Purpose: Comprehensive evaluation of velopharyngeal insufficiency (VPI) typically includes auditory- perceptual assessment, nasometry, and anatomical evaluations. At times, these examinations are limited by the resources, invasiveness, time and expertise required to perform them. In such instances, the mirror-fogging test would be an ideal screening tool for VPI as it can be performed simply and quickly with minimal resources. However, the sensitivity and specificity of this screening tool have yet to be documented. This study sought to validate the mirror-fogging test as a screening tool for VPI when compared to auditory-perceptual assessments and nasometry. Methods: The charts of 60 participants from our VPI clinic at a tertiary care hospital were retrospectively reviewed: 40 exhibited VPI and 20 were negative for VPI according to auditory-perceptual testing and nasometry. Nasometry scores identified a priori as two standard deviations above normal were judged to be diagnostic for VPI. Auditory-perceptual testing was deemed diagnostic for VPI with hypernasality and audible emission scores above 1 using the American Cleft Palate Association (ACPA) clinical scale for VPI. The sensitivity and specificity for the mirror-fogging test was determined using auditory-perceptual testing and nasometry as diagnostic standards. Results: The mirror-fogging test had a sensitivity of 0.95, a specificity of 0.95 and a positive predictive value of 0.97. Significantly higher auditory-perceptual scores were demonstrated for the features of hypernasality (p <0.008), audible nasal emission (p <0.001), and velopharyngeal function (p <0.001) in the mirror-fogging test positive group. Conclusion: The mirror-fogging test is highly correlated with both auditory-perceptual speech assessment and nasometry, thus, validating its utility as a screening tool for VPI.
Although bicarbonate and hydrogen ions (pH) are known to play significant roles in the physiology of the cochlea, the details of these interrelationships have only received limited attention. Since bicarbonate ions represent the predominant pH buffer, one factor which profoundly affects pH in the cochlea is the prevailing level of carbon dioxide. In the present study, endocochlear potential (EP), endolymph pH (PHe) and scala vestibuli perilymph pH (PHv) were monitored in the second tum of the guinea pig cochlea during manipulations of the systemic CO2 level. Hypercapnea and hypocapnea were induced by varying the CO2 content of inspired air while the animal was slightly hyperventilated. Hypercapnea decreased PHe and PHv and increased the EP, while hypocapnea produced opposite results. In separate studies, endolymph potassium concentration (Ke) was found to be decreased by hypercapnea and increased by hypocapnea. No systematic changes of endolymph Clor Na were found. CO2-induced EP, pH and Ke changes were virtually abolished by intravenous administration of the carbonic anhydrase inhibitor, acetazolamide. These findings support the view that HCO3/CO2 buffering of pH plays a prominent role in the pH regulation of cochlear fluids and may play a key role in endolymph electrolyte homeostasis.
Bicarbonate provides the dominant pH buffer of the cochlear fluids.In the present study, perilymph bicarbonate concentration was manipulated during which endocochlear potential, cochlear fluids pH and cochlear sensitivity to sounds were monitored.Perilymphatic perfusion of medium containing elevated HCO 3 -, at higher pH than normal, produced a decrease in endolymph pH.Similarly, perfusion of nominally HCO 3 --free solution, with lower pH than normal, produced an increase in endolymph pH.When pH changes were induced with HEPES-buffered media, endolymphatic and perilymphatic pH changed in the same direction.The observed endolymph pH changes induced by perilymphatic HCO 3 -manipulations therefore depend on HCO 3 -, rather than pH changes.These findings can be explained by the generation of localized changes of CO 2 in the cochlear fluids associated with bicarbonate homeostasis.These data demonstrate some key properties of the CO 2 / HCO 3 -buffer system and suggest the likely role for carbonic anhydrase in tissues of the lateral wall.In practical terms, the data also suggest that the pH stability of inner ear fluids cannot be adequately maintained when bicarbonate-altered media are perfused, especially when pH buffers other than HCO 3 -are used.
