bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medial Arytenoidectomy versus Transverse Cordotomy as a Treatment for Bilateral Vocal Fold Paralysis
Authors: Bosley Brooke , Rosen Clark A. , Simpson C. Blake , McMullin Brian T. , Gartner-Schmidt Jackie L. 
Published: October 2014

Objectives: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared. Methods: The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained. Results: Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively. Conclusions: Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.
Three-Dimensional Reconstruction of the Human Semicircular Canals and Measurement of Each Membranous Canal Plane Defined by Reid's Stereotactic Coordinates
Authors: Hashimoto Shinichiro , Naganuma Hideaki , Tokumasu Koji , Itoh Akihiko , Okamoto Makito 
Published: October 2014

Objectives: Equations for estimating the planar relationships of the human semicircular canals were devised by Blanks et al from a dissected bony labyrinth in a human skull. However, a similar study on the membranous semicircular canal planes has never been published. Methods: In this study, the angle between each membranous canal plane and Reid's stereotactic horizontal plane was measured on serial histologic sections of 7 temporal bones from Japanese adults. We reconstructed the 3 semicircular canals by computer-aided 3-dimensional analysis. The angles between each pair of both bony and membranous canal planes were measured. Results: In the bony labyrinth, the angles between the 2 canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.51° ± 2.98° (mean ± SD), 91.70° ± 1.85°, and 94.52° ± 3.32°, respectively. The angles between the 2 membranous canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.05° ± 4.74°, 91.03° ± 2.93°, and 91.92° ± 5.22°, respectively. Conclusions: The data from our study of the membranous labyrinth showed that the angles between each canal plane and the others were much closer to 90° than was found by Blanks et al for the bony labyrinth.
Efficacy of Montelukast in the Treatment of Nasal Polyposis
Authors: Kieff David A. , Busaba Nicolas Y. 
Published: October 2014

Objectives: Twenty-four consecutive patients with symptomatic nasal polyposis and nonallergic or perennial rhinitis who were undergoing chronic nasal steroid therapy were prospectively evaluated for response to adjunctive oral montelukast sodium therapy. Methods: The patients were undergoing daily intranasal steroid sprays for a minimum of 6 months before being started on montelukast sodium 10 mg by mouth per day for 3 months while intranasal steroids were continued. The patients were given a validated symptom score survey at the start and end of therapy, with a lower score indicating fewer symptoms. The nasal polyps were submitted to biopsy before and after treatment to determine their degree of eosinophilia. Eosinophilia was graded in a blinded fashion by an independent pathologist on a scale of 0 to 3, with 3 being severe. Patients with seasonal allergies were excluded, and the studied patients were treated during the winter season to avoid confounding by potential seasonal allergic responses. Results: The patients tended to improve on montelukast therapy in terms of their symptom scores and polyp eosinophil counts. The symptoms improved in 17 patients (71%) and remained the same or worsened in 7 patients (29%). The symptom score for the group improved from a pretreatment value of 33.4 (SD, 7.73) to a posttreatment value of 23.3 (SD, 13.73; p < .001). In addition, the eosinophilia score improved from 2.3 (SD, 0.68) to 1.5 (SD, 0.82; p < .01). The improvement was most noticeable in the patients with perennial allergies. Conclusions: These results suggest that montelukast appears to be beneficial for some patients with nasal polyposis. Patients with perennial allergies and nasal polyposis seem more likely to respond to the treatment than those with nonallergic nasal polyposis.
Endoscopic Treatment of Severe Tracheal Stenosis
Authors: Schweinfurth John M. 
Published: October 2014

