Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia.

PURPOSE: No standardized treatment regimen exists for juvenile recurrent parotitis (JRP). The investigators hypothesized that irrigation with saline only without local anesthesia will be an effective and beneficial option. METHODS: Using a retrospective study design, a series of children with typical symptoms of JRP who were treated with at least one irrigation therapy were evaluated. This treatment consisted of irrigation of the affected gland with 3-10 ml saline solution without any type of anesthesia. The outcome variables were patient/parent satisfaction, frequency and duration of acute JRP episodes, and the need for antibiotics before and after irrigation therapy. RESULTS: The case series was composed of six boys aged 3.3-7.7 years who experienced one to eight sessions of irrigation therapy. The period of follow-up was 9-64 months. We observed a total resolution of symptoms in two children and an improvement in the other four. No relevant side effects were seen. CONCLUSION: Our results suggest that irrigation therapy is a reasonable, simple, and minimally invasive treatment alternative for JRP. In contrast to sialendoscopy or sialography, there is no need for general anesthesia or radiation exposure.

[Cartilage vs. temporal fascia as graft material]. / Knorpel vs. temporale Faszie als Transplantatmaterial.

So far, comparative studies have shown no significant audiological difference between cartilage and fascia grafts. In this retrospective study, the Turkish scientists E E Callioglu et al. examined next audiological results and morphological results after surgical cartilage and fascial tympanoplasty in patients with comparable preoperative hearing and middle ear pathology.

Trauma Can Induce Telangiectases in Hereditary Hemorrhagic Telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease of the fibrovascular tissue resulting in visceral vascular malformations and (muco-) cutaneous telangiectases with recurrent bleedings. The mechanism behind the disease is not fully understood; however, observations from HHT mouse models suggest that mechanical trauma may induce the formation of abnormal vessels. To assess the influence of environmental trauma (mechanical or light induced) on the number of telangiectases in patients with HHT, the number of telangiectases on the hands, face, and lips were counted on 103 HHT patients possessing at least three out of four Curaçao criteria. They were then surveyed for information concerning their dominant hand, exposure to sunlight, and types of regular manual work. Patients developed more telangiectases on their dominant hand and lower lip (Wilcoxon rank sum test: p < 0.001). Mechanical stress induced by manual work led to an increased number of telangiectases on patients' hands (Mann-Whitney U test: p < 0.001). There was also a positive correlation between sun exposure and the number of telangiectases on the lips (Mann-Whitney U test: 0.027). This study shows that mechanical and UV-induced trauma strongly influence the formation of telangiectases in HHT patients. This result has potential implications in preventive measures and on therapeutic approaches for HHT.

Endoscopic laser resection of laryngeal cancer: is it oncologically safe? Position statement from the American Broncho-Esophagological Association.

The purpose of this report is to summarize the salient points made during a panel discussion at the 88th Annual Meeting of the American Broncho-Esophagological Association about the efficacy and oncological safety of endoscopic laser treatment of laryngeal cancer. Guidelines for endoscopic laser management of early glottic and supraglottic cancer, including contraindications for this treatment modality, are presented. On the basis of all currently available data, the panel, which critically considered the question of oncological safety, is of the opinion that endoscopic laser resections are oncologically safe when applied judiciously and by a skilled oncological surgeon. Relative contraindications for endoscopic laser resection of laryngeal cancer include instances in which the whole tumor cannot be visualized; large tumors that require removing too much of the functional laryngeal unit, severely decreasing airway protection and leading to aspiration; and cartilage invasion. Specific contraindications for supraglottic cancer include bilateral arytenoid involvement and direct extension into the neck.

Association of the Human Bocavirus With Tonsil Squamous Cell Carcinomas.

