bluuebunny/crossref_metadata_2025 huggingface dataset:
Blinded Evaluation of the Effects of High Definition and Magnification on Perceived Image Quality in Laryngeal Imaging
Authors: Otto Kristen J. , Hapner Edie R. , Baker Michael , Johns Michael M.
Published: October 2014

Objectives:

Advances in commercial video technology have improved office-based laryngeal imaging. This study investigates the perceived image quality of a true high-definition (HD) video camera and the effect of magnification on laryngeal videostroboscopy.

Methods:

We performed a prospective, dual-armed, single-blinded analysis of a standard laryngeal videostroboscopic examination comparing 3 separate add-on camera systems: a 1-chip charge-coupled device (CCD) camera, a 3-chip CCD camera, and a true 720p (progressive scan) HD camera. Displayed images were controlled for magnification and image size (20-inch [50-cm] display, red-green-blue, and S-video cable for 1-chip and 3-chip cameras; digital visual interface cable and HD monitor for HD camera). Ten blinded observers were then asked to rate the following 5 items on a 0-to-100 visual analog scale: resolution, color, ability to see vocal fold vibration, sense of depth perception, and clarity of blood vessels. Eight unblinded observers were then asked to rate the difference in perceived resolution and clarity of laryngeal examination images when displayed on a 10-inch (25-cm) monitor versus a 42-inch (105-cm) monitor. A visual analog scale was used. These monitors were controlled for actual resolution capacity.

Results:

For each item evaluated, randomized block design analysis demonstrated that the 3-chip camera scored significantly better than the 1-chip camera (p <.05). For the categories of color and blood vessel discrimination, the 3-chip camera scored significantly better than the HD camera (p <.05). For magnification alone, observers rated the 42-inch monitor statistically better than the 10-inch monitor.

Conclusions:

The expense of new medical technology must be judged against its added value. This study suggests that HD laryngeal imaging may not add significant value over currently available video systems, in perceived image quality, when a small monitor is used. Although differences in clarity between standard and HD cameras may not be readily apparent on small displays, a large display size coupled with HD technology may impart improved diagnosis of subtle vocal fold lesions and vibratory anomalies.
Intralaryngeal Thyroglossal Duct Cyst: Implications for the Migratory Pathway of the Thyroglossal Duct
Authors: Loh Woei Shyang , Chong Siew Meng , Loh Kwok Seng
Published: October 2014

An atypically located thyroglossal duct cyst in a 42-year-old man is described. A purely intralaryngeal thyroglossal duct cyst is extremely rare and can mimic other laryngeal lesions. This case demonstrates that thyroglossal duct cyst is a possible cause of intralaryngeal swellings and would have significant implications for the manner in which they are managed.
Magnetic Resonance Imaging Findings in the Evaluation of Traumatic Anosmia
Authors: Wise Jeffrey B. , Moonis Gul , Mirza Natasha
Published: October 2014

Objectives:

Head trauma is a common cause of anosmia, but diagnosis is typically late, owing to more life-threatening sequelae of the injury. Herein, we describe our workup for a case of traumatic anosmia and the magnetic resonance imaging (MRI) findings both at the time of injury and at the 18-month follow-up.

Methods:

We present a case report and a review of the literature.

Results:

A 33-year-old woman presented to our institution with a chief complaint of loss of smell and taste following an occipital blow to her head that occurred when she was hit by a car while riding a bicycle. We present the findings of MRI performed at the time of the injury and at the 18-month follow-up. We describe the clinical progression of her disease, from symptoms of parosmic and phantosmic episodes accompanied by dysgeusia to total anosmia at the 18-month follow-up.

Conclusions:

We advocate the use of MRI, coupled with otolaryngology consultation and formal olfactory testing, in the diagnosis, management, and counseling of patients with anosmia sustained from head injury.
Anterior Atticoantrostomy for Cholesteatoma Surgery
Authors: Uyar Yavuz , Öztürk Kayhan , Keles Bahar , Arbaǧ Hamdi , Ülkü Çaǧatay Han
Published: October 2014

Objectives:

We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma.

Methods:

A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002.

Results:

Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 ± 13.4 dB and 16.9 ± 14.7 dB, and the mean high-tone bone conduction was 19.0±6.2 dB and 21.1 ±6.6 dB, in the preoperative and postoperative periods, respectively.

Conclusions:

In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.
Management of Cerebral Vascular Structures during Endoscopic Treatment of Encephaloceles: A Clinical Report
Authors: Bolger William E.
Published: October 2014

Objectives:

Otolaryngologists are increasingly being called upon to treat patients with cerebrospinal fluid leak and encephaloceles. The endoscopic approach to the skull base through the nose and paranasal sinuses has proven effective and is well tolerated by patients. With its more widespread and frequent use, unusual cases and potential complications are becoming more apparent.

Methods:

Treatment of Two clinical cases in which a cerebral vascular structure was encountered during endoscopic treatment of an encephalocele is presented, and the condition is reviewed.

Results:

Two patients presented after a skull base injury that occurred during endoscopic sinus surgery. In each case the initial treating surgeon attempted endoscopic repair of a cerebrospinal fluid leak, but the repair failed and the leak persisted. Upon referral to the author, in each case, a traumatic encephalocele with an active leak was apparent, and during repair a cerebral vessel was encountered. It appeared that the vessel had been “pulled down” into the skull base defect with the encephalocele's migration into the sinonasal cavity.

