bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, Morphology, and Prognosis of Human Papillomavirus in Tonsillar Cancer
Authors: Luginbuhl Adam , Sanders Melinda , Spiro Jeffrey D. 
Published: October 2014

Objectives: We sought to identify the prevalence of human papillomavirus (HPV) in tonsillar squamous cell carcinoma, and to examine the relationship of HPV to prognosis and tumor morphology. Methods: We performed in situ hybridization for HPV and retrospective clinical outcome analysis. Results: Of the 48 patients with tonsillar carcinoma, in situ hybridization identified 35% as HPV-positive tumors. Age-matched controls had no evidence of HPV. There was no significant difference between HPV-positive and HPV-negative patients regarding age (p = 0.34), tobacco consumption (p = 0.59), alcohol consumption (p = 0.91), or treatment method (p = 0.39). Forty-four patients were eligible for outcome analysis. The overall rate of recurrence in this population was 25%, and the disease-specific survival rate was 84%. There was no significant difference between the two groups either in the incidence of recurrence (p = 0.14) or in the disease-specific survival rate (p = 0.19). HPV-associated tumors developed from the tonsillar crypts significantly more frequently than did HPV-negative tumors (p = 0.01). Conclusions: As previously described, HPV is significantly associated with squamous cell carcinoma of the tonsil; however, HPV status in our series did not correlate with clinical outcome. Morphologically, we found that HPV-positive tumors had their origin in the tonsillar crypts, whereas HPV-negative tumors arose from the surface epithelium.
Superior Thyroid Cornu Syndrome: An Unusual Cause of Cervical Dysphagia
Authors: Mortensen Melissa , Ivey Chandra M. , Iida Minoru , Woo Peak 
Published: October 2014

Objectives: Ossification of a superior thyroid cornu in men may cause pharyngeal airway impingement and result in cervical dysphagia. We report on a clinical case series of this rare condition, called superior thyroid cornu syndrome. This is the first report of a case series of this entity as a possible cause of cervical dysphagia that was successfully treated with an endoscopic procedure. Methods: A clinical case series of 12 patients were identified as having superior thyroid cornu syndrome (years 2001 to 2006). Eleven patients were male and 1 was female; their mean age was 54.6 years. They complained of unresolved throat pain, difficulty swallowing, and/or pain on swallowing. On flexible laryngoscopy, there was an asymmetric indentation of the pharynx due to a prominent superior thyroid cornu. Laryngeal manipulation produced the pain and exposed the prominent cornu in the airway. Computed tomographic evidence of calcification of the superior thyroid horn without other abnormality was noted. Results: After maximal medical treatment with proton pump inhibitors, anti-inflammatory agents, nasal steroids, antihistamines, and/or other allergy treatments, 8 of the patients who had persistent symptoms were treated by transoral pharyngotomy and resection of an approximately 2.0 × 0.5-cm segment of a thyroid cornu. Vast improvement in symptoms occurred in 6 patients, and complete symptom resolution occurred in 3 of those 6. Two of 8 patients reported improvement in swallowing, but persistent pain. The follow-up duration was between 2 and 15 months from the time of surgery. Conclusions: Superior thyroid cornu syndrome may be a rare cause of cervical dysphagia. It may be diagnosed by careful laryngoscopy with laryngeal palpation followed by a computed tomography scan. Surgical resection of the affected superior thyroid cornu by transoral pharyngotomy appears to be effective in relief of symptoms.
Surgical and Medical Treatment of Hearing Loss in Mixed Otosclerosis
Authors: Félix-Trujillo Manuel Martín , Valdez-Martínez Edith , Ramírez Jorge Eduardo , Lozano-Morales Ramón 
Published: October 2014

