Traumatic Neuroma in the External Auditory Canal.

Traumatic neuroma is the reparative proliferation of axons and Schwann cells at the proximal end of a severed nerve following injury or surgery. Traumatic neuromas with or without clinical symptoms have rarely been reported in the external auditory canal. A 50-year-old woman with a history of trauma visited our otorhinolaryngology clinic with a 7 × 5-mm mass localized on the anterior wall of the external auditory canal. The mass was easily removed via surgical excision and was histopathologically diagnosed as a neuroma. No signs of recurrence were observed after excision. Herein, the authors present this case, along with a review of the literature.

Prognostic Factors Affecting Surgical Outcomes in Squamous Cell Carcinoma of External Auditory Canal.

OBJECTIVES: Carcinomas of the external auditory canal (EAC) are rare, and management remains challenging. Previous studies seeking prognostic factors for EAC cancers included cancers other than carcinomas. In this study, we analyzed the treatment outcomes of, prognostic factors for, and survival rates associated with specifically squamous cell carcinoma (SCC) of the EAC. METHODS: A retrospective review of 26 consecutive patients diagnosed with SCCs of the EAC in a 10-year period was performed in terms of clinical presentation, stage, choice of surgical procedure, and adjunct therapy. Overall survival (OS) and recurrence-free survival (RFS) were calculated and univariate analysis of prognostic factors was performed. RESULTS: The median age of the 26 patients with SCCs of the EAC was 63 years (range, 40 to 72 years), and 16 males and 10 females were included. According to the modified University of Pittsburgh staging system, the T stages were T1 in 11, T2 in six, T3 in four, and T4 in five cases. The surgical procedures employed were wide excision in three cases, lateral temporal bone resection (LTBR) in 17, and extended LTBR in four, and subtotal temporal bone resection in two. Two patients underwent neoadjuvant chemotherapy, and two underwent adjuvant chemotherapy. One patient received preoperative radiation therapy, and eleven received postoperative radiation therapy. Of the possibly prognostic factors examined, advanced preoperative T stage and advanced overall stage were significant predictors of RFS, but not of OS. CONCLUSION: The advanced T stage and overall stage were associated with decreased survival after surgical treatment in patients with SCC of the EAC, highlighting the importance of clinical vigilance and early detection.

Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma.

OBJECTIVES: Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. METHODS: A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. RESULTS: In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. CONCLUSION: Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.

A Case of Incus Vibroplasty: Postoperative Changes in Residual Hearing.

In patients with mild to severe hearing loss, conventional hearing aids offer limited benefits and several problems with feedback and cosmesis. Middle ear implants are a feasible option for patients with moderate to severe hearing loss who are unable to achieve adequate benefit from or cannot tolerate hearing aids for various reasons. Here we present a case of middle ear implant surgery using Vibrant Soundbridge with incus vibroplasty technique, and describe the hearing changes during postoperative follow-up.

Gadolinium enhanced 3D proton density driven equilibrium MR imaging in the evaluation of cisternal tumor and associated structures: comparison with balanced fast-field-echo sequence.

OBJECTIVES: Although Gadolinium enhanced bFFE is commonly used to evaluate cisternal tumors, banding artifact may interrupt interpretation and adjacent nerve and vessels differentiation is known to be difficult. We analyzed the qualities of Gd enhanced 3D PDDE in the evaluation of cisternal tumors, comparing with bFFE. MATERIAL AND METHODS: Forty five cisternal tumors (33 schwannoma and 12 meningioma) on both bFFE and PDDE were retrospectively reviewed. For quantitative analysis, contrast ratios of CSF to tumor and tumor to parenchyma (CRC/T and CRT/P) on both sequences were compared by paired t-test. For qualitative analysis, the readers gauged the qualities of the two MR sequences with respect to the degree of demarcating cisternal structures (tumor, basilar artery, AICA, trigeminal nerve, facial nerve and vestibulocochlear nerve). RESULTS: In quantitative analysis, CRC/T and CRT/P on 3D PDDE was significantly lower than that of 3D bFFE (p < 0.01). In qualitative analysis, basilar artery, AICA, facial nerve and vestibulocochlear nerves were significantly better demarcated on 3D PDDE than on bFFE (p < 0.01). The degree of demarcation of tumor on 3D PDDE was not significantly different with that on 3D bFFE (p = 0.13). CONCLUSION: Although the contrast between tumor and the surrounding structures are reduced, Gd enhanced 3D PDDE provides better demarcation of cranial nerves and major vessels adjacent to cisternal tumors than Gd enhanced bFFE.

