American Journal of Otolaryngology - Head and Neck Medicine and Surgery - Articles in Press

Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study - Corrected Proof

2010-05-31

Abstract: Objectives: Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions. Hyperchromatic supranuclear stria (HSS) in the ciliated cells (CCs) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa. The aim of this study was to compare the effects of nasal irrigations with sulfurous, salty, bromic, iodic (SSBI) thermal water or isotonic sodium chloride solution (ISCS) in patients with nonallergic chronic rhinosinusitis, considering the endoscopic, functional, microbiological, and cytological evidence (including the ratio of HSS-positive CCs to total CCs [the HSS+ rate]).Methods: In a prospective, randomized, double-blind setting, 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month.Results: An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations. Before treatment, Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group. After the nasal irrigations, there was no sign of the bacteria in either group. Only the SSBI water irrigations significantly reduced total nasal resistance, as determined by rhinomanometry. Mild nasal irritation (6 cases) and episodes of extremely limited epistaxis (5 cases) were only reported after SSBI thermal water irrigations. Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month.Conclusions: Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis, whereas only SSBI irrigations significantly reduced total nasal resistance. Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations.

The efficacy of rhinoplasty alone in facial rejuvenation - Corrected Proof

Kian Karimi, Robert T. Adelson — 2010-05-21

Abstract: Purpose: The aim of the study was to demonstrate whether rhinoplasty alone is a rejuvenating procedure for the aging face.Materials and methods: Photographs of the right profile of 48 white females older than 55 years were recorded using standardized techniques. Each of the subjects' noses underwent computer-simulated rhinoplasty to conform to aesthetic canons of the ideal nose. Forty-eight evaluators, blinded to the purpose of the study, were shown either the natural right profile or the morphed image. The evaluators then estimated subject age.Results: Evaluators were divided into younger and older cohorts. Computer-simulated rhinoplasty alone did not prove to be statistically rejuvenating (Hotelling-Lawley Trace, P = .203). This finding held true for both the younger and older cohort of evaluators (P = .98). Although not statistically significant, evaluators estimated the age of the morphed images to be 6.5 years (mean) younger than actual age for all subjects.Conclusions: Rhinoplasty alone is not statistically rejuvenating in the profile view of white females older than 55 years. However, age estimation may be less accurate than was hypothesized for the profile view, possibly because of other visual queues.

Autologous cartilage injection for the patulous eustachian tube - Corrected Proof

Soo-Keun Kong, Il-Woo Lee, Eui-Kyung Goh, Sung-Hwan Park — 2010-05-14

Abstract: The eustachian tube (ET) is normally closed, but it opens temporarily during swallowing. Patients with a patulous ET (PET) have various aural symptoms such as aural fullness, autophony, and hearing their own breathing. These symptoms are caused by abnormal transmission of sound from the pharynx to the middle ear via an open ET with little attenuation. We introduce a novel injection technique for the treatment of PET using autologous cartilage. This procedure is minimally invasive and has been successfully used to treat PET in 2 patients.

End-tidal carbon dioxide concentration monitoring in obstructive sleep apnea patients - Corrected Proof

Chen Weihu, Ye Jingying, Han Demin, Zhang Yuhuan, Wang Jiangyong — 2010-05-13

Abstract: Purpose: The objective of this study was to investigate the end-tidal carbon dioxide concentration (ETco2) monitoring in obstructive sleep apnea (OSA) patients during sleep and to explore whether the ETco2 value may explain a significant portion of the relationship between ETco2 value and apnea/hypopnea index (AHI) and nocturnal oxygenation indices.Materials and methods: Thirty-eight consecutive patients underwent overnight polysomnography and were synchronously monitored for ETco2 using an microstream capnometer. Mean and maximum values during wake time and different sleep stages were recorded.We grouped 38 OSA patients into 2 subgroups on the basis of their difference of mean total sleep time and wake time ETco2 [(T − W) ETco2]; one group, 20 patients with (T − W) ETco2 less than 0, and the other group,18 patients with (T − W) ETco2 greater than 0.Results: Group with (T − W) ETco2 less than 0 patients exhibited higher AHI (mean ± SD, 68.58 ± 22.78 vs. 27.61 ± 19.44 events/h) and lower nocturnal oxygenation indices (minimum Sao2, 67.85 ± 10.08 vs. 82.61% ± 6.07%; mean Sao2, 91.29 ± 3.31 vs. 95.15% ± 1.88%) compared with the other group.Conclusions: In summary, the study provides preliminary data showing that ETco2 potentially can be used in continuous monitoring of OSA patients. And, (T − W) ETco2 can indicate the severity of OSA.

A possible association between maternal otitis media and ear defect in their offspring - Corrected Proof

Nándor Ács, Ferenc Bánhidy, Erzsébet H. Puhó, Andrew E. Czeizel — 2010-05-10

Abstract: Background: The possible association between otitis media in pregnancy (OMP) and structural birth defects, that is, congenital abnormalities (CAs), in their offspring has not been studied.Methods: The data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980 and 1996, was evaluated.Results: There were 58 (0.25%) and 55 (0.14%) of 22 843 cases and 38 151 controls with mothers who had OMP, respectively. There was association of OMP and a higher risk of ear CA.Conclusions: A possible explanation for the association of OMP with higher risk of ear CA may be some morphological deviation of the inner ear.

Conversion of canalolithiasis to cupulolithiasis in the course of a horizontal benign paroxysmal positional vertigo case - Corrected Proof

2010-05-07

Abstract: The benign paroxysmal positional vertigo of the horizontal semicircular canal is manifested with either geotropic or apogeotropic horizontal nystagmus. A 61-year-old male patient who experienced repeated episodes of positional vertigo is presented in this study. The vertigo was reported to be more severe while rotating his head to the left and then to the right. The initial examination revealed a geotropic purely horizontal nystagmus at the lateral positions of the head compatible with canalolithiasis of the left horizontal semicircular canal. In this case, the otoconia debris migrates from the vestibule into the horizontal semicircular canal through its nonampullary end, where they float freely (canalolithiasis). Five days later, the geotropic nystagmus transformed to apogeotropic. Thus, it may be assumed that the otoconia debris adhered to the cupula and converted the canalolithiasis to cupulolithiasis of the horizontal semicircular canal on the same side. With rotation of the head to the left while the patient was in the supine position, gravity causes the weighted cupula to deflect ampullofugally, resulting in apogeotropic nystagmus; the opposite was noticed when the head was rotated to the right. The so-called barbecue maneuver was initially effective curing the geotropic form of the condition and consequently the modified Semont maneuver for the apogeotropic form.

