The role of MMP-2, MMP-9, and TIMP-1 in the pathogenesis of nasal polyps: Immunohistochemical assessment at eight different levels in the epithelial, subepithelial, and deep layers of the mucosa

April 27, 2015     Nuray Bayar Muluk, MD; Osman Kürşat Arikan, MD; Pınar Atasoy, MD; Rahmi Kiliç, MD; Eda Tuna Yalçinozan, MD
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Abstract

We conducted a prospective study to investigate the role of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the pathogenesis of nasal polyps. Our study group consisted of 24 patients-21 men and 3 women, aged 23 to 70 years (mean: 45.97 ± 11.60)-with nasal polyposis who underwent functional endoscopic sinus surgery. For comparison purposes, we assembled a control group of 11 patients-6 men and 5 women, aged 18 to 56 years (mean: 29.90 ± 14.22)-without nasal polyps who underwent septoplasty and/or rhinoplasty. We analyzed 36 polyp specimens obtained from the study group (10 from the nasal cavity, 10 from the maxillary sinus, and 16 from the ethmoid sinus) and 11 tissue specimens from the control group (each control provided 1 specimen from the inferior turbinate). We then calculated the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and the deep paraglandular layer of the mucosa. In general, we found that MMP-2, MMP-9, and TIMP-1 values were higher in the nasal polyp group. These differences became less so as patients' ages and the duration of polyps increased. We conclude that the most important role that MMP-2 plays in polyp growth may be in terms of perivascular localization and an increase in vascular permeability, which causes inflammatory cell migration and edema in the extracellular matrix. An increase in MMP-2 in glandular tissue may lead to hydrolysis of tissue matrix components. The degraded extracellular matrix may result in fibrosis of the polyps. An increase of MMP-9 in the apical part of the epithelium in the polypoid tissue of the nasal cavity, maxillary sinus, and ethmoid sinus may facilitate the epithelial and endothelial cell migration that is observed during polyp development and growth.

Introduction Nasal polyposis is a chronic disease of the upper airway that is characterized by inflammatory cell infiltration, tissue remodeling that includes extracellular matrix (ECM) accumulation, and fibrosis. The inflammatory cellular infiltrate in nasal polyposis has been shown to consist of eosinophils, lymphocytes, plasma cells, and mast...

Bilateral true vocal fold atrophy

April 27, 2015     Jason Bell, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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The most common cause of vocal fold atrophy is aging, but other causes include paresis, menopause, and thyroiditis, as well as neuromuscular junction disorders such as myasthenia gravis.

A 52-year-old computer programmer and avocational baritone complained of having a weak voice; odynophonia; decreased range, resonance, and projection; and difficulty with his passagio with voice breaks. His voice difficulties began after having a total thyroidectomy for micropapillary thyroid cancer. He declined postoperative radioactive iodine...

Perineural spread of cutaneous squamous cell carcinoma along the great auricular nerve

April 27, 2015     Daniel Thomas Ginat, MD, MS; Diana Bolotin, MD, PhD; Alexander J. Langerman, MD
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Although perineural tumor spread in the head and neck most commonly involves the cranial nerves, particularly the trigeminal and facial nerves, the spinal nerve branches can also be affected.

Parathyroid localization using 4D-computed tomography

April 27, 2015     Darrin V. Bann, PhD; Thomas Zacharia, MD; David Goldenberg, MD, FACS; Neerav Goyal, MD, MPH
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To decrease the risk of iatrogenic cancers associated with 4D-CT, several groups have used one- or two-phase imaging protocols to identify parathyroid adenomas.