Developmental gene expression profiling along the tonotopic axis of the mouse cochlea.

The mammalian cochlear duct is tonotopically organized such that the basal cochlea is tuned to high frequency sounds and the apical cochlea to low frequency sounds. In an effort to understand how this tonotopic organization is established, we searched for genes that are differentially expressed along the tonotopic axis during neonatal development. Cochlear tissues dissected from P0 and P8 mice were divided into three equal pieces, representing the base, middle and apex, and gene expression profiles were determined using the microarray technique. The gene expression profiles were grouped according to changes in expression levels along the tonotopic axis as well as changes during neonatal development. The classified groups were further analyzed by functional annotation clustering analysis to determine whether genes associated with specific biological function or processes are particularly enriched in each group. These analyses identified several candidate genes that may be involved in cochlear development and acquisition of tonotopy. We examined the expression domains for a few candidate genes in the developing mouse cochlea. Tnc (tenacin C) and Nov (nephroblastoma overexpressed gene) are expressed in the basilar membrane, with increased expression toward the apex, which may contribute to graded changes in the structure of the basilar membrane along the tonotopic axis. In addition, Fst (Follistatin), an antagonist of TGF-ß/BMP signaling, is expressed in the lesser epithelial ridge and at gradually higher levels towards the apex. The graded expression pattern of Fst is established at the time of cochlear specification and maintained throughout embryonic and postnatal development, suggesting its possible role in the organization of tonotopy. Our data will provide a good resource for investigating the developmental mechanisms of the mammalian cochlea including the acquisition of tonotopy.

Nasal Colonization of Methicillin-Resistant Staphylococcus aureus in Patients with Chronic Suppurative Otitis Media.

BACKGROUND AND OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) is one of major pathogens in patients with chronic suppurative otitis media (CSOM). In addition to intrinsic MRSA infection of the mastoid air cell system, nasal colonization of MRSA, a known predictor of postoperative surgical site infection, may pose increased risk of postoperative complications. The purpose of this study is to describe microbiology of preoperative nasal swab screening and localized middle ear specimens in patients undergoing otologic surgeries. SUBJECTS AND METHODS: Forty-nine consecutive patients with CSOM who underwent middle ear surgery were included. Preoperative nasal swabs for MRSA, and preoperative and intraoperative middle ear swabs were collected and compared for pathogens. RESULTS: Preoperative nasal swab screening confirmed MRSA colonization in 3/49 patients (6.1%) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 9/49 patients (18.4%). Correlation with preoperative culture results and nasal swab screening results were compatible in 2/4 patients with positive nasal swab for MRSA and 1/9 patients with positive nasal swab for MRCNS. Postoperative conversion to MRSA was observed in 3 patients. CONCLUSIONS: The rate of nasal MRSA colonization among patients with CSOM was higher than among the general community. Preoperative MRSA colonization was associated with MRSA from middle ear specimens. Further studies are warranted to investigate the possible benefit of preoperative treatment of MRSA colonized patients undergoing middle ear surgeries.

Interferon-gamma suppresses Na+ -H+ exchanger in cultured human endolymphatic sac epithelial cells.

Adequate regulation of endolymphatic pH is essential for maintaining inner ear function. The Na(+)-H(+) exchanger (NHE) is a major determinant of intracellular pH (pH(i)), and facilitates Na(+) and fluid absorption in various epithelia. We determined the functional and molecular expression of NHEs in cultured human endolymphatic sac (ES) epithelial cells and examined the effect of IFN-gamma on NHE function. Serial cultures of human ES epithelial cells were generated from tissue samples. The molecular expression of NHE1, -2, and -3 isoforms was determined by real-time RT-PCR. The functional activity of NHE isoforms was measured microfluorometrically using a pH-sensitive fluorescent dye, 2',7'-bis(carbonylethyl)-5(6)-carboxyfluorescein (BCECF), and a NHE-inhibitor, 3-methylsulfonyl-4-piperidinobenzoyl guanidine methanesulfonate (HOE694). NHE1, -2, and -3 mRNAs were expressed in human ES epithelial cells. Functional activity of NHE1 and -2 was confirmed in the luminal membrane of ES epithelial cells by sequentially suppressing Na(+)-dependent pH(i) recovery from intracellular acidification using different concentrations of HOE694. Treatment with IFN-gamma (50 nM for 24 h) suppressed mRNA expression of NHE1 and -2. IFN-gamma also suppressed functional activity of both NHE1 and -2 in the luminal membrane of ES epithelial cells. This study shows that NHEs are expressed in cultured human ES epithelial cells and that treatment with IFN-gamma suppresses the expression and functional activity of NHE1 and -2.