Objectives: Endoscopic treatment of subglottic and tracheal stenosis has traditionally been reserved for short-segment and web-like stenoses with normal cartilage. This retrospective case series review was undertaken to examine my experience with definitive endoscopic treatment for circumferential and complete tracheal stenosis with loss of cartilaginous support. Methods: Patients who presented with tracheostomy dependence or dyspnea as a result of clinically significant tracheal stenosis over a 2-year period were treated endoscopically. Mitomycin C was applied after dilation in 19 patients. Three patients with complete stenosis and cartilage collapse underwent endoscopic placement of a silicone elastic stent, which was in place for less than 23 days. Results: Twenty patients were treated for tracheal stenosis over a 2-year period. No surgical complications were observed after operation in the endoscopic treatment group. Three of 6 patients with complete stenoses and 8 of 10 patients with circumferential stenoses with cartilage involvement gained airways that remained patent. Nine patients' stenoses resolved after the initial treatment. Three patients (15%) eventually required tracheal resection. The follow-up periods ranged from 5 to 25 months. Conclusions: Although some limitations apply, severe and complete tracheal stenoses may be successfully treated endoscopically with the techniques described. Definitive endoscopic treatment may be considered before tracheal resection in select cases. Endoscopic treatment is associated with few complications, low morbidity, a short operative time, and a short length of hospitalization.
Effect of Pepsin on Laryngeal Stress Protein (Sep70, Sep53, and Hsp70) Response: Role in Laryngopharyngeal Reflux Disease
Authors: Johnston Nikki , Dettmar Peter W. , Lively Mark O. , Postma Gregory N. , Belafsky Peter C. , Birchall Martin , Koufman Jamie A. 
Published: October 2014

Objectives: The objectives of this study were to define the conditions that give rise to a stress protein response in laryngeal epithelium and to investigate whether and how stress protein dysfunction contributes to reflux-related laryngeal disease. Methods: Western analysis was used to measure stress protein (squamous epithelial proteins Sep70 and Sep53 and heat shock protein Hsp70) and pepsin levels in esophageal and laryngeal tissue specimens taken from both normal control subjects and patients with pH-documented laryngopharyngeal reflux (LPR) who had documented lesions, some of whom had laryngeal cancer. A porcine organ culture model was used to examine the effects of low pH and pepsin (0.1% porcine pepsin A) on stress protein levels. A laryngeal squamous carcinoma (FaDu) cell line was used to examine uptake of human pepsin 3b-tetramethyl-5 and -6 isothiocyanate. Results: Sep70, Sep53, and Hsp70 were found to be expressed at high levels, and pepsin was not detected, in esophageal and laryngeal specimens taken from normal control subjects and in esophageal specimens taken from LPR patients. The patients with LPR were found to have significantly less laryngeal Sep70 (p = .027) and marginally less laryngeal Sep53 (p = .056) than the normal control subjects. Laryngeal Hsp70 was expressed at high levels in the LPR patients. The patients with laryngeal cancer had significantly lower levels of Sep70, Sep53 (p < .01), and Hsp70 (p < .05) than the normal control subjects. A significant association was found between the presence of pepsin in laryngeal epithelium from LPR patients and depletion of laryngeal Sep70 (p < .001). Using the organ culture model, we demonstrated that laryngeal Sep70 and Sep53 proteins are induced after exposure to low pH. However, in the presence of pepsin, Sep70 and Sep53 levels are depleted. Confocal microscopy analysis of cultured cells exposed to labeled pepsin revealed that uptake is by receptor-mediated endocytosis. Conclusions: These findings suggest that receptor-mediated uptake of pepsin by laryngeal epithelial cells, as may occur in LPR, causes a change in the normal acid-mediated stress protein response. This altered stress protein response may lead to cellular injury and thus play a role in the development of disease.
Immunohistochemical Distinction of Intestinal-Type Sinonasal Adenocarcinoma from Metastatic Adenocarcinoma of Intestinal Origin
Authors: Resto Vicente A. , Krane Jeffrey F. , Faquin William C. , Lin Derrick T. 
Published: October 2014

