bluuebunny/crossref_metadata_2025 huggingface dataset:
SLNB and Outcomes in Cutaneous Melanoma of the Head and Neck
Authors: Smith Valerie Alison , Lentsch Eric J. , Cunningham Joan E.
Published: September 2011

Objective

Among patients with cutaneous melanoma of the head and neck (CMHN) and ≥1 positive sentinel lymph node (SLN): 1) Determine if completion regional lymphadenectomy (RL) is associated with improved survival.2) Determine if survival differs between patients with 1 and >1 positive SLN.

Method

Using the Surveillance Epidemiology and End Results (SEER) database, years 1998 to 2007, we identified 5,399 patients with primary CHNM who underwent excisional surgery and examination of ≥1 lymph node with follow‐up >12 months. Clinicopathologic and outcomes data were examined using chi‐square tests.

Results

In preliminary analysis, 495 patients had 1 positive node and 387 had >1 positive node. Disease‐specific survival (DSS) was statistically different between these 2 groups (64% and 47%), respectively, chi‐square p1 node were involved (P =. 112 and. 891 respectively).

Conclusion

In this simple preliminary analysis, CHNM patients with >1 positive lymph node had poorer survival compared with patients with a single positive lymph node. Among patients with SLN‐positive CHNM, regional lymphadenectomy did not improve survival compared with patients who underwent SLNB alone. Formal survival analyses results will be presented.
Snail Drives Erlotinib Resistance in Head and Neck Squamous Cell Carcinoma Cells
Authors: Dennis Miranda S. , Wang Guanyu , Luo Jie , Dubinett Steven , Sidell Douglas R. , Abemayor Elliot , St. John Maie
Published: September 2011

Objective

Snail positivity is predictive of poorly differentiated, invasive, and regionally metastatic HNSCC tumors. We have demonstrated the role of Snail in the inflammation‐induced promotion of EMT. Here, we investigate the capacity of Snail to drive EMT in human oral epithelial cell lines, and its ability to confer drug resistance.

Method

Snail was overexpressed in HOK and OKF oral epithelial cell lines. AIG assays, wound healing assays, invasion and migration assays, spheroid modeling, and drug resistance assays were performed. Differential gene expression between Snail‐overexpressing and control epithelial and tumor cell lines was evaluated using gene expression microarray analysis.

Results

The overexpression of Snail in human oral epithelial cell lines (HOK, OKF) drives EMT. OKF‐Snail and HOK‐Snail lines demonstrate growth in anchorage‐independent growth assays; a decreased capacity to form tight spheroids; increased resistance to erlotinib; and a highly invasive and migratory nature. Gene expression analysis also revealed Snail‐associated differential gene expression with the potential to affect inflammatory cytokine regulation, migration, invasion, and diverse aspects of HNSCC progression.

Conclusion

Snail controls the mesenchymal phenotype and drives erlotinib resistance in HNSCC cells. Snail may prove to be a useful marker in predicting EGFR inhibitor responsiveness.
Anthropometric Study of the Caucasian Nose in the City of Curitiba: Importance of Population Assessment
Authors: Ballin Annelyse C. , Carvalho Bettina , Sarraff‐Berger Cezar A. , Mocellin Marcos , Becker Renata V.
Published: September 2011

Objective

1) Evaluate the aesthetic parameters of Caucasian noses of Curitiba, Brazil, and compare them with standard aesthetic ideals from the literature.

Method

Prospective cohort study through assessment of anthropometric measurements (intercanthal width [IW], alar width [AW], length, nasofrontal angle [NFA], nasolabial angle [NLA], nasal tip projection) of the Caucasian noses from photographs and comparison with the ideal of literature, with statistical analysis.

Results

A total of 100 volunteers were evaluated, including students and employees connected to the Health Department of HC/UFPR. Met IW0 (sd:8), NLA range 105,430 (sd:10,5) and nasal tip projection 0.63 (GoodeMethod) and 2.1:1 (Baum Method). The naso‐frontal angle showed statistical significance between genders (p = 0.0008).

Conclusion

Caucasian noses of Curitiba are shorter, with a wider base, and less projected than the aesthetic ideal, showing possible miscegenation of the population and the importance of population studies for evaluation, preoperative counseling, and surgical planning.
Survival Based on Smoking Status in Head and Neck Cancer
Authors: Emerick Kevin S. , Diephuis Bradford , Michaelson James , Busse Paul , Jara Sebastian , Deschler Daniel G. , Clark John
Published: September 2011

Objective

1) Assess the impact of smoking status on disease‐specific and overall survival in head and neck cancer. 2) Identify subsite specific differences in survival related to smoking status.

Method

Retrospective analysis of a single institution database from 1980 through 2008. Patients were categorized by site of primary tumor and smoking status. Kaplan Meier analysis was used to calculate survival, and log rank and chi square analysis were used to identify significant differences.

Results

Significant overall and disease‐specific survival differences were observed between current, previous, and non‐smokers. Current smokers had a lower survival in all subsites except for oral cavity. The biggest differences were observed in the oropharynx subsite. 5‐year disease‐specific survival for oropharyngeal cancer was: current smokers 57.0%, non‐smokers 86.9%, and previous smokers 81.8% (P <. 05). Similar overall survival differences were observed. Smoking status did not impact on overall or disease‐specific survival in oral cavity cancer.

