bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carcinosarcoma of the Parotid Gland: Report of a Case with Immunohistochemical Findings
Authors: Liess Benjamin D. , Hirschi Scot , Zitsch Robert P. , Frazier Shellaine , Konrad Angela 
Published: October 2014

Objectives: Carcinosarcoma (true malignant mixed tumor) of the parotid gland is an extremely uncommon tumor composed of both carcinomatous and sarcomatous components. An understanding of this manifestation is crucial to guide management and treatment of this disease. Methods: A patient who presented with facial nerve weakness and a painful mass of the parotid gland underwent fine needle aspiration, laboratory testing, and computed tomography of the neck that demonstrated a large parotid malignancy. The patient underwent surgical treatment followed by radiotherapy. Histologic and immunohistochemical examination of the specimen was performed. Results: This report of a slow-growing parotid mass with otalgia and facial nerve weakness was treated with radical parotidectomy, supraomohyoid neck dissection, and cable graft repair of the excised facial nerve, which was completely encircled by tumor. Postoperative radiotherapy was administered. Histologic and immunohistochemical evaluation demonstrated carcinosarcoma. Conclusions: Carcinosarcoma is an unusual tumor of the parotid gland. Treatment generally involves surgery with subsequent radiotherapy. Long-term close follow-up is recommended, for this tumor has a high propensity for both local and regional recurrence and metastasis.
Results, Hearing Rehabilitation, and Follow-up with Magnetic Resonance Imaging after Tympanomastoid Exenteration, Obliteration, and External Canal Overclosure for Severe Chronic Otitis Media
Authors: Ketelslagers Katrien , Somers Thomas , De Foer Bert , Zarowski Andrzej , Offeciers Erwin 
Published: October 2014

Objectives: We sought to evaluate the results, auditory rehabilitation, and follow-up with magnetic resonance imaging (MRI) after tympanomastoid exenteration with obliteration of the mastoid cavity and overclosure of the external ear canal in patients with severe chronic otitis media that was resistant to medical therapy and conventional surgery and was associated with a profound sensorineural or severe conductive hearing loss. Methods: Twenty-nine patients were analyzed and underwent this surgical technique. Twelve patients had, during the same or later stage, either cochlear implantation, fixture implantation for a bone-anchored hearing aid, or middle ear implantation. For follow-up control of the obliterated cavity, delayed gadolinium-enhanced, T1-weighted MRI in combination with non-echo planar imaging diffusion weighted sequences were used. Results: No patient had recurrent otorrhea after an average follow-up period of 4.75 years. One patient had a residual cholesteatoma as shown by new MRI techniques, and this was successfully resected. One patient developed complications 6 months after 1-stage tympanomastoid exenteration and cochlear implantation. Conclusions: This technique is very useful in selected patients with severe chronic otitis media that is resistant to medical therapy and surgery and is associated with a profound sensorineural or severe conductive hearing loss. New sequences in MRI are used for postoperative follow-up of these obliterated cavities and seem reliable for the detection of residual or recurrent cholesteatoma. Middle ear implantation and cochlear implantation can be relatively safely performed in these patients in a second stage.
Drug Delivery System of Hepatocyte Growth Factor for the Treatment of Vocal Fold Scarring in a Canine Model
Authors: Ohno Tsunehisa , Hirano Shigeru , Kanemaru Shin-Ichi , Yamashita Masaru , Umeda Hiroo , Suehiro Atsushi , Tamura Yoshihiro , Nakamura Tatsuo , Ito Juichi , Tabata Yasuhiko 
Published: October 2014