Activation of epithelial sodium channel in human middle ear epithelial cells by dexamethasone.

The middle ear epithelium functions to maintain a fluid-free middle ear cavity. Dysfunction of the middle ear epithelial ion and fluid transport is implicated in the pathogenesis of fluid collection in the middle ear cavity, characteristic of otitis media with effusion. The efficacy of steroid therapy for the treatment of otitis media with effusion remains controversial, and postulated modulation of transepithelial transport function in middle ear epithelia has yet to be demonstrated. The effect of dexamethasone on Na(+) transport and fluid absorption capacity was investigated in cultured normal human middle ear epithelial (NHMEE) cells. Dexamethasone produced a significant increase in amiloride-sensitive short-circuit current (Isc). Dexamethasone significantly increased expression levels of mRNAs and proteins of Epithelial Sodium Channel (ENaC)-alpha and -beta subunits. In addition, the ENaC-dependent fluid absorption was significantly increased after dexamethasone treatment. In summary, we have shown that dexamethasone stimulates ENaC activity and ENaC-dependent fluid absorption in NHMEE cells. These findings suggest glucocorticosteroids may be beneficial in treatment of otitis media with effusion by stimulating Na(+) transport and fluid clearance in the middle ear epithelia.

Interleukin-1beta suppresses epithelial sodium channel beta-subunit expression and ENaC-dependent fluid absorption in human middle ear epithelial cells.

Recent reports have shown that cytokines inhibit fluid absorption by suppressing Na(+) channel activity in various epithelia. In this study, we investigated the role of epithelial sodium channel (ENaC) in fluid absorption in normal human middle ear epithelial (NHMEE) cells, as well as the effects of Interleukin (IL)-1beta on ENaC expression and fluid absorption in NHMEE cells. We confirmed that ENaC alpha, beta and gamma were predominantly expressed on the apical surface of the NHMEE cells by immunocytochemistry. Addition of amiloride, a potent ENaC blocker, to apical membranes of NHMEE cells decreased the fluid absorption rate in a dose-dependent manner. Treatment with 10 ng/ml IL-1beta for 24 h suppressed ENaC beta expression, the ENaC-dependent short-circuit current (Isc), and ENaC-dependent fluid absorption. When the NHMEE cells were pretreated with a phospholipase C (PLC)inhibitor (U73122, 10 microM), a protein kinase C (PKC) inhibitor (Calphostin C, 0.1 microM), or extracellular signal regulated kinase (ERK) 1/2 inhibitor (PD98059, 10 microM), the amiloride-sensitive currents in IL-1beta-treated cells were reversed to control levels; an effect not seen with SB202190 (an inhibitor of p38 mitogen-activated protein (MAP) kinase) or SP600125 (a reversible inhibitor of c-Jun N-terminal kinase). In this study we showed that ENaC is essential for fluid absorption in NHMEE cells and that IL-1beta suppresses the ENaC-dependent current via the PLC-PKC-ERK1/2 pathway. These results suggest that IL-1beta may contribute to fluid retention in otitis media with effusion by changing electrolyte transport and reducing middle ear epithelial fluid absorption.

Intracanalicular facial nerve schwannoma.

OBJECTIVE: To investigate the capability of preoperative evaluations in predicting the precise anatomic origin of intracanalicular tumors. STUDY DESIGN: We conducted a retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 11 patients (8 men and 3 women, 26-70 years old) with intracanalicular tumors who were treated surgically were included. INTERVENTIONS: Pure-tone average, auditory brainstem response, caloric test, and temporal magnetic resonance imaging were done in all 11 patients. Electroneuronography has only been performed since 2003, and only 3 patients were evaluated. MAIN OUTCOME MEASURE: Preoperative symptoms, pure-tone average, auditory brainstem response, caloric test, electroneuronography, and magnetic resonance imaging were compared between patients with facial nerve schwannomas and patients with vestibular schwannomas. RESULTS: Postoperatively, facial nerve schwannomas were diagnosed pathologically in 2 (18%) of 11 patients. There were not any clues suggesting facial nerve schwannoma in preoperative evaluations. CONCLUSION: A facial nerve schwannoma may be misdiagnosed as a vestibular schwannoma, especially when the tumor is confined to the internal auditory canal. There are no useful preoperative evaluation tools in predicting the precise nerve origin of intracanalicular tumors. These emphasize the need to fully inform the patient preoperatively.