The importance of acoustic reflex for communication - Corrected Proof

2010-05-07

Abstract: Purpose: The purpose of the study was to compare the speech recognition capacity between listeners with and without acoustic reflex using different types of noises and intensities.Materials and methods: We studied 18 women allocated to 2 groups: acoustic reflex present (20 ears) and absent (16 ears). They were presented with 180 disyllable words (90 to each ear), emitted randomly at a fixed intensity of 40 dB above the pure tone average hearing level. At the same time, 3 types of noises were presented ipsilaterally (white, pink, and speech), one at a time, at 3 intensities: 40, 50, and 60 dB above the pure tone average hearing level.Results: The ages and auditory thresholds were statistically equal between the groups. There was a significant difference in mean number of hits between the 2 groups for the 3 types of noises used. There was also a significant difference in mean number of hits for noise type and intensity when white and pink noise was used at 40 and 50 dB and for all the intensities when speech was used.Conclusion: Acoustic reflex helps communication in high-noise environments and is more efficient for speech sounds.

Protective effects of Salvia miltiorrhiza against cisplatin-induced ototoxicity in guinea pigs - Corrected Proof

2010-05-07

Abstract: Objective: The aim of the study was to investigate the protective effects of Salvia miltiorrhiza (SM) against cisplatin-induced ototoxicity in guinea pigs.Methods: Thirty-nine guinea pigs were randomly divided into 3 groups. The first group (control group) received physiologic saline by intraperitoneal (i.p.) injection for 5 days. The second group (cisplatin group) was treated with cisplatin (2 mg/kg per day, i.p. injection) for 5 days. The third group (SM group) was given SM (8 g/kg per day, i.p. injection) for 2 days and then was given SM (8 g/kg per day, i.p. injection) and cisplatin (2 mg/kg per day, i.p. injection) for 5 days. Auditory brain stem response (ABR) and cochlea blood flow measurement were used to evaluate cochlea function. The structures of cochlea were observed by light microscope, scanning electron microscope, transmission electron microscope (TEM), and immunohistochemical examination.Results: Cisplatin could cause severe acoustic damages including significant elevation of ABR threshold, substantial losses of outer hair cells and inner hair cells, and severe damage on the stria vascularis and spiral ganglion cells (SGCs). Although in SM group, the increased tendency of threshold was milder than that in cisplatin group. The damages in cochlea and stria vascularis were also less severe than those in cisplatin group. The expression of induced nitric oxide synthase in the cochlea and SGC in SM group was lower than that in cisplatin group.Conclusions: Salvia miltiorrhiza can significantly reduce the cisplatin-induced side effects.

Extrapulmonary small cell carcinoma metastasis to the external auditory canal with facial nerve paralysis - Corrected Proof

Kelli L. Rudman, Ericka King, David M. Poetker — 2010-05-07

Abstract: Objectives: The aim of the study was to present a case of small cell carcinoma arising from the tonsil with metastasis to the external auditory canal (EAC) and associated facial nerve paralysis.Methods: This study includes a case report and review of the literature.Conclusions: Extrapulmonary small cell carcinoma from the head and neck is rarely described and carries a poor prognosis. It often presents with widely metastatic disease. To our knowledge, this is the first case report describing extrapulmonary small cell carcinoma from the tonsil with metastatic disease to the EAC. Irregular lesions in the EAC must be considered suspicious for metastasis in a patient with a history of cancer.

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures - Corrected Proof

Jae Ho Chung, Myung Chul Shin, Hyun Jung Min, Chul Won Park, Seung Hwan Lee — 2010-05-05

Abstract: With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.

Epithelioid hemangioendothelioma of the middle ear in a child - Corrected Proof

Howard S. Moskowitz, Ronald Jaffe, Barry E. Hirsch — 2010-05-05

Abstract: The differential diagnosis of middle ear masses encompasses a wide variety of pathologic conditions. In this report, we describe the case of a 6-year-old girl who presented with facial nerve weakness and was found to have a middle ear mass. The mass was excised, and final pathology revealed hemangioendothelioma. This report describes the youngest patient with this diagnosis presenting as a middle ear mass in the Western literature. This article provides this patient's presentation, imaging and histopathologic findings, and clinical course and reviews the current literature on this unique pathologic diagnosis.

The role of CD44 and matrix metalloproteinase–9 expression in predicting neck metastasis of supraglottic laryngeal carcinoma - Corrected Proof

İmdat Yüce, Ali Bayram, Sedat Çağlı, Özlem Canöz, Sevgi Bayram, Ercihan Güney — 2010-05-03

Abstract: Aim: The aim of this study is to evaluate the role of CD44 and matrix metalloproteinase (MMP)–9 expression in predicting neck metastasis of supraglottic laryngeal carcinoma.Materials and methods: Two hundred ninety-four supraglottic laryngeal cancers were treated surgically from 1991 to 2005. Ninety-four of the 294 patients had pathologically metastatic lymph node (pN+). Among the 94 patients, 30 pN+ patients were selected via random sampling. Sex-, T value–, and differentiation-matched 30 patients who had pathologically negative neck were also selected. CD44 and MMP-9 antibodies were applied to the tumor representative sections that were derived from paraffin sections by using the streptavidin-biotin method. The association between immunohistochemical results and histopathologic lymph node metastasis was analyzed statistically. The association between immunostaining of CD44 and MMP-9 was also analyzed.Results: Overexpression of CD44 and MMP-9 was found to be significantly higher in pN+ patients. There was fair concordance between immunostaining of CD44 and MMP-9.Conclusion: Although wider multiinstitutional and multidisciplinary studies are needed to draw specific conclusions, CD44 and MMP-9 can be useful in the prediction of neck metastasis in the supraglottic laryngeal carcinoma.

Usefulness of computed tomography Hounsfield unit density in preoperative detection of cholesteatoma in mastoid ad antrum - Corrected Proof

Min-Hyun Park, Yoon Chan Rah, Young Ho Kim, Ji-hoon Kim — 2010-05-03

Abstract: Purpose: This study was performed to evaluate the usefulness of Hounsfield unit (HU) to better distinguish cholesteatoma from other inflammatory conditions in the mastoid ad antrum before primary mastoid surgery.Materials and methods: We enrolled 82 patients who underwent tympanomastoidectomy for treatment of chronic otitis. Forty-one patients were pathologically diagnosed with cholesteatoma, whereas the others were diagnosed with inflammatory granulation. These lesions were confirmed, and HU was measured in preoperative computed tomography. The difference in HU between cholesteatoma and non-cholesteatoma tissues was analyzed, and the improvement in the diagnosis of cholesteatoma after inclusion of HU data was calculated.Results: The HU was calculated as 42.68 ± 24.42 in the cholesteatoma group and 86.07 ± 26.50 in the non-cholesteatoma group. The differences between the 2 groups were statistically different (Student t test, P < .01). By applying the HU, the sensitivity (51.2%–80.5%), specificity (80.5%–87.8%), positive predictive value (72.4%–86.8%), and negative predictive value (62.3%–81.8%) to diagnose cholesteatoma improved.Conclusions: The HU density was found to be statistically different between cholesteatoma and inflammatory granulation tissue in mastoid antrum. An improved diagnosis of cholesteatoma was achieved after adjusting for the HU.