Objectives: Vocal fold scarring remains a therapeutic challenge. Previous studies have indicated that hepatocyte growth factor (HGF), a strong antifibrotic element, has therapeutic potential for restoring scarred vocal folds. To enhance the effect of HGF in vivo, we developed a novel drug delivery system (DDS) in which HGF is embedded in gelatin hydrogel and continuously released over a period of 2 weeks. In the present study we investigated the therapeutic efficacy of the HGF DDS on vocal fold scarring by using a canine model. Methods: The vocal folds of 8 beagles were unilaterally scarred by stripping the entire layer of the lamina propria. The contralateral vocal folds were kept intact as normal controls. One month after the procedure, hydrogels (0.5 mL) containing 1 μg of HGF were injected into the scarred vocal folds of 4 dogs (HGF-treated group), whereas hydrogels containing saline solution were injected in the other 4 dogs (sham group). Histologic and vibratory examinations were completed for each group 6 months after the initial surgery. Results: The excised larynx experiments showed significantly better vibration in terms of mucosal wave amplitude and glottal closure in the HGF-treated group compared to the sham group. Histologic evaluation of the vocal folds indicated remarkable reduction in collagen deposition and tissue contraction, with favorable restoration of hyaluronic acid and elastin in the HGF-treated group. Conclusions: The present findings suggest that the novel HGF DDS may provide favorable effects in restoring the vibratory properties of scarred vocal folds.
Impact of Treatment of Gastroesophageal Reflux on Obstructive Sleep Apnea-Hypopnea Syndrome
Authors: Friedman Michael , Gurpinar Berk , Lin Hsin-Ching , Schalch Paul , Joseph Ninos J. 
Published: October 2014

Objectives: We test the hypothesis that treatment of gastroesophageal reflux disease (GERD) can improve obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: One hundred forty-six patients with OSAHS underwent a complete history-taking, physical examination, and laboratory testing, including questions related to GERD symptoms. Full-night attended polysomnography, 24-hour wireless pH study at the upper esophagus, snoring level evaluation, Epworth Sleepiness Scale, and quality-of-life surveys were completed for each patient. Patients who tested positive for GERD were treated with esomeprazole magnesium 40 mg once daily for 2 to 12 months. The 24-hour pH study was repeated, and those patients with elimination of GERD were reevaluated by polysomnography, snoring level evaluation, Epworth Sleepiness Scale, quality-of-life surveys, and subjective data collection. Results: Forty-one patients completed single-dose treatment with esomeprazole, but the repeat 24-hour pH study showed that 9 patients had persistent GERD. In the 29 patients who completed phase 2 with normal pH study findings, the snoring level decreased from 9.7 ± 0.5 to 7.9 ± 1.3 (p < .0001), the Epworth Sleepiness Scale score decreased from 14.2 ± 2.5 to 11.1 ± 2.4 (p < .0001), the apnea-hypopnea index decreased from 37.9 ± 19.1 to 28.8 ± 11.5 (p = .006), and the minimum saturation of oxygen increased from 84.1% ± 7.8% to 86.9% ± 5.0% (p = .055). Conclusions: Treatment of GERD had a significant impact on the reduction of the apnea-hypopnea index, snoring, and daytime sleepiness. Elimination of GERD should be part of a comprehensive treatment plan for patients with OSAHS.
Auditory Skills Checklist: Clinical Tool for Monitoring Functional Auditory Skill Development in Young Children with Cochlear Implants
Authors: Meinzen-Derr Jareen , Wiley Susan , Creighton Jodi , Choo Daniel 
Published: October 2014

Objectives: The Auditory Skills Checklist© (ASC) was developed to address the need for tools to evaluate functional auditory skill progress in very young children with sensorineural hearing loss. We describe the development, validation, and utility of the ASC for use in young children with cochlear implants. Methods: Using the ASC, we measured auditory skills in 37 subjects who received cochlear implants at no more than 36 months of age. Repeated measures analysis was conducted to determine expected auditory skill development after implantation. Interrater reliability was tested on a small subset. The ASC was compared to the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) to determine its validity in measuring functional auditory skills. Results: The ASC had excellent internal consistency (Cronbach's alpha, 0.98) and interrater reliability (intraclass correlation coefficient, 0.99), and was highly correlated with the IT-MAIS (r = 0.90). According to the repeated measures analysis, children who received a cochlear implant at 36 months of age or earlier were expected to increase their ASC score by 8 points every 3 months (beta coefficient, 8.3; p < .001). Conclusions: The ASC is a clinically relevant and easily administered tool for assessing the functional auditory skills of young children with a cochlear implant. By assessing auditory skill development over time with the ASC, we can better realize expectations for a particular child based on his or her age, hearing loss level, and management strategies in place.
Treatment of Early-Stage Glottic Cancer by Transoral Laser Resection
Authors: Hartl Dana M. , de Monès Erwan , Hans Stéphane , Janot François , Brasnu Daniel 
Published: October 2014

