatively safe intervention that can be used in the treatment of chronic frontal sinusitis, even in patients with advanced disease.
Preoperative and Postoperative Intracranial Complications of Acute Mastoiditis
Authors: Mallur Pavan S. , Harirchian Sanaz , Lalwani Anil K. 
Published: October 2014

Objectives: We determined the clinical characteristics and treatment outcomes of an unusual cluster of intracranial complications seen in acute mastoiditis (AM). Methods: We performed a retrospective review of pediatric patients treated for AM in a tertiary care hospital from March 2006 to March 2007. Results: Eleven children, 6 months to 10 years of age (mean age, 3.8 years), were treated for AM confirmed by computed tomography, which identified asymptomatic intracranial complications in 8 of the 11 patients: These were sigmoid sinus thrombosis (4 patients), epidural abscess (4), perisigmoid abscess or bony erosion (2), and tegmen mastoideum dehiscence (1). All patients required operative intervention with tympanomastoidectomy, although only 2 patients required neurosurgical intervention, consisting of evacuation of epidural abscess and sigmoid sinus thrombosis, respectively. Cultures yielded routine organisms and 1 multidrug-resistant strain of Streptococcus pneumoniae. One patient developed reaccumulation of the subperiosteal abscess that required revision mastoidectomy, and another patient developed postoperative sigmoid sinus thrombosis. Conclusions: Although uncommon, intracranial complications of AM may present without clinical signs or symptoms. Computed tomography of the temporal bone with contrast is essential for identifying asymptomatic complications. Mastoidectomy remains the mainstay of surgical treatment. Neurosurgical intervention and anticoagulation may be avoided with protracted postoperative intravenous antibiotics. Postoperative vigilance is crucial, as complications may evolve despite aggressive therapy.
Assessing the Additional Disease Burden of Polyps in Chronic Rhinosinusitis
Authors: Bhattacharyya Neil 
Published: October 2014

Objectives: This study was undertaken to determine the differential disease burden between chronic rhinosinusitis (CRS) cases with and without nasal polyposis (NP). Methods: A consecutive series of adult patients who met clinical and radiographic criteria for CRS was assessed with the Rhinosinusitis Symptom Inventory, nasal endoscopy, and computed tomography. Three clinical groups were examined: 1) CRS without NP, 2) CRS with primary NP (no prior surgery), and 3) CRS with recurrent NP (prior surgery). The groups were compared with respect to symptom presentation, medical resource utilization, and medication costs. Results: Two hundred eighty-six CRS cases without NP, 131 CRS cases with primary NP, and 45 CRS cases with recurrent NP were studied; their mean Lund scores were 8.8, 13.2, and 16.3, respectively (p < 0.001). Statistically significant differences in severity for nasal (p = 0.002), facial (p = 0.025), oropharyngeal (p = 0.017), and systemic symptoms (p = 0.042) between groups were noted, whereas total symptoms did not differ between groups (p = 0.339). Medication use and physician visits were similar between groups (p = 0.335 and p = 0.951, respectively). The aggregate yearly medication costs were significantly greater for the recurrent polyp group ($866) than for either the non-polyp group ($570; p = 0.013) or the primary polyp group ($565; p = 0.020). Conclusions: Patients with non-polyp CRS and those with primary polyp CRS present with different symptom phenotypes, but exhibit similar total symptom burdens and medical resource consumption. The presence of polyps does not necessarily confer a dramatic additional disease burden in CRS.
Characteristics of Isolated Sphenoid Sinus Aspergilloma: Report of Twelve Cases and Literature Review
Authors: Lee Ta-Jen , Huang Shiang-Fu , Chang Po-Hung 
Published: October 2014