Introduction and Aim: The aim of the present study was to compare aural temperature measurements with conventional methods (axillary and oral) in patients with unilateral tympanic membrane perforation or myringosclerosis. The study also aimed to test the potential nasal use of infrared thermometer. Materials and Methods: Forty-four adult patients with monoaural tympanic membrane perforation and 29 adult patients with monoaural myringosclerosis were included in this prospective study conducted between June 2007 and November 2008. The contralateral ears of the patients were normal. Inter-aural, axillary, oral and nasal temperature measurement results of the patients were compared. Results: Similar measurement results were obtained from the two ears in patients with monoaural perforation (P = 0.7780, SD± 0.3189). Similarly, in patients with monoaural myringosclerosis, no statistically significant difference was found between the measurements from the normal and diseased ear (P = 0.9346, SD± 0.2244). Measurements obtained by using nasal infrared thermometer was significantly lower compared to aural, axillary and oral measurements (p<0.0001). Conclusion: Perforation of tympanic membrane and myringosclerosis are usually asymptomatic and their presence does not effect the aural temperature measurements done by an infrared tympanic thermometer. Nasal temperature measurement by an infrared thermometer is not a reliable method, as it gives significantly lower results than actual body temperature.
Background: Nasopharyngeal carcinoma (NPC) is a tumor arising from the epithelial cells that cover the surface and line the nasopharynx. NPC is a relatively rare malignancy in most parts of the world but it is endemic in many geographical regions, including Southern China, Southeast Asia and the Middle East/North Africa., Indonesia in particular, the incidence is relatively high, ranks 5 th out of 10 large tumors of the body and ranks 1 st in our department. Objective: To study the relationship between the expressions of LMP1 and VEGFR (Flt-4) proteins compared with staging and histopathological features of nasopharyngeal carcinoma (NPC) in Indonesian population. Materials and Methods: A cross sectional study with explorative approached was conducted in Makassar-Indonesia from July 2006 to August 2007. The expression of VEGFR (Flt-4) and LMP-1 proteins was examined by immuno histochemical with avidin-biotin methods staining in 45 NPC specimens. Result: VEGFR (Flt-4) and LMP-1 were expressed in 100% and 42,1% of NPC specimens. No significant difference in correlation (p>0,05) between staging with VEGFR(Flt-4) and LMP-1 expression, these results indicated that VEGFR(Flt- 4) and LMP-1 were expressed during early stage to prepare for enhancing metastatic capacity to the later stage of NPC. There was negative correlation (p<0,05) between histopathological classification with VEGFR(Flt-4) and LMP-1 expression, this indicated that the expression of VEGFR(Flt-4) and LMP-1 was much higher in WHO type II (well differentiated) than WHO type III (undifferentiated). WHO type II well-known as more less sensitive to radiotherapy than WHO type III, according to the prognostic value; WHO type III better than type II. There was strong positive correlation (r= 0,990, p<0,05) between LMP-1 with VEGFR(Flt-4) expression, thereby LMP-1 induces production or expression of VEGF. No significant correlation was found between staging and histopathological features, VEGFR(Flt-4) and LMP-1 expression with alcohol, smoking, betel leaves-areca nuts, air pollution (wood's fire stove, mosquito repellent's smoke) and preservative foods (salted fish, canned food and smoked meat). Conclusion: These results suggest that both VEGFR (Flt-4) and LMP-1 expressions are valuable prognostic markers for prognostic prediction in NPC patients.
The purpose of this study was to examine the feasibility of interstitial MR lymphography using Superparamagnetic Iron Oxide (SPIO) to detect sentinel lymph nodes (SLNs) in head and neck cancer. For two patients with cT2N0 squamous cell carcinoma of the tongue, the submucosal injection of SPIO as well as sentinel lymph node navigation surgery (SLNNS) was performed before undergoing surgical treatment. SPIO was used for MR lymphography and Tc-99m phytate for SPECT. We compared the images by both modalities. Berlin blue stain was also performed postoperatively to verify if SLNs had the uptake of SPIO. The lymph nodes with MR signal attenuation and those with hot spots were probed to be anatomically identical. All the lymph nodes detected as a SLN by a gamma-probe contained the blue granules from SPIO. These data suggest that SPIO can be a novel tracer for performing SLNNS and SLN biopsy (SLNB) in oral cancer patients with cN0 neck.
