Vocal folds analysis using global energy tracking.

INTRODUCTION: Detection and quantification of oscillatory irregularities in laryngeal videostroboscopy can be particularly difficult for the human expert. Accordingly, there is a wide interest in automated methods for recovering the folds' temporal trajectory. Unfortunately, current methods typically provide only crude glottal measurements. OBJECTIVES: An automated procedure for consistently tracking the entire vocal folds' boundary in laryngeal stroboscopy videos, even when the glottal opening is closed. METHODS: A preprocessing frame-by-frame crude midpoint identification is followed by an active contour evolution to detect the global boundary in each frame independently. A global energy active contour is then jointly defined over the entire video sequence, and the full glottal boundary is detected throughout the video via standard energy minimization. RESULTS: The vocal folds' boundary is accurately tracked in normal and abnormal stroboscopy videos collected in a clinical setting, and that exhibit a varied range of visual characteristics (eg, lighting conditions). A proof-of-concept evaluation based on the analysis of the waveform of the location of points along the boundary separates between a normal and two markedly different abnormal subjects, and automatically provides a hypothesized localization of the abnormality. CONCLUSION: The first method for automatically tracing the temporal trajectory of all points along the vocal folds' boundary in all frames of a stroboscopy video is presented. The approach opens the door for novel analysis of all regions of the contour, which in turn may lead to automated localization of pathologies.

Identification and immunolocalization of the innate immune receptor CD14 in hypertrophic adenoids and tonsils.

The purpose of this study is to determine the expression of CD14 as a marker of the innate immunity in hypertrophic adenoids and tonsils. Twenty-four pediatric patients (age <12 years) with obstructive adenotonsillar hypertrophy, confirmed by sleep study were included in this study. Intensity and expression of positive CD14 infiltrating cells was assessed by immunohistochemistry in specific histologic areas. In tonsils, CD14 immunoreactivity was demonstrated in intraepithelial lymphocytes located in the basal layer of the stratified squamous mucoepithelium. CD14 expression was significantly higher in mucosal layers and inter-follicular areas of tonsils than adenoid tissues [(p < 0.001), (p = 0.021), respectively]. CD14 expression was significantly higher in the submucosal layers of adenoids than tonsil tissues (p = 0.002). Hypertrophic adenoids and tonsils from children with OSA are prominent sites of innate defense, with over expression of CD14. The enhanced expressions of CD14 cells in adenoids and tonsils may be an important factor for the development and persistence of adenoids and tonsils enlargement causing OSA in children. CD14 expression in adenoids and tonsils illustrates an important immunological sentinel function of the innate immunity of the upper airway.

The imperative of the Sistrunk operation: review of 160 thyroglossal tract remnant operations.

OBJECTIVE: Analysis of the pre- and postoperative features, long-term follow-up, and complications. STUDY DESIGN AND METHODS: Case series with chart review of 160 thyroglossal tract remnant excisions over a 20-year period (1988-2007). RESULTS: The mean age of diagnosis was 10.9 +/- 14.2 years with 63.8 percent male predominance. There was a prior history of thyroglossal tract remnant infections in 70 percent of patients, and 30 percent presented with cutaneous fistulas. The majority had ultrasound imaging that identified cysts mainly (66.7%) in the infrahyoid region. Preoperative fine-needle aspirations in 18 patients were benign. On pathological reevaluation, 26.5 percent had thyroid tissue inside the remnant, with one case of papillary carcinoma. After the Sistrunk operation, postoperative complications occurred in 7.5 percent including a 1.9 percent recurrence rate. CONCLUSIONS: All age groups had similar clinical presentations and outcomes. Ultrasound is a reliable and appropriate imaging modality for most patients. Surgery must effectively incorporate the tract and cyst to allow low recurrence rates (<2%). Clinically diagnosed thyroglossal tract remnant may, in fact, be other pathologies in 10 percent of cases. Nevertheless, our recommendation is a Sistrunk procedure for all midline neck lesions suspected to be a thyroglossal tract remnant.