Objectives: Distinction of intestinal-type sinonasal adenocarcinoma (ITAC) from adenocarcinoma of intestinal origin metastatic to the sinonasal cavity may be extremely difficult on histologic grounds alone. We studied the role of cytokeratin (CK) and mucin (MUC) expression in differentiating ITAC, metastatic adenocarcinoma of intestinal origin, and non-intestinal-type sinonasal adenocarcinoma (non-ITAC). Methods: We stained specimens from 5 cases of ITAC and 4 cases of non-ITAC, along with 4 colonic and 3 duodenal adenocarcinoma controls, with CK7 and CK20, MUC2 and MUC5, neuron-specific enolase (NSE), chromogranin (CHR), and carcinoembryonic antigen (CEA) in order to examine the possible combinations of markers that best aid in the diagnosis of these lesions. We also performed a retrospective review of our clinical experience with these rare lesions. Results: CK7 staining was positive in all ITAC and non-ITAC cases, whereas all cases displaying gastrointestinal-type differentiation (ITAC and metastatic intestinal cases) stained positive for both CK20 and MUC2. Staining for MUC5, NSE, CHR, and CEA was variable. Conclusions: Tumors with the CK7+, CK20+, MUC2+ immunophenotype are likely primary sinonasal lesions, whereas tumors with the CK7−, CK20+, MUC2+ profile warrant further clinical evaluation to exclude metastatic disease from the gastrointestinal tract. Complete surgical resection of ITAC remains the mainstay of therapy.
Treatment of Adductor-Type Spasmodic Dysphonia by Surgical Myectomy: A Preliminary Report
Authors: Koufman Jamie A. , Rees Catherine J. , Halum Stacey L. , Blalock David 
Published: October 2014

Objectives: Despite the belief that it represents a central neurologic dysfunctional process, adductor-type spasmodic dysphonia without tremor is usually effectively treated by injection of botulinum toxin A; however, in most cases such injections must be repeated every few months. A promising new surgical procedure is herein reported. Methods: Under local anesthesia with intravenous sedation, a large laryngoplasty window is created, and under direct vision with intraoperative voice monitoring, fibers from the thyroarytenoid and lateral cricoarytenoid muscles are removed until breathiness occurs. The two sides are staged; that is, one side is done at a time, with surgery on the second side being performed 3 to 6 months after that on the first side, if needed. Results: This was a retrospective, unblinded study of 5 patients who underwent myectomy of the thyroarytenoid and lateral cricoarytenoid muscles. The preliminary results show improved voice fluency in all patients at 5 to 19 months of follow-up. There was no period of prolonged breathiness or dysphagia in any of the patients, and there were no surgical complications. Conclusions: Myectomy of the thyroarytenoid and lateral cricoarytenoid muscles is a promising new surgical treatment for adductor-type spasmodic dysphonia that may effectively mimic “permanent” botulinum toxin injections.
Quantitative and Comparative Studies of the Vocal Fold Extracellular Matrix I: Elastic Fibers and Hyaluronic Acid
Authors: Hahn Mariah S. , Kobler James B. , Starcher Barry C. , Zeitels Steven M. , Langer Robert 
Published: October 2014

Objectives: This study examines the elastic fiber and hyaluronic acid (HA) content of the midmembranous vocal fold laminae propriae (LPs) of humans, dogs, pigs, and ferrets. Methods: Lamina propria elastin was quantified by measuring the amino acid desmosine, and HA was measured by an enzyme-linked immunosorbent assay-based technique. Quantitative histology was used to evaluate elastin and HA levels in specific LP regions. The distributions of fibrillin-1, a primary microfibrillar component of elastic fibers, and of tropoelastin, an indicator of elastin synthesis, were immunohistochemically analyzed. Results: Elastin and HA constituted 8.5% ± 2.1% and 0.82% ± 0.11% of human LP, respectively, relative to tissue total protein. Although the mean LP desmosine levels were similar across species, the mean HA levels in canine (p < 3.1 × 10−5), porcine (p < 1.5 × 10−5), and ferret (p < 6.6 × 10−4) LPs were 3 to 4 times higher than that in humans. Marked interspecies differences in elastin, fibrillin-1, tropoelastin, and HA distributions were observed histologically. Conclusions: The elastin content of the human LP is roughly twice that of the dermis, whereas the HA content of the human LP is similar to that of the dermis. Although all species had similar levels of desmosine, histologic evaluation indicates that the porcine elastin distribution is most similar to that of the human LP. Fibrillin-1 staining suggests that stress in the human LP may be particularly high in the superior superficial layer, and tropoelastin staining indicates that the rate of LP elastin turnover may vary spatially.
Lack of Association between Inherited Thrombophilic Risk Factors and Idiopathic Sudden Sensorineural Hearing Loss in Italian Patients
Authors: Cadoni Gabriella , Scipione Simona , Rocca Bianca , Agostino Stefania , La Greca Carmelo , Bonvissuto Davide , Paludetti Gaetano 
Published: October 2014