A 72-year-old female patient presented with a single-sided stuffy nose, headache, purulent running nose and purulent cough for several years. A large posterior maxilloethmoidal cell was noted behind the maxillary sinuses bilaterally and found to drain into the superior nasal meatus. She underwent unilateral functional endoscopic sinus surgery with right ethmoidectomy and middle meatal antrostomy. The postoperative course was uneventful. A well developed posterior ethmoidal cell extends to superolateral portion of sphenoid sinus is called as Onodi's cell. A well developed posterior ethmoidal cell extends to the maxillary sinus more than 50% of the antrum space as the case we presented. We have tentatively named this unique finding a posterior "maxilloethmoidal cell."
Gunshot wound injuries to the face result in a varied scope of traumatic injuries.Mandible fractures may occur through this mechanism of injury, however when caused by firearms, the patterns of fracture and overall composite defects resulting are unique.The velocity of the weapon and the distance from which the injury occurred often determines the extent of injury produced from the penetrating force.A review of the management of mandibular fractures from penetrating trauma is presented.Operative and reconstructive options including advantages and disadvantages are discussed for consideration to produce the optimal result for rehabilitation of the injured patient.
Endoscopic approaches and techniques of otologic surgery are becoming more prevalent. The use of endoscopy in cholesteotoma, tympanoplasty, and other middle ear surgery is extensively documented (1, 2). Furthermore, the use of endoscopy to assist in established transcranial approaches to the internal auditory canal (IAC) and cerebellopontine angle (CPA) is becoming more widely accepted (3). Retrosigmoid resections of CPA tumors using only endoscopic visualization have been described (4, 5).
Objective: To evaluate, industry independently, the accuracy of the Watch-PAT100 system (WP100) (Itamar Medical; Caesarea, Israel), a portable home sleep test, compared to polysomnography, the gold standard for diagnosing obstructive sleep apnea syndrome. Methods: Prospective clinical trial. 27 patients (24 male, 3 female) were evaluated at our institution's sleep laboratory. The apnea hypopnea index and oxygen desaturation index were used to compare the 2 testing modalities. Results: Non-parametrical testing showed a Kendall's tau = 0.685 for apnea hypopnea index and 0.748 for oxygen desaturation index. We found that the WP100 system overestimated the severity of obstructive sleep apnea syndrome in 33% when compared to polysomnography. The test-agreement was in particular poor when the WP100 indicated moderate to severe obstructive sleep apnea syndrome. Conclusion: The WP100 seems accurate for classification of obstructive sleep apnea syndrome severity up to a WP100- measured apnea hypopnea index of 15. In patients with an apnea hypopnea index of more than 15 as measured with the WP100, additional polysomnography should be performed.
Purpose: Obstructive sleep apnea (OSA) is a common disease that is estimated to affect 2% of middle-aged women and 4% of middle-aged men.Reported risk factors include obesity, increased neck circumference, male sex and anatomical abnormalities of the face.Although edentulism is reported to change the anatomy and also impair the function of the upper airway, it has not been typically recognized as a risk factor for sleep-related breathing disorders. Methods:The subject of this report is a 55 years old man with a body mass index (BMI) of 33 kg/m 2 .Cephalometric assessments of head radiographs taken in the lateral plane with and without dentures were performed; mandible planehyoid (MP-H) distance and the posterior airway space (PAS) were measured.Oxygen saturation (SaO 2 ) and apnea/hypopnea index (AHI) were evaluated.Results: A comparison of the polysomnographies taken with and without wearing the dentures during the night showed that AHI was reduced (from 20.0/h to 5.7/h) and mean SaO 2 increased (from 94.0% to 96.0%).Cephalometric analysis showed that the removal of dentures led to a striking increase in the anteroposterior oropharyngeal wall distance from 5 mm to 10 mm, while the mandible plane-hyoid distance does not change.Conclusions: These findings were consistent with the hypothesis that edentulism not always worse OSA by an oropharyngeal collapse.Given the common occurrence of both conditions among the elderly, such as the reduction of obstructive sleep apneas with or without dentures, the observed relationship requires further investigations on the mechanisms through which the loss of teeth could help upper airway collapse during the night.In the present paper a case of reduction of OSA without dentures during sleep is shown.
