bluuebunny/crossref_metadata_2025 huggingface dataset:
Significant Post-Tonsillectomy Pain is Associated with Increased Risk of Hemorrhage
Authors: Sarny Stephanie , Habermann Walter , Ossimitz Guenther , Stammberger Heinz
Published: October 2014

Objectives:

In this study, we set out to assess the association of postoperative pain types with the risk of hemorrhage after tonsillectomy.

Methods:

The questionnaire-based study was conducted on 335 patients who had undergone tonsillectomy. Hemorrhage risk and postoperative pain were evaluated retrospectively with use of a visual analog scale for 5 time periods (day 1, days 2 to 3, days 4 to 7, days 7 to 14, and later).

Results:

Five pain types were identified by a cluster analysis. The most frequent pain types, I (24.8%; 83 patients) and II (50.8%; 170 patients), show decreasing pain, with pain type II starting on a higher level than pain type I. Pain types III (10.7%; 36 patients) and IV (1.2%; 4 patients) start at a low level with increasing pain for the first few days. In type III, pain decreases after 1 week, whereas type IV consists of a high level of pain for more than 2 weeks. Pain type V (12.5%; 42 patients) involves a very high level of pain from the beginning, which decreases only gradually. Pain type I is associated with a low hemorrhage rate. Patients with increasing pain (types III and IV) and pain type V show a significantly higher hemorrhage risk.

Conclusions:

Patients who have severe or increasing pain in the first few days after tonsillectomy have a significantly higher risk of hemorrhage.
Accuracy of Cochlear Implant Recipients in Speech Reception in the Presence of Background Music
Authors: Gfeller Kate , Turner Christopher , Oleson Jacob , Kliethermes Stephanie , Driscoll Virginia
Published: October 2014

Objectives:

This study examined speech recognition abilities of cochlear implant (CI) recipients in the spectrally complex listening condition of 3 contrasting types of background music, and compared performance based upon listener groups: CI recipients using conventional long-electrode devices, Hybrid CI recipients (acoustic plus electric stimulation), and normal-hearing adults.

Methods:

We tested 154 long-electrode CI recipients using varied devices and strategies, 21 Hybrid CI recipients, and 49 normal-hearing adults on closed-set recognition of spondees presented in 3 contrasting forms of background music (piano solo, large symphony orchestra, vocal solo with small combo accompaniment) in an adaptive test.

Outcomes:

Signal-to-noise ratio thresholds for speech in music were examined in relation to measures of speech recognition in background noise and multitalker babble, pitch perception, and music experience.

Results:

The signal-to-noise ratio thresholds for speech in music varied as a function of category of background music, group membership (long-electrode, Hybrid, normal-hearing), and age. The thresholds for speech in background music were significantly correlated with measures of pitch perception and thresholds for speech in background noise; auditory status was an important predictor.

Conclusions:

Evidence suggests that speech reception thresholds in background music change as a function of listener age (with more advanced age being detrimental), structural characteristics of different types of music, and hearing status (residual hearing). These findings have implications for everyday listening conditions such as communicating in social or commercial situations in which there is background music.
Single-Incision Robot-Assisted Transaxillary Surgery for Early-Stage Papillary Thyroid Cancer
Authors: Ciabatti Pier Guido , Burali Giulia , D'Ascanio Luca
Published: October 2014

Objectives:

We describe the surgical details, results, and learning curve of a proposed technique for single-incision transaxillary robot-assisted thyroid surgery for early-stage thyroid cancer.

Methods:

We performed single-incision transaxillary robot-assisted total thyroidectomy with the da Vinci surgical system in 29 patients (5 male, 24 female; median age, 45 years; age range, 19 to 69 years) with papillary thyroid cancer (cT1 N0) using our proposed technique with selected instrumentation. Preoperative ultrasound examination, fine-needle aspiration cytology, and contrast computed tomographic scanning were performed in all subjects. Ultrasound examination was carried out 1 month after surgery to assess the amount of residual thyroid tissue.

Results:

No procedure was converted to conventional open surgery. The mean total operation time was 178.51 ± 24.18 minutes, and the mean console time was 126.10 ± 14.47 minutes. A progressive reduction of console time was noted (160 minutes for the first procedure versus 102 minutes for the last one). No cases of permanent hypocalcemia, recurrent laryngeal nerve palsy, or postoperative bleeding occurred. The mean amount of postoperative residual thyroid tissue on ultrasound examination was 8.93 ± 2.15 mm.

Conclusions:

The single-incision transaxillary robot-assisted total thyroidectomy we propose is a feasible and relatively safe procedure in selected patients with early-stage thyroid cancer.
Dysregulation of Histone Deacetylase and Histone Acetyltransferase in Development of Wegener's Granulomatosis
Authors: Takagi Dai , Nakamaru Yuji , Suzuki Masanobu , Fukuda Satoshi
Published: October 2014

Objectives:

We investigated the function of the decreases in histone deacetylase (HDAC) and histone acetyltransferase (HAT) in Wegener's granulomatosis (WG) patients compared with healthy subjects.

Methods:

Seven patients with WG, diagnosed according to the American College of Rheumatology criteria, were examined. Fresh peripheral blood mononuclear cells were isolated from the WG patients and healthy subjects, and then whole-cell proteins were prepared. We measured the total HDAC and HAT activity in peripheral blood mononuclear cells from WG patients. The HDAC2 expression was analyzed by Western blot.