Objectives: We investigated the presence of congenital thrombophilic risk factors in a population of consecutive Italian patients affected by idiopathic sudden sensorineural hearing loss (SSNHL). Methods: We investigated 48 patients with idiopathic SSNHL for the presence of congenital thrombophilic risk factors. The factor V Leiden G1691A, the prothrombin G20210A allele, and methylenetetrahydrofolate reductase (MTHFR) C677T genotypes were investigated. Allele frequencies and genotype distribution of all factors found in patients were compared to those of 48 healthy subjects of the same ethnic background by χ2 and odds-ratio analysis. Odds ratios and 95% confidence intervals were calculated for allele and genotype frequencies of all thrombophilia variants. Statistical significance was accepted with a p value of less than .05. We also performed the following blood tests: hemacytometric analysis including platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, protein S, protein C, antithrombin III, and activated protein C resistance. Results: In our series, we did not find an association between SSNHL and abnormal levels of antithrombin III, protein C, protein S, D-dimer, or fibrinogen; activated protein C resistance; or factor V G1691 A, prothrombin G20210A, or MTHFR C677T mutations. Conclusions: At present, the few studies regarding genetic polymorphisms of congenital thrombophilic factors in SSNHL are not conclusive. According to our data, factor V G1691A, prothrombin G20210A, and MTHFR C677T variants should be not considered risk factors for SSNHL. Further large prospective studies are needed to provide currently lacking information and to improve our knowledge in the field before we recommend the determination of genetic polymorphism in SSNHL as routine practice.
Preoperative Administration of Rofecoxib versus Ketoprofen for Pain Relief after Tonsillectomy
Authors: Louizos Antonios A. , Pandazi Ageliki B. , Koraka Christina P. , Davilis Dimitrios I. , Georgiou Loucas G. 
Published: October 2014

Objectives: We evaluated the analgesic efficacy and the opioid-sparing effect of oral rofecoxib compared with intramuscular (IM) ketoprofen in tonsillectomy. Methods: Seventy-seven adult patients were randomized into 2 groups: group R (n = 39), which received a single oral preoperative dose of rofecoxib 50 mg, and group K (n = 38), which received 2 IM doses of ketoprofen 100 mg (before surgery and after 12 hours). In both groups, additional IM meperidine hydrochloride 1 mg/kg was given. All patients received general anesthesia. A pain score (visual analog scale, 0 to 100) was assessed both at rest and during swallowing at 30 minutes and at 4, 8, 12, 16, and 24 hours after operation. If the pain score exceeded 40, patients were given meperidine as rescue analgesia. Results: The pain scores during rest and swallowing in group R were significantly lower (p > .05) than those of group K at 4, 8, and 12 hours after operation. Meperidine was given as rescue medication in significantly more patients of group K (76%) than of group R (38%; p > .05). Conclusions: Oral premedication with rofecoxib seems to be more effective than use of ketoprofen in decreasing postoperative pain and the need for opioid rescue medication after elective tonsillectomy. Both drugs seem to be relatively safe as far as postoperative bleeding is concerned.
Cochlear Implantation in Children with Inner Ear Malformations
Authors: Kim Lee-Suk , Jeong Sung-Wook , Huh Min-Jung , Park Young-Deok 
Published: October 2014