Objectives: Isolated sphenoid sinus aspergilloma (ISSA) is a form of fungal sinus infection that is distinct from allergic fungal sinusitis, invasive fungal disease, and Aspergillus granulomas. In this study, we identify the characteristics of patients with ISSA to achieve timelier intervention for this easily neglected disease. Methods: In a retrospective study of patients with ISSA in our institution (1995 to 2006), 12 were identified. Results: Sixty-seven percent of our patients were more than 50 years of age, and a female preponderance was noted. Headache and postnasal drip were the two most common symptoms, and the samples from 78% of our patients with postnasal drip were blood-tinged. Computed tomographic scanning provided a sensitivity of 64%, whereas endoscopic examination failed to identify abnormalities in any patients. Conclusions: Four characteristics were identified in the diagnosis of ISSA: Female; usually above 50 years of age; with postnasal drip (especially blood-tinged); and headache (particularly periorbital or retro-orbital).
Role of Subglottal Shape in Turbulence Reduction
Authors: Oren Liran , Khosla Sid , Murugappan Shanmugam , King Richard , Gutmark Ephraim 
Published: October 2014

Objectives: In previous work, we found that airflow at the superior edge of the vocal folds, in the excised canine larynx, can be laminar even when the tracheal airflow is predominantly turbulent. Turbulent flow directly above the folds may lead to an irregular or “rough” voice. Thus, it is important to determine the mechanism of turbulence reduction. From fluid mechanics, it is known that a smoothly converging duct will reduce turbulence. In this study, we tested the hypothesis that the majority of the turbulence reduction is due to the smooth converging shape of the subglottis. Methods: In 3 excised canine larynges, hot-wire anemometry was used to measure the turbulence intensity (TI) below the cricoid cartilage and 2 to 3 mm above the superior edge of the vocal folds. Laminar flow was seen when the TI was approximately less than 2%. For our measurements, flow into the subglottis had an average TI of more than 20% (high turbulence) in the shear layer and a TI of more than 15% in the center of the jet. The larynges were tested under steady conditions (folds not phonating) with the vocal processes approximated. Results: For the center of the jet, there is moderate turbulence below the cricoid cartilage and laminar flow 2 to 3 mm above the folds. For the shear layer, there is very high turbulence below the cricoid cartilage and low turbulence 2 to 3 mm above the folds. Conclusions: The smooth converging shape of the subglottis can produce a significant reduction in turbulence. These findings may have important voice implications for operations that may change the subglottal shape (such as vocal fold medialization or airway reconstruction).
Postviral Vagal Neuropathy
Authors: Rees Catherine J. , Henderson Arthur H. , Belafsky Peter C. 
Published: October 2014

Objectives: Postviral vagal neuropathy (PVVN) is a clinical diagnosis characterized by laryngeal complaints initiated by an upper respiratory tract infection (URI). Little is known about the natural history of this disease, and only small case series have been reported. We describe the clinical presentation, symptoms, patient demographics, and natural history of PVVN. Methods: A cross-sectional survey of all patients with a diagnosis of PVVN from January 1, 2006, to December 31, 2006, was prospectively administered, detailing disease onset, type and duration of symptoms, demographics, and previous treatment. The Reflux Symptom Index, Voice Handicap Index, and laryngoscopic findings were collected for each patient. Results: Forty-four patients with PVVN were identified. The mean age (±SD) was 48 ± 13 years, and 73% of the patients were female. The most common initial URI symptoms were cough (89%), nasal congestion (75%), and rhinorrhea (64%). Fifty-nine percent of the patients took antibiotics, and the mean time between symptom onset and presentation to the laryngologist was 83 ± 127 weeks. The most common persistent symptoms were cough (52%), throat clearing (48%), dysphonia (41.5%), and vocal fatigue (43%). Fifty-seven percent of the patients consulted 3 or more physicians for their symptoms. The mean Voice Handicap Index was 13.4 ± 10.3, and the mean Reflux Symptom Index was 17.7 ± 11. Fortynine percent of the patients had evidence of vocal fold paresis on strobovideolaryngoscopy. Conclusions: PVVN is a clinical entity characterized by a complex of laryngeal symptoms that begin after a URI. The symptoms include chronic cough, excessive throat clearing, dysphonia, and vocal fatigue. Affected individuals are typically in their fifth decade of life and appear more likely to be women. Most patients have seen multiple physicians, and the time to laryngologist referral is often delayed.
Marsupialization of Vocal Fold Retention Cysts: Voice Assessment and Surgical Outcomes
Authors: Hsu Cheng-Ming , Armas Gian Luca , Su Chih-Ying 
Published: October 2014

