bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Esophageal Foreign Bodies and Secondary Mediastinitis in Children
Authors: Cole Stephanie , Kearns Donald , Magit Anthony 
Published: October 2014

Objectives: The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children. Methods: A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported. Results: Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical and/or surgical treatment, the patients were released from the hospital tolerating soft diets. There were no reports of long-term complications in our series of patients. Conclusions: It is critical to rule out esophageal and airway foreign bodies in pediatric patients with respiratory symptoms that do not respond to medical treatment. Timely recognition of an esophageal foreign body generally allows for removal with minimal morbidity, whereas the incidence of serious complications increases significantly when the diagnosis is delayed. Our series provides support for conservative management of mediastinal complications after removal of chronically retained esophageal foreign bodies in children.
Lung Volumes Used during Speech Breathing in Tracheoesophageal Speakers
Authors: Bohnenkamp Todd A. , Forrest Karen M. , Klaben Bernice K. , Stager Joel M. 
Published: October 2014

Objectives: The purpose of this study was to determine how tracheoesophageal (TE) speakers manipulate lung volumes to meet speech demands and how respiratory compromise (chronic obstructive pulmonary disease [COPD]) and task variables influence these behaviors. Methods: The lung volumes of 9 male TE speakers (4 with COPD, 5 without) during tidal breathing, spontaneous speech, and reading were investigated. Repeated-measures multivariate analyses of variance were used to compare lung volumes and utterance length across speech tasks and by respiratory health. A one-way analysis of variance was used to compare aerodynamic measures and intelligibility by COPD diagnosis. Results: There was a significant main effect of task and a significant interaction effect of COPD and task on lung volumes at initiation and termination of speech. The TE speakers terminated speech exclusively below the resting expiratory level (REL) in both speech tasks because of elevated RELs, which are often present after laryngectomy. There were no main effects of COPD on any lung volume measures and no significant group differences in utterance length, aerodynamic measures, or intelligibility. Conclusions: Intelligibility and aerodynamic measures were not influenced by lung volumes and were comparable to findings of previous research. Speaking past the REL might be a compensation to optimize expiratory control for speech in a compromised system and a marker for the increased effort often anecdotally described by TE speakers.
Congenital Mastoid Cholesteatoma: Case Series, Definition, Surgical Key Points, and Literature Review
Authors: Giannuzzi Anna Lisa , Merkus Paul , Taibah Abdelkader , Falcioni Maurizio 
Published: October 2014

Objectives: We evaluate 3 new cases of congenital cholesteatoma confined to the mastoid process, and compare them with cases presented in the literature in order to better define this rare lesion. Methods: We performed a retrospective chart analysis of all congenital cholesteatomas treated surgically in a tertiary referral and skull base center. We performed a complete analysis (history, radiologic, and surgical) of all patients with congenital cholesteatoma confined to the mastoid process; we then performed a literature review and compared our findings with the presented cases. Results: The results of preoperative imaging were in line with the surgical findings. The most important surgical issue in this type of lesion was the management of the sigmoid sinus and the jugular bulb. Half of the cases previously reported in the literature appeared not to fulfill the definition criteria of a congenital cholesteatoma of the mastoid process. Conclusions: Congenital cholesteatoma confined to the mastoid process is a rare lesion, and is even more exceptional upon critical review of the literature. Symptoms are often lacking or nonspecific, and although cases have a congenital origin, the diagnosis often is not made until adulthood. A combined congenital cholesteatoma group with middle ear and mastoid features seems to fill in the gap in the definition. Management of the sigmoid sinus and the jugular bulb is the most demanding surgical key point.
Light and Electron Microscopic Observation of Regenerated Fungiform Taste Buds in Patients with Recovered Taste Function after Severing Chorda Tympani Nerve
Authors: Saito Takehisa , Ito Tetsufumi , Narita Norihiko , Yamada Takechiyo , Manabe Yasuhiro 
Published: October 2014