Background: The human bocavirus (HBoV) is known to persist latently in the infected host cells and seems to replicate its DNA via the DNA damage response system, which is frequently defect in tumors and correlates with microsatellite instability (MSI). Because HBoV is able to persist in the infected tissues, induces pro-fibrotic and pro- cancerogenic cytokines in vivo and in vitro, and is detected in colorectal and lung tumors, the virus may be involved in cancerogenesis at least as a cofactor. Recently it was shown that the adenotonsillar tissue is an important site of HBoV1 persistence and replication. Considering the background that approximately 60% of oropharyngeal cancers were thought to be attributable to a HPV infection, a co-participation of HBoV in terms of a chronic virus infection might play a role in the cancerogenesis of tonsil tumors. Methods: Formalin-fixed, paraffin-embedded tonsil tumor samples were screened for HBoV and HPV DNA. Positive tissue sections were afterward subjected to fluorescence in situ hybridization (FISH) analysis to identify HBoV and HPV infected cells. By use of an in vitro cell culture model with primary tonsil fibroblasts, keratinocytes, and lymphocytes infected by HBoV we tried to find the target cells of virus replication. MSI testing was based on a previously published protocol using a de-multiplexed PCR followed by fluorescent detection of PCR products in a capillary sequencing device. Results: In total 62 of 103 (60, 19%) of the tonsil squamous cell carcinomas tested positive for HBoV DNA and 66 of 103 (66%) samples were identified as HPV positive. The FISH analysis revealed both double infection of HPV and HBoV in the same cells as well as single infections of both viruses within the tumor tissue. Twenty-two of 62 HBoV positive tumors tested HPV negative, 40 of 62 tissue sections were HBoV and HPV positive. We analyzed 21 out of the 62 HBoV positive tumors for MSI. Of those four tonsils displayed MSI in at least 1 of 10 microsatellite markers. Conclusion: Our findings support the hypothesis that human bocavirus infections as a cofactor may have an impact on tumor development in tonsils, although it still remains possible that HBoV solely displays a tumor tropism.

Overexpression of p68 mRNA in head and neck squamous cell carcinoma cells.

BACKGROUND: Head and neck squamous cell carcinomas (HNSCC) are aggressively growing tumors with only marginal improvement in outcome despite ongoing developments in treatment protocols. This problem has been associated with a lack of therapy individualization on tumor biological properties. MATERIALS AND METHODS: mRNA expression profiles of HNSCC and normal epithelial cells were compared in order to identify genes associated with cancer formation. Differential display was used to trace gene fragments showing differential expression in HNSCC cells, which were than isolated, re-amplified, cloned and sequenced. RESULTS: A 131-bp-long fragment was identified to be overexpressed in HNSCC cells that revealed a 99.3% homology with p68 mRNA. The differential expression was confirmed by Northern hybridization. CONCLUSION: The data presented suggest an involvement of p68 in the process of malignant transformation or progression of HNSCC.

Comparison of the glottic closure reflex in traditional "open" versus endoscopic laser supraglottic laryngectomy.

OBJECTIVES: Cancer of the supraglottic larynx may be surgically treated with either traditional "open" supraglottic laryngectomy (OSL) or endoscopic laser supraglottic laryngectomy (ELSL). Pharyngeal dysphagia is a well-documented consequence of traditional OSL from which near-normal swallowing characteristically recovers 14 to 40 days after surgery. Conversely, ELSL results in the resumption of serviceable swallowing within 2 to 7 days after surgery. METHODS: A prospective assessment of the glottic closure reflex in 6 consecutive patients who had ELSL was performed by fiberoptic endoscopic evaluation of swallowing with sensory testing. RESULTS: All 6 patients with ELSL demonstrated an intact glottic closure reflex both before surgery and 48 to 72 hours after surgery. In contrast, 7 of 8 historical control patients who had OSL demonstrated a persistent absence of the glottic closure reflex 3 weeks to 12 years later. CONCLUSIONS: Although a number of clinical factors influence swallowing recovery, one important factor separating our patient groups was the preservation of the glottic closure reflex in patients who underwent endoscopic laser resection. Because the loss of the glottic closure response persists for years after traditional OSL, it is concluded that the sensory field deficit caused by superior laryngeal nerve section is largely not recoverable; however, compensatory mechanisms remain important in serviceable recovery, even if delayed after operation. Indeed, preservation of the glottic closure response appears to enhance swallowing recovery when equivalent compensatory mechanisms are used.