Objectives: The aim of this study was to assess the outcomes of cochlear implantation in children with inner ear malformations (IEMs). Methods: A retrospective review of 212 children who received implants from September 1994 to May 2004 was performed. Forty-six of them had radiologic evidence of IEMs. The preoperative evaluations, intraoperative findings, postoperative complications, and performance outcomes were analyzed. For the comparative analysis of performance outcomes, the children with IEMs were matched and compared with children with a normal inner ear who had received implants. Statistical analysis was performed with a repeated-measures analysis of variance. Results: All of the children were studied with computed tomography and magnetic resonance imaging. Three-dimensional volume rendering of magnetic resonance images was performed in cases that were difficult to interpret because of structural complexity. The operative findings included aberrant facial nerves in 2 children and cerebrospinal fluid gushers in 22 children. Intraoperative fluoroscopic examination was performed to evaluate electrode placement. There were no serious postoperative complications. All children with IEMs achieved open-set speech perception abilities, except for the children with a narrow internal auditory canal (IAC), and showed progressive improvement of their speech perception abilities over time. There were no statistically significant differences in performance measured by the Common Phrases test between the 2 groups. Although the repeated-measures analysis of variance indicated that children with IEMs performed more poorly than those with a normal inner ear on the Phonetically Balanced Kindergarten test for phonemes, statistical significance was not found at 2 years after implantation. The children with a narrow IAC benefited from the implantation and used the device every day, although their speech perception abilities were limited. Conclusions: The results of the present study show that cochlear implantation can be performed relatively safely in deaf children with IEMs and that they receive considerable benefit from their implants. Substantial benefit can be expected from implantation in children with most kinds of IEMs, except for a narrow IAC, which is often associated with limited results.
Varicella-Zoster Virus Load and Cochleovestibular Symptoms in Ramsay Hunt Syndrome
Authors: Ohtani Fumio , Furuta Yasushi , Aizawa Hiroshi , Fukuda Satoshi 
Published: October 2014

Objectives: The mechanism by which varicella-zoster virus (VZV) reactivation causes cochleovestibular symptoms (CVSs) in patients with Ramsay Hunt syndrome (RHS) remains to be elucidated. The present study analyzed the relationship between VZV load and the onset of CVSs in RHS. Methods: The subjects consisted of 56 patients with RHS; 29 exhibited CVSs and facial paralysis (FP; group 1), and 27 exhibited FP without CVSs (group 2). The VZV DNA copy number in the saliva was measured with a quantitative polymerase chain reaction. Anti-VZV antibodies were assayed by an enzyme-linked immunosorbent assay with paired sera. Results: There was no significant difference in maximum viral copy number between the Two groups. In group 1, CVSs occurred at various times between the early phase and the regression phase of VZV reactivation. In some patients, CVSs occurred in the early phase of VZV reactivation, before the onset of zoster lesions and FP. Conclusions: There are various different patterns in the development of eighth cranial nerve dysfunction, which is caused by progression of neuritis or labyrinthitis following VZV reactivation. Our data suggest that CVSs in RHS may also be caused by reactivation of VZV in the spiral and/or vestibular ganglia.
Imaging the Human Vocal Folds in Vivo with Optical Coherence Tomography: A Preliminary Experience
Authors: Klein Adam M. , Pierce Mark C. , Zeitels Steven M. , Anderson R. Rox , Kobler James B. , Shishkov Milen , de Boer Johannes F. 
Published: October 2014

Objectives: Optical coherence tomography (OCT) and polarization-sensitive OCT (PS-OCT) are promising noninvasive methods for in vivo, cross-sectional imaging of the microstructure of the vocal folds. Previous studies in other tissues have shown an axial resolution of less than 10 μm and a maximum imaging depth of about 2 mm. The objectives of this pilot study were to obtain images from the vocal folds of subjects who were being evaluated and/or treated for vocal fold disease and to evaluate how well normal and pathologic microstructure could be seen in these images. Methods: Twenty-six vocal folds in 13 subjects were imaged with a flexible OCT probe. The images were successfully collected from subjects who were either topically anesthetized or under general anesthesia for microlaryngoscopic procedures. Results: The thickness of the epithelium, the relative collagen content of the subepithelial connective tissue, and certain characteristic features of lesions (including cysts, scarring, and papilloma) were seen in the OCT and PS-OCT images. Conclusions: “Live microscopy” of the human vocal folds is very promising for improved diagnosis, mapping, and treatment planning. To our knowledge, this study is the first application of PS-OCT for in vivo imaging of the human vocal folds.