Conclusions:

This unusual clinical condition is discussed along with the potential complications that can result from it. Otolaryngologists who treat encephaloceles should be aware of the possibility of encountering a cerebral vessel and should understand the potential complications and management options.
Postcricoid Hemangioma of Childhood: Report of Four Cases
Authors: Awwad Ramez J. , Mortelliti Anthony J.
Published: October 2014

Hemangiomas are the most common tumor of infancy, and the vast majority occur in the head and neck region. In children, laryngeal hemangiomas typically occur below the level of the true vocal folds, in the region of the subglottis, and other sites are exceedingly rare. We present four cases of hemangiomas located in the postcricoid region of the hypopharynx. Because of the location of these lesions, children may present with obstructive symptoms such as dysphagia, intermittent aspiration, hypersalivation, or recurrent respiratory infections. Clinical diagnosis is relatively easily made with flexible laryngoscopy, as the lesions have a propensity to enlarge with crying or straining. When these patients are examined under general anesthesia in a relaxed state, however, the lesions are typically much smaller, and can even go unnoticed. Unlike other reported cases, the postcricoid hemangiomas in our patients were not causing any symptoms and were simply incidental findings. Thus, we believe that the true incidence of postcricoid hemangiomas is likely higher than reports suggest. To our knowledge, we report the longest follow-up (6 years) of a patient with a postcricoid hemangioma and are the first to describe the natural course of such a lesion.
Postnatal Development of Rat Vocal Folds
Authors: Tateya Tomoko , Tateya Ichiro , Munoz-Del-Rio Alejandro , Bless Diane M.
Published: October 2014

Objectives:

In this study we aimed to determine the feasibility of using a rat model for the study of postnatal vocal fold (VF) development.

Methods:

Eighteen male rats that were 3 days old, 3 weeks old, or 8 months old were analyzed histologically with Alcian blue stain used for detecting hyaluronic acid, elastin–van Gieson stain for elastin, Oil Red O and gold chloride stains for vitamin A–containing lipid droplets, and immunohistochemistry for vimentin (general fibroblast marker) and collagen types I and III.

Results:

The macula flava (MF) was observed as a mass of cells that expressed vimentin intensively in the cytoplasm. The MF showed denser hyaluronic acid and collagen type I than did the midmembranous portion of the VF lamina propria. Clear developmental changes were evident in the MF and other regions. The vimentin-positive cells of the 3-day-old MF were mainly oval-shaped and had less cytoplasm, whereas those of the 8-month-old MF were spindle- and stellate-shaped and had more cytoplasm, similar to that reported in humans. Vitamin A–containing lipid droplets were limited to the 3-week-old and 8-month-old MFs and were not present in the 3-day-old VF.

Conclusions:

These results suggest that a rat model is useful in studying VF development and that vitamin A is related to the maturity of the VF.
Reconstruction of the Columella with Bilateral Nostril Sill Flaps
Authors: Demir Zühtü , Özdil Kubilay , Karamürsel Sebat , Yüce Serdar , Öktem Fatih , Çelebioğlu Selim
Published: October 2014

The treatment of total columellar defects is very difficult, and there is not any first choice in reconstruction of these defects. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. We report a pediatric patient with a defect involving the entire columella. Reconstruction of the defect was accomplished with laterally based bilateral nostril sill flaps. An acceptable cosmetic result was obtained. This method can be done as a single-stage operation with an excellent color and texture match. We think that this method leads to good aesthetic results, and should be considered for total columellar reconstruction.
Expandable Tracheal Stenting for Benign Disease: Worth the Complications?
Authors: Eller Robert L. , Livingston William J. , Morgan C. Elliott , Peters Glenn E. , Sillers Michael J. , Magnuson J. Scott , Rosenthal Eben L.
Published: October 2014

Objectives:

To characterize the limitations of self-expandable stents in the management of benign tracheal stenosis, we performed a retrospective review at a tertiary care medical center.

Methods:

Patients who underwent tracheal stenting were assessed for the cause and severity of tracheal stenosis, comorbidities, stent-related complications, and follow-up airway procedures.

Results:

Sixteen adults (12 women, 4 men; mean age, 47 years) had a total of 26 stents placed for benign disease. Intubation-related stenoses were most frequent (81%). The average follow-up time was 20 months (range, 1 to 40 months). Each stent remained functional for an average of 12.4 months. In the study group, 87% had a complication that required surgical intervention to maintain a patent airway. The most common problem was granulation tissue formation at the ends of the stent causing airway restenosis (81%), and 5 patients (31%) required tracheotomy as a result of restenosis around the stent. Fourteen of the stents (56%) were removed or expelled from the patients.