Nasal RANTES and eotaxin production pattern in response to rhinovirus infection.

Tissue eosinophilia is a hallmark of nasal polyposis and its pathogenesis is an area of high interest. RANTES and eotaxin are both known to recruit eosinophils, however, the mechanisms triggering their induction are still uncertain, and viral infections have been suggested to be involved in this process. Therefore, we investigated whether rhinovirus infection is a stimulus for RANTES and eotaxin expression and production. Fibroblasts were cultured from healthy nasal mucosa obtained during endonasal surgery. Cultured cells were infected with human rhinovirus-16 for one to 72 hours. Following total RNA isolation and reverse transcription, RANTES- and eotaxin-mRNA levels were analyzed. In addition, RANTES and eotaxin secretion was measured in culture supernatants by means of an ELISA. Rhinovirus infection induces RANTES-mRNA expression as early as one hour after infection, persisting for up to 72 hours. Eotaxin-mRNA profiles did not alter significantly from control. Protein production was confirmatory for both chemokines, indicating distinct translational latency. Our data suggest that RANTES functions as a host defence mechanism responding to rhinovirus infection, thus supporting a linkage between rhinovirus infections and the pathogenesis of nasal polyposis.

Association between human beta defensin expression and cholesteatoma formation.

OBJECTIVE: To investigate an association between human beta defensin (hBD) expression and cholesteatoma formation. METHODS: hBD-2 mRNA expressions were assessed in healthy external acoustic meatus skin organ cultures before and after stimulation with Pseudomonas aeruginosa. In addition, hBD-1 and hBD-2 protein production of stimulated and non-stimulated external acoustic meatus skin was visualized by immunohistochemistry. Furthermore, hBD-1 and hBD-2 mRNA expression was analyzed in 25 external acoustic meatus skin, 29 cholesteatoma, and 18 non-cholesteatoma control samples. Non-stimulated meatal tissue preparation did not express hBD-2, whereas incubation with P. aeruginosa demonstrated hBD-2 induction. RESULTS: The hBD-1 mRNA expression was detected in cholesteatoma (14/17), meatal skin, and middle ear mucosa (11/18). hBD-2 mRNA expression was shown in eight cholesteatoma (28.5%) and in three middle ear mucosa tissue samples (37.5%). CONCLUSION: Our data suggest constitutional hBD-1 and inducible hBD-2 expression in chronic middle ear infection and cholesteatoma. Failure of hBD-1 and hBD-2 expression might dispose to exacerbation of cholesteatoma disease. The organ culture model of the external acoustic meatus skin is effective in order to evaluate germ stimulation experiments.

Modeling the Test-Retest Statistics of a Localization Experiment in the Full Horizontal Plane.

HYPOTHESIS: Two approaches to model the test-retest statistics of a localization experiment basing on Gaussian distribution and on surrogate data are introduced. Their efficiency is investigated using different measures describing directional hearing ability. BACKGROUND: A localization experiment in the full horizontal plane is a challenging task for hearing impaired patients. In clinical routine, we use this experiment to evaluate the progress of our cochlear implant (CI) recipients. Listening and time effort limit the reproducibility. METHODS: The localization experiment consists of a 12 loudspeaker circle, placed in an anechoic room, a "camera silens". In darkness, HSM sentences are presented at 65 dB pseudo-erratically from all 12 directions with five repetitions. This experiment is modeled by a set of Gaussian distributions with different standard deviations added to a perfect estimator, as well as by surrogate data. Five repetitions per direction are used to produce surrogate data distributions for the sensation directions. To investigate the statistics, we retrospectively use the data of 33 CI patients with 92 pairs of test-retest-measurements from the same day. RESULTS: The first model does not take inversions into account, (i.e., permutations of the direction from back to front and vice versa are not considered), although they are common for hearing impaired persons particularly in the rear hemisphere. The second model considers these inversions but does not work with all measures. CONCLUSION: The introduced models successfully describe test-retest statistics of directional hearing. However, since their applications on the investigated measures perform differently no general recommendation can be provided. The presented test-retest statistics enable pair test comparisons for localization experiments.