Results:

We found that total HDAC activity was significantly decreased in WG patients compared to that in healthy subjects (p < 0.05). Furthermore, we found a negative correlation between total HDAC activity and C-reactive protein titer. Total HAT activity was significantly increased in WG patients.

Conclusions:

These results demonstrated reduced HDAC activity and an increase in HAT activity in WG. These were associated with concomitant induction of WG-related inflammation. Thus, dysregulation of HDAC and HAT may contribute to the disease pathogenesis of WG.
The Very First Cry: A Multidisciplinary Approach toward a Model
Authors: Nicollas Richard , Vicente Jérome , Brutin David , Giordano Jérome , Medale Marc , Giovanni Antoine , Ouaknine Maurice , Triglia Jean-Michel
Published: October 2014

Objectives:

In previous work, we showed that a rigid larynx-like geometry can generate a sound by itself. However, very little is known about the exact mechanisms and control of the larynx during the first cry of life. The goal of this work was to understand how the very first cry is generated.

Methods:

Simultaneous high-speed imaging and sound recording on 2 excised 38-week term human fetus larynges were performed. The behaviors of the vocal folds and the false vocal folds were studied separately. The behavior of the vocal folds after resection of the supraglottic structures was also analyzed. A comparative acoustic analysis of the first cry and of the sound generated by the excised organs was performed.

Results:

Our data showed that the vocal folds in a larynx with the pressure conditions of the first cry do not generate sound themselves, but induce aerodynamic conditions leading to vibrations of other parts of the larynx.

Conclusions:

The similarities between the sound generated by an excised larynx and the first cry suggest a lack of neurologic control of the larynx during production of the first cry. A model-algorithm is proposed.
Spectral-Cepstral Estimation of Dysphonia Severity: External Validation
Authors: Awan Shaheen N. , Solomon Nancy Pearl , Helou Leah B. , Stojadinovic Alexander
Published: October 2014

Objectives:

The current study applied an acoustic algorithm incorporating measures from cepstral and spectral analyses, the Cepstral Spectral Index of Dysphonia (CSID), in an attempt to externally validate the CSID as an acoustic estimate of dysphonia severity.

Methods:

Correlation (Pearson's r) between the CSID and trained listener-perceived severities as rated on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was calculated from sentence and sustained vowel samples from 56 patients before or after they underwent thyroid surgery.

Results:

A strong correlation was identified between the mean CSID values calculated across CAPE-V sentences and vowels and the median rating of perceived overall severity ( r = 0.82; p < 0.001). The CSID values did not differ significantly from their corresponding auditory-perceptual ratings of dysphonia severity for these samples (CSID: Mean, 15.54, SD, 16.63; CAPE-V Severity: Mean, 17.33, SD, 13.61; p = 0.16).

Conclusions:

Independent testing of an acoustic algorithm incorporating measures from cepstral and spectral analyses (the CSID) confirmed a strong correlation of the CSID to perceptual ratings of overall voice quality. This study provides external validation of the CSID as a robust correlate of dysphonia severity as rated by trained listeners.
Clinical Outcomes of Transoral Robotic Surgery for Head and Neck Tumors
Authors: Park Young Min , Kim Won Shik , Byeon Hyung Kwon , De Virgilio Armando , Lee Sei Young , Kim Se-Heon
Published: October 2014

Objectives:

In order to reduce treatment-related morbidity rates and increase patients' quality of life, robot-assisted surgery using the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, California) has been studied actively in the field of head and neck surgery. This study analyzes our experiences therewith in order to evaluate the feasibility and efficacy of robot-assisted surgery via a transoral approach in the head and neck area.

Methods:

Between April 2008 and December 2011, 141 patients were treated with robot-assisted surgery via a transoral approach.

Results:

Robot-assisted surgeries were successfully completed via a transoral approach in all patients. The mean robotic operative time was 69.3 minutes, and the mean time for setup of the robotic system was 10.4 minutes. The average blood loss during the operation was 29.6 mL (range, 0 to 300 mL). Patients who underwent robot-assisted surgery were satisfied with their cosmetic results and treatment outcomes.

Conclusions:

Robot-assisted surgery via a transoral approach was confirmed to be feasible and efficient in the field of head and neck surgery. Further research is needed to investigate the long-term functional and oncological results of robot-assisted surgery.
Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction
Authors: Kelly Elizabeth A. , Koszewski Ian J. , Jaradeh Safwan S. , Merati Albert L. , Blumin Joel H. , Bock Jonathan M.
Published: October 2014

Objectives:

We sought to review the dysphagia-related outcomes and quality of life in a series of patients with upper esophageal sphincter (UES) dysfunction treated with cricopharyngeal (CP) botulinum toxin (BTX) injection, and to identify patient characteristics or CP muscle histologic features that predict efficacy of BTX injection.

Methods:

A retrospective chart review was performed on patients with UES dysfunction who underwent CP BTX injection. Dysphagia-related quality-of-life questionnaires based on the Eating Assessment Tool (EAT-10) were mailed to patients.