Objectives: We assessed the effect of using preoperative sodium fluoride (NaF) on the difficulty of working with the footplate during stapedectomy and its effect on the postsurgical hearing gain in patients with mixed otosclerosis (ie, otosclerosis and/or otospongiosis). Methods: There were 2 groups of patients with mixed otosclerosis. The experimental group was made up of patients with an active focus of the disease; they received NaF for 6 months and then underwent stapedectomy. The control group was made up of patients with an inactive focus of the disease; they underwent stapedectomy without administration of NaF. Results: The difference between the study groups in the degree of difficulty in extracting the footplate was not found to be statistically significant. Both groups had hearing gains in bone and air conduction. The level of posttreatment hearing gain in the group exposed to NaF was greater than that in the nonexposed group. Conclusions: Sodium fluoride administered to patients with mixed otosclerosis and an active focus of disease does not increase the difficulty of working with the footplate during stapedectomy, and it increases the hearing gain after the procedure.
Glottal Reconstruction with a Tissue Engineering Technique Using Polypropylene Mesh: A Canine Experiment
Authors: Yamashita Masaru , Kanemaru Shin-Ichi , Hirano Shigeru , Umeda Hiroo , Kitani Yoshiharu , Omori Koichi , Nakamura Tatsuo , Ito Juichi 
Published: October 2014

Objectives: The larynx must be resected in some cases of cancer or stenosis, and various techniques are generally employed to fill the resulting defect. No ideal way, however, has been established to restore vocal function after this form of insult. The aim of this preliminary feasibility study in a canine model was to investigate the effectiveness of a polypropylene-based tissue engineering approach to repair a partial glottal defect. Methods: Eight dogs were used in this study. A laryngeal defect involving resection of the left vocal fold was created through a thyroid cartilage window. A scaffold made of polypropylene and collagen was preclotted and wrapped with autologous fascia lata, inserted through the window, and sutured to the laryngeal defect in 5 dogs. The defect was reconstructed with an adjacent sternohyoid muscle flap in 3 control dogs. The surgical site was evaluated 3 months after operation by fiberscopic examination, computed tomographic imaging, histologic evaluation, and study of excised larynges. Results: On fiberscopic examination, the experimental group implants were completely covered with regenerated mucosa in all cases, and a favorable vocal fold contour was found in 4 of the 5 cases. One case was characterized by a concave vocal fold shape and red granulation. In the control group, the muscle flap was replaced by scarred mucosa with a concave vocal fold contour in 2 cases, and there was soft white granulation at the anterior resected edge in the third case. The histologic data revealed the regeneration of lined epithelium, subepithelial tissue, and muscle structure in both groups. The excised larynx phonatory data revealed reduced vibratory amplitude in the experimental group compared with the control group; however, excised phonation was not achieved in 2 of the 3 cases in the control group. Conclusions: This polypropylene-based tissue engineering technique appears to be a viable tool for glottal reconstruction; however, additional refinement is required to maximize long-term phonatory function.
Multiparameter Analysis of Titanium Vocal Fold Medializing Implant in an Excised Larynx Model
Authors: Witt Rachel E. , Hoffman Matthew R. , Friedrich Gerhard , Rieves Adam L. , Schoepke Benjamin J. , Jiang Jack J. 
Published: October 2014

Objectives: We evaluated the efficacy of the titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis (UVFP) on the basis of acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup. Methods: Measurements were recorded on 8 excised canine larynges with simulated UVFP before and after medialization with a TVFMI. Results: The phonation threshold flow (p < 0.001) and phonation threshold power (p = 0.008) decreased significantly after medialization. The phonation threshold pressure also decreased, but this difference was not significant (p = 0.081). Jitter (p = 0.005) and shimmer (p = 0.034) decreased significantly after medialization. The signal-to-noise ratio increased significantly (p = 0.05). Differences in mucosal wave characteristics were discernible but not significant. The phase difference between the normal and paralyzed vocal folds (p = 0.15) and the amplitude of the paralyzed vocal fold (p = 0.78) decreased. The glottal gap decreased significantly (p = 0.004). Conclusions: The TVFMI was effective in achieving vocal fold medialization, improving vocal aerodynamic and acoustic characteristics of phonation significantly and mucosal wave characteristics discernibly. This study provides objective, quantitative support for the use of the TVFMI in improving vocal function in patients with UVFP.
Arytenoid Adduction for Correcting Vocal Fold Asymmetry: High-Speed Imaging
Authors: Kimura Miwako , Imagawa Hiroshi , Nito Takaharu , Sakakibara Ken-Ichi , Chan Roger W. , Tayama Niro 
Published: October 2014