Objectives: We reviewed outcomes of treatment of early glottic carcinoma by transoral laser resection. Methods: We performed a retrospective study of tumor stage, type of cordectomy (European Laryngological Society), resection margins, local control, and laryngeal preservation. Results: Of 142 patients treated with curative intent, 79 (92% male; average age, 63 years) were retained for this study, on the basis of availability of information regarding resection margins, the absence of adjuvant radiotherapy, and follow-up of at least 2 years. The tumors were classified pTis (n = 21), pT1a (n = 51), or pT1b (n = 7) and were treated by cordectomy types I (23%), II (30%), III (27%), IV (6%), and V (14%). The average follow-up was 56 months (range, 24 to 150 months). The overall 5-year actuarial recurrence-free survival rate was 89%, and the 5-year actuarial disease-specific survival rate was 97.3%. There were 11 local recurrences (14%); 7 were treated by another laser resection, 1 by radiotherapy, 1 by supracricoid partial laryngectomy, and 2 by total laryngectomy. The overall rate of final local control with the laser alone was 100% for patients with initially positive margins, 95% for those with initially suspicious margins, and 94% for those with free margins. The overall rate of organ preservation was 100% for patients with positive or suspicious margins and 96% for those with free margins. Margin status (p = .39), cordectomy type (p = .67), and anterior commissure involvement (p = .16) were not statistically related to recurrence (Kaplan-Meier calculations with nonparametric univariate analysis). The recurrence rate was significantly higher for T1b tumors, however (p = .001). Conclusions: Laser microresection provides high rates of local control and organ preservation for early glottic cancer. Positive or suspicious margins were not related to recurrence, nor was anterior commissure involvement. This study implies that suspicious margins can be managed with a “watch-and-wait” attitude. Re-treatment with laser, external partial laryngectomy, and radiotherapy remain therapeutic options for recurrences.
Long-Term Botulinum Toxin Dose Consistency for Treatment of Adductor Spasmodic Dysphonia
Authors: Holden Paul K. , Vokes David E. , Taylor Michael B. , Till James A. , Crumley Roger L. 
Published: October 2014

Objectives: Botulinum toxin (BTX) injection is currently the primary and most common treatment for adductor spasmodic dysphonia (ADSD). A variety of injection strategies and dosage regimens have been described. This study reports on our experience with the dosage schedule and dosing consistency of BTX for the treatment of ADSD. Methods: We retrospectively reviewed our laryngeal BTX database for the period 1991 to 2005. Our strict inclusion requirements limited our selection to 13 patients who had received a minimum of 6 injections (average, 11.5; range, 6 to 19) of BTX for ADSD. Results: The average total dose of BTX to the larynx for each treatment episode was 3.9 units (range, 1.5 to 7.5). The total dose administered tended to trend downward among patients who began treatment from 1991 to 1998, indicating that the initial dose (usually 2.5 units per side) may have been high. Those patients who began from 1999 onward had a more stable dose, indicating that the initial dose (usually 1.5 units per side) was more suitable. The subjects underwent an average of 2.2 injections (range, 1 to 5) before reaching their optimal BTX dose. The total number of treatments performed in this group of patients was 150, of which 145 were successful (96.7%). Conclusions: The BTX dose for the optimal treatment of ADSD usually remains consistent over time, as does the treatment interval. An initial dose of 1.5 units per side or less appears to improve dosing stability, indicating that the initial dosing of 2.5 units per side in our study was often greater than required. The optimal BTX dose was usually ascertained by the second or third injection. In our patient population, the long-term dosing consistency of BTX confirmed that neither tachyphylaxis nor increasing sensitivity to BTX occurred during the course of treatment for ADSD.
Successful Cochlear Implantation in a Patient with Bilateral Progressive Sensorineural Hearing Loss after Traumatic Subarachnoid Hemorrhage and Brain Contusion
Authors: Fujimoto Chisato , Ito Ken , Takano Shingo , Karino Shotaro , Iwasaki Shinichi 
Published: October 2014