Objectives: Although total excision remains the standard treatment for vocal fold retention cysts, postoperative deficits and damage to the vocal folds still occur. Marsupialization is a more conservative technique and can prevent these complications. Methods: In this prospective clinical series, 25 patients underwent the marsupialization procedure. Under a direct laryngomicroscope, the cystic wall margin was retracted medially with microforceps. An incision was made with microscissors encircling the equator of the cyst. The cyst contents drained from the cystic cavity when the capsule was sectioned. For 7 patients with concomitant marked vocal fold atrophy, strap muscle transposition laryngoplasty was simultaneously performed. Results: All patients had complete preoperative and postoperative voice parameter analyses. A subjective improvement in voice quality was reported by 23 of the 25 patients (92%). A small recurrent vocal fold cyst was detected in 1 patient. Small vocal fold deficits and sulcus vocalis were detected in 2 and 4 patients, respectively. Only 1 patient described a worse voice after operation. No other complications were noted. Conclusions: Marsupialization of vocal fold retention cysts is a simple, relatively safe, and effective surgical treatment. Voice improvement, a low incidence of recurrence, and minimal vocal fold deficits demonstrate the validity of this technique. Marked preoperative vocal fold atrophy or postoperative glottal gap can be managed with medialization laryngoplasty.
Influence of Blood Pressure Manometer Feedback on the Parameters of the Vestibular Evoked Myogenic Potential Test
Authors: Suh Myung-Whan , Kim Ji Soo , Koo Ja-Won 
Published: October 2014

Objectives: The objective of this study was to evaluate the merits of a blood pressure (BP) manometry feedback method for measurement of vestibular evoked myogenic potentials. Methods: Sixty ears of 30 normal volunteers were prospectively investigated. The vestibular evoked myogenic potentials were recorded under 3 different conditions: In the feedback-negative (FB–) condition, ie, in a sitting position without feedback; in the feedback-positive (FB+) condition, ie, in a sitting position with self-monitored BP feedback (using a BP cuff); and in a supine condition, ie, in a supine position without feedback. The interaural amplitude difference (IAD) ratios and interaural latency differences were analyzed. Results: The mean IAD ratio was smaller in the FB+ condition than in the FB– and supine conditions, but the difference was without statistical significance. The upper limits of the normal range of the IAD ratios were 39.5%, 18.3%, and 25.9% for the FB–, FB+, and supine conditions, respectively. The interaural latency difference of p13 was significantly smaller in the supine condition than in the FB– and FB+ conditions. Conclusions: Although the reduction of the mean IAD ratio did not reach statistical significance by feedback monitoring in our study, feedback using a BP manometer may have some clinical significance, in that a more stable IAD ratio may be obtained with a narrower normal range and a smaller variation.
Demonstration of Nasopharyngeal and Middle Ear Mucosal Biofilms in an Animal Model of Acute Otitis Media
Authors: Hoa Michael , Syamal Mausumi , Sachdeva Livjot , Berk Richard , Coticchia James 
Published: October 2014