Results:

Forty-nine patients (30 female, 19 male; average age, 59 ± 16 years) with UES dysfunction have been treated at our institution with CP BTX injection since 2000. Seventeen of these patients also underwent CP myotomy. Injections of BTX were occasionally repeated after the treatment effect subsided, and the BTX dose varied widely (average, 39 ± 19 units). Improvement in symptoms was noted by 65% of patients. The overall complication rate was minimal, although many patients complained of transient worsening of dysphagia after CP BTX injection. Biopsy specimens of the CP muscle were evaluated in the subset of patients with CP BTX injection who proceeded to myotomy, with results of neuropathic, myopathic, and mixed histologic subtypes. The EAT-10 scores demonstrated a general trend toward improved swallowing outcomes after CP BTX injection.

Conclusions:

This study reviewed findings from the largest published series of BTX treatment of UES dysfunction and evaluated the efficacy, patient satisfaction, and complications of this procedure. Dysphagia-related quality-of-life outcomes appear to be improved after CP BTX injection.
Topographic Distribution of Biofilm-Producing Bacteria in Adenoid Subsites of Children with Chronic or Recurrent Middle Ear Infections
Authors: Torretta Sara , Drago Lorenzo , Marchisio Paola , Gaffuri Michele , Clemente Ignazio Alessandro , Pignataro Lorenzo
Published: October 2014

Objectives:

Bacterial biofilms have been found in the adenoids of children with recurrent acute otitis media (AOM) and persistent otitis media with effusion (OME). However, the possible difference in biofilm-producing bacteria (BPBs) between the adenoid surface at the nasopharyngeal dome (ND) and near the ostium of the eustachian tube (ET) has not been investigated. This study aimed to assess the difference in BPBs between adenoid biopsy specimens of the ND and those taken near the pharyngeal ostium of the ET in children with chronic adenoiditis with recurrent AOM and/or persistent OME.

Methods:

We collected adenoid biopsy specimens from the ND and ET during transoral endoscopic adenoidectomy to assess BPB by means of spectrophotometric analysis.

Results:

We collected 135 adenoid biopsy specimens from 45 children. BPBs were detected significantly (p = 0.04) more frequently in the ET samples than in the ND samples, mainly Staphylococcus aureus. Although the prevalence of S aureus was slightly greater in the ND samples, and that of Streptococcus pneumoniae and Moraxella catarrhalis was slightly greater in the ET samples, these differences were not statistically significant.

Conclusions:

The fact that BPBs were significantly more frequently located near the ostium of the ET suggests that the adenoids are a reservoir for bacteria and indicates that hypertrophic adenoids (particularly hypertrophy near the ostium of the ET) play a role in recurrent AOM and/or OME.
Visualizing Collagen Network within Human and Rhesus Monkey Vocal Folds Using Polarized Light Microscopy
Authors: Julias Margaret , Riede Tobias , Cook Douglas
Published: October 2014

Objectives:

Collagen fiber content and orientation affect the viscoelastic properties of the vocal folds, determining oscillation characteristics during speech and other vocalization. The investigation and reconstruction of the collagen network in vocal folds remains a challenge, because the collagen network requires at least micron-scale resolution. In this study, we used polarized light microscopy to investigate the distribution and alignment of collagen fibers within the vocal folds.

Methods:

Data were collected in sections of human and rhesus monkey ( Macaca mulatta) vocal folds cut at 3 different angles and stained with picrosirius red.

Results:

Statistically significant differences were found between different section angles, implying that more than one section angle is required to capture the network's complexity. In the human vocal folds, the collagen fiber distribution continuously varied across the lamina propria (medial to lateral). Distinct differences in birefringence distribution were observed between the species. For the human vocal folds, high birefringence was observed near the thyroarytenoid muscle and near the epithelium. However, in the rhesus monkey vocal folds, high birefringence was observed near the epithelium, and lower birefringence was seen near the thyroarytenoid muscle.

Conclusions:

The differences between the collagen networks in human and rhesus monkey vocal folds provide a morphological basis for differences in viscoelastic properties between species.
Stability of Aspiration Status in Healthy Adults
Authors: Todd J. Tee , Stuart Andrew , Lintzenich Catherine R. , Wallin Jordan , Grace-Martin Karen , Butler Susan G.
Published: October 2014

Objectives:

In multiple separate studies, we consistently found that approximately 30% of asymptomatic healthy older adults silently aspirated liquids during flexible endoscopic evaluation of swallowing (FEES). We subsequently questioned whether aspiration status remained stable in healthy older adults over time. The purpose of this study was to determine the stability of aspiration status in healthy older adults over time.

Methods:

Eighteen healthy older participants, comprising of 9 aspirators and 9 nonaspirators whose aspiration status was identified in a previous study, underwent a second FEES approximately 6 to 21 months later. The participants contributed 36 swallows, comprising 5-, 10-, 15-, and 20-mL boluses of milk (ie, 1 bolus of each volume of skim, 2%, whole, and soy milk) and water via cup and straw delivery, during the original FEES. An abbreviated protocol was administered for the repeat FEES. The Penetration-Aspiration Scale was used to rate all swallows.

Results:

A McNemar test demonstrated no change in aspiration status among participants between the initial test and the retest (p > 0.999).

Conclusions:

In this cohort, the aspiration status was stable over about 12 months. This finding lends credence to the premise that trace aspiration of liquids may be a normal and consistent finding in some healthy older adults.
Combined Optical Coherence Tomography and Endobronchial Ultrasonography for Laser-Assisted Treatment of Postintubation Laryngotracheal Stenosis
Authors: Murgu Septimiu D. , Colt Henri G.
Published: October 2014

Objectives:

We describe the use of combined optical coherence tomography (OCT) and endobronchial ultrasonography (EBUS) to identify the residual hypertrophic tissues and persistent inflammation that are known contributors to stricture recurrence after laser-assisted mechanical dilation (LAMD) of laryngotracheal stenosis (LTS).