Conclusions:

The implantation of self-expandable stents is a minimally invasive method of managing benign tracheal stenosis. Although a small subset of patients may benefit from placement, the majority of patients have complications that require intervention to maintain a patent airway. Thoughtful discretion is critical in selecting patients for this intervention.
Multiple Auditory Steady-State Responses in Children and Adults with Normal Hearing, Sensorineural Hearing Loss, or Auditory Neuropathy
Authors: Attias Joseph , Buller Nora , Rubel Yehudith , Raveh Eyal
Published: October 2014

Objectives:

We tested the clinical effectiveness of multiple auditory steady-state responses (ASSRs) for the objective assessment of hearing thresholds in patients with and without hearing loss, candidates for cochlear implants, and children with auditory neuropathy.

Methods:

The study sample included 29 subjects with sensorineural hearing loss (SNHL), 18 candidates for cochlear implants, 11 subjects with auditory neuropathy, and 18 subjects with normal hearing thresholds. Behavioral hearing thresholds and ASSRs to carrier frequencies of 0.5, 1, 2, and 4 kHz were obtained. Special care was taken to minimize possible aliasing and high-intensity multiple stimulation effects. Differences and correlations between the ASSRs and the behavioral thresholds were determined.

Results:

The ASSR estimation of behavioral thresholds in the normal-hearing group was elevated, whereas very close predictions were found for the SNHL group. The correlations between the Two measures ranged from 0.86 at 0.5 kHz carrier frequency to 0.94 at 2 kHz. In the cochlear implant candidates and the auditory neuropathy group, the ASSR thresholds generally overestimated the behavioral audiogram. In these groups the number of detected ASSRs was higher than the number of behavioral responses, especially for the high-frequency carrier stimuli.

Conclusions:

Multiple ASSRs may reliably predict the behavioral threshold in subjects with SNHL and may serve as a valuable objective measure for assessing the hearing threshold across different frequencies in candidates for cochlear implants and children with auditory neuropathy.
Histological Study of Acute Vocal Fold Injury in a Rat Model
Authors: Tateya Tomoko , Tateya Ichiro , Sohn Jin Ho , Bless Diane M.
Published: October 2014

Objectives:

We used an acute vocal fold injury in a rat model to characterize vocal fold wound healing by studying the expression pattern of the extracellular matrix components in the vocal fold lamina propria.

Methods:

Vocal fold stripping was performed unilaterally in 27 Sprague-Dawley rats. The vocal folds were harvested at 5 time points (1, 3, 5, 7, and 14 days) and histologically analyzed by Alcian blue stain, trichrome stain, and immunofluorescence with antibodies to collagen type I, collagen type III, and fibronectin.

Results:

Re-epithelialization occurred by day 3 and was complete by day 14. Granulation tissue was formed by day 3. Hyaluronic acid and collagen type I appeared in injured vocal folds by day 3, peaked at day 5, and thereafter decreased. Collagen type III and fibronectin appeared by day 1 and continued to be intense at all time points after day 3.

Conclusions:

These results suggest that the expression of these extracellular matrix components peaks in the period around days 3 to 5, and that the characteristics of wound healing in the vocal fold are similar to those in the skin in the early phases, but differ during the subsequent remodeling phase.
Safety and Feasibility of Balloon Catheter Dilation of Paranasal Sinus Ostia: A Preliminary Investigation
Authors: Brown Christopher L. , Bolger William E.
Published: October 2014

Objectives:

Endoscopic sinus surgery (ESS) is an effective option for managing patients in whom medical therapy for rhinosinusitis fails. However, ESS is not always successful, and serious complications can occur. New techniques and instrumentation that improve outcomes and reduce complications would be seriously welcomed. Innovative catheter-based technology has improved treatment of several conditions such as coronary artery disease, peripheral vascular disease, and stroke. Recently, catheter devices have been developed for the paranasal sinuses. Cadaver studies confirm the potential use of these devices in rhinosinusitis. The objective of this investigation was to ascertain the feasibility and safety of these newly developed devices in performing catheter-based dilation of sinus ostia and recesses in patients with rhinosinusitis.

Methods:

A nonrandomized prospective cohort of 10 ESS candidates was offered treatment with a new technique of balloon catheter dilation of targeted sinus ostia. The frontal, maxillary, and sphenoid sinuses were considered appropriate for this innovative catheter-based technology. The primary study end points were intraoperative procedural success and absence of adverse events.

Results:

A total of 18 sinus ostial regions were successfully catheterized and dilated, including 10 maxillary, 5 sphenoid, and 3 frontal recesses. No adverse events occurred. Mucosal trauma and bleeding appeared to be less with catheter dilation than is typically observed with ESS techniques.

Conclusions:

Dilation of sinus ostial regions via balloon catheter–based technology appears to be relatively safe and feasible. Larger multicenter clinical trials are now warranted to further establish safety and to determine the role of this new technique.
Electromyography Findings of the Cricopharyngeus in Association with Ipsilateral Pharyngeal and Laryngeal Muscles
Authors: Halum Stacey L. , Shemirani Nima L. , Merati Albert L. , Jaradeh Safwan , Toohill Robert J.
Published: October 2014

Objectives:

We reviewed a large series of cricopharyngeal (CP) muscle electromyography (EMG) results and compared them with the EMG results from the inferior constrictor (IC), thyroarytenoid, (TA), cricothyroid (CT), and posterior cricoarytenoid (PCA) muscles.