Objectives: The aim of this study was to evaluate the mean number of regenerated fungiform taste buds per papilla and perform light and electron microscopic observation of taste buds in patients with recovered taste function after severing the chorda tympani nerve during middle ear surgery. Methods: We performed a biopsy on the fungiform papillae (FP) in the midlateral region of the dorsal surface of the tongue from 5 control volunteers (33 total FP) and from 7 and 5 patients with and without taste recovery (34 and 29 FP, respectively) 3 years 6 months to 18 years after surgery. The specimens were observed by light and transmission electron microscopy. The taste function was evaluated by electrogustometry. Results: The mean number of taste buds in the FP of patients with completely recovered taste function was significantly smaller (1.9 ± 1.4 per papilla; p < 0.01) than that of the control subjects (3.8 ± 2.2 per papilla). By transmission electron microscopy, 4 distinct types of cell (type I, II, III, and basal cells) were identified in the regenerated taste buds. Nerve fibers and nerve terminals were also found in the taste buds. Conclusions: It was clarified that taste buds containing taste cells and nerve endings do regenerate in the FP of patients with recovered taste function.
Prediction of Vestibular Schwannoma Growth: A Novel Rule Based on Clinical Symptomatology
Authors: Timmer Ferdinand C. A. , Artz Janneke C. J. M. , Beynon Andy J. , Donders Rogier T. , Mulder Jef J. S. , Cremers W. R. J. , Graamans Kees 
Published: October 2014

Objectives: The aim of this study was to formulate a predictive rule for vestibular schwannoma growth during the initial observation period after diagnosis. Methods: Logistic regression models were fitted, with tumor growth in the first year as the dependent variable and patient characteristics as the independent variables. Backward selection was used to eliminate superfluous predictors. The area under the receiver operating characteristic curve was taken as a measure of the model's discriminative power. Results: Eventually, the model or rule consisted of 4 significant growth predictors: Localization (if extrameatal, +1; if intrameatal, 0), sudden sensorineural hearing loss (if present, −1; if absent, 0), balance symptoms (if present, +1; if absent, 0), and complaints of hearing loss for less than 2 years (if present, +1; if absent, or present for more than 2 years, 0). A higher score indicates a higher likelihood of tumor growth during the period of observation after diagnosis. If the total score is 0 or less, the likelihood of tumor growth during the first year after diagnosis is less than 10%. If the score is 3, the likelihood of growth during the first year after diagnosis is more than 70%. Conclusions: We were able to create a useful rule to predict vestibular schwannoma growth during the first year after diagnosis.
Histopathology of the Temporal Bone in a Case of Superior Canal Dehiscence Syndrome
Authors: Teixido Michael , Kung Brian , Rosowski John J. , Merchant Saumil N. 
Published: October 2014

Objectives: We describe the histopathologic findings in the temporal bones of a patient who had, during life, received a diagnosis of superior canal dehiscence (SCD) syndrome. Methods: The patient was found to have SCD syndrome at 59 years of age. She became a temporal bone donor, and died of unrelated causes at 62 years of age. Both temporal bones were prepared in celloidin and examined by light microscopy. Results: The patient developed bilateral aural fullness, pulsatile tinnitus, and difficulty tolerating loud noises after minor head trauma at 53 years of age. The symptoms were worse on the right. She also had Valsalva-induced dizziness and eye movements, as well as sound-induced dizziness (more prominent on the right). Audiometry showed a small air-bone gap of 10 dB in the right ear. Vestibular evoked myogenic potential testing showed an abnormally low threshold of 66 dB on the right, and a computed tomography scan showed dehiscence of the superior canal on the right. Histopathologic examination of the right ear showed a 1.4 × 0.6-mm dehiscence of bone covering the superior canal. Dura was in direct contact with the endosteum and the membranous duct at the level of the dehiscence. No osteoclastic process was evident within the otic capsule bone surrounding the dehiscence. The left ear showed thin but intact bone over the superior canal. Both ears showed focal microdehiscences of the tegmen tympani and tegmen mastoideum. The auditory and vestibular sense organs on both sides appeared normal. No endolymphatic hydrops was observed. Conclusions: The findings were consistent with the hypothesis put forth by Carey and colleagues that SCD may arise from a failure of postnatal bone development, and that minor trauma may disrupt thin bone or stable dura over the superior canal.
Functional Outcomes after Lateral Crural J-Flap Repair of External Nasal Valve Collapse
Authors: Tan Susan , Rotenberg Brian 
Published: October 2014