Methods:

Commercially available high-frequency EBUS (approximately 100-μm resolution) and time-domain OCT (approximately 10- to 20-μm resolution) systems were used to visualize airway wall microstructures in the area of hypertrophic tissue formation before and after LAMD in 2 patients with complex circumferential postintubation LTS.

Results:

Before LAMD, EBUS revealed a homogeneous layer consistent with hypertrophic tissue overlying a hyperechogenic layer corresponding to tracheal cartilage. OCT revealed a homogeneous light backscattering layer and an absence of layered microstructures within hypertrophic tissue. Immediately after LAMD, OCT of the laser-charred tissue showed high backscattering and shadowing artifacts; OCT of noncharred tissue showed bright light backscattering regions that suggested acute inflammation. EBUS revealed thinner but persistent hypertrophic tissue overlying the cartilage. Stenosis recurred in both patients.

Conclusions:

Intraoperative use of EBUS and OCT could potentially identify residual hypertrophic tissues and persistent inflammation during or after LAMD. It might help physicians predict stricture recurrence, prompting alternative therapeutic strategies and avoidance of repeated endoscopic treatments for LTS.
Utility of Two-Stage Laryngotracheal Reconstruction in the Management of Subglottic Stenosis in Adults
Authors: Deckard Nathan , Yeh Justin , Soares Danny J. , Criddle Michael , Stachler Robert , Coticchia James
Published: October 2014

Objectives:

We examined a retrospective case series to evaluate the utility of two-stage laryngotracheal reconstruction (LTR) in the management of subglottic stenosis (SGS) in adults. Operative correction of SGS with LTR has been practiced successfully in the pediatric population. However, in the adult population, cricotracheal resection has been a more common alternative.

Methods:

We reviewed the medical records at the Wayne State University Department of Otolaryngology-Head and Neck Surgery. We included all adult patients with SGS who underwent LTR and completed the recommended procedures between December 24, 2003, and October 1, 2010.

Results:

Twelve of the 14 patients identified were decannulated (86%). Of the 12 decannulated patients, 1 required a salvage operation, eventually achieving decannulation after cricotracheal resection. Therefore, although our overall decannulation rate was 86%, the rate with LTR alone was 79%. The majority of our patients (71%) had high-grade (grade III or IV) stenosis.

Conclusions:

We conclude that LTR is a viable option for adult patients with SGS. In children, LTR is a relatively safe and often-performed procedure. With use of modern techniques, it has the potential to be applicable to adults, as well. It has the added benefit of avoiding the pitfalls and complications associated with cricotracheal resection.
Adjunctive Procedures after Pediatric Single-Stage Laryngotracheoplasty
Authors: Willis Elena B. , Folk David , Bent John P.
Published: October 2014

Objectives:

We report the frequency and success rates of adjunctive airway procedures after pediatric single-stage laryngotracheoplasty (LTP) and review different adjunctive techniques in a prospectively enrolled and retrospectively reviewed case series.

Methods:

Of 31 LTP procedures performed from 2008 to 2011 at an academic tertiary care children's hospital, 10 were single-stage LTP procedures. These 10 cases were analyzed to determine the number and type, if any, of adjunctive procedures required after LTP, as well as the subglottic response and decannulation rates.

Results:

Of the 10 patients with single-stage LTP procedures, 6 patients required a total of 16 postoperative adjunctive airway procedures. The adjunctive procedures included granulation tissue removal with forceps or a carbon dioxide laser, stent placement, mitomycin C application, and triamcinolone acetonide injection. One patient also required tracheotomy placement and, eventually, cricotracheal resection. All 6 patients had significant improvement of subglottic and/or tracheal stenosis on their most recent endoscopic examination. With a minimum follow-up of 12 months, all 6 patients were decannulated.

Conclusions:

In this series, more than half of our pediatric patients who underwent single-stage LTP required 1 or more postoperative adjunctive procedures, and all had successful outcomes.
Causes of Dysphagia in a Tertiary-Care Swallowing Center
Authors: Hoy Monica , Domer Amanda , Plowman Emily K. , Loch Randall , Belafsky Peter
Published: October 2014

Objectives:

Dysphagia can be caused by a myriad of disease processes, and it has significant impacts on patients' quality of life, life expectancy, and economic burden. To date, the most common causes of dysphagia in outpatient tertiary-care swallowing centers are unknown. We undertook this study to determine these prevalences. We also describe the diagnostic techniques utilized to establish the diagnosis.

Methods:

The electronic charts of 100 consecutive patients who presented to an outpatient tertiary-care university swallowing center between January 2010 and April 2011 were retrospectively reviewed. Information regarding patient demographics, validated symptom surveys, diagnostic workups, and ultimate diagnoses was abstracted and tabulated into a central database. Descriptive statistics were used to evaluate the association between patient symptoms and diagnoses.

Results:

The mean age of the entire cohort was 62 ± 13.5 years, and 58% of the cohort was male. The most common identified causes of dysphagia were reflux (27%), postirradiation dysphagia (14%), and cricopharyngeus muscle dysfunction (11%). In 13% of cases, the cause of dysphagia was undetermined. The diagnostic tests utilized included flexible laryngoscopy (71%; 17% with endoscopic swallow evaluation), modified barium swallow study (45%), esophagoscopy (35%), barium esophagography (21%), manometry (10%), and ambulatory pH testing (2%).