Methods:

We performed a retrospective review of all CP muscle EMG reports from studies performed between January 1996 and June 2003. All of the tested elements from the CP muscle EMG reports were recorded. The EMG results were recorded for the ipsilateral IC, TA, CT, and PCA muscles if they were simultaneously tested. Each muscle result was classified as normal, neurogenic inactive axonal injury (IAI), or neurogenic active axonal injury (AAI), and the muscle findings were compared. A patient chart review was performed to determine a clinical correlation.

Results:

Fifty-nine patients underwent CP muscle EMG. Eighteen patients had bilateral EMG studies, making a total of 77 CP muscle studies. Nineteen sets of CP muscle results were normal, 43 demonstrated neurogenic IAI, and 15 demonstrated neurogenic AAI. The ipsilateral IC and CP muscles had the same innervation status in 27 of 28 studies (p > .0001). When the ipsilateral TA muscle was studied simultaneously with the CP muscle, 31 of 50 studies had the same innervation status (p = .005). The ipsilateral CT and CP muscles demonstrated the same innervation status in 40 of 50 studies (p > .0001). The correlations between the CP and IC muscle findings and between the CP and CT muscle findings were both stronger than the correlation between the CP and TA muscle findings (p > .0001 and p = .024, respectively). The chart review demonstrated the clinical findings to be consistent with the EMG results.

Conclusions:

The EMG studies demonstrated that CP muscle findings have the strongest correlation with IC muscle findings, followed by the CT and TA muscles. This outcome does not support theories indicating that the recurrent laryngeal nerve innervates the CP muscle in all cases.
Dissection of the Internal Carotid Artery following Trauma of the Soft Palate in Children
Authors: Pierrot Sebastien , Bernardeschi Daniele , Morrisseau-Durand Marie-Paule , Manach Yves , Couloigner Vincent
Published: October 2014

Objectives:

We undertook this report to underline the risks of lesions of the internal carotid artery after lateral oropharyngeal trauma in children and to discuss the diagnosis and treatment of this complication.

Methods:

We present 2 pediatric cases of carotid dissection following lateral soft palate trauma.

Results:

In 1 case, transient symptomatic cerebral ischemia occurred 24 hours after the initial traumatic injury. In both patients, the carotid dissection was assessed by magnetic resonance imaging with vascular and diffusion sequences. Treatment with low–molecular weight heparin calcium was maintained for several months. At the end of follow-up, both children were asymptomatic.

Conclusions:

We suggest noninvasive imaging of the carotid artery by enhanced computed tomographic scanning after trauma to the lateral part of the soft palate in children. Magnetic resonance imaging with vascular and diffusion sequences is useful in assessing the extension of the dissection toward the cerebral circulation and in early detection of cerebral ischemia. Anticoagulation with heparin probably reduces the risks of cerebral infarction. Patients must regularly undergo physical examination and noninvasive imaging of the carotid artery for at least 1 year after the traumatic injury.
Cranial Nerve Involvement in Nasopharyngeal Carcinoma: Response to Radiotherapy and its Clinical Impact
Authors: Li Jian-Cheng , Mayr Nina A. , Yuh William T. C. , Wang Jian Z. , Jiang Guo-Liang
Published: October 2014

Objectives:

To evaluate the cranial nerve (CN) palsy associated with nasopharyngeal carcinoma (NPC), we studied factors that influenced the neurologic outcome of radiotherapy (RT), and the patterns and time course of neurologic recovery of CN palsy.

Methods:

Between July 1987 and July 1989, 93 patients who presented with CN palsy at the time of diagnosis of NPC were studied. All patients underwent external-beam RT with either cobalt-60 or 6-MV photon beams to a dose of 69 to 84 Gy at 2 Gy per fraction. The time course and pattern of neurologic recovery (complete, partial, or none) from CN palsy were evaluated. Age, sex, stage, histology, incidence and distribution of types of CNs involved, duration of CN palsy, and time course of tumor response during RT were correlated with the patterns and the time course of neurologic CN recovery by univariate and multivariate analyses.

Results:

The cases of CN palsy most commonly involved CN V (38%), CN VI (26%), and CN XII (11%), which accounted for the majority of the cases (75%). The time course of CN recovery was variable and protracted. Most patients showed significant improvement upon completion of RT (51%, 19%, and 30% complete, partial, and no recovery, respectively) and further improvement 6 months after RT (58%, 17%, and 25%, respectively). Cranial nerves V, VI, and XII accounted for 75% of cases with no recovery. Recovery was best for CNs II, IX, and XI and the sympathetic nerve (100%, 87%, 100%, and 100%, respectively) and worst for CNs IV, VII, and XII (67%, 60%, and 40%, respectively, with no recovery). Neurologic CN recovery correlated significantly with the pretherapy duration (>3 months versus ≥3 months) of CN palsy (88% versus 62%; p = .002, multivariate analysis), the time course of clinical tumor regression, and neurologic symptom improvement during RT. Age, sex, T stage, N stage, histology, anterior versus posterior CN palsies, and base of skull involvement were not significant.