Introduction: Although Streptococcus pneumoniae (SP), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) are major pathogenic bacteria of acute otitis media (AOM) in children, responsibility of their resistance to antimicrobial agents for intractable AOM has not been cleared. In this study, cultured bacteria from the adenoid of otitis-prone children were compared with those of children who had no apparent episodes of AOM to know the most responsible pathogens for intractable AOM. Methods: Sixty-eight children who had episodes of recurrent or persistent AOM were subjected to this study and 19 children without apparent episodes of AOM but with obstructive sleep apnea were taken as controls. Nasopharyngeal swab specimens were obtained from the adenoid transorally during the adenoidectomy, instead of conventional transnasal harvesting, to avoid contamination. Prevalence of SP, HI, and MC in each group was compared using the chi-squared or Fischer's exact test, and p-values <0.05 were considered significant. Results: SP was identified in 60.3% of otitis-prone children and in 52.6% of control children, and this difference indicated no statistically significance (p=0.54). HI was isolated from 77.9% of subjects and from 47.4% of controls, and the difference revealed significant (p=0.009). Above all, beta-lactamase negative HI (BLNAR) was caught in 39.7% of the study group, but in none of the control group (p=0.002). MC was identified in 32.4% and in 5.3%, individually, with significant difference (p=0.04). Conclusion: HI was more frequently isolated from otitis-prone children, and was considered to make AOM more intractable. The pathogenic role of MC for AOM may be evident.
Objectives: Previous studies have shown that both motor exercises and vestibuloocular tests reveal a difference in the balance function of deaf and normal-hearing children and adolescents. The purpose is to evaluate the influence on balance function of the hearing status. Material and Methods: A total of 80 children and adolescents between the ages of 4 and 20 years were studied. Of these, 40 children were either deaf or severely hearing impaired. The remaining 40 were control subjects of equivalent age without hearing or balance impairment. The EquiTest ® , a device used in computerized dynamic posturography, was employed for the investigations. Mean equilibrium and latency scores from both groups were compared using t-tests for unrelated random samples. Results: The deaf children achieved significantly lower equilibrium scores and latency scores than the control group. A positive linear relationship exists between the age of the subjects and the equilibrium scores obtained. Gender, extent of hearing loss and cause of deafness have no significant effect on the balance function of the deaf children. Deaf subjects with normal caloric excitability achieved significantly higher equilibrium scores than those with vestibular deficits. Conclusions: The results support the hypothesis that damage to the cochlea, whatever its cause, may also detrimentally affect the vestibular organ. They do not, however, exclude the possibility that the poorer balance proficiency shown by deaf children may have other possible causes, such as CNS damage. The fact that equilibrium scores increase with increasing age can be seen as indicating the maturation of central nervous mechanisms involved in integrating the various sensory qualities in the sense of balance. An improvement in vestibular function through special training appears plausible, although this would necessitate diagnosis at a very early stage.