Objectives: We address the proper indications for cochlear implantation for profound deafness with possible retrocochlear involvement by reporting successful implantation in a patient with traumatic subarachnoid hemorrhage and brain contusion. Methods: We present a patient (55-year-old man) who had bilateral progressive sensorineural hearing loss after traumatic subarachnoid hemorrhage and brain contusion. Preoperative imaging and functional studies were done, as well as routine tests, to evaluate the possible performance of the cochlear implant. Results: Sensorineural hearing loss developed promptly after head trauma with progressive deterioration. The cause of progressive sensorineural hearing loss remained unknown. Distortion product otoacoustic emissions demonstrated bilateral inner ear (outer hair cell) damage. Highly impaired speech discrimination despite less marked pure tone average elevation and a focal lesion in the left middle temporal gyrus suggested the possibility of coexisting retrocochlear lesions. After thorough discussion of the possible outcomes, cochlear implantation was successfully performed 25 months after the trauma. The patient became able to use a telephone. Conclusions: We advocate that profound bilateral sensorineural hearing loss caused by traumatic head injury, even with possible involvement of central auditory pathways, should not be regarded as a contraindication to cochlear implantation, as long as bilateral inner ear dysfunction is clearly demonstrated and there is no obvious evidence of central deafness.
Receptor-Mediated Uptake of Pepsin by Laryngeal Epithelial Cells
Authors: Johnston Nikki , Wells Clive W. , Blumin Joel H. , Toohill Robert J. , Merati Albert L. 
Published: October 2014

Objectives: Previous data suggest a mechanistic link between exposure to pepsin and cellular changes that lead to laryngopharyngeal disorders. Initial confocal microscopy analysis of pepsin uptake by cultured hypopharyngeal epithelial cells revealed that pepsin may be taken up by a specific process. The objective of this study was to use electron microscopy to confirm the initial confocal findings and to determine whether uptake of pepsin by laryngeal epithelial cells is receptor-mediated. Methods: Cultured human hypopharyngeal FaDu cells and human laryngeal biopsy specimens, taken from the posterior larynx of “control” patients without symptoms or findings of laryngopharyngeal reflux, were exposed to purified human pepsin 3b with or without transferrin (a marker for receptor-mediated endocytosis) in vitro. Uptake of pepsin was documented by electron microscopy. Results: Pepsin co-localized with transferrin in intracellular vesicles; this finding confirms that pepsin is taken up by laryngeal epithelial cells by receptor-mediated endocytosis. Conclusions: This is a novel finding that further defines the role and mechanism of pepsin-mediated injury in laryngopharyngeal reflux. The objective of ongoing research is to identify the receptor and investigate potential antagonists as a new therapeutic option for patients with reflux-attributed disease — In particular, those patients who have persistent symptoms despite acid suppression therapy.
Utilization of the LifeStat Emergency Airway Device
Authors: Mouadeb Debbie A. , Rees Catherine J. , Belafsky Peter C. 
Published: October 2014

Objectives: Management of the airway in an emergency may be a harrowing experience. The equipment necessary to perform this procedure is often inaccessible. The LifeStat emergency airway is a portable device approved by the US Food and Drug Administration in 1997 for emergency cricothyrotomy. It is small enough to secure to a keychain, thus allowing instantaneous access at all times. We present a retrospective case series to report the experience of clinicians who have used the LifeStat device. Methods: A survey instrument was sent to a convenience sample of health-care professionals who purchased the LifeStat emergency airway. The survey queried device use, user demographics, and the success, ease, complications, and location of use. Results: One thousand surveys were distributed, and 100 individuals responded. Fifteen percent (15 of 100) reported use of the device on 17 occasions. The LifeStat was used successfully in all 17 cases. Eighty-two percent (14 of 17) of emergency use was in hospitals. In all cases the device was positioned successfully on the first attempt. No complications were reported. Conclusions: The LifeStat device provides a relatively safe and effective means of performing emergency cricothyrotomy. The majority of emergency situations in which the device was deployed occurred in hospital settings.
Ansa Cervicalis-to-Recurrent Laryngeal Nerve Anastomosis for Unilateral Vocal Fold Paralysis: Experience of a Single Institution
Authors: Lorenz Robert R. , Esclamado Ramon M. , Teker Aysenur M. , Strome Marshall , Scharpf Joseph , Hicks Douglas , Milstein Claudio , Lee Walter T. 
Published: October 2014