Interleukin-1beta upregulates Na+-K+-2Cl- cotransporter in human middle ear epithelia.

Disruption of periciliary fluid homeostasis is the main pathogenesis of otitis media with effusion (OME), one of the most common childhood diseases. Although the underlying molecular mechanisms are unclear, it has been suggested that the altered functions of ion channels and transporters are involved in the fluid collection of middle ear cavity of OME patients. In the present study, we analyzed the effects of a major cytokine interleukin (IL)-1beta, which was known to be involved in the pathogenesis of OME, on Na(+)-K(+)-2Cl(-) cotransporter (NKCC) in human middle ear cells. Intracellular pH (pH(i)) was measured in primary cultures of normal human middle ear epithelial (NHMEE) cells using a double perfusion chamber, which enabled us to analyze the membrane-specific transporter activities. NKCC activities were estimated by the pH(i) reduction due to bumetanide-sensitive intracellular uptake of NH(4) (+). In NHMEE cells, NKCC activities were observed only in the basolateral membrane, and immunoblotting using specific antibodies revealed the expression of NKCC1. Interestingly, IL-1beta treatments augmented the basolateral NKCC activities and increased NKCC1 expression. In addition, IL-1beta treatments stimulated bumetanide-sensitive fluid transport across the NHMEE cell monolayers. Furthermore, an elevated NKCC1 expression was observed in middle ear cells from OME patients when compared to those from control individuals. The above results provide in vitro and in vivo evidence that the inflammatory cytokine IL-1beta upregulates NKCC1 in middle ear epithelial cells, which would be one of the important underlying mechanisms of excess fluid collection in OME patients.

Dexamethasone increases fluid absorption via Na+/H+ exchanger (NHE) 3 activation in normal human middle ear epithelial cells.

The proper homeostasis of the liquid lining the surface of the middle ear cavity is vitally important for maintaining a fluid-free middle ear cavity. Disruption of this homeostasis leads to fluid collection in the middle ear cavity and results in otitis media with effusion. We demonstrated the molecular and functional expression of the Na+/H+ exchanger (NHE)s in normal human middle ear epithelial (NHMEE) cells. We also evaluated the role of NHEs in fluid absorption and the effect of dexamethasone on NHE function and NHE-dependent fluid absorption in NHMEE cells. Western blot analysis was performed for NHE1, -2, and -3 in NHMEE cells. The fluid absorption rate was measured after liquid application on the luminal surface of the cells. Intracellular pH (pHi) was measured using the pH-sensitive fluorescent probe bis-(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF)-AM. NHE activity was determined as Na+-induced pHi recovery from an acid load achieved by luminal exposure to 40 mmol/l NH4Cl. NHE1, -2 and -3 were all expressed in the NHMEE cells. The pHi recovery rate was suppressed by inhibition of NHE2 and -3 with HOE694 at concentrations greater than 50 microM. Inhibition of NHE3 with 650 microM of HOE694 or S3226 significantly decreased the fluid absorption rate. Dexamethasone increased the Na+-induced pHi recovery rate which was reversed by the inhibition of NHE3 with 650 microM of HOE694. Dexamethasone treatment up-regulated NHE3 expression in a dose-dependent manner. The fluid absorption rate was increased by treatment with dexamethasone (10(-7) M) and reversed by the inhibition of NHE3. In summary, we have shown that NHE3 are involved in the regulation of both pHi and fluid absorption on the luminal surface of NHMEE cells. Dexamethasone stimulates NHE3 expression and NHE3-dependent fluid absorption in NHMEE cells. These findings provide a new insight into mechanisms that regulate periciliary fluid and the therapeutic mechanisms behind steroid treatment of otitis media with effusion.

ENaC- and CFTR-dependent ion and fluid transport in human middle ear epithelial cells.