Sinonasal undifferentiated carcinoma as a third primary neoplasm: A case report and review of the literature

April 27, 2015     John J. Chi, MD; Michael D. Feldman, MD; James N. Palmer, MD
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Abstract

A 71-year-old man with a history of a pituitary prolactinoma and metastatic pancreatic carcinoma presented with epistaxis, visual changes, bilateral ophthalmoplegia, involuntary closure of the left eye, and ptosis of the right eye. The patient was found to have a soft-tissue mass in the posterior nasal cavity with extension through the floor of the sella turcica, the sphenoid sinuses, cavernous sinuses, and suprasellar region. The patient was subsequently taken to the operating room. Intraoperative frozen section of the sinonasal mass demonstrated carcinoma. The final pathology of the mass revealed sinonasal undifferentiated carcinoma (SNUC)-the patient's second skull base lesion and third primary neoplasm. SNUC is a rare neoplasm of the sinonasal cavities that rapidly progresses from symptom onset to mortality in the presence of aggressive multidimensional therapies. Given its poor prognosis and possibly devastating treatments, an open discussion of treatment options between physicians and the patient is of the utmost importance. Although SNUC is rare, it is important that practicing otolaryngologists, neurosurgeons, and skull base surgeons be familiar with this disease process-especially when caring for patients with a history of a benign skull base neoplasm and concern for possible recurrence, as was the case in this report.

Introduction Sinonasal undifferentiated carcinoma (SNUC) is a rare neoplasm of the nasal cavity and paranasal sinuses. Patients frequently present with extensive local disease involving the superior nasal cavity and ethmoid sinuses. Disease may also invade the anterior skull base and orbits. Presenting complaints include epistaxis, visual changes...

Is there a relationship between myeloperoxidase activity and conductive hearing loss in chronic otitis media complicated by cholesteatoma?

April 27, 2015     Ozlem Celebi Erdivanli, MD; Arif Sanli, MD
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Abstract

We conducted a prospective, controlled study of patients with chronic otitis media and cholesteatoma (1) to examine the expression of myeloperoxidase (MPO) using immunohistochemical staining techniques and (2) to investigate the relationship between MPO activity and the degree of conductive hearing loss in these patients. Our study population included 51 adults-26 men and 25 women, aged 18 to 58 years (mean: 37.5)-who had been diagnosed with chronic otitis media and cholesteatoma by physical examination and computed tomography (study group). Another 30 patients-13 men and 17 women, aged 18 to 52 years (mean: 32.7)-who had chronic otitis media without cholesteatoma served as the control group. Following audiometric evaluations, all patients underwent appropriate surgery. Postoperatively, cholesteatoma samples were analyzed by immunostaining for MPO positivity as a marker for acute inflammation. We found that MPO activity was present in all 51 study patients (100%) but in only 10 controls (33.3%); the difference was statistically significant (p< 0.01). In the study group, the degree of MPO activity was slight in 6 patients (11.8%), moderate in 24 patients (47.1%), and intense in 21 patients (41.2%), while in the control group, all 10 MPO-positive cases showed only a slight degree of activity. We also found a statistically significant association in the study group between the degree of MPO activity and the degree of conductive hearing loss (χ2 = 13.518; p < 0.001). We encourage further study of all steps in the process of cholesteatoma formation.

Advanced airway management teaching in otolaryngology residency programs in Canada: A survey of residents

April 27, 2015     Val&eacute;rie C&ocirc;t&eacute;, MD; Lukas H. Kus, MD, MSc; Xun Zhang, PhD; Keith Richardson, MD; Lily H.P. Nguyen, MD, MSc, FRCS(C)
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Abstract