Wernicke's encephalopathy in the course of chemoradiotherapy for head and neck cancer - Corrected Proof

German Fikhman, Joseph R. Berger, Thomas J. Gal — 2010-05-03

Wernicke's encephalopathy is a medical emergency. Immediate treatment with thiamine is required to prevent permanent neurologic injury. Although the classical context for Wernicke's encephalopathy is the malnourished alcoholic patient, it is seen in many other conditions in which thiamine deficiency arises. Indeed, 1 of the 3 initial cases reported by Wernicke et al in 1881 developed as a consequence of esophageal injury after the ingestion of sulfuric acid. Wernicke's encephalopathy has been recognized with increasing frequency after bariatric surgery and with cancer . Wernicke's encephalopathy occurring in the latter settings often results in diagnostic confusion resulting in a delay of therapy. We report 2 cases of Wernicke's encephalopathy occurring during the course of therapy for head and neck cancer.

Laser disruption and killing of methicillin-resistant Staphylococcus aureus biofilms - Corrected Proof

2010-05-03

Abstract: Objective: The aim of the study was to study the efficacy of 2 different lasers in vitro, in disrupting biofilm and killing planktonic pathogenic bacteria.Materials and methods: Biofilms of a stable bioluminescent of Staphylococcus aureus Xen 31 were grown in a 96-well microtiter plate for 3 days. The study included 7 arms: (a) control; (b) ciprofloxacin (3 mg/L, the established minimum inhibitory concentration [MIC]) alone; (c) shock wave (SW) laser alone; (d) near-infrared (NIR) laser alone; (e) SW laser and ciprofloxacin; (f) SW and NIR lasers; (g) SW, NIR lasers, and ciprofloxacin. The results were evaluated with an in vivo imaging system (IVIS) biophotonic system (for live bacteria) and optical density (OD) for total bacteria.Results: Without antibiotics, there was a 43% reduction in OD (P < .05) caused by the combination of SW and NIR suggesting that biofilm had been disrupted. There was an 88% reduction (P < .05) in live biofilm. Ciprofloxacin alone resulted in a decrease of 28% of total live cells (biofilm remaining attached) and 58% of biofilm cells (both P > .05). Ciprofloxacin in combination with SW and SW + NIR lasers caused a decrease of more than 60% in total live biomass and more than 80% of biofilm cells, which was significantly greater than ciprofloxacin alone (P < .05).Conclusions: We have demonstrated an effective nonpharmacologic treatment method for methicillin-resistant Staphylococcus aureus (MRSA) biofilm disruption and killing using 2 different lasers. The preferred treatment sequence is a SW laser disruption of biofilm followed by NIR laser illumination. Treatment optimization of biofilm is possible with the addition of ciprofloxacin in concentrations consistent with planktonic MIC.

Alterations of p53 and Bcl-2 protein expression in the recurrent laryngeal and pharyngeal squamous cell carcinoma - Corrected Proof

Usama M. Rashad, Mahmoud R. Hussein, Samy M. Algizawy — 2010-05-03

Abstract: Background: Identification of molecular events of the recurrent squamous cell carcinoma (SCC) of the larynx and pharynx may aid in refining treatment strategies and improving outcome. The underlying molecular events of these recurrent tumors involve alterations in the tumor suppressor genes (p53) and protooncogenes (Bcl-2). We hypothesize that the development of these recurrent tumors involves alterations of the p53 and Bcl-2 proteins.Methods: To test this hypothesis, 15 laryngeal and pharyngeal biopsy specimens obtained from 15 patients with recurrent laryngeal or pharyngeal SCC with different grades (II-IV) were immunostained for p53 and Bcl-2 protein expression.Results: Examination of the percentage of positive cells in the normal mucosa and SCC, respectively, showed significant up-regulation of p53 (0.0 ± 0.0 vs 51.8 ± 5.9, P = .00) and Bcl-2 protein expression (36.5 ± 3.5 vs 74.6 ± 1.9, P = .00).Conclusions: Alterations of the p53 and Bcl-2 proteins occur during the development of recurrent SCC. Additional studies are needed to confirm and extend our results.

Cochlear changes in presbycusis with tinnitus - Corrected Proof

2010-05-03

Abstract: Objectives: The pathophysiology of tinnitus is obscure and its treatment is therefore elusive. Significant progress in this field can only be achieved by determining the mechanisms of tinnitus generation, and thus, histopathologic findings of the cochlea in presbycusis with tinnitus become crucial. We revealed the histopathologic findings of the cochlea in subjects with presbycusis and tinnitus.Material and methods: The subjects were divided into 2 groups, presbycusis with tinnitus (tinnitus) group and presbycusis without tinnitus (control) group, with each group comprising 8 temporal bones from 8 subjects. We quantitatively analyzed the number of spiral ganglion cells, loss of cochlear inner and outer hair cells, and areas of the stria vascularis and spiral ligament.Results: There was a significantly greater loss of outer hair cells in the tinnitus group compared with the control group in the basal and upper middle turns. The stria vascularis was more atrophic in the tinnitus group compared with the control group in the basal turn.Conclusions: Tinnitus is more common in patients with presbycusis who have more severe degeneration of outer hair cells and stria vascularis.

Esophageal fish bone migration induced thyroid abscess: case report and review of the literature - Corrected Proof

Ching Yuan Chen, Jyh Ping Peng — 2010-05-03

Abstract: A thyroid abscess is a rare condition, and it is so infrequently encountered. A migrated fish bone is a rare otolaryngologic emergency indicated when the foreign body penetrates through the esophageal mucosa into the thyroid gland space of the neck after several weeks of swallowing. We present the case of a 50-year-old woman who had fever and anterior neck painful mass. An intrathyroid abscess was diagnosed; and she underwent thyrotomy with transcervical approach. A foreign body, which proved to be a fish bone and which fortunately did not cause any adverse effects, was removed.