Background: In mammals, sensory hair cells and supporting cells that comprise the auditory epithelium (i.e. organ of Corti) lose the ability to proliferate or regenerate after embryogenesis and are considered terminally differentiated. Previously, it was demonstrated that deletion of p27 Kip1 , a cyclin dependent kinase inhibitor, extends the period of cellular proliferation beyond embryogenesis in the organ of Corti, resulting in supernumary supporting cells and hair cells. Methodology/Principle Findings: We now report that p27 deletion results in an increased number of inner and outer hair cells at one month of age. These hair cells display normal phenotypes including uptake of AM1-43, a mechanotransduction dye. Outer Hair Cells (OHCs) in the p27-/- cochlea appropriately express Prestin, the cellular protein essential for OHC electromotility. This has not been observed in new hair cells induced by deletion of Rb or over expression of Atoh1. Ototoxic antibiotics (aminoglycosides) can cause hair cell loss resulting in hearing loss. In p27 Kip1 +/- and -/- mice, aminoglycosides induce de novo supporting cell proliferation and hair cell regeneration. Thus, in addition to mediating cell cycle withdrawal during embryogenesis, p27 blocks cycle re-entry after embryogenesis and maintains the terminally differentiated state in the organ of Corti. In p27 Kip1 +/- and -/- mice, Cyclin E expression was observed in supporting cells on postnatal day 0, increased in expression by postnatal day 7 and was maintained into adulthood. Following p27 inhibition, Cyclin E expression in supporting cells is presumed to drive cell cycle re-entry.
Granular cell tumor is a relatively uncommon benign neoplasm that occurs in almost any part of the body, with the head and neck region involved in 45 to 65% of the cases.The peak of incidence is generally in the fourth to sixth decades of life, while it is very rarely encountered in children.Usually, it appears as a singular nodular mass covered by intact overlying mucosa.Its etiology and histogenesis is unclear; in addition, its nature is sometimes questioned due to the occurrence of malignancy in less than 2% of all lesions, and/or recurrence or metastasis to regional lymph nodes despite a benign histopathological appearance.In the present paper, we describe a case with intraoral location occurred in a child, whose clinical and immunohistopathological features seem to confirm a benign course of tumor even in the childhood.
Objectives: Head and neck nonmelanoma cutaneous carcinomas (NMCC) may have poor outcomes, such as metastasis and recurrence.It remains unclear which patients are at increased risk for poor outcomes.We characterize a population of NMCC seen in a head and neck surgical practice.We sought to identify predictors of poor outcome in head and neck NMCC.Study Design: A retrospective cohort study of 161 patients with head and neck NMCC who presented to a university based otolaryngology-head and neck surgery practice over a 13 year period was performed.The study group included 127 men and 34 women, age range: 33 -92 years.Subjects and Methods: Tumor characteristics of the study population were recorded, and statistical analysis and Kaplan-Meier survival calculations were performed to determine predictors of poor outcomes.Results: 113 squamous cell carcinomas (SCC) and 48 basal cell carcinomas (BCC) were identified.Among SCC patients, there was a 44% incidence of metastasis and a 47% incidence of recurrence.Among BCC patients, there was a 10% incidence of metastasis and a 50% incidence of recurrence.Twenty percent of SCC patients had a history of immunosuppression.Among SCC patients with immunosuppression, 83% had metastasis or recurrence.Survival for SCC patients with metastatic disease was significantly worse than patients without metastases.The presence of parotid metastases in SCC conferred a survival advantage when compared to other sites of metastases. Conclusion:The incidence of poor outcomes in NMCC was higher in our series than reported in the literature.Survival patterns of our study parallel those of similar studies in the literature.
Objectives: Large cutaneous defects of the cheek and external ear present a reconstructive challenge. While free tissue transfer has been increasingly used for such defects, many patients with these malignancies are poor candidates for lengthy reconstructive surgery. The cervicofacial and cervicothoracic advancement flaps have been previously described as a simple method for reconstructing defects of the face and neck. However, for large facial defects, these flaps typically require wide undermining with the final closure sometimes under tension. We describe our experience utilizing a modified approach to the cervicofacial rotation flap which has little tension of the defect closure and avoids incisions or undermining of tissue inferior to the clavicle. Study Design: Retrospective chart review. Methods: Sixteen patients underwent a modified cervicofacial rotation flap for immediate reconstruction of a cheek and/or total auriculectomy defect. Results: Primary cutaneous malignancies were the most common surgical indication, followed by parotid tumors with overlying skin involvement. Five patients had total auriculectomy defects while 11 patients had defects involving cheek skin without auriculectomy. Defect diameter size varied from 5 to 12 centimeters. Two patients required skin grafting of the donor site. Four patients had minor wound dehiscences that were treated with local wound care and allowed to close by secondary intention. Conclusions: We describe a modified approach to the cervicofacial rotation flap which minimizes undermining to provide a tension-free closure of the defect. Our approach is a simple, reliable method for coverage of large cutaneous defects involving the cheek and external ear.