Prevalence and clinical significance of anticardiolipin, anti-beta2-glycoprotein-1, and anti-heat shock protein-70 autoantibodies in sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) is frequently classified as 'idiopathic' since the causative factor responsible for its onset is not identified in most cases. In the present study, we determined whether SSNHL is clinically associated with serum anti-heat shock protein-70 (anti-HSP70) and antiphospholipids (anti-PLs) autoantibodies and whether these autoantibodies have an impact on the prognosis of SSNHL. Sera from 63 patients with SSNHL were screened prospectively for the presence of anti-HSP70 and anti-PLs autoantibodies by an enzyme-linked immunosorbent assay test. Anti-PLs antibodies in this study consisted of anticardiolipin, and anti-beta(2)-glycoprotein-1 antibodies. Serum was assayed for anti-HSP70 IgG antibodies using recombinant human HSP70. Demographic, clinical, and audiometric variables were analyzed to find the possible role of serum autoantibodies in SSNHL patients. Sixteen patients (25.4%) had demonstrable anti-HSP70 antibodies in serum. Twenty-one patients (33.3%) showed a positive result for at least one isotype (IgM or IgG) of anti-PLs. In 19% of the patients, anti-HSP70 and anti-PLs antibodies were positive in two combinations. A statistically significant association was found between anti-HSP70 antibodies and the Siegel recovery grade subgroup. SSNHL patients who were positive for anti-HSP70 antibodies showed a significantly higher rate of complete recovery and incomplete but partial recovery than SSNHL patients without anti-HSP70 antibodies (p = 0.0496). Statistically significant association was found between total anticardiolipin, total anti-beta(2)-glycoprotein-1, total anti-PLs, and anti-PLs in combination with anti-HSP70 antibodies and age (p = 0.0229). The detection of autoantibodies to HSP70 and PLs offers a pliable explanation for the immune-mediated mechanism of SSNHL. The present study confirms and supports previous studies regarding the association between anti-HSP70 and anti-PLs antibodies with SSNHL, and is the first to identify a positive association between anti-HSP70 antibodies and a positive outcome of SSNHL. Further studies are necessary in order to identify and further clarify the immunologic role of the presence of autoantibodies and their impact on the prognosis of SSNHL.

Enterovirus, cytomegalovirus, and Epstein-Barr virus infection screening in idiopathic sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) is frequently classified as 'idiopathic' since the causative factor is not identified in most cases. In the present study we determined whether SSNHL is associated with common viral infections, namely enterovirus, cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Between April 2004 and March 2005, we conducted a prospective cohort study on 48 unselected patients with unilateral idiopathic SSNHL. Plasma samples obtained at presentation were analyzed for the presence of enterovirus RNA by reverse-transcription polymerase chain reaction (RT-PCR). Recent occurrence of CMV and EBV infection was determined by serological tests. Among 23 men and 25 women aged 18-84 years (mean age 51.67 years), none presented with clinical symptoms of a viral infection compatible with preceding or concurrent viral infection. One patient (2.08%) had evidence of enterovirus infection by RT-PCR, 3 patients (6.25%) had EBV IgM, and none were positive for CMV IgM. The majority of SSNHL patients (91.67%) did not have evidence of any of the three common viral infections upon presentation. The present study failed to identify recent or concurrent systemic viral infections among SSNHL patients, except for a small proportion who demonstrated recent viral infection. Therefore the theory that viral infection is a factor in SSNHL pathogenesis is not supported by this study. Further studies in larger patient populations and different epidemiological settings are required in order to verify the true role of viral infections in SSNHL.

Ingestion of caustic substances: a 15-year experience.

OBJECTIVE: The objective of this study was to analyze the circumstance, demographic features, clinical findings, and complications of caustic ingestion in relation to the type and amount of caustic substance. STUDY DESIGN: The authors conducted a retrospective cohort study in a tertiary medical center. METHODS: The authors reviewed medical records from 1988 to 2003 of patients with a history of caustic ingestion and clinical signs of injury to the aerodigestive tract. Parameters examined included age at presentation, gender, demographic status, nature of the caustic substance ingested, amount of substance, circumstance of the event, diagnostic tools, degree of injury, and anatomic distribution of the injury, early and late complications, and requirement for ventilatory support. RESULTS: A total of 50 cases of caustic ingestion were identified (age range, 5 months-71 years). A biphasic distribution of the patients was noted; half were children under 5 years old and the remainder was adults. The most common caustic agent ingested was alkaline (42%) followed by acidic (32%) and chlorine bleach (26%). The most frequent cause for ingestion was accidental (67%) as opposed to attempt suicide (33%). All cases of attempted suicide occurred in adults. Most of them reported ingestion of large amounts of caustic substance. In the pediatric group, an association between the caustic agent and ethnicity was observed. Among Jewish children, alkaline cleaning agents were the most common cause (82%). Acetic acid was the most common substance ingested by the Arab children (100%). The findings of rigid esophagoscopy in 36 patients were as follows: first-degree esophageal injury in 16 (44%), second-degree in 6 (17%), third-degree in 7 (19%), fourth-degree in 6 (17%), and one (3%) was normal. Mucosal injury to the esophagus was worse in the acidic ingestion group as compared with the alkaline substance ingestion group with marginally statistically significant difference in the median degree of injury between the three types of ingested substances (P = .054). Mucosal injury to the esophagus was worse among patients who attempted suicide as compared with accidental ingestion with a statistically significant difference in the median degree of injury between the two reasons for ingestion (P = .002). CONCLUSION: Severity of injury from caustic ingestion damages depend on the type of ingested substance, which varies depending on ethnicity. Ingestion of caustic agents by children involves specific substances according to the season, cultural and religious festivals, and ethnicity. The majority of adult cases are intentional with more serious injuries and a higher rate of complications. In our series, ingestion of acidic substances and ingestion associated with suicide attempt had the most severe consequences.

Imagination of body rotation can induce eye movements.