Conclusions:

According to our limited data, most patients with CN palsy respond well to RT. That the time course of neurologic recovery is variable and can be protracted indicates a need for continuous and close neurologic surveillance. The poorer neurologic outcome associated with a longer duration of CN symptoms may be related to a more severe long-term CN compression that results in irreversible damage. Timely diagnosis of NPC and fast institution of therapy are therefore critical to improving the neurologic outcome.
Elasticity of the Human False Vocal Fold
Authors: Chan Roger W. , Fu Min , Tirunagari Neeraj
Published: October 2014

Objectives:

Very little is known about the elasticity of the human ventricular fold (false vocal fold). To better understand the potential role of the false fold in the fluid dynamics and aeroacoustics of phonation, we made some measurements on the elastic properties of human ventricular fold tissues in vitro.

Methods:

Uniaxial tensile stress-strain characteristics of 6 male and 6 female false fold specimens were quantified with sinusoidal stretch-release deformation. Midcoronal sections of 3 specimens were examined to quantify the relative densities of collagen, elastin, seromucous glandular tissue, and adipose tissue by digital image analysis.

Results:

Nonlinear stress-strain curves with hysteresis (viscous energy loss) were observed, with large interindividual differences. A hybrid linear-exponential model was used to determine the elastic modulus (tangent Young's modulus) of the false fold. On average, the male false fold was twice as stiff as the female at a tensile strain of 20% to 30%.

Conclusions:

This preliminary gender-related difference in elasticity could be attributed to a higher proportion of glandular tissue in the female false fold, due to the lower elastic modulus of glands. The present data allow one to develop a more comprehensive biomechanical model of phonation, for optimizing postoperative voice production following laryngeal reconstruction procedures.
Tissue Engineering for Regeneration of the Tracheal Epithelium
Authors: Nomoto Yukio , Suzuki Teruhisa , Tada Yasuhiro , Kobayashi Ken , Miyake Masao , Hazama Akihiro , Wada Ikuo , Kanemaru Shinichi , Nakamura Tatsuo , Omori Koichi
Published: October 2014

Objectives:

The slowness of epithelialization on the artificial trachea that has been successfully used in humans is a problem. The purpose of this study was to develop a way to regenerate the epithelium on the surface of this artificial trachea.

Methods:

In an in vitro study, isolated rat tracheal epithelial cells were seeded on a collagenous gel that was stratified on a collagenous sponge. Histologic and immunohistochemical examinations were made. In an in vivo study, we transplanted grafts with green fluorescent protein–positive tracheal epithelial cells onto the tracheal defects of normal rats. At 3, 7, 14, and 30 days after the operation, histologic and immunohistochemical examinations were made.

Results:

In the in vitro study, the 3 layers — the epithelium, gel, and sponge — could be observed. The epithelium expressed cytokeratin 14, cytokeratin 18, and occludin. In the in vivo study, the artificial trachea was covered with epithelium at 3 days after operation, and then the epithelium differentiated from single- or double-stratified squamous epithelium into columnar ciliated epithelium. Green fluorescent protein–positive cells were found 3 days after operation.

Conclusions:

We believe that the method used in our experiment is an effective way to regenerate the epithelium on the surface of an artificial trachea. With further experimentation, this method should be suitable for clinical application.
Sensory Testing in the Assessment of Laryngeal Sensation in Patients with Amyotrophic Lateral Sclerosis
Authors: Amin Milan R. , Harris Donna , Cassel Stacy Gallese , Grimes Eric , Heiman-Patterson Terry
Published: October 2014

Objectives:

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease of unknown cause. Mortality in the population is frequently due to aspiration pneumonia. Although typically considered to be a disorder limited to motor neuron involvement, some investigators have indicated that decreased sensory function in ALS patients additionally contributes to the disease process. The objective of this study was to evaluate laryngopharyngeal sensation in the ALS population in order to quantify the range of sensory deficits and correlate any abnormalities with demographic data to determine which patients are at risk of having sensory deficits.

Methods:

We examined the sensation of the larynx in 22 patients with ALS to determine whether a sensory deficit was present. After completion of a dysphagia questionnaire and medical history, patients underwent flexible endoscopic evaluation of swallowing with sensory testing (FEESST) to evaluate sensory function. Threshold values were determined and recorded for initiation of the adductor reflex.

Results:

The results of the sensory and swallowing function assessments performed on 22 patients demonstrate abnormal sensation in 54.5% of the tested population. Asymmetric findings were noted in 75% of these patients. There was no correlation noted between the presence of sensory deficits and the severity or duration of the disease.

Conclusions:

Progressive dysphagia in the ALS population has typically been attributed to muscle weakness. This study points to the presence of sensory deficits in the larynx, which can further affect proper swallowing function.
Carbon Dioxide Laser Fiber for Laryngeal Cancer Surgery
Authors: Zeitels Steven M. , Kobler James B. , Heaton James T. , Faquin William
Published: October 2014

Objectives:

The carbon dioxide laser has evolved to be the premier dissecting instrument for hemostatic cutting during endolaryngeal cancer resection. However, dissection is limited to mirror-reflected line-of-sight delivery of the laser. A recently developed flexible, hollow photonic bandgap fiber (PBF) appears to offer advantages in endolaryngeal dissection.

Methods:

The suitability of the PBF for human application was evaluated in a canine experiment in which human surgical procedures for microlaryngoscopic en bloc partial laryngectomy were simulated. The specimens that were resected endoscopically and the completion laryngectomy specimen were evaluated histologically.