Cough while shaving after total laryngectomy: traumatic neuroma of the internal laryngeal nerve more likely - Corrected Proof

Vinayak Rohan, S. Vishak — 2010-05-03

We read with great interest the article by Aroor et al regarding cough while shaving after total laryngectomy. We have our own reservations regarding the diagnosis. We believe that the patient's symptom most probably was caused by the traumatic neuroma of the internal laryngeal nerve.

Difficulty in shaving: a rare complication after total laryngectomy: response to letter to the editor - Corrected Proof

Gangadhara Somayaji KS, Rajeshwari Aroor, Deviprasad Shetty — 2010-05-03

We went through the comments made in the letter to the editor section regarding our article “Difficulty in shaving: a rare complication after total laryngectomy” published in the month of November 2009. The author has expressed his reservations about our diagnosis and feels that traumatic neuroma of the internal laryngeal nerve could be the most likely cause for the cough in our case. We beg to differ from him and strongly stand by our diagnosis.

Pulsatile tinnitus as a first symptom of essential thrombocythemia - Corrected Proof

2010-05-03

Abstract: Tinnitus is the sensation of sound inside the head and is a common symptom encountered daily by otorhinolaryngologists. Pulsatile tinnitus sufferers hear rhythmical noise at the same rate as a heartbeat and can present a diagnostic challenge. In this report, we present a 32-year-old patient with pulsatile tinnitus that led to the diagnosis of essential thrombocythemia. The symptom of pulsatile tinnitus allowed an early diagnosis of essential thrombocythemia and a more favorable prognosis. The case demonstrates the importance of blood tests for all patients who present with pulsatile tinnitus of unknown origin.

Severe manifestation of oral pemphigus - Corrected Proof

2010-05-03

Abstract: This article describes a case of pemphigus vulgaris in a relatively young patient with exacerbated characteristics, widespread lesions, and rapid evolution. A 40-year-old woman sought treatment, complaining about severe oral pain and dysphagia. Intraoral inspection revealed ulcerated lesions on the lips, buccal mucosa, and floor of the mouth. The number of lesions quickly increased and resembled erythema multiforme. She also presented blistering lesions on the back, abdomen, neck, and eyes. Incisional oral biopsy revealed pemphigus vulgaris. This report emphasizes the importance of early diagnosis of an oral biopsy in systemic diseases and the management of the lesions.

Unilateral nasal polyposis: clinical presentation and pathology - Corrected Proof

Mehmet Habesoglu, Tulay Erden Habesoglu — 2010-04-15

We have read with great interest the article by Dr Shawn et al entitled “Unilateral nasal polyposis: clinical presentation and pathology” in the American Journal of Otolaryngology-Head and Neck Medicine and Surgery 29 (2008) 230-232. However, we are suspicious about the statistical data of the article.

Sutureless tympanoplasty using acellular dermis - Corrected Proof

Anoop Raj, Ankush Sayal, P.K. Rathore, Ravi Meher — 2010-04-14

Abstract: Objective: A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome.Study design: Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing.Results: There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups.Conclusion: Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain.

Impact on hearing of routine ear suctioning at the tympanic membrane - Corrected Proof

Jeffrey J. Nelson, Andrew Giraud, Ronald Walsh, Anthony J. Mortelliti — 2010-04-14

Abstract: Objective: Patient and equipment safety has become increasingly scrutinized in today's medical care. Routine otolaryngologic evaluation often involves suctioning with Frazier-type suction devices in the ear canal for improved visualization, but data are limited on the potential acoustic trauma from ear canal suction devices. This study intends to document the objective and subjective effects of ear canal suctioning to identify any risk for hearing threshold shifts or other potential negative effects.Patients and Methods: Prospective study on 21 healthy volunteers enlisted for evaluation. Presuctioning tympanogram, audiogram, and otoacoustic emissions data were obtained. Spectrum analyses were recorded during ear canal suctioning with a probe microphone placed lateral to the tympanic membrane. Subjective data were recorded, and a follow-up audiogram and otoacoustic emissions were obtained to identify any temporary threshold shifts.Results: Spectrum analyses revealed a high degree of variability between subjects. A peak intensity of 111 dB sound pressure level was recorded. All patients tolerated suctioning, and none reported hearing loss. No threshold shifts were observed. Subjective data failed to correlate with the objective recorded intensities.Conclusions: Clinicians and patients need to be acutely aware of potential risks and benefits from any medical intervention. Routine ear canal suctioning can be extremely loud and uncomfortable for patients. This study failed to document objective proof of hearing detriment from ear canal suctioning, although the possibility exists during office and surgical intervention. Further study and potential alternative suctioning methods deserve attention.

Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy - Corrected Proof

Babak Saedi, Mohammad Sadeghi, Mohammad Mojtahed, Hossein Mahboubi — 2010-04-14

Abstract: Objective: This study was designed for better understanding of the role of different methods of nasal endoscopy in the assessment of adenoid hypertrophy and comparing them with lateral neck radiography and patients' symptoms.Subjects and method: From August 2007 until January 2009, in the otolaryngology ward of a tertiary referral center, 89 patients who had symptoms related to chronic mouth breathing participated in this study. History of the symptoms related to adenoid hypertrophy was obtained from them. In addition, all patients underwent nasal endoscopy and lateral nasopharynx x-ray. The clinician who did nasal endoscopy was blinded to information about clinical data and x-ray and vice versa. Afterward, the relationship between symptoms and each diagnostic procedure was evaluated.Results: Patients had a mean age of 9.47 ± 4.68 years. In the evaluation of the relationship between symptoms grading and grading in lateral neck radiography, this relationship was significant about snoring. Furthermore, there was a significant relationship between the endoscopic size of adenoid and number of the episodes of acute otitis media. The sum of symptoms grading had a significant relationship with the size of adenoid in lateral neck x-ray, but not in nasal endoscopy.Conclusion: The results of the present study indicated that both radiography and nasal endoscopy could define the relationship between adenoid hypertrophy and associated symptoms and therefore are complementary. Between them, despite the popularity of nasal endoscopy, radiography can serve as a better planning tool.