Objectives We hypothesized that high-speed digital imaging provides a quantitative method to evaluate the effect of arytenoid adduction for the correction of asymmetric and irregular vocal fold vibration in unilateral vocal fold paralysis. Methods Six subjects with unilateral vocal fold paralysis participated in the study (4 male, 2 female; mean [±SD] age, 52.5 ± 21.3 years). Videokymographic and laryngotopographic methods for image analysis were performed for highspeed recordings of vocal fold vibration for visualizing the glottal vibratory patterns, and for quantifying the frequency of vibration of each vocal fold, respectively. Comparisons of the paralyzed and the normal vocal folds were made before and after arytenoid adduction. Results Analysis of the laryngotopographs revealed 2 distinct frequencies of vibration for the paralyzed and the contralateral vocal folds for all subjects before surgery. After arytenoid adduction, the vibration frequencies became identical or nearly identical in all subjects. Conclusions Asymmetric vibration in vocal fold paralysis was exemplified by differences in vibration frequency between the vocal folds. The present data showed that after arytenoid adduction the vibration frequencies and the vibratory patterns of the contralateral vocal folds approached symmetry. This surgical procedure could improve the functional symmetry of the larynx for phonation.
Vocal Function Exercises for Presbylaryngis: A Multidimensional Assessment of Treatment Outcomes
Authors: Sauder Cara , Roy Nelson , Tanner Kristine , Houtz Daniel R. , Smith Marshall E. 
Published: October 2014

Objectives Presbylaryngis, or aging of the larynx, can adversely affect vocal function and quality of life in the elderly. This preliminary investigation examined the effects of vocal function exercises, a physiologic voice therapy approach, as a primary treatment for presbylaryngis. Methods Nine consecutive elderly patients with presbylaryngis (2 female, 7 male) underwent a 6-week course of voice therapy employing vocal function exercises. Pretherapy-versus-posttherapy comparisons were made of self-ratings of voice handicap and phonatory effort level, as well as auditory-perceptual voice assessments, acoustic analyses, and visual-perceptual evaluations of laryngeal images. Results After treatment, patients reported significant reductions on Voice Handicap Index scores, phonatory effort levels, and voice disorder severity. Blinded listeners rated the posttreatment voices as significantly less breathy and strained. However, comparison of pretreatment and posttreatment maximum phonation times, acoustic measures, and laryngeal images did not reveal significant changes. Conclusions These preliminary data suggest that vocal function exercises produce significant functional and perceptual improvements in voice, and deserve further attention as a treatment for elderly patients with presbylaryngis.
Hemoglobin Monitoring in Head and Neck Cancer Patients Undergoing Radiotherapy
Authors: Montgomery Jennifer , Syed Mohammed Iqbal , Rana Indu , Singh Jatinder , Clark Louise J. 
Published: October 2014

Objectives Anemia is a well-recognized factor for local recurrence and decreased survival in cancer patients undergoing radiotherapy. Additionally, lower hemoglobin (Hb) levels have a negative impact on radiotherapy efficacy and response rates. The objective of this audit was to investigate how frequently Hb levels were observed in head and neck cancer patients receiving radiotherapy within a multidisciplinary team setting. Methods We performed a retrospective first-cycle audit in a university hospital in Glasgow that is a tertiary referral center for head and neck cancer. Included were 78 patients with head and neck cancer who were undergoing radiotherapy. Online laboratory services and clinical case sheets were checked for each patient to monitor the frequency of observation of Hb levels before, during, and after radiotherapy. Results Of these 78 patients, only 49 had their Hb level checked before radiotherapy treatment, only 9 during radiotherapy, and only 27 after completion of radiotherapy treatment (p < 0.0001). Of the 49 patients with preradiotherapy Hb levels available, 24% were found to be anemic; none of these patients had their Hb monitored during radiotherapy, and only 4 had Hb levels recorded after completion of treatment. Conclusions This audit has highlighted that despite evidence emphasizing that anemia in cancer is an independent prognostic factor for recurrence, there is no formal protocol for Hb monitoring in head and neck cancer patients undergoing radiotherapy. The audit has also demonstrated that Hb monitoring is infrequently performed and that subsequent observation of the Hb level is suboptimal.
Congenital Cholesteatoma: Posterior Lesions and the Staging System
Authors: Inokuchi Go , Okuno Taeko , Hata Yuko , Baba Miyuki , Sugiyama Daisuke 
Published: October 2014