The human saccule has preserved the ancestral ability to respond to high-intensity acoustic stimulations, generating a contraction reflex of the cervical tract muscles. Recording the muscular bioelectric potentials following saccular stimulation allows the evidence of the vestibular-evoked myogenic potentials (VEMPs). The aim of this study was to record VEMPs in alert and anesthetized guinea pigs to evaluate the possible different impacts of some anesthetic drugs on VEMP recording. Sixteen guinea pigs, divided into four groups, were employed for the study. Each group underwent general anesthesia induced using different pharmacological regimens; auditory and vestibular functions were examined with Auditory Brain Response (ABR) and VEMP methods. The analysis of the results showed that the VEMPs recording performance was strictly related to the alert status of the guinea pigs: VEMPs were not recordable during anesthesia while reappeared at awakening, with the same temporal and morphological characteristics of pre-anesthesia. ABR was instead normally present during anesthesia without showing any differences with all the various anesthetic drugs employed. These results prompted us to conclude that anesthetic drugs cause the disappearance of saccular reflex in guinea pigs, not minding the specific type of drugs employed. This evidence, in agreement with the data available in literature for humans, induces and encourages future studies about sacculocollic reflex and its possible application in clinical practice.
Two apoptosis-related proteins Bax and Bcl-2 in bcl-2 gene family were studied in thirty-one randomly selected patients with T1 to T4 adenoid cystic carcinoma of the major salivary glands and minor glands of oral and nasal mucosa to investigate their prognostic value.Sections from diagnostic, formalin-fixed, paraffin-embedded specimens were stained immunohistochemically to detect Bax and Bcl-2 protein.No correlation was found between Bcl-2 and Bax expression.Bax expression correlated negatively with N-classification (p=0.0132).Tumors with low Bax expression (p=0.0088) or high Bcl-2 expression (p=0.0054)correlated with a shorter disease-free period.The combined parameters Bcl-2 -Bax and Ki-67 -Bax, showed an enhanced prognostic significance (p=0.002respectively).Our investigation revealed that Bax and Bcl-2 expression have prognostic value in ACC.The combined evaluation between these two proteins or between Ki-67 and Bax expression revealed an enhanced prognostic potential.
Introduction: Among the alterations caused by the use of aminoglycosides, the A1555G mitochondrial mutation is one of the most important ones.Objective: To investigate the prevalence of the A1555G mutation in patients with sensorineural hearing loss related with or without the use of aminoglycoside antibiotics.Materials and Methods: Study of control-case in a sample of 27 patients with hearing loss, as the cases, and in 100 neonates, with normal hearing, as the control group.DNA was extracted from leukocyte blood samples and specific primers were used to amplify the Cytochrome b gene and the region that encloses the A1555G mutation of the mitochondrial DNA, using the polymerase chain reaction and the restriction fragment length polymorphism techniques. Results:The presence of mitochondrial DNA was confirmed in all of the 127 study samples, due to the amplification of the Cytochrome b gene region in all such samples.The A1555G has not been identified in any of the 27 patients with hearing loss, nor in the 100 neonates of the control group.Conclusions: Results are in accordance with studies which state that the A1555G mutation is not prevalent in the Americas.There is some interest in determining the real prevalence of this mutation and in the investigation of other mutations which may cause hearing loss associated to the use of aminoglycosides, or not, in the Brazilian population.