Operating room fires in otolaryngology: risk factors and prevention - Corrected Proof

Lee P. Smith, Soham Roy — 2010-04-14

Abstract: Purpose: The aim of the study was to characterize the causes of operating room (OR) fires in otolaryngology.Materials and methods: A questionnaire was designed to elicit the characteristics of OR fires experienced by otolaryngologists. The survey was advertised to 8523 members of the American Academy of Otolaryngology—Head and Neck Surgery.Results: Three hundred forty-nine questionnaires were completed. Eighty-eight surgeons (25.2%) witnessed at least one OR fire in their career, 10 experienced 2 fires each, and 2 reported 5 fires each. Of 106 reported fires, details were available for 100. The most common ignition sources were an electrosurgical unit (59%), a laser (32%), and a light cord (7%). Twenty-seven percent of fires occurred during endoscopic airway surgery, 24% during oropharyngeal surgery, 23% during cutaneous or transcutaneous surgery of the head and neck, and 18% during tracheostomy; 7% were related to a light cord, and 1% was related to an anesthesia machine. Eighty-one percent of fires occurred while supplemental oxygen was in use. Common fuels included an endotracheal tube (31%), OR drapes/towels (18%), and flash fire (where no substrate burned) (11%). Less common fuels included alcohol-based preparation solution, gauze sponges, patient's hair or skin, electrosurgical unit with retrofitted insulation over the tip, tracheostomy tube, tonsil sponge, suction tubing, a cottonoid pledget, and a red rubber catheter.Conclusions: OR fire may occur in a wide variety of clinical settings; endoscopic airway surgery, oropharyngeal surgery, cutaneous surgery, and tracheostomy present the highest risk for otolaryngologists. Electrosurgical devices and lasers are the most likely to produce ignition.

Refractory erythromelalgia of the ears: response to mexiletine - Corrected Proof

Alejandra C. Vivas, Julia Escandon, Robert S. Kirsner — 2010-04-14

Abstract: Erythromelalgia is a rare condition characterized by burning pain, erythema, swelling, and increased temperature usually in the extremities. We present an unusual presentation of erythromelalgia of the ears in a patient who has been refractory to multiple therapies and in whom relief of symptoms was achieved with the use of mexiletine. A review of clinical presentation, pathophysiology, and therapeutic options are presented.

Laryngeal reinnervation after vagal paraganglioma resection: a case report - Corrected Proof

Eric D. Lamarre, Robert R. Lorenz, Claudio Milstein, Joseph Scharpf — 2010-04-14

A 36-year-old man presented to the clinic with a 3-month history of an enlarging right-sided neck mass. He had some associated pain in the region but denied any dysphonia, dysphagia, flushing, palpitations, diarrhea, or previous syncopal episodes. He denied a history of tobacco use, chronic alcohol use, or a family history of paragangliomas. Physical examination demonstrated a right-sided level II neck mass measuring approximately 5 cm in anterior-posterior dimension that was tender to touch. Palpation of the neck did not reveal any additional lymphadenopathy. All cranial nerves were functional with particular attention to cranial nerve X: he had symmetric palatal elevation and normal laryngeal function on fiberoptic nasopharyngolaryngoscopy. The mucosal surface of the entire upper aerodigestive tract was unremarkable.

Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model - Corrected Proof

Dennis S. Poe, Bassem Matta Nashed Hanna — 2010-04-14

Abstract: Background: Balloon catheter dilation of diseased sinus ostia has recently demonstrated efficacy and safety in the treatment of chronic sinus disease with 2 years of follow-up. Similar to sinus surgery, initial studies of partial resection of inflamed mucosa from within the cartilaginous eustachian tube (ET) have demonstrated efficacy and safety in the treatment of medically refractory otitis media with effusion. Therefore, balloon dilation of the cartilaginous ET was investigated as a possible treatment modality for otitis media.Methods: A protocol for sinus balloon catheter dilation was evaluated in each of the cartilaginous ETs in 8 fresh human cadaver heads. Computed tomographic scans and detailed endoscopic inspections with video or photographic documentation were performed pre- and posttreatment, and gross anatomical dissections were done to analyze the effects of treatment and to look for evidence of undesired injury.Results: Catheters successfully dilated all cartilaginous ETs without any significant injuries. There were no bony or cartilaginous fractures, and 3 specimens showed minor mucosal tears in the anterolateral or inferior walls. Volumetric measurements of the cartilaginous ET lumens showed a change from an average of 0.16 to 0.49 cm3 (SD, 0.12), representing an average increase of 357% (range, 20–965%).Conclusions: Balloon catheter dilation of the nasopharyngeal orifice of the ET was shown to be feasible and without evidence of untoward injury. A significant increase in volume of the cartilaginous ET was achieved. A clinical study is now indicated to determine whether balloon dilation will demonstrate lasting benefits and safety in the treatment of otitis media.

Effect of fasting on voice in males - Corrected Proof

2010-04-14

Abstract: Purpose of the study: The aim of the study was to study how fasting between 12 and 14 hours affects voice production.Study design: This is a prospective study of male subjects.Material and method: A total of 26 healthy male subjects were recruited for the study. The age varied between 22 and 50 years with a mean of 28 years. Exclusion criteria included hoarseness at the time of presentation, history of recent upper respiratory tract infection, or microlaryngeal surgery. Subjects were evaluated while fasting and nonfasting. Each subject was asked about vocal fatigue and ease of phonation. This was followed by acoustic analyses and laryngeal videostroboscopy.Results: The incidence of vocal fatigue was not higher while fasting compared to nonfasting (P = 1.00). Phonatory effort was significantly greater during fasting (P < .001). Fifty percent of the subjects had an increase in their phonatory effort. There was a significant decrease in the habitual pitch, voice turbulence index, and noise-to-harmonic ratio (P = .018, .045, and .001, respectively). There were no laryngeal videostroboscopic changes.Conclusion: Fasting in males results in an increase in phonatory effort. These phonatory changes may be secondary to dehydration as well as overall neuromuscular fatigability.

Is there any synergic effect for coadministration of mitomycin C and halofuginone on the skin wound healing? - Corrected Proof

2010-04-14

Abstract: Objective: This study compared the potencies of the antifibrotic agents mitomycin C (MMC) and halofuginone (HFN) and investigated whether coadministration of these agents produces synergic effects in an animal skin wound model.Subjects and methods: Twenty male Sprague-Dawley rats were used for this study. After a full-thickness excisional wound was made on the dorsum of each rat, each rat was treated with topical mitomycin, intraperitoneal HFN, or both. Wound surface areas were measured over time, and histologic analysis was performed after wounds healed completely.Results: The groups treated with MMC alone, HFN alone, and a combination of the two all exhibited delayed wound healing compared with the untreated group. Histologically, fibrosis and matrix metalloproteinase–2 expression were significantly inhibited in the treated groups. However, there were no gross or histologic differences between the MMC-treated group, the HFN-treated group, and the combination-treatment group.Conclusions: Both MMC and HFN inhibited excessive fibrosis. However, there was no significant difference in the antifibrotic effects of MMC and HFN on surgically induced skin wounds. Moreover, combination treatment with both MMC and HFN failed to confer an additional antifibrotic effect on skin wounds when compared with treatment with MMC or HFN alone.

