Natasha Mirza

In vivo and in vitro neurogenesis in human olfactory epithelium.

The birth and differentiation of neurons have been extensively studied in the olfactory epithelium (OE) of rodents but not in humans. The goal of this study was to characterize cellular composition and molecular expression of human OE in vivo and in vitro. In rodent OE, there are horizontal basal cells and globose basal cells that are morphologically and functionally distinct. In human OE, however, there appears to be no morphological distinction among basal cells, with almost all cells having round cell bodies similar to rodent globose basal cells. Unlike the case in rodents, human basal cells, including putative neuronal precursors, express p75NGFR, suggesting a distinctive role for p75NGFR in human OE neurogenesis. Molecular expression of neuronal cells during differentiation in human OE grossly follows that in rodents. However, the topographical organization of immature and mature ORNs in human OE differs from that of rodents, in that immature and mature ORNs in humans are dispersed throughout the OE, whereas rodent counterparts have a highly laminar organization. These observations together suggest that the birth and differentiation of neuronal cells in human OE differ from those in rodents. In OE explant culture, neuronal cells derived from human OE biopsy express markers for immature and mature neurons, grossly recapitulating neuronal differentiation of olfactory neurons in vivo. Furthermore, small numbers of cells are doubly label for bromodeoxyuridine and olfactory marker protein, indicating that neuronal cells born in vitro reach maturity. These data highlight species‐related differences in OE development and demonstrate the utility of explant culture for experimental studies of human neuronal development. J. Comp. Neurol. 483:154–163, 2005.

Head and Neck Manifestations of Plasma Cell Neoplasms

Multiple myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma are plasma cell neoplasms. They represent distinct manifestations of a disease continuum, whereby the clinical findings are critical to diagnosis. Plasma cell neoplasms are histologically similar, and distinguishing one from the other has significant implications for treatment and survival. Plasma cell neoplasms are relatively unusual malignancies of the head and neck region. We present a case series of plasma cell neoplasms involving the skull base, paranasal sinus, larynx, and mandible as an introduction to a complete review of the literature on plasma cell neoplasms of the head and neck area.

Prevalence of unsuspected acoustic neuroma found by magnetic resonance imaging.

OBJECTIVES: Acoustic neuromas (ANs) comprise 6% of intracranial tumors. Population and autopsy studies have widely divergent estimates of AN incidence. With widespread use of MRI, asymptomatic ANs will be identified, which should improve estimates of the prevalence of this tumor. METHODS: The reports of all brain MRI scans during a 5-year period were retrospectively searched for the diagnosis of AN. MRIs obtained because of a suspicion of AN were discarded, leaving only the unsuspected ANs. RESULTS: A total of 24,246 MRI studies were performed during this time period. Seventeen patients had unsuspected ANs. Eight tumors were smaller than 1 cm, 6 were between 1 and 2 cm, and 3 were 2 cm or larger. For all MRI scans, we found 7.0 unsuspected ANs per 10,000 brain MRI studies (0.07%). CONCLUSION: The true prevalence of AN is likely greater than the 10 per million per year previously reported. This implies that there may be a larger number of asymptomatic ANs than previously suspected.

Paradoxical vocal fold motion: Presentation and treatment options

Paradoxical vocal fold motion is a rare disorder in which adduction of the folds occurs on inspiration. The disorder presents with signs of airway obstruction and often airway distress, so proper diagnosis by the otorhinolaryngologist is critical to subsequent management. We present a retrospective review of 10 patients with the diagnosis of paradoxical vocal fold motion seen over a 6-year period. Eight patients were females, and 6 required an acute airway intervention at presentation; 3 patients eventually underwent tracheotomy for respiratory decompensation. Six patients had a prior diagnosis of asthma, and this was determined to contribute to their respiratory status. Five patients were treated with botulinum toxin and 2 with flexible nasolaryngoscopic biofeedback, which improved the outcome. A review of the literature confirms a female predominance of patients presenting with paradoxical adduction and airway distress, often with a history of asthma and psychopathology. Our experience with botulinum toxin and biofeedback suggests that these procedures are viable treatment options in the management of patients with this disorder.

Electrogustometric thresholds: Relationship to anterior tongue locus, area of stimulation, and number of fungiform papillae

is well established that, on the anterior tongue, thresholds for chemical tastants are inversely related to the number of fungiform papillae. However, it is not known whether this is the case for thresholds to electrical currents presented to the lingual surface. In this study, electrical thresholds for 16 subjects were determined at four left-side anterior lingual locations: tongue tip (TT), a region 1.7 cm posterior to the tip, a region 3.4 cm posterior to the TT, and a region 1.7 cm from the tip along the lateral margin. Two electrode sizes were employed (12.5 and 50 mm2), and stimulus duration was held constant at 0.5 s. The number of fungiform papillae was determined using videomicroscopy. Analogous to what is seen with chemical stimulation, an inverse relationship was present between the mean electrical thresholds, expressed in terms of current density, and the number of papillae within the stimulated regions. The TT --which has the highest density of fungiform papillae -- was found to be more sensitive than the other tongue regions evaluated. Also paralleling chemical thresholds, the mean electrical threshold values were lower (i.e., sensitivity was higher) at a given tongue locus for the 50-mm2 than for the 12.5-mm2 stimulus area. Overall, this study demonstrates that thresholds for electrical stimulation vary across discrete regions of the anterior tongue and are specifically related to the number of fungiform papillae within the stimulated regions. These observations provide additional support for the hypothesis that lingual sensations induced by low levels of electrical current are mediated by the taste system.