Objectives: One treatment option for unilateral vocal fold paralysis (UVFP) is ansa cervicalis-to-recurrent laryngeal nerve (ansa-RLN) anastomosis to provide reinnervation to the affected vocal fold. The advantages of this treatment approach are that it 1) provides vocal fold tone, bulk, and tension, 2) is technically simple, and 3) does not preclude other medialization procedures. We present all patients who have undergone ansa-RLN anastomosis for UVFP at our institution. Methods: An Institutional Review Board-approved retrospective chart review was performed to include all patients who had undergone an ansa-RLN anastomosis procedure for UVFP at our institution. Data from clinical and endoscopic laryngoscopy with stroboscopy were recorded. Statistical analysis was performed on visual and perceptual vocal data. Results: A total of 46 patients were included in the study. Stroboscopic analysis and perceptual vocal evaluation was performed in a blinded fashion on the 21 patients who had preoperative and postoperative stroboscopy. Severity, roughness, breathiness, and strain all improved significantly over time. Glottic closure, vocal fold edge, and supraglottic effort all significantly improved after operation. Of the 38 patients with at least 3 months of follow-up, all except 1 demonstrated evidence of reinnervation. Conclusions: This technique for treating UVFP results in significant improvements in patients' voice and on visual examination.
Cricotracheal Resection in Nontracheotomized Adults: A Prospective Case Series
Authors: Sittel Christian , Blum Sebastian , Streckfuss Alexandra , Plinkert Peter K. 
Published: October 2014

Objectives: Cricotracheal resection is a modern technique of airway reconstruction used in cases of subglottic stenosis. We report a case series of adult, nontracheotomized patients. Methods: Fifteen patients with significant subglottic stenosis were identified as presenting with dyspnea and stridor. The stenosis was grade III in 14 cases and grade II in 1 case, according to the Cotton classification. The causes were manifold, with intubation and tracheostomy being the predominant risk factors. Cricotracheal resection was performed in all cases with preoperative and postoperative videotracheoscopy. Results: The mean postoperative intubation time was 41.7 hours (11 to 103 hours), and the mean length of stay in the intensive care unit was 2.6 days (3 to 9 days). Videotracheoscopy for reassessment was performed after 96 days (average). In 13 of the 15 patients the subglottic lumen was returned to a normal diameter. In 1 case a recurrent stenosis was managed with repeated endoscopic interventions. One patient died on postoperative day 4 because of a pulmonary embolism. Additional complications consisted of 1 axillary venous embolism, 4 cases of ventilator-associated pneumonia, and 1 case of transient unilateral recurrent nerve palsy that recovered completely. Conclusions: Cricotracheal resection is a reliable and versatile technique for the reconstruction of the subglottic airway, almost regardless of the underlying cause. Most complications observed have not been associated directly with the procedure, but reflect the significant comorbidity of the patient population. There seems to be an increased risk for thromboembolic events that may be a consequence of the preoperative immobilization of dyspneic patients.
Orocutaneous and Pharyngocutaneous Fistula Closure Using a Vacuum-Assisted Closure System
Authors: Andrews Brian T. , Smith Russell B. , Hoffman Henry T. , Funk Gerry F. 
Published: October 2014

Objectives: The vacuum-assisted closure (VAC) system is a topical negative pressure dressing that has been used extensively to manage a multitude of complicated wounds, including enterocutaneous fistula. We hypothesize that the VAC system may also facilitate the closure of orocutaneous and pharyngocutaneous fistulas. Methods: A retrospective chart review was performed. Results: Three patients were identified. Two patients developed fistulas after undergoing salvage laryngectomy, and 1 patient developed a fistula after having a hemiglossectomy defect reconstructed by a radial forearm free flap. The VAC system was successful in closing the fistula in 2 of the 3 patients. Complete fistula closure took 3 and 11 days in the 2 cases. The 1 failure of fistula closure was due to poor collapsibility of the neck tissue along the fistula tract caused by fibrosis following prior radiotherapy. Conclusions: The VAC system is a feasible treatment option for closing head and neck fistulas, especially when collapsible tissue is present at the fistula site.