Objectives: We performed this study to determine the role of nasopharyngeal and middle ear (ME) biofilms in acute otitis media (AOM). Methods: Sixty female 6-month-old chinchillas, free of ME disease, were utilized. Experimental animals were inoculated with influenza A followed by Streptococcus pneumonia 7 days later. Control animals were inoculated with Sorensen's phosphate buffer. Daily otoscopy and tympanometry was performed, and the animals were painlessly sacrificed on days 1, 2, 5, 8, and 14. All mucosae were harvested and prepared for scanning electron microscopy. Results: The ME inflammation, initially detected on day 2 after bacterial inoculation, peaked on day 8. Eight percent of the dually inoculated chinchillas displayed type B tympanograms, and 40% displayed type C. Otoscopic evaluation of tympanic membrane inflammation was rated from 0 to 4 (0 = normal and 4 = severe drainage and/or inflammation) according to an otoscopic grading system. Ten percent of the experimental chinchillas had a grade 2 score, 20% had grade 3, and 6.7% had grade 4. The controls demonstrated no abnormal tympanometric or otoscopic findings. Scanning electron microscopic imaging showed dense biofilms on 83% of the nasopharynges and 67% of the MEs on day 8 in the experimental animals. All animals with ME biofilms had biofilms in the nasopharynx. The controls did not demonstrate biofilm formation. Conclusions: The study parallels the natural pathogenesis of AOM in humans. The demonstration of mucosal biofilms in both the nasopharynx (58%) and the ME (47%) of animals with ME inflammation and/or infection lends further support to the importance of mucosal biofilms in the pathogenesis of AOM.
Lamina Propria Cellularity and Collagen Composition: An Integrated Assessment of Structure in Humans
Authors: Muñoz-Pinto Dany , Whittaker Peter , Hahn Mariah S. 
Published: October 2014

Objectives: In this study, we quantitatively examined cell density, collagen types I and III, and regional variations in collagen fiber thickness and orientation in the human midmembranous vocal fold lamina propria (LP). Methods: Lamina propria samples were solubilized with proteinase K or with cyanogen bromide. Cell density was assessed in proteinase K digests by measuring DNA and normalizing it to tissue total protein. Collagen types I and III were quantified by enzyme-linked immunosorbent assay–based detection of collagen type–specific peptides generated by cyanogen bromide digestion. In addition, LP total collagen was determined by measuring sample hydroxyproline levels. Variations in collagen fiber thickness and orientation with LP region were evaluated by examining picrosirius red–stained LP sections with circularly polarized light. Results: The mean (±SEM) cell density in the LP and associated epithelium was approximately 0.57 ± 0.09 million cells per milligram of tissue total protein. Collagen type III composed an average of 34% to 40% of LP total collagen. Quantitative histology indicated that the superficial LP contained an average of 70% thin, 26% intermediate, and 4% thick collagen fibers. This is in contrast to the intermediate and deep LPs, each of which contained less than 25% thin and more than 50% thick collagen fibers. The angular deviations in collagen fiber orientation were relatively large and were similar in magnitude across all LP layers. Conclusions: The total cell density of the LP and associated epithelium was intermediate between that of hyaline cartilage and dermis. The ratio of collagen type III to total collagen in the LP was similar to that of highly elastic lung parenchyma and roughly twice that of the comparatively less-elastic dermis. The average thickness of collagen fibers increased markedly with increasing LP depth, and the relatively large angular deviations in fiber orientation appeared to correspond in part to the crimped nature of LP collagen fibers.
Acquired Atresia of the External Auditory Canal: Recurrence and Long-Term Results
Authors: Magliulo Giuseppe 
Published: October 2014

Objectives: I describe the clinical symptoms and signs of acquired atresia of the external auditory canal (EAC) and the technique used to manage it. Methods: Forty-one consecutive patients affected by acquired atresia of the EAC were assessed by otoscopy, pure tone audiometry, computed tomography, and traditional and echo-planar diffusion-weighted magnetic resonance imaging. The anatomic and functional hearing results were evaluated. Results: At surgery for acquired atresia of the EAC, an EAC cholesteatoma was found in 3 of the 41 patients. Twenty-three of the 41 patients were followed for at least 5 years. Recurrence was seen in 9 of the 25 ears (36%) over the entire period of observation. Twenty-one, 23, and 22 of the patients had a normal or nearly normal contour and size of the ear canal at 6 months, 1 year, and 5 years, respectively. The results were similar for the air-bone gap. Conclusions: The main complication following surgery was recurrence. There was recurrence at 6 months in 4 patients (16%). Recurrence was seen in 12% of the cases at the 5-year follow-up. Similar findings were clear on evaluation of the hearing results. This result demonstrates that the surgical procedure, even when performed correctly, did not afford a stable, long-lasting outcome in a cohort of patients.