Results:

Observations from this experiment revealed that en bloc partial laryngectomy procedures were substantially easier to achieve as compared with prior experience in humans. This improvement resulted from three factors: 1) enhanced tangential dissection due to increased angulation of the laser energy, 2) enhanced procedural orientation due to proprioception of the tissues in contact mode, and 3) improved hemostasis. Histopathologic analysis of the resection margins revealed minimal thermal trauma.

Conclusions:

The PBF shows substantial promise for human application in endoscopic partial laryngectomy. It will likely enhance the ability of any surgeon to extend his or her indications for performing endoscopic laryngeal cancer resections regardless of philosophy (en bloc resection or piecemeal).
Classroom Performance of Children with Cochlear Implants in Mainstream Education
Authors: Damen Godelieve W. J. A. , van den Oever-Goltstein Marilène H. L. , Langereis Margreet C. , Chute Patricia M. , Mylanus Emmanuel A. M.
Published: October 2014

Objectives:

We compared classroom performance of children with a cochlear implant (CI) with that of their normal-hearing peers in mainstream education.

Methods:

Thirty-two CI children in mainstream education, congenitally or prelingually deaf, participated in this study, as did 37 hearing classmates. Their teachers filled out 2 questionnaires: the Assessment of Mainstream Performance (AMP) and the Screening Instrument for Targeting Educational Risk (SIFTER). A high Fletcher index and open-set speech perception scores were obtained.

Results:

The children with CIs scored above average on the AMP and sufficiently well in all but one area (communication) of the SIFTER questionnaire. Class rankings did not differ significantly between the CI students and their normal-hearing peers. Overall, the normal-hearing group outperformed the CI group. The classroom performance of CI children correlated negatively with duration of deafness and age at implantation. All longitudinal audiological data of the CI children showed improvement in open-set speech recognition.

Conclusions:

Although the results are encouraging, the CI group scored significantly less well than their normal-hearing peers on most questionnaire domains of both the AMP and the SIFTER. The most important variables for the outcome in this study were age at implantation and duration of deafness.
Thyroglossal Duct Cyst with Intralaryngeal Extension
Authors: Soliman Ahmed M. S. , Lee Joseph M.
Published: October 2014

Objectives:

Thyroglossal duct cysts with intralaryngeal extension are rare. We present only the 10th reported case in the literature.

Methods:

The clinical presentation, diagnosis, and treatment of the patient are reviewed and summarized. The uniqueness of the case, as well as the diagnostic and treatment pitfalls of this subgroup of patients, is presented.

Results:

Our patient, at 76 years of age, is the only woman and the oldest person reported to have had a thyroglossal duct cyst with intralaryngeal extension.

Conclusions:

Intralaryngeal extension should be considered when there is hoarseness, dysphagia, or dyspnea associated with a thyroglossal duct cyst. Office laryngoscopy and computed tomography make the diagnosis. Care must be taken with airway management and intraoperative dissection for good outcomes.
The Widely Patent Cochleovestibular Communication of Edward Cock is a Distinct Inner Ear Malformation: Implications for Cochlear Implantation
Authors: Khan Aayesha M. , Levine Stephen R. , Nadol Joseph B.
Published: October 2014

Objectives:

In 1838, Edward Cock described the anatomic findings in 4 inner ears with a widely patent communication between the cochlea and the vestibule that is now frequently referred to as the “common cavity deformity” and is often confused with Michel's “otocyst deformity.” Little is known about the anatomic characteristics, including the presence of neural elements in this malformation.

Methods:

Light microscopy and 2-dimensional and computerized 3-dimensional reconstructions were used to determine the histopathology and spiral ganglion cell counts in 7 temporal bones with a widely patent cochleovestibular communication.

Results:

In all 7 specimens, the cochlea, vestibule, and semicircular canals were distinguishable and a bony defect resulting in an abnormal communication of perilymphatic space between the cochlea and vestibule was present. The ductus reuniens was abnormally wide in all. The cochlear duct varied from less than 1 turn to up to 2 turns. The mean spiral ganglion cells were estimated as a percentage of age-matched normal controls at 2.3%, 16.5%, and 26.8% when the cochlea was approximately 1, 1½, and 2 turns, respectively (p = .007). The cribrose area consisted of a thin membrane in 2 specimens, and Rosenthal's canal openly communicated with the cerebrospinal fluid space in 3 specimens. The stapes footplate was abnormal in all 7 specimens and consisted of a central defect bridged by a thin membrane in 4 specimens. The facial nerve was dehiscent in 5 specimens (71%) and also followed an anomalous course in 2 specimens (28%).

Conclusions:

The widely patent cochleovestibular communication is a distinct inner ear malformation, recognition of which may have important clinical implications. Estimates of spiral ganglion cells can be predicted from the number of cochlear turns. Although cochlear implantation is feasible in patients with this malformation, a higher risk of cerebrospinal fluid gushers, facial nerve injuries, meningitis, and poor performance would be predicted. A better understanding of the anatomy will allow more effective surgical planning and techniques and may have a significant impact in improving outcomes.
Risk of Second Primary Malignancy after Radioactive Iodine Treatment for Differentiated Thyroid Carcinoma
Authors: Bhattacharyya Neil , Chien Wade
Published: October 2014

Objectives:

The association between second primary malignancy (SPM) and radioactive iodine (RAI) is controversial. We examined the association between RAI and SPM after treatment of differentiated thyroid carcinoma (DTC) using a large cohort from a national cancer database.