Objectives We described the characteristics of congenital cholesteatoma in Japanese patients and assessed whether the staging system is useful for predicting the rate of residual disease, the need for reexploration, and surgical outcomes. Methods We performed a retrospective chart analysis of 23 consecutive patients with congenital cholesteatoma. Results The proportion of cases with anterior-superior quadrant involvement was significantly lower in the Asian group than in Western patients. The total residual rate was 26%, and there was a positive association between stage and residual rate, ranging from 0% in stage I and II to 44% in stage IV. Canal wall–up tympanomastoidectomy was the most frequent procedure (57%), and 61% had reexploration. Conclusions Congenital cholesteatoma in Asia is less likely to involve the anterior-superior quadrant than in Western patients. The 4-stage system was useful for predicting residual rates, even in patients in whom anterior-superior quadrant involvement was less common. Postoperative hearing was significantly related to the stages. A routine second-look procedure may be unnecessary in the early stages, whereas reexploration would be better performed in advanced stages. Endoscopy might reduce residual disease and the need for reexploration in the near future.
Multicenter Evaluation of the Digisonic SP Cochlear Implant Fixation System with Titanium Screws in 156 Patients
Authors: Guevara Nicolas , Sterkers Olivier , Bébéar Jean-Pierre , Meller Renaud , Magnan Jacques , Mosnier Isabelle , Amstutz Isabelle , Lerosey Yannick , Triglia Jean-Michel , Roman Stéphane , Gahide Ivan 
Published: October 2014

Objectives: We describe and evaluate the process of fixation of the Digisonic SP cochlear implant with two titanium screws. Methods: The characteristics of this implant allow cochlear implantation using a minimal incision, a subperiosteal pocket, and fixation with two titanium screws, without drilling a custom-fitted seat or creating suture-retaining holes in the skull. The fixation system relies on two tailfins for use of osseo-integratable screws, incorporated into the cochlear implant housing. The first version of this fixation system was modified after a case of device migration: The size of the titanium insert inside the silicone tailfin was increased. Data on 156 patients (8 months to 86 years of age) from a 4-year period in 6 cochlear implantation centers were retrospectively evaluated. Ten patients have undergone bilateral implantation. Results: Of 166 implantations, 4 postoperative infections and 1 device failure after head trauma were reported. No cerebrospinal fluid leaks or epidural hematomas were reported. One device migration was observed in the first series; no device migrations occurred in the second series. Conclusions: The fixation system with screws embedded in the Digisonic SP involves a fast and simple surgical technique that seems to efficiently prevent implant migration.
Do Viscid Secretions Have a Role in Nasal Polyp Formation?
Authors: Sayed Ramadan Hashem , Abu-Dief Eman E. , Mohamed Doha S. 
Published: October 2014

Objectives: We compared histologic findings on light microscopy of viscid secretions found in association with nasal polyps with those found in patients with chronic sinusitis without polyposis (CSWP). The differences might further understanding of nasal polyp pathogenesis. Methods: In a prospective controlled study, viscid secretions found in association with nasal polyps were collected at endoscopic sinus surgery. Retained secretions in patients with CSWP acted as a control group. Both were fixed in 10% formalin, processed, and examined with a light microscope. Results: Viscid secretions were encountered among nasal polyps in 25 of 132 patients (18.9%). Polyps containing multiloculated cysts filled with viscid secretions were found in 2 of them. Histologic examination of viscid secretions showed variable histologic pictures, ranging from a homogeneous material infiltrated with inflammatory cells, newly formed blood vessels, and bundles of collagen fibers to a well-developed connective tissue core covered with a respiratory epithelium in some areas. Histologic examination of retained secretions in patients with CSWP revealed amorphous material infiltrated with inflammatory cells with no further maturation or epithelial coverage. Conclusions: Viscid secretions, originating from ruptured mucosal cysts, might represent the initial step in nasal polyp pathogenesis. The variable histologic pictures detected possibly reflect different stages in nasal polyp formation from these secretions. Factors postulated in nasal polyp etiopathogenesis might trigger maturation and changes in the morphological structure of these secretions.
Bone Marrow Stem Cell Transplantation to Olfactory Epithelium
Authors: Ochi Naoki , Doi Kiyoshi , Uranagase Masahiro , Nishikawa Tasuku , Katsunuma Sayaka , Nibu Ken-Ichi 
Published: October 2014