Ion channels, such as the epithelial sodium channel (ENaC), are essential for maintaining a fluid-free middle ear cavity by controlling periciliary fluid. Deviations from the normal volume or compositions of periciliary fluid are probably responsible for otitis media with effusion. To elucidate the physiologic roles of the ENaC and cystic fibrosis transmembrane conductance regulator (CFTR) in the middle ear mucosa, we compared the electrophysiological activity and protein expressions of ENaC and CFTR in normal human middle ear epithelial (NHMEE) cells with those in normal human nasal epithelial (NHNE) cells. We also evaluated the role of ENaC and CFTR in fluid transport by NHMEE cells. Short-circuit current (Isc) was measured in cell monolayers by modified Ussing chambers. Immunoblotting was performed for ENaC and CFTR. In addition, transepithelial fluid transport was measured after loading 100 microl of fluid onto the luminal cell surface. The amiloride-sensitive Isc in NHMEE cells was much larger than in NHNE cells, whereas the forskolin-induced Isc, presumably mediated by CFTR, was significantly smaller in NHMEE cells. ENaC subunits alpha, beta, and gamma were all detected in NHMEE cells, and their expressions were stronger than those in NHNE cells. In comparison, CFTR was also detected in the middle ear mucosa, but at a lower expression level than in NHNE cells. NHMEE cells showed more amiloride-sensitive fluid absorption than NHNE cells. In contrast, fluid absorption was less sensitive to forskolin/IBMX in NHMEE cells than in NHNE cells. The ATP induced Cl- efflux and the amplitude of ATP-induced current in NHMEE cells was much larger than in NHNE cells. In the present study, we have demonstrated an enhanced amiloride-sensitive Isc and fluid absorption in NHMEE cells, where the role of CFTR is limited. Our data also suggest that the ATP-induced Cl- channel could be an alternative Cl- channel to CFTR in NHMEE cells.

Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket.

OBJECTIVE: To evaluate the surgical outcome in patients who have undergone mastoid and epitympanic obliteration technique. STUDY DESIGN: : Retrospective review. SETTING: Tertiary care referral center. PATIENTS: The study group included 151 patients with cholesteatoma who underwent mastoid and epitympanic obliteration technique. This technique was applied to cases who had a strong chance of recurrent retraction pocket and cholesteatoma formation, including those patients with an adhesive drum indicating poor eustachian tube function (n = 52) and patients with a destructive scutum (n = 68). Thirty-one patients had both an adhesive drum and a destructive scutum. INTERVENTION: The connection between the mastoid cavity and the middle ear was blocked by obliterating the epitympanum and antrum with bone pate and the remaining mastoid cavity with abdominal fat. MAIN OUTCOME MEASURES: The postoperative drum state, the incidence of retraction pocket formation and cholesteatoma recurrence, the surgical complications of obliteration, and the hearing outcome. RESULTS: In 114 of 151 patients (75.4%), the middle ear was well healed and well aerated. The retraction pocket formation or cholesteatoma recurrence did not develop in any subject. Postauricular skin depression was the most common complication of this technique (n = 31 [20.5%]). In three patients (2.0%), the bone pate used for obliteration was infected. Of the 56 cases who underwent a staged operation to regain their hearing, 37 resulted in a postoperative air-bone gap less than 20 dB hearing level. CONCLUSION: Mastoid and epitympanic obliteration is an effective option for preventing a retraction pocket and cholesteatoma recurrence in patients with a poorly functioning eustachian tube or a defective scutum, while preserving the same advantage of the canal wall up technique.

P2Y2 agonist induces mucin secretion via Ca2+- and inositol 1,4,5-triphosphate-dependent pathway in human middle ear epithelial cells.