Spontaneous osteodural defects of the temporal bone: diagnosis and management of 12 cases - Corrected Proof

2010-04-14

Abstract: Objectives: The objectives of the study were to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of patients with spontaneous dural defect of temporal bone and to explore the possible contribution of idiopathic intracranial hypertension.Methods: Medical records of consecutive patients with spontaneous defects of the temporal bone were reviewed. Clinical presentation, diagnostic process, exploration of benign intracranial hypertension, surgical management, and outcome of patients are presented.Results: Six of the 12 patients presenting with spontaneous cerebrospinal fluid otorrhea were women. Ages ranged from 38 to 76 years. Seven patients presented with meningitis. The location and the extent of the occurring defect were detected by computed tomography in all cases. Radiologic signs of empty sella syndrome, indicator of benign intracranial hypertension, were revealed in 3 cases using magnetic resonance imaging. Six tegmen defects were repaired using a middle fossa approach without recurrence. Four patients received the combined approach. All patients had complete resolution of the cerebrospinal fluid leak, although 2 cases developed adverse effects attributable to surgical procedure.Conclusion: The diagnosis of spontaneous cerebrospinal fluid otorrhea requires clinical suspicion in the setting of meningitis and persistent serous otitis media. High-resolution computed tomography can confirm the diagnosis. The authors' findings advocate the multilayered closure technique through a middle fossa approach.

The caudal septum angle of deflection: an objective analysis for caudal septum deviation - Corrected Proof

Stephen Maturo, Manuel A. Lopez — 2010-04-14

Abstract: ObjectivesThe purposes of the study were to describe an objective technique for the evaluation of caudal septum deviation (CSD) and to evaluate the effectiveness of an open septorhinoplasty technique for treatment of CSD.Study design: A retrospective review of septorhinoplasty cases involving CSD was performed. For all patients, preoperative basal view photographs were analyzed. All patients underwent an external septorhinoplasty approach for treatment of their CSD. After a minimum of 4 months, postoperative basal view photographs were analyzed.Results: Seventeen patients had significant CSD and airway obstruction. The mean change in their caudal septum angle of deflection was 22° (P < .05). All patients had subjective improvement in their nasal airway obstruction. There were no complications.Conclusion: We describe a method to objectively analyze CSDs in septorhinoplasty candidates. An external approach using nasal base reconstruction techniques results in an improvement of CSD and subsequent nasal airway patency.

Unilateral nasal polyposis: clinical presentation and pathology. Response to the editor letter by Tulay Habesoglu, MD - Corrected Proof

Stil Kountakis — 2010-04-14

This letter is in response to a letter to the editor written by Mehmet and Tulay Habesoglu regarding the article “unilateral nasal polyposis: clinical presentation and pathology,” Am J Otolaryngol 2008;29:230-2.

Spontaneous nystagmus in benign paroxysmal positional vertigo - Corrected Proof

2010-04-14

Abstract: Objective: The purpose of this study was to evaluate the presence and eventually to study the features of spontaneous nystagmus (Ny) in our patients with diagnosis of benign paroxysmal positional vertigo (BPPV).Patients and methods: We retrospectively reviewed the clinical records of patients who presented with vertigo spells and were managed at our tertiary care referral center. Patients with only idiopathic BPPV presenting with typical vertigo spells and positioning Ny characteristic of the disease were included in this study. To investigate the positioning Ny, we studied the patients in the sitting position, during the head shaking test, and during the Dix-Hallpike test and the McClure-Pagnini test (Ny provoked by rotation of the head in a supine patient). Ny responses in all patients were observed using infrared videoscopy.Results: We managed 412 patients affected by BPPV. Of the 412 patients, 292 (70.87%) were diagnosed to be having posterior canal-BPPV and 110 (26.99%) patients had horizontal canal-BPPV (HC-BPPV). The remaining 10 patients (2.44%) were identified to have anterior canal-BPPV. Spontaneous Ny in sitting position was observed, by infrared videoscopy, only in the patients affected by HC-BPPV.Conclusion: Spontaneous Ny in BPPV can be observed with infrared videoscopy in patients affected by HC-BPPV. The origin of this Ny is most likely due to a natural inclination of horizontal semicircular canal with respect to the horizontal plane. This Ny stops after flexion of the head in neutral position, and for this reason, it should be considered as a seemingly spontaneous Ny. This Ny, in our experience, is observed in most HC-BPPV patients but does not indicate the need for a different management protocol or any different prognostic value of HC-BPPV.

Adult rhabdomyoma in the parapharyngeal space: report of 2 cases and review of the literature - Corrected Proof

2010-04-14

Abstract: Rhabdomyomas are rare benign mesenchymal tumors with skeletal muscle differentiation. They are less commonly encountered than are their malignant counterparts, rhabdomyosarcomas. Rhabdomyomas fall into 2 general categories: cardiac and extracardiac types. Extracardiac rhabdomyomas are among the rarest tumors in humans and can be subclassified as fetal, juvenile, and adult types depending on the individual tumor's degree of differentiation by light microscopy. Adult extracardiac rhabdomyoma has a strong predilection for occurrence in the head and neck, mainly in the area of larynx and pharynx. In this article, 2 cases of parapharyngeal rhabdomyoma are reported together with a review of the world literature.

Nasal nitric oxide and other diagnostic procedures in seasonal allergic rhinitis: elderly vs juvenile patients - Corrected Proof

Andrzej Bozek, Jolanta Krajewska, Jerzy Jarzab — 2010-04-09

Abstract: Purpose: The type of allergy and other diagnostic procedures were analyzed in a group of elderly seasonal allergic rhinitis (SAR) patients and were compared with young SAR people and a control group.Materials and methods: Study group consisted of 248 patients with mean age 64.1 ± 4.2 years. They were compared with 289 young SAR people (mean age, 23.7 ± 5.8 years) and with a control group. Allergic sensitization was assessed using the skin prick test (SPT) and specific immunoglobulin (Ig) E measurements. The SAR symptoms were monitored using visual graphic scale. Measurement of nasal fractional exhaled nitric oxide (FeNO) level obtained with handheld chemiluminescence analyzer during and after pollen season was compared with control groups.Results: In the elderly patient group, a prevalence of allergy to grass, rye, and mugwort was noticed. In 134 (54%) patients, SPT results to grass were positive; and the specific IgE level was elevated (mean value, 22.8 ± 13.1 IU/mL), whereas in 83 (33%) subjects, positive SPT results to mugwort and elevated serum specific IgE concentration (mean value, 31.9 ± 9.1 IU/mL) were observed. During the pollen season, a significantly higher FeNO level was noted in both young and elderly SAR patients in comparison with their respective control groups. In young patients, the mean FeNO level was 61.8 ± 17.2 parts per billion, whereas in the elderly group, it was 58.2 ± 11.8 parts per billion.Conclusions: SAR in elderly patients is a problem that cannot be neglected. The natural course of SAR in the elderly is similar to other age groups. However, hypersensitivity to different pollens in the analyzed group needs further study.