Influence of Age on the ‘Nasal Cycle’†

The nasal cycle is classicially defined as a side‐to‐side fluctuation in nasal engorgement and airflow, with period lengths ranging from approximately 1 to 5 hours. This cycle, as well as its variants (e.g., cyclic changes on one side of the nose only), is produced by alterations in autonomic tone of the nasal vasculature and reportedly correlates with a number of ultradian rhythms, including asymmetries in left:right cerebral electroencephalographic (EEG) activity and differential performance on visual/spatial psychological tasks. Since the pacemaker for the nasal cycle is believed to lie within the suprachiasmatic nucleus of the hypothalamus, and this nucleus evidences degeneration in later life, we sought to determine whether the nasal cycle or its variants changes with age. To achieve this end, we used a liquid crystal thermography exhalation monitor to measure relative airflow of the two nasal chambers at 15‐minute intervals for 6 hours in 60 people representing four age categories: 18 to 29 years (n=12); 30 to 49 years (n=15); 50 to 69 years(n=13); and 70 to 85 years (n=20). Overall, the proportion of subjects exhibiting the alternating rhythmicity associated with the classic nasal cycle decreased with age. No association was present between nasal cycle parameters and scores on the Mini‐Mental State Examination (MMSE). The results suggest that the classic nasal cycle may be a marker for age‐related central nervous system changes.

Larynx preservation with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Correlation of videostroboscopic findings and voice parameters.

Classically, the formation of a mucosal wave is dependent on the pliable mucosa present in the vocal fold. The supracricoid partial laryngectomy with cricohyoidoepiglottopexy is an organ preservation surgical technique in which both true vocal folds, both false vocal folds, both paraglottic spaces, and the entire thyroid cartilage are resected. The functional goal is speech and swallowing without a permanent tracheostomy. In an effort to further study voice production in these patients, we performed laryngeal stroboscopy in 5 patients. Analysis was performed with a modified Bless grading system. In addition, speech and voice parameters were also measured and correlated with stroboscopic findings. The key finding in this study was the presence of a periodic mucosal wave on the anterior aspect of the arytenoid cartilage, where it abuts the epiglottic cartilage. Patients with lower periodicity and symmetry scores tended to have lower jitter and shimmer percentages.

NaCl thresholds: relationship to anterior tongue locus, area of stimulation, and number of fungiform papillae

NaCl detection thresholds were determined for 12.5- and 50-mm(2) lingual areas at four anterior tongue locations in eight subjects using a device that allowed for accurate temporal and spatial presentation of tastants to small regions of the anterior tongue. The locations, all on the right side of the tongue, were the tongue tip, an area 1.7 cm posterior to the tongue tip, and regions 1.7 and 3.4 cm posterior to the tip along the tongues lateral margin. Stimulus duration was 0.75 s. Thresholds were established using a two-alternative forced-choice single-staircase procedure, and the number of fungiform papillae at each stimulation site was counted with the aid of videomicroscopy. NaCl thresholds were lower for the 50-mm(2) than the 12.5-mm(2) stimulation area at all target sites, and were directly related to papillary number among and within the stimulated regions. For a given number of papillae, thresholds were lower within the 12.5-mm(2) than within the 50-mm(2) stimulation region, likely reflecting taste bud density and activation of common afferent pathways. The tongue tip was more sensitive than any other tongue region, and the lateral margins were seemingly more sensitive than the lingual centrum. Large individual differences in taste sensitivity and tongue papilla numbers were noted, and some subjects were insensitive to the highest tastant concentrations at the nontip loci. This study empirically demonstrates that NaCl detection sensitivity varies across discrete regions of the anterior tongue and is related to the relative number and density of fungiform papillae.

Tongue piercing... The new rusty nail

Cephalic tetanus is a rare form of the tetanus caused primarily by wounds or other infectious processes involving the head and neck. This condition frequently progresses to the generalized form of tetanus with the attendant risks and complications.

Laryngeal Findings in Users of Combination Corticosteroid and Bronchodilator Therapy

Educational Objective: At the conclusion of this article, the readers should be able to 1) describe the laryngeal findings in patients who use combination therapy for asthma, 2) discuss the mechanism of laryngeal irritation from the use of inhalers, and 3) describe possible mechanisms for reducing laryngeal irritation and secondary dysphonia from the use of inhalers.