Methods:

From the Surveillance, Epidemiology and End Results (SEER) database, all index cases of DTC (papillary or follicular) were extracted for the years 1988 to 2001. Two cohorts were constructed: 1) patients with DTC who were not treated with RAI, and 2) patients with DTC who were treated with RAI. For each cohort, we tabulated all subsequent malignancies for each patient, identifying patients in each group with 1 or more SPMs.

Results:

According to inclusion criteria, 18,882 cases of DTC treated without RAI (mean follow-up, 55.5 months) and 10,349 cases treated with RAI (mean follow-up, 61.8 months) were identified. The most common SPM sites were breast or prostate followed by colon or lung for both groups. On univariate analysis, SPMs developed in 6.7% of patients without RAI versus 4.8% of those with RAI (p > .001, univariate χ2). However, on multivariate analysis, only age and male gender had statistically significant hazard ratios (1.052 and 1.438, respectively; p > .001); follicular carcinoma histology and use of RAI did not influence occurrence of SPM after DTC (p = .180 and p = .789, respectively).

Conclusions:

Use of RAI does not elevate the risk of SPM. Concern about SPM induction should not adversely affect the decision to administer RAI for DTC.
Submucosal Minimally Invasive Lingual Excision: An Effective, Novel Surgery for Pediatric Tongue Base Reduction
Authors: Maturo Stephen C. , Mair Eric A.
Published: October 2014

Objectives:

The aim of this study was to develop an effective single intraoral, minimally invasive technique to reduce the enlarged tongue base in children with obstructive macroglossia.

Methods:

We present the anatomic dissection of fresh cadavers and a representative case series of children who underwent submucosal minimally invasive lingual excision (SMILE) with a plasma-mediated radiofrequency device (coblation) under intraoral ultrasonic and endoscopic guidance. Multiple anatomic dissections determined the relative location of the hypoglossal nerve and lingual neurovascular bundle in relation to removable tongue base musculature. A pediatric case series demonstrates the straightforward SMILE technique.

Results:

Laboratory anatomic dissection and clinical lingual ultrasonography revealed the surgical safety borders for SMILE. The surgical safety and efficacy of SMILE is demonstrated by preoperative and postoperative clinical examinations and polysomnograms in children with obstructive macroglossia (such as Beckwith-Wiedemann and Down syndromes and tongue vascular malformation). Coblation submucosally removes excessive tongue base tissue through a small anterior tongue incision. SMILE was performed without excessive pain, bleeding, edema, infection, or tongue dysfunction.

Conclusions:

SMILE is an effective novel operation that incorporates coblation with ultrasonography and endoscopic guidance for children who need tongue base reduction. Anatomic dissection and clinical cases demonstrate the potential for aggressive yet relatively safe tissue removal by this minimally invasive technique. SMILE also has significant potential for adults with obstructive sleep apnea due to a large tongue base.
Correlation of Radiologic Findings and Clinical Outcome in Pharyngeal Pouch Stapling
Authors: Tsikoudas Alexandros , Eason David , Kara Naveed , Brunton John N. , Mountain Rodney E.
Published: October 2014

Objectives:

We undertook to identify any correlation between radiologic findings and clinical outcome in pharyngeal pouch surgery.

Methods:

We performed a retrospective case control study in a teaching hospital in Dundee, Scotland. The subjects were 21 patients who underwent pharyngeal pouch stapling. We used a novel method to measure the characteristics of each pouch by focusing on a triangular area in the neck of the pouch.

Results:

A correlation was found between the radiologic preoperative findings and the clinical outcome. A short triangle was more likely to result in postoperative complications, whereas a long one was more likely to require revision surgery.

Conclusions:

It is possible to predict the surgical outcome from the radiologic characteristics of the diverticulum. We believe that our findings may have important clinical implications.
Effect of Steroids on Increased Permeability of Blood Vessels of the Stria Vascularis after Auditory Ossicle Vibration by a Drill in Otologic Surgery
Authors: Hashimoto Kazuya , Seki Morihiro , Miyasaka Hiroe , Watanabe Kensuke
Published: October 2014

Objectives:

The vibration caused by drills used for middle ear surgery is considered one of the causes of postoperative sensorineural deafness. Seki et al reported that when drill-induced damage was created in the auditory ossicles of guinea pigs, permeability across the capillary vessels in the stria vascularis increased significantly with the duration of drill-induced vibration. The present study was undertaken to examine changes in permeability across the stria vascularis capillaries following vibration in experimental animals pretreated with steroids, with the goal of developing a method of preventing a vibration-induced increase in permeability across these capillaries.

Methods:

After an intravenous dose of hydrocortisone and horseradish peroxidase, the auditory ossicles of guinea pigs were vibrated with a drill for 60 seconds.

Results:

Intravenous steroid administration before vibration reduced the leakage of horseradish peroxidase from the stria vascularis capillaries after vibration.