Impact to the head increases cochlear implant reimplantation rate in children.

OBJECTIVE: To describe the outcome of cochlear implantation in children and to discuss the cause and management of cochlear reimplantation. STUDY DESIGN: Retrospective chart review. METHODS: The medical records of 110 patients younger than 18 years of age, who underwent cochlear implantation at the Department of ORL, Head and Neck Surgery, of the University of Kiel, Germany, were reviewed for demographics, complications, and history of revision surgery. The patients had previously had implantation with either Nucleus (including the Contour) devices or MED-EL devices. RESULTS: Length of use before cochlear explanation ranged from 4 days to 3.9 years. Reimplantation was caused by traumatic device failure, wrong electrode insertion and infection of implanted area. Results indicated a reimplantation rate of 5.4% in children compared to 0.8% in adults, mostly resulting from the greater risk of children receiving an impact to the head. Postoperative performance data showed no decrease in scores taken before failure. CONCLUSIONS: Though young children who are developing their motor skills are probably at greater risk of a cochlear reimplantation resulting from device failure following head trauma, surgical revision with reimplantation can be performed safely and without decrement to performance.

Quality of life assessment in otorhinolaryngology. History, measures and methods.

The term "quality of life" was first mentioned in 1920 in economic journals and became an issue in the early 1960s in North America. Initially it became accepted in social sciences and later in medicine. The development of generic measures began in the early 1970s and continues today. Disease-specific measures were introduced in the 80th and 90th. During that time methodological studies were implemented and additional emphasis was put on analytic approaches, interpretation of scale scores and cultural including language issues. In ENT study groups began slowly with research in the 1980s and expanded during the 1990s. Today Quality of Life is an accepted part of medical research and covers a broad field of issues. Study groups in ENT work on allergy treatment, oncology and economic aspects of Quality of Life research as well as patient's perception of hearing devices. Future challenges include conceptualization and testing of theoretical models, further refinement of individualized measures for use in routine clinical practice and the inclusion of Quality of Life information in health databases. This article describes the methodological concept, the history of Quality of Life assessment in ENT and gives a detailed overview on current measures.

The antileukoprotease secretory leukocyte protease inhibitor (SLPI) and its role in the prevention of HPV-infections in head and neck squamous cell carcinoma.

Recently, we demonstrated a significant inverse correlation between HPV-infection and SLPI-expression suggesting that SLPI protects against HPV-infection of HNSCC. Here we analyzed in a single lab setting 307 formalin-fixed paraffin-embedded HNSCC cases (tonsillar n = 135; non-tonsillar: n = 172) from eight health care centers. Samples were analyzed for SLPI gene- and protein-expression. Annexin A2, its heterotetramer A2t, putatively facilitating HPV- and SLPI-cell entry, was measured to study the correlation between SLPI and annexin A2. Data were correlated with tobacco consumption and HPV-status. Overall, HPV-DNA prevalence was 23.5% (72/307); attributed to: 43.7% (59/135) tonsillar and 7.6% (13/172) non-tonsillar cases. Smoking resulted in 6.44-fold increased and HPV-infection in 3.46-fold decreased SLPI-gene expression in all HNSCC with similar significant results obtained in tonsillar and non-tonsillar SCC separately. Correlating annexin A2- and SLPI-gene expression showed a significant surplus of annexin A2 in HPV-positive tumors (4.21× more annexin A2) and 6.72× more annexin A2 than SLPI in nonsmokers in all HNSCCs and similar significant results for both tumor entities separately. The surplus of annexin A2 in non-smokers and HPV-positive patients supports our hypothesis that decreased SLPI levels facilitate HPV-infection i.e., increased SLPI-expression may protect against HPV-infection of tonsillar and non-tonsillar SCC.

Geographical and anatomical influences on human papillomavirus prevalence diversity in head and neck squamous cell carcinoma in Germany.