Purinergic agonists regulate mucin secretion in the airway epithelial cells. This study examined the effects of the apical application of purinergic agonists on Ca(2+) influx ([Ca(2+)](i)), and mucin secretion along with their underlying signaling pathway in normal human middle ear epithelial (NHMEE) cells. The apical membrane of NHMEE cells were stimulated with various purinergic agonists, including UTP, and the [Ca(2+)](i) was measured using a miniature Ussing double perfusion chamber. P2Y(2) receptor in NHMEE cells was also localized by immunohistochemistry. UTP-induced mucin secretion was quantified by an immunoblotting assay. The order of the purinergic agonist potency with respect to [Ca(2+)](i) determined in this study was ATP = UTP > 2-MeSATP > UDP >> adenosine which is consistent with that obtained from P2Y(2) receptor activation. The P2Y(2) receptor is expressed in the apical membrane of monolayered cultured NHMEE cells. Apical UTP-induced [Ca(2+)](i) was inhibited by 2-aminoethoxydiphenyl borate (2-APB) but not by ryanodine. UTP-induced mucin secretion was inhibited by a Ca(2+) chelating agent, BAPTA-AM, and was stimulated by ionomycin. UTP-induced mucin secretion was also suppressed by U73122 and 2-APB, while Calphostin C suppressed it to a small extent and PD98059 was ineffective. Caffeine also inhibited the UTP-induced [Ca(2+)](i) and mucin secretion. These results suggest that the P2Y(2) receptor is expressed in NHMEE cells, and plays a major role in modulating the [Ca(2+)](i) from the IP(3)-sensitive intracellular Ca(2+) store. UTP-induced mucin secretion in NHMEE cells is strongly dependent on Ca(2+)- and IP(3).

Perichondrial flap to prevent chondritis and cartilage necrosis in salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation: a new procedure.

CONCLUSION: We conclude that our new closure method using the posterior- and inferior-based perichondrial flap may diminish the chance of development of chondritis in salvage vertical partial laryngectomized patients with recurrent glottic cancer. OBJECTIVE: Post-radiation laryngeal chondritis with resultant cartilage necrosis is one of the most dreaded complications of radiotherapy treatment of glottic carcinoma. In the case of salvage vertical partial laryngectomy, the risk of its development may be increased. We introduce a new posterior- and inferior-based perichondrial flap procedure to prevent postoperative chondritis after salvage vertical partial laryngectomy. MATERIAL AND METHODS: The perichondrium is incised along the midline and upper border of the thyroid cartilage, but not along the inferior border, unlike the conventional method. Then, the posterior- and inferior-based perichondrial flap, along with the cricothyroid muscle fascia, is elevated from the midline. For closure of the pharyngeal lumen, the outer perichondrium of the lesion side is sutured to the inner perichondrium of the contralateral side to protect the larynx from pharyngeal secretion. The utility of this procedure is reviewed retrospectively in 10 patients with locally persistent or recurrent squamous cell carcinoma of the vocal cord after failed laryngeal radiation therapy between 1994 and 2001. RESULTS: None of our patients developed chondritis postoperatively. The interval between the operation and removal of the tracheostomy tube ranged from 8 to 23 days (mean 12 days). Patients were able to swallow without aspiration within 7-22 days of the operation (mean 10 days). Discharge from hospital was possible after a mean recovery period of 11 postoperative days.

Changes of esophageal motility after total laryngectomy.

OBJECTIVE: Total laryngectomy completely interrupts the continuity of the proximal digestive tract and may lead to derangement in esophageal motility. The purpose of this investigation was to find out how total laryngectomy changes the resting and the maximum contracting pressures of the upper esophageal sphincter muscle and how it affects the coordination of the contraction and the relaxation between the pharynx and the upper esophageal sphincter muscles. If changes in the function of the upper esophageal sphincter muscle should occur, this study will also demonstrate how it affects the motility of the esophagus and the lower esophageal sphincter muscle. METHODS: In an attempt to explain postoperative motility changes, the stationary pull through method of manometric evaluation was used to quantify the alteration in esophageal motility. For the manometric evaluation of the esophagus, a polyethylene catheter with 8 internal tubes was used. The study was performed on a group of 15 patients with total laryngectomy and 15 people without esophageal disease or symptoms as the control group. RESULTS: There was a statistically significant difference between the laryngectomy group and the control group for both the resting and maximum contraction pressures as well as for coordination and relaxation of the upper esophageal sphincter. (P < 0.05) In the laryngectomy group, 3 patients who complained of postoperative dysphasia showed more severe functional changes. The proximal esophageal body pressure and peristaltic waves were significantly decreased in the laryngectomy group. No significant difference between the laryngectomy group and the control group was noted in terms of the lower esophageal resting sphincter pressure and the postdeglution pressure. There also was no significant difference between the two groups in the degree of lower esophageal sphincter coordination and relaxation. CONCLUSION: From these results, it may be concluded that interruption of the cricopharyngeal muscle and pharyngeal plexus after laryngectomy not only may produce local derangement of upper esophageal sphincter function but also may produce abnormalities in peristalsis of the proximal esophageal body. However, the function of lower esophageal sphincter did not show any significant difference between the laryngectomy group and the control group.