Objectives: We sought to develop a new therapeutic strategy for degeneration of olfactory receptor neurons (ORNs). Methods: We transplanted into Balb/C mice, locally by transnasal injection and systemically via the tail vain, BrdU-labeled bone marrow stem cells, also known as NRGs, which have the ability to differentiate into neural cells. Bone marrow stem cells engrafted into the olfactory epithelium were examined immunohistochemically. Results: Compared with previous studies, in which bone marrow was transplanted rather than bone marrow stem cells, migration of transplanted bone marrow stem cells into the olfactory epithelium was observed earlier, and engraftment rates were significantly higher. However, migrated bone marrow stem cells were positive for GAP43 but not for olfactory marker protein. Conclusions: These results suggest that engrafted cells had differentiated into premature, but not mature, ORNs. Further experiments using autologous bone marrow stem cells in combination with various growth factors and/or neurotrophic factors should aid the development of new therapeutic methods for degenerated ORNs.
How Does the Absence or Presence of Subglottal Medialization Affect Glottal Airflow?
Authors: Grisel Jedidiah , Khosla Sid , Murugappan Shanmugam , Lakhamraju Raghava , Aubry James , Gutmark Ephraim , Huntress Gordon 
Published: October 2014

Objectives: Our previous work has shown that the symmetric, smooth, convergent shape of the subglottis reduces turbulent airflow at the glottal entrance. Medialization thyroplasty may alter the glottal shape and is very likely to introduce some degree of glottal asymmetry, which could result in increased turbulence and a reduction in voice quality. This study reports the effects of medializing and not medializing the subglottis in silicone models of human cadaveric larynges. Methods: In experiment 1, silicone models of 4 human cadaveric larynges were created. The subglottis was then completely medialized in all 4 models. Hot-wire anemometry was used to measure velocity and turbulence profiles at the entrance and exit of the subglottis. In experiment 2, 1 model was created to accommodate incremental medialization of the glottis without any medialization of the subglottis. Airflow characteristics were likewise measured. Results: In experiment 1, the average maximum turbulence intensity (TI) at the exit of the larynx was less than the TI of incoming tracheal airflow for all 4 larynges. In experiment 2, incremental medialization of the glottis did not affect the TI for medialization up to 35%. However, the TI significantly increased for medialization of 53%. Conclusions: Medialization of the subglottis does not significantly affect the turbulence reduction properties of the subglottis, even though subglottal asymmetry is introduced. On the other hand, large amounts of medialization of the glottis only (with no subglottal medialization) can introduce significant amounts of turbulence.
Computed Tomography and Otosclerosis: A Practical Method to Correlate the Sites Affected to Hearing Loss
Authors: Wycherly Benjamin J. , Berkowitz Frank , Noone Anne-Michelle , Kim H. Jeffrey 
Published: October 2014

Objectives: We present a practical method for correlating computed tomography (CT) scans with hearing loss in otosclerosis. Methods: We reviewed the CT scans of 18 patients (34 ears) with clinical otosclerosis who were seen between 2007 and 2008. The scans were reviewed by an otologist in a clinical office setting, followed by a blinded radiologist working at an imaging workstation. The 5 most commonly affected sites in otosclerosis were evaluated for evidence of otospongiosis and then correlated with the degree of air-bone gap and sensorineural hearing loss. Results: Positive CT findings were noted in 70.5% of ears, with a 94% concordance between readings. The sites affected included the ante fenestram (21 ears), round window niche (12), cochlear promontory (4), cochlear apex (3), and posterior fenestram (2). The average air-bone gap increased with each additional site of involvement within an otic capsule (p = 0.004). The bone conduction threshold also increased, on average, with each additional affected site (p = 0.047). Conclusions: Most patients with clinical evidence of otosclerosis have evidence of otosclerosis on CT that is readily detected in the office setting. Ears with more affected sites have a significantly greater degree of air-bone gap and sensorineural hearing loss.