Conclusions:

The most common causes of dysphagia in a tertiary-care swallowing center are reflux, postirradiation dysphagia, and cricopharyngeus muscle dysfunction. A precise cause for the symptom could not be identified in 13% of our cohort. Endoscopic visualization (laryngoscopy, flexible endoscopic evaluation of swallowing, and transnasal esophagoscopy) and fluoroscopic swallow studies were the investigations most often utilized. These techniques can be used to arrive at a diagnosis in 80% of cases.
Descending Mediastinitis with Mediastinal Abscess after Supracricoid Partial Laryngectomy
Authors: Benito José , Espinoza Sophie , Gutiérrez-Fonseca Raimundo , Bagan Patrick , Laccourreye Ollivier
Published: October 2014

We document a rare and not-yet-reported condition after supracricoid partial laryngectomy: The development of descending mediastinitis with mediastinal abscess. We present a case in which early diagnosis and team management allowed for a successful outcome. The pathophysiology of this severe complication, as well as its diagnosis, management, and prevention, is discussed, together with a review of the medical scientific literature.
Factors Influencing Morbidity after Surgical Management of Malignant Thyroid Disease
Authors: More Yogesh , Shnayder Yelizaveta , Girod Douglas A. , Sykes Kevin J. , Carlisle Michael P. , Chalmers Brian , Kraemer CodyJo , Tsue Terance T.
Published: October 2014

Objectives:

We performed a retrospective study of cases from 2005 to 2010 at an academic tertiary care center to analyze the factors that influence morbidity in surgical management of thyroid malignancy.

Methods:

The rates of recurrent laryngeal nerve (RLN) injury and hypoparathyroidism (HPT) were analyzed in the entire cohort. The comparison groups were 1) primary surgery versus revision; 2) total thyroidectomy versus total thyroidectomy combined with neck node dissection; and 3) two groups defined by surgical technique according to the RLN approach: Group 1, in which the RLN was identified inferiorly in the tracheoesophageal groove, and group 2, in which the RLN was identified near the cricothyroid joint point of entry.

Results:

We reviewed 308 patients who underwent surgery for thyroid cancer. Thirty-six (11.7%) had temporary HPT, and 8 (2.6%) had permanent HPT. Of a total of 586 RLNs at risk, 16 (2.7%) had temporary damage and 2 (0.3%) had permanent damage. The incidences of temporary RLN injury significantly differed between the primary-surgery and revision-surgery groups (2.5% versus 15.6%; p = 0.001), and also between the groups with total thyroidectomy and thyroidectomy with neck dissection (1.2% versus 7.8%; p = 0.027). The incidences of temporary HPT were significantly different between the groups with primary surgery and revision surgery (6.6% versus 31.3%; p = 0.001), between the groups with total thyroidectomy and total thyroidectomy with neck dissection (4.7% versus 15.6%; p = 0.009), and between group 1 and group 2 (surgical technique in terms of RLN approach; 8.2% versus 17.9%; p = 0.011). Permanent HPT and permanent RLN injury both occurred rarely in this cohort, with no significant differences among comparison groups.

Conclusions:

Our study shows a higher incidence of temporary RLN injury and temporary HPT in revision surgery cases and in total thyroidectomy with neck dissection. Temporary HPT was significantly more common when the RLN was identified near the cricothyroid joint.
Voice-Related Symptoms and Their Effects on Quality of Life
Authors: Merrill Ray M. , Roy Nelson , Lowe Jessica
Published: October 2014

Objectives:

The purpose of this study was to identify the extent to which selected voice symptoms formed underlying constructs called factors, and the degree to which these factors influenced specific quality-of-life domains among a group of relatively healthy older adults.

Methods:

A cross-sectional survey was completed in October 2010 by 461 individuals 50 years of age and older. The questionnaire items included demographics, medical history, health, voice use, and voice symptoms. Quality-of-life indicators were used from the Short Form 36 Health Survey, an 8-scale measure of functional health and well-being.

Results:

Two clusters of symptoms were identified in the factor analysis. One cluster, consisting of 5 voice-related symptoms and labeled “phonatory effort,” shared all significant negative correlations with health outcomes, whereas the other cluster, consisting of 2 voice-related symptoms and labeled “chronic throat condition,” had a pattern of sharing significant negative correlations with only 3 health outcomes. All voice symptoms had significant negative correlations with general health, bodily pain, and energy/fatigue.

Conclusions:

Voice-related symptoms share complex relationships with and have negative effects on health outcomes. The specific mechanisms of impact need further research in order for us to better understand these effects on quality of life and how to prevent and treat the symptoms.
Predictors of Hearing Preservation in the Management of Labyrinthine Fistulas Positioned on the Semicircular Canals
Authors: Albu Silviu , Amadori Maurizio , Babighian Gregorio
Published: October 2014

Objectives:

We sought to identify factors that would predict hearing preservation in the treatment of semicircular canal labyrinthine fistulas.

Methods:

Between 1990 and 2010, 97 patients with semicircular canal fistulas were operated on and enrolled in this retrospective study. In 62 patients the matrix was removed and the fistula was sealed, whereas in 35 patients the canal was drilled, the matrix was detached, and the canal was occluded. Perioperative corticosteroids were administered in 51 patients. The main outcome measures were the bone conduction thresholds evaluated at 1 year after the operation. Factors considered for possible association with hearing preservation included age, gender, site and size of the fistula, primary versus revision surgery, surgeon, perioperative corticosteroid treatment, and surgical management of the fistula.