Neonatal dacryocele with endonasal cyst: revisiting the management - Corrected Proof

Moshe Hain, Yosef Bawnik, Meir Warman, Doron Halperin, Hana Leiba — 2010-01-11

Abstract: Purpose: The aim of the study was to present a consecutive series of neonatal dacryocele with endonasal cyst diagnosed and treated in our institution and to compare our management regimen and outcome with those reported in the literature.Methods: The study was conducted at a university-affiliated teaching hospital. Study population included 5 infants, ages 1 day to 1 month, with either noninfected or infected neonatal dacryocele with endonasal cyst. Management included antibiotic treatment (topical and/or systemic) and local lacrimal massage. When conservative treatment failed, endoscopic identification and incision of the endonasal cyst with subsequent lacrimal duct irrigation with fluorescein and antibiotics were carried out in the office. Main outcome measures included resolution of symptoms and recurrence rate.Results: Between the years 2003 and 2007, 5 infants were diagnosed and treated. All had unilateral dacryocele with endonasal cyst. Female-to-male ratio was 4:1. Age ranged from 1 day to 1 month old. Three had dacryocystitis (60%) before treatment. None had symptoms of airway obstruction. One patient was successfully treated conservatively with firm massage by the ophthalmologist resulting in rupture of the endonasal cyst and did not require further treatment. Four patients were treated with a combined ophthalmology/otolaryngology surgical procedure. All patients were treated in an office setting without general anesthesia. One patient underwent computed tomographic imaging before treatment to confirm the diagnosis. Follow-up ranged from 1 month to 50 months with an average of 23 months. Complete resolution was observed in all patients without recurrence and without complications.Conclusions: We report on the successful surgical treatment of neonatal dacryocele with endonasal cyst in an office setting without the use of general anesthesia, using endoscopic incision of the cyst and irrigation alone. The high success rate of this relatively benign office procedure encourages its use and further supports the approach of early surgical intervention, thus, helping to avoid infectious complications that can be severe at this age.

Conservative management of transnasal intracranial injury - Corrected Proof

2010-01-08

Abstract: The purpose of this study was to explore the conservative management for an unusual case of transnasal intracranial injury. A 3-year-old female child presenting with transnasal injuries after a domestic accident whereby she apparently fell while holding a large pair of scissors, which then penetrated her left nasal cavity, piercing her nasal cavity, ethmoid sinus, and skull base. The scissors were removed from her nasal cavity. The patient had scant cerebrospinal rhinorrhea and no other additional neurologic deficits noted at the time, as well as no long-term developmental deficits. This report highlights the occurrence of this rare condition. The role of radiologic studies such as computed tomographic scans and plain films in diagnosis and management of this case is affirmed. The strategy of minimally invasive treatment of this injury can be a reasonable treatment option.

The effect of radiosurgery on cochlear implant function - Corrected Proof

Soo-Keun Kong, Eui-Kyung Goh, Il-Woo Lee, Kyong-Myong Chon — 2009-12-25

Abstract: Cochlear implants are used worldwide for the treatment of severe to profound bilateral sensorineural hearing loss in both adults and children. A number of implantees are likely to be treated with radiosurgery later in life, but very little is known about the effects of radiosurgery on cochlear implants. We report a cochlear-implanted patient who underwent radiosurgery due to a recurrent meningioma. After radiosurgery, the impedance of the implant maintained a normal range, and auditory performance tests were unchanged as compared to before radiosurgery. This is the first report addressing the effects of radiosurgery in a patient with a cochlear implant.

Biofilms in chronic suppurative otitis media and cholesteatoma: scanning electron microscopy findings - Corrected Proof

James Saunders, Michael Murray, Anthony Alleman — 2009-12-25

Abstract: Background: Biofilms play a role in the pathogenesis of a variety of otorhinolaryngologic diseases, including otitis media and cholesteatoma. Despite this, relatively few studies have undertaken to demonstrate the presence of biofilms tissues from patients with chronic otitis media or infected cholesteatoma.Objective/hypothesis: Our objective is to detect evidence of biofilms human chronic ear infections with scanning electron microscopy (SEM). We hypothesized that bacterial biofilms are present in patients with chronic otitis media.Study design: We performed prospective collection of tissue collected during middle ear surgery from 16 patients undergoing middle ear or mastoid surgery with chronic ear infections.Methods: A total of 31 middle and mastoid tissue samples were harvested at the time of surgery and processed with critical point drying for SEM analysis. Samples were then searched for evidence of biofilms.Results: Bacterial-shaped objects were identified that displayed both surface binding and the presence of a glycocalyx in 4 patients, findings consistent with bacterial biofilms. Most of these (3 of 4) were in patients with infected cholesteatoma, and biofims were identified in 60% of cholesteatoma cases (3 of 5). On the other hand, only 1 of 7 cases with chronic suppurative otitis media had evidence of biofilms.Conclusion: SEM supports the hypothesis that bacterial biofilms are common in chronic infections associated with cholesteatoma and are present in some cases of chronic suppurative otitis media without cholesteatoma.

Metastasis to head and neck area: a 16-year retrospective study - Corrected Proof

Soussan Irani — 2009-12-23

Abstract: Purpose: One of the most striking qualities of cancer is its spread throughout the body. The location of a metastatic mass may help to identify the primary tumor. Metastases to head and neck area can occur either from local structures or from distant organs.Materials and methods: This study was a retrospective review of patients from a University Hospital in Tehran, Iran, during the period 1992 to 2008. The data were analyzed for sex, age, primary site of tumors, metastatic site, and histology of the tumors. The tumors were classified into 2 groups: intraoral and extraoral.Results: A total of 191 cases were found; of these, 118 (62%) were men and 73 (38%) were women. The most common intraoral primary site was tongue (anterior and posterior parts). Thyroid gland was the most frequent primary extraoral site. The most frequent metastatic site was the lymph node, and level II most commonly involved lymph nodes, followed by level I.Conclusion: Metastases are an infrequent finding in head and neck region and they may represent the initial manifestation of the disease. Diagnostic evaluation of metastatic lesion will detect the primary tumor.

Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review - Corrected Proof

Vincent Tan Eng Soon — 2009-12-23

Abstract: Objective: Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome.Methods: The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review.Results: All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 109/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery.Conclusion: Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography–demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.

Study of protective effect on rat cochlear spiral ganglion after blast exposure by adenovirus-mediated human β-nerve growth factor gene - Corrected Proof

Jian Wu, Bing Liu, Jingping Fan, Qiubei Zhu, Jiang Wu — 2009-12-21

Abstract: Objective: To study whether adenovirus-mediated human β-nerve growth factor (Ad-hNGFβ) gene has any protective effect on rat cochlear spiral ganglion after blast exposure.Methods: Deafness was induced by blast exposure (172.0 dB) in 20 healthy rats. Seven days after blast exposure, Ad-hNGFβ was infused into the perilymphatic space of 10 animals as the hNGFβ/blast group, and artificial perilymph fluid (APF) was infused into the perilymphatic space of 10 animals as the APF/blast control group. An additional control group consisted of 10 healthy rats which received Ad-hNGFβ target gene with no blast exposure (hNGFβ/control group). Auditory functions were monitored by thresholds of auditory brain stem responses (ABR). At weeks 1, 4, and 8 postoperatively, the animals were killed, and the cochleae were removed for immunohistochemical, hematoxylin and eosin staining study.Results: The ABR threshold shifts in the hNGFβ/blast group were significantly smaller than that of APF/blast control group. There were no significant differences of the ABR values between before and after operation in the hNGFβ/control group. Expression of Ad-hNGFβ protein was detected in each turn of the cochlea in the first week, with almost equal intensity in all turns. In the fourth week, the reactive intensity decreased. In the eighth week, no reaction was detectable. The results of hematoxylin and eosin stain showed that the number of spiral ganglions in the hNGFβ/blast group was significantly greater than that of the APF/blast control group in the 4th week (P < .01).Conclusion: Adenovirus-mediated human β-nerve growth factor can be expressed at a high level and for a relatively long period in the blast impaired cochlea, suggesting that Ad-hNGFβ has a protective effect on rat cochlear spiral ganglion cells after blast exposure.

Pathologic correlations of otologic symptoms in acute lymphocytic leukemia - Corrected Proof

2009-12-21

Abstract: Objectives: To assess the clinicopathologic correlations of otologic complaints in patients with acute lymphocytic leukemia.Design: Otologic complaints and histologic findings were evaluated in 25 temporal bones of 13 acute lymphocytic leukemia patients.Results: Nine patients had a history of otologic complaints, including hearing loss, otalgia, otorrhea, and vertigo in 5, 3, 3, and 2 patients, respectively. Hemorrhage was most commonly observed in the middle ear (6 patients, 9 temporal bones) and was also observed in cochlea (4 patients, 4 temporal bones), and vestibule (6 patients, 6 temporal bones). Leukemic infiltration was observed in the petrous apex (13 patients, 24 temporal bones), middle ear (7 patients, 14 temporal bones), cochlea (3 patients, 4 temporal bones), vestibule (3 patients, 4 temporal bones), and internal auditory canal (5 patients, 8 temporal bones). Inflammatory changes were observed in the cochlea (5 patients, 8 temporal bones) and vestibule (5 patients, 8 temporal bones). Middle ear effusion containing floating tumor cells was observed in 4 temporal bones of 3 patients. Irreversible histopathologic changes of the middle ear, such as the destruction of the ossicles, perforation of the tympanic membrane, and granulation tissues were observed in 5 temporal bones of 4 patients.Conclusions: Ear involvement is common in acute lymphocytic leukemia patients. With prolonged survival due to the progress of treatment, the diagnosis and treatment of nonhematopoietic system symptoms, such as ear problems due to acute lymphocytic leukemia, have become more important.

Osteochondroma of the coronoid process (Jacob's disease): an unusual cause of restricted jaw motion - Corrected Proof

Nicholas D'Ambrosio, Robert M. Kellman, Sasan Karimi — 2009-12-21

Abstract: Osteochondromas are the most common benign bone tumor, most commonly found in the ends of long bones; however, they rarely involve facial bones, particularly the mandible. Osteochondromas involving the coronoid process have rarely been reported in the literature but pose a diagnostic dilemma. When large enough, osteochondromas of the mandibular coronoid process can form a joint with the zygomatic arch (Jacob's disease). This pseudoarticulation results in restricted jaw motion, which can clinically be mistaken for temporomandibular joint dysfunction. We report a case of a 39-year-old man with chronic restricted jaw motion undiagnosed for several years.

The utility of fine needle aspiration to identify unusual pathology in a parapharyngeal mass - Corrected Proof

Erin L. Ohmann, Barton F. Branstetter, Jonas T. Johnson — 2009-12-21

Abstract: The parapharyngeal space is a complex and well-defined anatomical zone lying lateral to the pharynx and medial to the ramus of the mandible. Although tumors of this space are rare, the parapharyngeal space is difficult to examine clinically; and diagnostic modalities of computerized tomographic scanning and magnetic resonance imaging are primarily used in the evaluation of parapharyngeal space lesions. We present a case report of a second branchial cleft sinus of the parapharyngeal space diagnosed with the assistance of fine needle aspiration (FNA), and we recommend FNA of parapharyngeal masses to provide definitive preoperative diagnoses.

Bilateral giant submandibular sialoliths and the role for salivary endoscopy - Corrected Proof

Carlos M. Rivera-Serrano, Barry M. Schaitkin — 2009-12-21

Abstract: Salivary stones larger than 15 mm are classified as giant sialoliths. They are uncommon in the practice of otolaryngology, and their management has always been a therapeutic challenge. Traditionally, when they cannot be retrieved by marsupialization, removal of the salivary gland has been advocated. Sialendoscopy and the recent development of combined endoscopic and external approaches for extraction of large stones with preservation of the major salivary glands are promising. We present the first case of simultaneous bilateral giant sialoliths, and the first report that associates giant sialoliths and the use of salivary endoscopy. In this case, both giant stones were removed with the assistance of a salivary endoscope and without removing the submandibular glands.

Re: Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss - Corrected Proof

Gedlicka Claudia — 2009-12-21

Thank you for the invitation to respond to the very interesting letter to the editor written by Dong-Hee Le. First issue/ethical aspect: Regarding the objection of ethical aspect of deciding to perform tympanotomy and sealing of the round window membrane in patients with acute unilateral sensorineural hearing loss after failure of conservative treatment, I would like to explain my point of view.