OBJECTIVE: Several studies have shown that spatiotemporal aspects of motion are stored and can be retrieved with the use of vestibular and somatosensory cues. The purpose of this study was to examine whether intentional imagination of body rotation can induce oculomotor activity similar to the typical vestibulo-ocular reflex (VOR). MATERIAL AND METHODS: Normal subjects without known vestibular and/or oculometric abnormalities were instructed to imagine a sensation of accelerating body rotation in the horizontal plane (rightward or leftward) while sitting in darkness with closed eyes, using only vestibular and somatosensory cues and not imaginary visual cues. Eye movements were recorded during the imagery session and also during a full, routine electronystagmography (ENG) test. All subjects selected for this study showed normal results in the ENG test, and none of them had gaze-evoked or end-point nystagmus. RESULTS: In response to imaginary rotations, horizontal eye movements were found in 91/121 recordings (75%) in 10 subjects. A typical pattern of nystagmus (0.3-3 Hz, 3-30 degrees /s maximal speed of slow component) was recorded in 53% of mental rightward rotations and 49% of leftward rotations. The fast component was always in the direction of the imaginary rotation (similar to a normal VOR). Other types of eye movement comprised either contralateral eye drift ( approximately 17% of trials) or macro square waves. In 25% of the recordings no definite eye movements could be detected during the mental maneuvers. CONCLUSION: These mentally induced eye movements seem to be due to a cortical process which can affect the normal input to the brainstem nuclei. A possible mechanism is discussed. This phenomenon may serve as an objective measurement of mental activity, may be used for testing the cognitive resources of patients and can probably be used for enhancing the rehabilitation process after acute vestibular insult.

Role of open incisional biopsy in parotid tumors.

OBJECTIVE: Parotid gland enlargement due to diffuse pathologic processes represents a diagnostic challenge for the surgeon. In such cases, fine-needle aspiration is inconclusive and superficial parotidectomy is usually performed. MATERIAL AND METHODS: The authors treated eight patients who underwent open incisional biopsy of the parotid gland with continuous monitoring of the facial nerve. RESULTS: In all cases, fine-needle aspiration cytology did not provide a definitive diagnosis while open incisional biopsy provided an accurate diagnosis of a lymphoproliferative disorder, with no operative complications. CONCLUSION: In certain infiltrative parotid diseases such as lymphoepithelial or lymphoproliferative diseases, when fine-needle aspiration biopsy is insufficient as tissue architecture is an important component of the pathological diagnosis, an open incisional biopsy can be considered. This procedure can provide an accurate histological diagnosis while avoiding superficial parotidectomy.

Vestibular involvement in myringitis bullosa.

OBJECTIVE: Cochlear involvement manifested by sensorineural or mixed-type hearing loss (HL) has been reported to occur in 30-67% of patients suffering from myringitis bullosa (MB). The goal of this study was to investigate the incidence and nature of vestibular involvement in MB. MATERIAL AND METHODS: All adult patients presenting to Hadassah University Hospital with MB between 2000 and 2002 were evaluated for inner ear involvement. Audiometry, tympanometry and electronystagmography (ENG) were performed within the first 48 h after presentation. The affected ears were examined on a regular basis and audiometric studies were repeated every other day. ENG was not repeated but a detailed questionnaire was administered and a thorough physical examination performed to rule out persistent vestibular dysfunction. RESULTS: Thirteen patients (17 ears) were diagnosed as suffering from MB. All 13 patients reported HL in the affected ears and 7 (54%) reported a sensation of vertigo at presentation. Audiometric tests revealed HL in all 17 affected ears: sensorineural HL in 2, mixed-type HL in 12 and conductive HL in 3. ENG was normal in only two cases, both of whom did not suffer from vertigo. Four patients with no vestibular symptoms whatsoever had an abnormal electronystagmogram. All seven patients who complained of vertigo had an abnormal electronystagmogram and recovered fully after treatment. All but two patients recovered their auditory function. CONCLUSIONS: Not only is the cochlear part of the inner ear affected in patients suffering from MB, but the vestibular part as well. Sensorineural HL and vestibular abnormalities should both be considered as manifestations of MB.

Characteristics of the type B tympanogram can predict the magnitude of the air-bone gap in otitis media with effusion.

Tympanometry is well established as a means of assessing the presence of fluid in the middle ear. The type B tympanogram is usually considered a unique entity. However, its shape may vary from a rounded type B with a "pseudopeak" to a completely flat response. The aim of this study was to compare the characteristics of the B curve (maximum admittance, tympanometric peak pressure, and area under the curve) to the viscosity of the middle ear fluid and to the air-bone gap (ABG). In 67 children (93 ears) who underwent ventilation tube insertion, no correlation was found between the viscosity of the middle ear fluid and the characteristics of the B curve. However, these characteristics were able to differentiate between a low ABG (0 to 20 dB) and a high ABG (>20 dB). A statistical difference was also found for the three parameters (maximum admittance, p < .0025; pressure, p < .025; and area under the curve, p < .0005). Tympanometry may be used as an objective measure to estimate the extent of conductive hearing loss, especially in young children.