We conducted a study to assess residents' levels of comfort with advanced airway management in Canadian otolaryngology residency programs. In October 2008, an electronic questionnaire was sent to all otolaryngology residents in Canada. Responses were voluntary and anonymous. The response rate was 64.8% (94 of 145 residents). Residents were asked about the amount of teaching they received and the amount they would like to receive each year in four areas: emergency surgical airway, pediatric airway, airway trauma, and management of complications during laryngoscopy/bronchoscopy. They were also asked how comfortable they were with their current level of knowledge in these areas. Overall, residents were not comfortable with difficult airway situations, scoring a mean of 3.08 on a 5-point Likert scale. Residents were most comfortable with the emergency airway and least comfortable with the pediatric airway. Overall, residents indicated that they had not received adequate teaching on advanced airway management, and they consistently desired more. With respect to the type of instruction, most residents requested more teaching via simulations, mannequins, and cadaver or animal models. Linear regression models revealed a positive relationship between their overall comfort with airway management and the number of airway teaching hours they received. Their consensus was that formal airway training should occur during postgraduate year (PGY) 2, with refresher courses offered every 2 years. This is the first wide-scale assessment of the status of airway teaching in otolaryngology residency programs in Canada. Overall, our findings suggest that otolaryngology residents in these programs are not comfortable with advanced airway management early in their training and feel they would benefit from a significant increase in airway teaching time. Comfort levels improved with increasing levels of training such that PGY5 residents indicated they were indeed comfortable with advanced airway management.

Introduction Airway management is an essential feature of otolaryngology. Problems with airway patency can lead to such devastating consequences as hypoxic injury and death, and thus the otolaryngologist's role in maintaining the airway in emergency or surgical settings is of critical importance. Therefore, a great deal of emphasis should be...

Biphasic synovial sarcoma of the hypopharynx

April 27, 2015     Ustun Osma, MD; H&uuml;lya Eyigor, MD; Dinc Suren, MD; Cem Sezer, MD; Mustafa Deniz Yilmaz, MD
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Abstract

Synovial sarcoma is a malignant mesenchymal neoplasm usually involving the extremities of young adults. Localization in the head and neck region is rare. Histologically, these lesions have biphasic and monophasic variants, the latter being more rare and difficult to identify. Immunohistochemistry plays a crucial role in the diagnosis. We report a case of a biphasic synovial sarcoma arising in the hypopharynx with a review of the literature concerning this rare neoplasm.

Distortion-product otoacoustic emissions testing in neonates treated with an aminoglycoside in a neonatal intensive care unit

April 27, 2015     Iosif Vital, MD; George Psillas, MD; Nikolaos Nikolaides, MD; George Kekes, MD; Stavros Hatzopoulos, MD; John Constantinidis, MD
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Abstract

We evaluated the ototoxic effect of aminoglycosides on the outer hair cells of newborns in a neonatal intensive care unit (NICU) by means of distortion-product otoacoustic emissions (DPOAE) testing. Our study population was made up of 164 newborns who were divided into three groups: group A consisted of 105 infants who were given aminoglycoside therapy (either gentamicin or amikacin, or a combination of the two) as treatment for suspected or proven bacterial infection and septic states; group B included 30 newborns who were not given an antibiotic or who were given an antibiotic other than an aminoglycoside; group C, a control group, was made up of 29 healthy neonates who were hospitalized in the well-baby nursery. All the neonates underwent DPOAE testing in both ears (the f2 primary tone was presented at 2.0, 2.5, 3.2, and 4.0 kHz). We found that 41 patients in group A (39.0%) and 13 in group B (43.3%) failed the DPOAE test in one or both ears; the difference between these two groups was not statistically significant (p = 0.673). In group C, the DPOAE fail rate was 13.8% (4 newborns). In group A, there was no statistically significant association between the pass/fail rate and the specific aminoglycoside that was administered, or in the duration of antibiotic treatment, the number of doses, and the size of the mean daily dose and the mean total dose. In clinical practice, DPOAE testing is a sensitive method of evaluating the integrity of the outer hair cells in the basal turn of the cochlea after exposure to ototoxic drugs such as aminoglycosides. However, our study did not demonstrate that the aminoglycosides had any ototoxic effect on the hearing of neonates in the NICU.

Giant Stensen duct calculus

April 27, 2015     Wen-Sen Lai, MD; Jih-Chin Lee, MD; Yueng-Hsiang Chu, PhD; Ying-Nan Chang, MD
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A sialolith in the anterior third of a Stensen duct usually can be extracted in a minimally invasive manner via trans-oral sialolithotomy to avoid the morbidity associated with a sialadenectomy.

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