Conclusions:

The findings suggested that steroids suppress the increase in permeability across the stria vascularis capillaries that results from drill-induced vibration.
Ambulatory Monitoring of Disordered Voices
Authors: Hillman Robert E. , Heaton James T. , Masaki Asa , Zeitels Steven M. , Cheyne Harold A.
Published: October 2014

Objectives:

Recently developed systems for ambulatory monitoring of voice use employ miniature accelerometers placed at the base of the anterior neck to sense phonation. As it is hoped that such systems will help improve the clinical assessment and management of voice disorders, this study was undertaken to determine the impact of dysphonia severity on the accuracy of accelerometer-based estimates of vocal function.

Methods:

Simultaneous recordings were made of oral acoustic (microphone) and neck skin acceleration signals for 6 normal speakers and 18 patients with voice disorders (mild to severe dysphonia) as they performed several speech tasks. Measures of phonation time, fundamental frequency, and sound pressure level were extracted from the Two types of signals and compared.

Results:

It was generally demonstrated that accelerometer-based measures closely approximated corresponding measurements obtained from a microphone signal across all levels of dysphonia severity. Furthermore, there was evidence that in some cases the accelerometer may actually represent a more robust approach for estimating phonation parameters in disordered voices.

Conclusions:

The results generally support the recent application of accelerometers as phonation sensors in ambulatory voice monitoring systems that can be used in the clinical assessment and management of voice disorders.
Validations of a Portable Home Sleep Study with Twelve-Lead Polysomnography: Comparisons and Insights into a Variable Gold Standard
Authors: Michaelson Peter G. , Allan Patrick , Chaney John , Mair Eric A.
Published: October 2014

Objectives:

Accurate and timely diagnosis for patients with obstructive sleep apnea (OSA) is imperative. Unfortunately, growing interest in this diagnosis has resulted in increased requests and waiting times for polysomnography (PSG), as well as a potential delay in diagnosis and treatment. This study evaluated the accuracy and viability of utilizing SNAP (SNAP Laboratories, LLC, Wheeling, Illinois), a portable home sleep test, as an alternative to traditional PSG in diagnosing OSA.

Methods:

This prospective clinical trial included 59 patients evaluated at our institution's sleep laboratory. Concurrent PSG and SNAP testing was performed for 1 night on each patient. Independent, blinded readers at our institution and at an outside-accredited institution read the PSG data, and 2 independent, blinded readers interpreted the SNAP data at SNAP laboratories. The apnea-hypopnea index (AHI) was used to compare the 2 testing modalities. The correlation coefficient, receiver operating characteristic curve analysis, and the Bland-Altman curves, as well as sensitivity, specificity, inter-reader variability, positive predictive value, and negative predictive value, were used to compare SNAP and PSG.

Results:

There is a definitive, statistically sound correlation between the AHIs determined from both PSG and SNAP. This relationship holds true for all measures of comparison, while displaying a concerning, weaker correlation between the different PSG interpretations.

Conclusions:

There is a convincing correlation between the study-determined AHIs of both PSG and SNAP. This finding supports SNAP as a suitable alternative to PSG in identifying OSA, while accentuating the inherent variation present in a PSG-derived AHI. This test expands the diagnostic and therapeutic prowess of the practicing otolaryngologist by offering an alternative OSA testing modality that is associated with not only less expense, decreased waiting time, and increased convenience, but also statistically proven accuracy.
Comparison of Functional Outcomes after Endoscopic versus Open-Neck Supraglottic Laryngectomies
Authors: Peretti Giorgio , Piazza Cesare , Cattaneo Augusto , De Benedetto Luigi , Martin Eva , Nicolai Piero
Published: October 2014

Objectives:

Endoscopic supraglottic laryngectomy (ESL) by carbon dioxide laser for selected T1-T3 supraglottic squamous cell carcinomas is a sound procedure with oncological results comparable to those obtained by open-neck supraglottic laryngectomy (ONSL). The aim of this study was to retrospectively evaluate functional outcomes after ESL in comparison with ONSL.

Methods:

We performed perceptual voice evaluation by GRBAS (grade, roughness, breathiness, asthenicity, strain), subjective analysis by Voice Handicap Index, objective analysis with the Multidimensional Voice Program, swallowing evaluation with the M. D. Anderson Dysphagia Inventory, video nasal endoscopic examination of swallowing, videofluoroscopy, and analysis of hospitalization time, need for and duration of feeding tube and tracheotomy, and complication and aspiration pneumonia rates in a group of 14 patients treated with ESL. These results were compared to those obtained in a historical group of 14 patients matched for T category who were treated with ONSL at the same institution. Statistical analysis was performed with the Mann-Whitney U and Pearson χ2 tests.

Results:

Comparison of comprehensive voice analysis, M. D. Anderson Dysphagia Inventory, and complication and aspiration rates showed no statistically significant differences between the Two groups. However, significant differences were found for video nasal endoscopic examination of swallowing (p = .03), videofluoroscopy (p = .03), hospitalization (p = .0001), feeding tube duration (p = .0001), and tracheotomy duration (p = .0001).

Conclusions:

Endoscopic supraglottic laryngectomy had a significantly lower functional impact on swallowing than ONSL, even though it was not subjectively perceived by patients, and was associated with less morbidity and a shorter hospitalization time.