Results:

The bone conduction hearing level was improved in 16 patients, remained unchanged in 73 patients, and had worsened in 11 patients. On the univariate analysis, good hearing was predicted by grade II fistula, canal plugging, and corticosteroid treatment. However, none of these factors attained significance in the logistic regression model.

Conclusions:

In surgery of semicircular canal fistulas, good hearing outcomes are to be expected if perioperative corticosteroids are administered, matrix removal and fistula sealing is performed in grade II fistulas, and canal occlusion is performed in grade III and IV fistulas.
Management of Upper Aerodigestive Tract Amyloidosis
Authors: Celenk Fatih , Durucu Cengiz , Baysal Elif , Karatas Zeynel A. , Polat Mustafa , Bakir Kemal , Mumbuc Semih , Kanlikama Muzaffer
Published: October 2014

Objectives:

The aim of this study was to discuss the treatment options for upper aerodigestive tract amyloidosis.

Methods:

Four patients with histologically confirmed amyloidosis were included in the study. All patients underwent surgical treatment. Three patients had laryngeal amyloidosis, and 1 patient had tonsillar amyloidosis.

Results:

Two of the cases of laryngeal amyloidosis were successfully treated with a combination of surgery and radiation therapy. One case of laryngeal amyloidosis was treated with surgery alone. The tonsillar amyloidosis was removed by tonsillectomy. None of the cases showed systemic involvement. Long-term follow-up of the patients showed no recurrence or evidence of systemic disease.

Conclusions:

Surgical resection is the primary treatment for patients with upper aerodigestive tract amyloidosis. Radiation therapy is especially effective in cases of recurrent amyloidosis with submucosal involvement. Pedunculated polypoid lesions may be treated with surgery alone, and in cases of recurrence, irradiation following the surgical removal should be considered. Tonsillectomy is usually sufficient for treating tonsillar amyloidosis.
Comparison of Carbon Dioxide Laser—Assisted versus Stapler-Assisted Endoscopic Cricopharyngeal Myotomy
Authors: Pollei Taylor R. , Hinni Michael L. , Hayden Richard E. , Lott David G. , Mors Matthew B.
Published: October 2014

Objectives:

We directly compared endoscopic carbon dioxide (CO2) laser and stapler treatment methods for both cricopharyngeal hypertrophy (CPH) and Zenker's diverticulum (ZD).

Methods:

We performed a single-institution retrospective chart review of 153 patients who underwent either CO2 laser–assisted or stapler-assisted endoscopic cricopharyngeal myotomy (CPM).

Results:

Isolated CPH was more likely to be treated with the CO2 laser than by stapler techniques. The ZD pouch size decreased significantly after surgery in both laser (p = 0.04) and stapler (p = 0.008) groups. The average duration of the procedure for CPM was longer for the laser than for the stapler (p = 0.01). Both techniques were successful when used in revision procedures. The overall complication rates were not statistically significantly different. Laser surgery trended toward a higher rate of major complications (2.4% versus 0%). Symptomatic recurrence was more likely after stapler surgery (p = 0.002). The rates of revision surgery were similar in the two groups (3.3% for laser and 4.3% for stapler).

Conclusions:

In the treatment of isolated CPH or ZD, stapler-assisted endoscopic surgery results in a shorter operative time, whereas laser-assisted CPM results in a decreased incidence of symptomatic recurrence.
Thyroid Storm Complicated by Fulminant Hepatic Failure: Case Report and Literature Review
Authors: Hambleton Catherine , Buell Joseph , Saggi Bob , Balart Luis , Shores Nathan J. , Kandil Emad
Published: October 2014

Objectives:

Thyroid storm is a presentation of severe thyrotoxicosis that has a mortality rate of up to 20% to 30%. Fulminant hepatic failure (FHF) entails encephalopathy with severe coagulopathy in the setting of liver disease. It carries a high mortality rate, with an approximately 60% rate of overall survival for patients who undergo orthotopic liver transplantation (OLT). Fulminant hepatic failure is a rare but serious complication of thyroid storm. There have been only 6 previously reported cases of FHF with thyroid storm.

Methods:

We present a patient from our institution with thyroid storm and FHF. A literature review was performed to analyze the outcomes of the 6 additional cases of concomitant thyroid storm and FHF.

Results:

Our patient underwent thyroidectomy followed by OLT. Her serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, and transaminase normalized, and she was ready for discharge within 10 days of surgery. She has survived without complication. There is a 40% mortality rate for the reported patients treated medically with these conditions. Of the 7 total cases of reported FHF and thyroid storm, 2 patients died. Only 2 of the 7 patients underwent thyroidectomy and OLT — Both at our institution. Both patients survived without complications.

Conclusions:

Thyroid storm and FHF each independently carry high mortality rates, and managing patients with both conditions simultaneously is an extraordinary challenge. These cases should compel clinicians to investigate liver function in hyperthyroid patients and to be wary of its rapid decline in patients who present in thyroid storm with symptoms of liver dysfunction. Patients with rapidly progressing thyroid storm and FHF should be considered for total thyroidectomy and OLT.
Pro-Resolution Mediator Lipoxin A4 and its Receptor in Upper Airway Inflammation
Authors: Shimizu Shino , Ogawa Takao , Seno Satoshi , Kouzaki Hideaki , Shimizu Takeshi
Published: October 2014

Objectives:

The resolution of inflammation is an active process controlled by several anti-inflammatory and pro-resolution mediators. Lipoxin A4, an endogenous lipid mediator, is a potential pro-resolution mediator that could attenuate inflammation. This study was conducted to elucidate the role of lipoxin A4 in upper airway inflammation.