The increased knowledge regarding HPV-infections in head and neck squamous cell carcinoma (HNSCC) has unexpectedly contributed to several uncertainties related to i) prevalence diversities depending on tumour site and geographical origin of the patients, ii) proportion of HPV-driven tumours among HPV-DNA-positive cases, and iii) identification of patients with HPV-attributed survival benefit. To investigate this heterogeneity, we analysed 307 HNSCC cases (tonsillar, n=135; non-tonsillar, n=172) from eight health care centers mostly from Northern Germany and determined HPV-DNA/mRNA and p16INK4A-status and combined results with the patient outcome. Overall HPV-DNA prevalence rate was 23.5% (72/307); attributed to: 43.7% (59/135) and 7.6% (13/172) tonsillar and non-tonsillar cases, respectively. Among these, 96.6% tonsillar and 38.5% non-tonsillar SCC were HPV-mRNA-positive. Although the study cohort was composed of patients from regions of rather close proximity, prevalence rates showed diversities of up to 40% in HNSCC subsite analysis with the lowest prevalence for tonsillar SCC in metropolitan areas (22.2%) vs. 50.9% in rural areas. Survival analysis identified p16INK4A alone as strongest predictor, followed by HPV-DNA-status alone or in combination with p16INK4A. This survival benefit was shown for tonsillar and non-tonsillar cases. Smoking significantly correlated with HPV-status, however, it does not influence survival when stratified for HPV. In conclusion, the data emphasize the urge for further data on HPV-infection in HNSCC to, e.g. clarify to what extent survival benefits of p16INK4A-positive patients are truly attributed to HPV-infections.

The primary role in biologic activity of the neutrophil chemokines IL-8 and GRO-alpha in cultured nasal epithelial cells.

Primary nasal epithelial cells were investigated for their ability to synthesize and deliver neutrophil chemotactic factors (chemokines) following tumor necrosis factor-alpha (TNF-alpha) induction. The chemokines interleukin8 (IL-8), growth-related oncogene-alpha (GRO-alpha), epithelial cell-derived neutrophil attractant-78 (ENA-78), and granulocyte chemotactic protein-2 (GCP-2) have been detected and characterized and shown to have different potencies in the chemotaxis of neutrophils. Cultures of primary nasal epithelial cells were treated with TNF-alpha in concentrations of 20 and 200 ng/ml for 2, 8, 24, and 72 h. The chemokine protein concentrations in the supernatants of the incubations were determined by the ELISA technique. Chemokine mRNA expression in epithelial cells was also measured using the reverse transcriptase-polymerase chain reaction (RT-PCR). The biologic activity of the chemokines was identified using a three-step high-performance liquid chromatography (HPLC) technique, a bioassay involving measurement of neutrophil chemotaxis in a single Boyden chamber. Both the IL-8 and GRO-alpha proteins and their respective mRNA appear to be induced by TNF-alpha in epithelial cells. The chemotactic responsiveness of both GRO-alpha and IL-8 appears to predominate after 24 h incubation with TNF-alpha. The chemokines GCP-2 and ENA-78 were only weakly induced by TNF-alpha. The neutrophil chemokines IL-8 and GRO-alpha were synthesized in nasal epithelial cell culture induced by TNF-alpha in biologically active concentrations of 0.8 ng/ml and 1.42 ng/ml, respectively. It appears that both the IL-8 and GRO-alpha chemokines may contribute to neutrophil tissue migration in sinusitis, whereas GCP-2 and ENA-78 are of secondary importance to the chemotaxis of neutrophils in this condition.

Carbon dioxide laser diverticulostomy: a new treatment for Zenker diverticulum.

In the United States, the traditional treatment for hypopharyngeal (Zenker) diverticulum has been single-stage transcutaneous diverticulectomy. Complications following this procedure include mediastinitis, vocal cord paralysis, esophageal stenosis, fistula, and recurrent or persistent diverticula. The development of endoscopic equipment has led to a new era of surgery for this condition. Magnification of anatomic landmarks allows for better precision during surgery and reduces both surgical procedure time and postoperative complications. Additional techniques, such as diathermy, bipolar coagulation, stapler, and laser surgery, all of which decrease intraoperative bleeding, lend further support to the procedure. In several randomized controlled clinical trials, endoscopic laser treatment of diverticulum has demonstrated the best results in terms of decreased morbidity and fewer complications. Thus, laser approaches for treating Zenker diverticulum deserve consideration.