Objectives: We evaluated the lateral crural J-flap technique in the surgical repair of external nasal valve collapse with standardized and validated outcome measurements. Methods: Prospective data were gathered on consecutive cases, performed by a single surgeon between 2007 and 2010, of adult patients who underwent a lateral crural approach to repair of external nasal valve collapse. Data were collected on diagnosis, surgical outcomes, and complications. Outcome measures included the Nasal Obstructive Symptom Evaluation and the Rhinoplasty Outcome Evaluation. Results: Fifteen patients were included in the study. Their follow-ups ranged from 9 to 13 months. All patients had statistically significant improvements in Nasal Obstructive Symptom Evaluation scores. There was no significant change in perceived nasal appearance after surgery as measured by the Rhinoplasty Outcome Evaluation. There were no surgical complications. Conclusions: The lateral crural J-flap approach to repair of external nasal valve collapse is a technically straightforward and relatively safe procedure. The efficacy is excellent at the 1-year follow-up examination.
Risk Factors for Deterioration of Bone Conduction Hearing in Cases of Labyrinthine Fistula Caused by Middle Ear Cholesteatoma
Authors: Ikeda Ryoukichi , Kobayashi Toshimitsu , Kawase Tetsuaki , Oshima Takeshi , Sato Toshinori 
Published: October 2014

Objectives: We evaluated the risk factors and outcomes of bone conduction (BC) hearing in cases of labyrinthine fistulas treated under the basic principle of complete removal of the cholesteatoma matrix. Methods: A total of 47 patients with labyrinthine fistulas were analyzed. The fistulas were classified into smaller (no more than 3 mm) and larger fistulas (more than 3 mm). The fistulas were classified by depth into 3 stages. Preoperative symptoms and postoperative results with special reference to BC hearing were analyzed. Results: Total preoperative loss of BC hearing was found in 3 of 36 ears (9%) in the smaller-fistula group and 4 of 11 ears (36%) in the larger-fistula group; this was a statistically significant difference. The BC hearing was preserved after operation in 30 of 31 ears (97%) in the smaller-fistula group and 5 of 7 ears (71%) in the larger-fistula group; this difference was also significant. The stage (depth) of the fistula did not correlate with the postoperative BC hearing. Conclusions: In smaller labyrinthine fistulas, complete removal of the cholesteatoma matrix can be relatively safely performed. However, in patients with larger fistulas, there is a potential for a complete loss of BC hearing.
Postoperative Results of Tympanoplasty with Mastoidectomy in Elderly Patients with Chronic Otitis Media
Authors: Ahn Joong Ho , An Yun Suk , Bae Ji Sun , Kim Do Yoon 
Published: October 2014

Objectives: We evaluated the long-term results of tympanoplasty with mastoidectomy in elderly patients with chronic otitis media (COM). Methods: We included 192 patients with intractable COM who underwent both tympanoplasty and mastoidectomy from the same surgeon between January 2003 and December 2006 and were followed up for more than 3 years. The patients were divided into two groups: An “old COM group” of 83 patients (more than 65 years of age) and a “young COM group” of 109 patients (between 21 and 40 years of age). We compared the preoperative and postoperative levels of hearing, the types of tympanoplasty and mastoidectomy, and the postoperative complications of the two groups. Results: Among the old COM group, 11 patients (13.3%) showed temporary postoperative complaints without serious sequelae. Between the old and young COM groups, there were no significant differences in the rates of associated cholesteatoma, middle ear swab culture results, or type of tympanoplasty, ossiculoplasty, and mastoidectomy. In the comparison of postoperative hearing improvement, both the old and young COM groups showed a significant decrease in air-bone gap, although the old COM group showed a significantly worse preoperative air-bone gap. There were no significant differences in the rates of re-perforation of the tympanic membrane or of reoperation between the two groups. Conclusions: From this study, we conclude that there is no reason to withhold surgery for COM on the assumption that older patients do not have good results or that the procedure is too risky.
Subepithelial Vocal Fold Infusion: A Useful Diagnostic and Therapeutic Technique
Authors: Burns James A. , Friedman Aaron D. , Lutch Matthew J. , Zeitels Steven M. 
Published: October 2014