Methods:

Nasal secretions were collected from patients with chronic rhinosinusitis with nasal polyposis, patients with allergic rhinitis, and control subjects. The concentration of lipoxin A4 was measured by enzyme-linked immunosorbent assay. Nasal tissues were obtained from nasal polyps and inferior turbinates during endonasal surgery. The mRNA expressions of lipoxygenases (LOXs), lipoxin receptor (formyl peptide receptor-like 1; FPRL-1), and cysteinyl leukotriene type 1 receptor (CysLT1R) in nasal tissues were examined by reverse-transcription polymerase chain reaction. Tissue localization of FPRL-1 was determined by immunohistochemical staining. The in vitro effect of lipoxin A4 on airway epithelial cells was also examined.

Results:

A significant concentration of lipoxin A4 was found in nasal secretions, and the concentration was increased in patients with allergic rhinitis. The mRNA expressions of 5-LOX, 15-LOX-1, FPRL-1, and CysLT1R were significantly greater in nasal polyps than in inferior turbinates. FPRL-1 was localized in nasal epithelial cells. Lipoxin A4 inhibited tumor necrosis factor α-induced interleukin 8 release from airway epithelial cells via its receptor FPRL-1.

Conclusions:

These results indicate that lipoxin A4 may play a role in the resolution of upper airway inflammation. A low concentration of lipoxin A4 may be involved in chronic inflammation of the upper airways.
Sleep Architecture Parameters That Predict Postoperative Resolution of Nocturnal Enuresis in Children with Obstructive Sleep Apnea
Authors: Thottam Prasad John , Kovacevic Larisa , Madgy David N. , Abdulhamid Ibrahim
Published: October 2014

Objectives:

We performed a prospective cohort study in a pediatric tertiary care center to determine whether preoperative sleep architecture is associated with complete resolution of nocturnal enuresis (NE) after adenotonsillectomy.

Methods:

Thirty-seven pediatric patients with primary NE who underwent adenotonsillectomy for obstructive sleep apnea (OSA) were evaluated. Preoperative polysomnograms, as well as preoperative and postoperative reports of NE, were recorded. We performed χ2 analysis, Fisher's exact test (for p values), and t-tests to evaluate the impact of multiple demographic characteristics on sleep architecture, comparing children with resolved NE to those with unresolved NE after adenotonsillectomy.

Results:

The patients' mean age was 8.0 years (SD, 2.32 years). All children had presurgical primary NE. No age or gender differences were identified between children with resolved NE and those with unresolved NE. After surgery, more than half of the participants had resolution of NE. A higher percentage of boys had unresolved NE (χ2 = 3.63; p = 0.06). Improvement of NE was identified in children with a higher obstructive apnea-hypopnea index and more desaturation events. Eleven of the 12 children with prolonged stage 2 sleep reported resolution of NE (p = 0.001). Children with an obstructive apnea-hypopnea index of greater than 10 had a significantly greater rate of resolution of NE (p = 0.01). Logistic regression demonstrated that an elevated body mass index and the interaction of severe OSA and prolonged stage 2 sleep predicted resolution of NE. All 10 children with severe OSA and an abnormal total time spent in stage 2 sleep had resolution of NE.

Conclusions:

Adenotonsillectomy is a treatment option for children with OSA and NE. Postoperative resolution of NE was seen in 51.4% of patients who underwent adenotonsillectomy. The children with both severe OSA and prolonged stage 2 sleep were 3.4 times as likely to have postoperative resolution of NE. These results suggest that there are significant differences in preoperative sleep architecture between children whose NE resolves after adenotonsillectomy and those whose NE does not resolve.
Association between Tinnitus and Sleep Disorders in the General Japanese Population
Authors: Izuhara Keiichi , Wada Keiko , Nakamura Kozue , Tamai Yuya , Tsuji Michiko , Ito Yatsuji , Nagata Chisato
Published: October 2014

Objectives:

There are few studies about the association between tinnitus and sleep disorders in the general population worldwide. This study assessed this association in a Japanese community.

Methods:

A total of 14,027 participants 45 to 79 years of age who were in the Takayama Study responded to a self-administered questionnaire about tinnitus and sleep disorders.

Results:

Of this population, 13.3% of men and 10.6% of women had current tinnitus. The percentages of insomnia, respectively, among individuals with and without tinnitus were 28.1% in men and 36.1% in women and 18.8% in men and 21.5% in women. There were 1.7-fold (95% confidence interval [CI], 1.4 to 2.1) and 1.8-fold (95% CI, 1.5 to 2.2) increases in the odds ratios (ORs) of insomnia for those with tinnitus compared with those without tinnitus in men and women, respectively. Loud or very loud tinnitus was associated with 2.8-fold (95% CI, 1.8 to 4.3) and 3.3-fold (95% CI, 1.9 to 5.6) increases in the OR of insomnia in men and women, respectively. Even low (ie, quiet) or moderate tinnitus was significantly associated with insomnia. Difficulty initiating sleep, difficulty maintaining sleep, and a poor perceived quality of sleep were also significantly associated with tinnitus.