Fine-needle aspiration cytology of the sentinel lymph node in head and neck cancer.

UNLABELLED: In squamous cell carcinoma of the head and neck, staging of the neck cannot rule out occult metastatic disease. An improved staging is necessary to avoid elective neck dissection in patients staged as N0. The study was performed to determine the feasibility of the detection of occult metastatic disease by ultrasound-guided fine-needle aspiration cytology (USgFNAC) of sentinel lymph nodes (SLN). METHODS: Sixteen consecutive patients diagnosed with oral, oropharyngeal, or dermal squamous cell carcinoma who had been staged as N0 underwent lymphoscintigraphy in double tracer technique to localize SLNs. A USgFNAC was performed on SLNs before elective neck dissection. The results of USgFNAC were compared with pathohistologic findings, which were regarded as the gold standard. RESULTS: Seven of 16 patients were upstaged to N+ after histopathologic examination of the neck dissection specimen. In only 1 of these patients was metastatic disease detected by USgFNAC of the SLN. CONCLUSION: The combination of lymphoscintigraphy and USgFNAC of the SLN improves preselection of N+ patients and, thus, the staging procedures. However, based on present results this method does not seem reliable in deciding whether an elective neck dissection can be avoided. A biopsy of the SLN with close histopathologic work-up seems to be mandatory for the detection of occult metastatic disease, because the merely incidental aspiration of micrometastatic material within normal-sized lymph nodes results in a high number of false-negative results by USgFNAC.

Human beta-defensin-2 in oral cancer with opportunistic Candida infection.

Candida albicans (CA) is a frequent opportunistic pathogen in cancer patients. Usually, human surfaces are protected, apart from physical barriers, by the production of human beta-defensins (hBD). hBD-2 shows a potent antimicrobial activity against CA. We therefore investigated whether CA induces hBD-2 expression in primary oral cells and if immunosuppressive betamethasone alters hBD-2 expression. Additionally, we studied, whether a lack of hBD-2 expression could explain opportunistic infection of tonsillar cancer. Primary oral epithelial cells and fibroblasts were stimulated with Candida albicans in a time- and dose-dependent manner with or without betamethasone preincubation. Total RNA from oral cells and specimens was isolated and hBD-2 expression was analyzed by semiquantitative RT-PCR. Our data demonstrate that opportunistic CA induced hBD-2 expression in a time- and dose-dependent manner, suggesting hBD-2 to be a fast antifungal, epithelia-derived immune response. Treatment with glucocorticoid could lead to diminished innate immunity based on suppression of inducible AP. Malignant transformation induces alteration of hBD-2 expression and leads to a reduced hBD-2 expression and subsequentially to Candida colonization on oral SCCs.

Cyfra 21-1 in diagnosis of distant metastases of head and neck carcinoma.

Follow-up examinations of patients might detect local tumor recurrences at a curable stage, which is more difficult for distant metastases (DM). Recently, elevated Cyfra 21-1 serum levels (CySL) could be shown not only to correlate with HNSCC-tumor size but also with development of DM. We focussed on the CySL of 476 HNSCC patients as a first step. At first time diagnosis, besides regular staging procedures, these patients were screened for CySL higher than 3.3 ng/ml. Seventeen out of 476 (3.9%) patients showed DM. Seventeen out of 19 patients (89.5%) presented elevated CySL: A further 830 patients with HNSCC were tested for changes in CySL in the course of disease (cut-off value 3.3 ng/ml). Seventy-one out of 830 patients (8.6%) showed elevated CySL. Tumor growth was found in 50 out of 71 patients (70.4%). In 54% of these patients (27 out of 50) DM were detected. Routine screening for CySL can lead to timely detection of DM in HNSCC, despite its fairly low sensitivity.