Objectives: Preservation of the maximum amount of subepithelial superficial lamina propria (SLP) remains an important goal during microlaryngoscopic surgery of phonatory mucosa. Volume expansion of the SLP (Reinke's space) with subepithelial infusion of saline solution has been widely adopted since its introduction in 1991. This technique has evolved so that it is currently used to assist with determining the depth of vocal fold disease, defining residual pliable SLP, enhancing microsurgical precision, and identifying unrecognized disease. The purpose of this investigation was to examine the indications, methods, and benefits of subepithelial infusion of saline solution as an adjunct technique during phonomicrosurgery. Methods: In a prospective case series, we collected data on 280 consecutive microlaryngoscopy procedures performed over a 12-month period. Subepithelial infusion of saline solution was included in 178 procedures. Results: New disease was identified in 20 of the 178 patients (scar in 15, sulcus in 4, and a mucosal bridge in 1). The depth of needle placement varied depending on the specific disease: 118 of the 178 infusions were done just below the epithelial basement membrane, and 60 infusions were performed deeper within the SLP, just superficial to the vocal ligament. The infusion technique provided surgical assistance in multiple ways, including identifying residual SLP (130 patients), defining the SLP-lesion interface (65 patients), lifting scar (60 patients), providing tension for cordotomy (47 patients), expanding the SLP volume to protect against laser damage (45 patients), and providing hydrostatic compression of vascular ectasias or varices for photoangiolysis (7 patients). The microlaryngoscopy procedures during which infusion was not performed (102 of 280 procedures) were primarily for nonglottic cancer (46 patients), stenosis (30 patients), or arytenoid granuloma (13 patients). Conclusions: Subepithelial infusion of the SLP with saline solution is a useful microsurgical adjunct during diagnosis and treatment of phonatory mucosal lesions.
Regeneration of Tracheal Epithelium Using a Collagen Vitrigel—Sponge Scaffold Containing Basic Fibroblast Growth Factor
Authors: Tani Akiko , Tada Yasuhiro , Takezawa Toshiaki , Imaizumi Mitsuyoshi , Nomoto Yukio , Nakamura Tatsuo , Omori Koichi 
Published: October 2014

Objectives: Our group has had good results in tracheal mucosal regeneration using a collagen vitrigel–sponge scaffold in an animal model. In this study, the effectiveness of this scaffold with the application of basic fibroblast growth factor (b-FGF) was investigated. Methods: A collagen vitrigel–sponge scaffold was fabricated with simultaneous addition of b-FGF. Three types of collagen vitrigel–sponge scaffolds were made: No b-FGF, 10 ng of b-FGF, and 100 ng of b-FGF. At 3, 5, 7, and 14 days after implantation in rats, the tracheas were removed and histologically evaluated. The regeneration of mucosal epithelium and the subepithelial layer was evaluated. Results: Mucosal epithelium, including pseudostratified epithelium and ciliated cells, regenerated earlier in the scaffolds when b-FGF was applied than when b-FGF was not applied. Regeneration of the subepithelial layer, infiltration of inflammatory cells and fibroblasts, and angiogenesis were promoted earlier in the scaffolds with b-FGF application. Conclusions: Our technique for tracheal reconstruction using collagen vitrigel–sponge scaffolds with b-FGF application affords a feasible approach for accelerating the regeneration of the intraluminal surface and subepithelial layer of tracheal tissue.
Neuromuscular Basis for Ventricular Fold Function
Authors: Young Nwanmegha , Wadie Mikhail , Sasaki Clarence T. 
Published: October 2014