Conclusions:

Insomnia and other sleep disorders were significantly associated with tinnitus in Japanese adults.
Reliability and Validity of the Italian Eating Assessment Tool
Authors: Schindler Antonio , Mozzanica Francesco , Monzani Anna , Ceriani Eleonora , Atac Murat , Jukic-Peladic Nikolina , Venturini Claudia , Orlandoni Paolo
Published: October 2014

Objectives:

We sought to evaluate the reliability and validity of the Italian EAT-10 (Italian Eating Assessment Tool; I-EAT-10).

Methods:

The study consisted of 4 phases: Item generation, internal consistency and reliability analysis, normative data generation, and validity analysis. Discussion of the EAT-10 with 30 patients and its back-translation were accomplished. The recruited population included 172 patients (40 with dysphonia and 132 with dysphagia) and 269 asymptomatic subjects for testing of internal consistency, and 94 patients with dysphagia and 158 asymptomatic subjects for test-retest reliability analysis. Normative data were gathered from the 269 subjects. The scores of patients and asymptomatic subjects were compared. The I-EAT-10 and flexible endoscopic evaluation of swallowing (FEES) scores in 94 patients were correlated. The I-EAT-10 scores made before and after successful swallowing rehabilitation in 38 patients were compared.

Results:

Excellent internal consistency (Cronbach's alpha values of 0.90 and 0.93) and strong test-retest reliability (intraclass correlation coefficients of 0.95 and 0.98) were found in patients and asymptomatic subjects. The I-EAT-10 mean (±SD) score of the normal cohort was 0.6 ± 1.1. The asymptomatic subjects and dysphonic patients scored lower than the dysphagic patients on the Kruskal-Wallis test (p = 0.001). The I-EAT-10 and FEES scores were mildly correlated. The mean I-EAT-10 score improved from 9.8 ± 10.3 to 5.8 ± 6.7 after swallowing rehabilitation (p = 0.04).

Conclusions:

The I-EAT-10 is a reliable, valid, symptom-specific outcome tool.
PEComa of the Nasal Cavity with Worrisome Histologic Features and Benign Behavior: A Case Report
Authors: Bocciolini Corso , Fornelli Adele , Casadei Gian Piero , Cattani Maria Grazia , Dall'Olio Danilo
Published: October 2014

Objectives:

PEComas (perivascular epithelioid cell tumors) are a family of neoplastic lesions that share overlapping ultrastructure and morphological and immunohistochemical appearance and include angiomyolipoma, lymphangioleiomyomatosis, and clear cell “sugar” tumor of the lung, as well as similar tumors that occur in a variety of visceral, cutaneous, and soft tissue sites throughout the body.

Methods:

A 40-year-old woman came to medical attention because of epistaxis and because of unilateral nasal obstruction of 3 months' duration. Endoscopic examination revealed a well-demarcated exophytic lesion attached to the anterior portion of the middle turbinate.

Results:

The lesion was superficially located, and therefore amenable to complete surgical excision. Seven years after surgery, the patient is alive and well, without evidence of local recurrence or metastastic disease. Based on morphological and immunohistochemical appearance, a diagnosis of PEComa with worrisome histologic features was rendered.

Conclusions:

In the present study, we describe a PEComa that occurred in the nasal cavity and discuss the behavior of this entity. The importance of recognizing this disease will ensure its consideration in the differential diagnosis of tumors of the head that have similar morphological features. The histogenesis of PEComa still remains elusive, and collection of additional cases with a prolonged follow-up will be important in accurately determining the behavior of these distinctive tumors.
In Vitro Epithelial Differentiation of Human Induced Pluripotent Stem Cells for Vocal Fold Tissue Engineering
Authors: Imaizumi Mitsuyoshi , Sato Yuka , Yang David T. , Thibeault Susan L.
Published: October 2014

Objectives:

We determined the feasibility and optimization of differentiating human induced pluripotent stem cells (hiPS) into nonkeratinized stratified squamous epithelial cells for vocal fold engineering.

Methods:

hiPS were cultured and assessed for differentiation in 3 conditions: A 3-dimensional (3D) hyaluronic acid (HA) hydrogel scaffold, a 3D HA hydrogel scaffold with epidermal growth factor (EGF), and a 3D HA hydrogel scaffold co-cultured with human vocal fold fibroblasts (hVFF). After 1, 2, and 4 weeks of cultivation, hiPS were selected for histology, immunohistochemistry, and/or transcript expression analysis.

Results:

At 4 weeks, hiPS cultivated with hVFF or with EGF had significantly decreased levels of Oct 3/4, indicating loss of pluripotency. Immunofluorescence revealed the presence of pancytokeratin and of cytokeratin (CK) 13 and 14 epithelial-associated proteins at 4 weeks after cultivation in hiPS EGF and hiPS hVFF cultures. The transcript expression level of CK14 was significantly increased for hiPS hVFF cultures only and was measured concomitantly with cell morphology that was clearly cohesive and displayed a degree of nuclear polarity suggestive of epithelial differentiation.

Conclusions:

We found that hiPS cultivated in 3D HA hydrogel with hVFF demonstrated the most robust conversion evidence to date of epithelial differentiation. Further work is necessary to focus on amplification of these progenitors for application in vocal fold regenerative biology.