Objectives: We sought to examine the neuromuscular basis for ventricular fold function. The primary function of the ventricular folds is to assist in the regulation of intra-abdominal and intrathoracic pressure. They also influence phonation in the setting of vocal fold paralysis or ventricular dysphonia, or after partial laryngectomy. The neuromuscular basis of true vocal fold function has been well studied; however, its neuromuscular correlates in the ventricular folds are ambiguous. The literature is unclear as to whether ventricular fold contraction is passive or active. The musculature and innervation responsible for this action also have not been well defined. The aim of this study was to provide clarity in regard to these mechanisms. Methods: We examined a whole-organ section of a human larynx from a patient with unilateral vocal fold paralysis. The region of the ventricular folds was compared on both the paralyzed and normal sides. Electrophysiological examination was performed in a porcine model. The superior laryngeal nerve was stimulated, and recording electrodes in both ventricular folds measured the electrical activity. The recurrent laryngeal nerve was then severed, and the experiment was repeated. Results: The histologic slides from the patient with unilateral vocal fold paralysis demonstrated atrophied ventricularis and thyroarytenoid muscles on the paralyzed side. On the unaffected side, these muscles were of normal size. The electrophysiological examination in the porcine model demonstrated findings consistent with innervation of the ventricularis muscle by the recurrent laryngeal nerve. An association of ventricularis muscle activity with ventricular fold contraction also was demonstrated. Conclusions: Ventricular fold adduction appears to be a result of ventricularis muscle contraction that is mediated by the recurrent laryngeal nerve.
Analysis of Clinical Negligence Claims following Tonsillectomy in England 1995 to 2010
Authors: Mathew Rajeev , Asimacopoulos Eleni , Walker David , Gutierrez Tatiana , Valentine Peter , Pitkin Lisa 
Published: October 2014

Objectives: We determined the characteristics of medical negligence claims following tonsillectomy. Methods: Claims relating to tonsillectomy between 1995 and 2010 were obtained from the National Health Service Litigation Authority database. The number of open and closed claims was determined, and data were analyzed for primary injury claimed, outcome of claim, and associated costs. Results: Over 15 years, there were 40 claims of clinical negligence related to tonsillectomy, representing 7.7% of all claims in otolaryngology. There were 34 closed claims, of which 32 (94%) resulted in payment of damages. Postoperative bleeding was the most common injury, with delayed recognition and treatment of bleeding alleged in most cases. Nasopharyngeal regurgitation as a result of soft palate fistulas or excessive tissue resection was the next-commonest cause of a claim. The other injuries claimed included dentoalveolar injury, burns, tonsillar remnants, and temporomandibular joint dysfunction. Inadequate informed consent was claimed in 5 cases. Conclusions: Clinical negligence claims following tonsillectomy have a high success rate. Although postoperative bleeding is the most common cause of negligence claims, a significant proportion of claims are due to rare complications of surgery. Informed consent should be tailored to the individual patient and should include a discussion of common and serious complications.
Intraoral Metal Contact Allergy as a Possible Risk Factor for Oral Squamous Cell Carcinoma
Authors: Weber Megan E. , Yiannias James A. , Hougeir Firas G. , Kyle Amber , Noble Brie N. , Landry April M. , Hinni Michael L. 
Published: October 2014

Objectives: Intraoral exposure to dental restorations can cause contact allergy that may induce carcinogenesis. We investigated the relationship of intraoral metal contact allergy to epithelial carcinogenesis. Methods: The prevalence of positive patch test reactions to dental restoration metals in 65 prospectively enrolled patients with newly or previously diagnosed oral squamous cell carcinoma (SCC) was compared to that in 48 control patients. The relative risk of oral SCC was estimated by calculating odds ratios for exposure to dental metals resulting in allergy. Results: Of the 65 patients with oral SCC, 34% were allergic to at least 1 adjacent metal. They were 1.57 times as likely as control patients to have metal contact allergy (odds ratio, 1.57; 95% confidence interval, 0.65 to 3.80) and more than 3 times as likely to react to mercury (odds ratio, 3.20; 95% confidence interval, 0.42 to 33.20). Conclusions: Patients with oral SCC who have metal dental restorations should undergo patch testing and possible removal of the restorations if their reactions are positive.