Conclusion

While a significant focus in head and neck cancer has been on HPV and tumor biomarkers, it is important to recognize smoking as an important factor in survival outcome for head and neck cancer. Both nonsmokers and previous smokers have a survival advantage over current smokers.
Targeted Endoscopic Nasopharyngectomy for Recurrent NPC
Authors: Ho Allen S. , Sunwoo John B. , Kaplan Michael J. , Yao Mike , Hwang Peter H. , Fee Willard E.
Published: September 2011

Objective

Evaluate targeted endoscopic nasopharyngectomy as a viable oncologic alternative to open nasopharyngectomy or radiation for recurrent nasopharyngeal carcinoma (NPC).

Method

A retrospective analysis at an academic medical center was performed for 13 patients who underwent endoscopic nasopharyngectomy for recurrent NPC (August 2005 to August 2010). Three patients had neck metastases for which a neck dissection was concurrently planned. Outcomes measured included 2‐year disease‐free survival, 2‐year overall survival, and complication rates.

Results

Including resections for subsequent recurrences, 19 endoscopic procedures were performed. Average age was 55.7 years, with mean follow‐up period 24.2 months. Mean OR time was 278 minutes, mean estimated blood loss was 197 ml, and mean hospitalization was 1.0 day. Negative margins were obtained in 78.9%: positive margins involved the parapharyngeal space, oropharynx, fossa of Rosenmuller, and infratemporal fossa. Four patients required repeat endoscopic nasopharyngectomy for re‐recurrence, despite having margins cleared or controlled with adjuvant treatment. Two‐year local disease‐free and overall survival rates were 69.2% and 100.0%, respectively. The complication rate was 52.6%, with no major complications.

Conclusion

Targeted endoscopic nasopharyngectomy is beneficial in recurrent NPC, with favorable morbidity and complication rates. Endoscopic surveillance facilitates identification of re‐recurrences, which often may be treated with additional directed resection. Stereotactic radiation may serve as an appropriate adjunct modality for disease control at positive margins.
The Effect of Treating Institution on Outcomes in HNCA
Authors: Lassig Amy Anne D. , Lindgren Bruce , Reynolds Margaret , Fernandes Patricia , Khariwala Samir , Yueh Bevan
Published: September 2011

Objective

Factors leading HNCA patients to seek radiation in a community vs academic center are incompletely described as are the effects of treating institution on outcomes. We investigated HNCA patient characteristics associated with community vs academic radiation, likelihood of successful treatment completion in both settings, and resulting survival data.

Method

A retrospective chart review was completed of all mucosal head and neck cancer patients who were treated at our institution from 2003 to 2008. Patients who received primary and adjuvant radiation were included. Numerous demographic and clinical variables were recorded, and statistical analysis was completed.

Results

A total of 386 patients were identified of which 146 patients completed treatment in the community and 213 at an academic center (27 excluded, location unknown). There was no significant difference in rate of planned treatment completion between community (94.5%) and academic centers (93.8%) (P = 1.000), or rate of treatment breaks, 23.1% and 26.9%, respectively (P =. 506). The academic group, however, had more advanced disease (P =. 021). The survival rate over time was statistically significant (P =. 003), with academic hospitals having better survival. The 5‐year survival rate for academic and community hospitals was 55.9% (95% CI = 48.1% ‐ 63.7%) and 42.9% (95% CI = 31.1% ‐54.6%), respectively.

Conclusion

At our institution, HNCA patients more frequently received radiation in an academic clinic. While rate of treatment completion and treatment breaks were similar between academic and community centers, academic centers treated more advanced cancer. Despite this, survival rates were better in patients treated in an academic setting.
Voice Quality after Recurrent Laryngeal Nerve Resection and Primary Reconstruction
Authors: Rohde Sarah L. , Wiggleton Jamie G. , Muckala Jennifer , Netterville James L. , Wright Charles T. , Rousseau Bernard
Published: September 2011

Objective

Evaluate clinician and patient perception of voice quality in patients who have undergone resection of the recurrent laryngeal nerve (RLN) and primary operative reconstruction with anastomosis or nerve graft during thyroid surgery.

Method

Prospective observational study of 9 patients who underwent primary operative reconstruction of the RLN by the senior author from 2002 to present. Outcome measures included: 1) speech pathologist perception of voice scored using the GRBAS scale, 2) patient perception of voice assessed by the Voice Handicap Index (VHI) questionnaire, and 3) visual laryngeal analysis from videostroboscopy examinations.

Results

The RLN was reconstructed with primary anastomosis (4), free nerve graft (3), or vagus‐RLN anastomosis (2). Seven patients had voice samples and videostroboscopy examinations obtained at a minimum of nine months from surgery. Six were judged to have slight disturbance of voice based on overall Grade scoring (G = 1). Five rated their voice normal or with a mild degree of severity on the VHI questionnaire (score range, 8‐29). Laryngeal analysis revealed the immobile vocal fold in the median, physiologic phonating position with preserved bulk, recovered tension, and glottic closure during phonation. Two patients less than 9 months from surgery had expected severe self perceived voice quality.

Conclusion

Primary anastomosis, free nerve grafting, and vagus‐RLN anastomosis are viable options for RLN reconstruction. VHI scores are comparable to VHI scores of patients who have undergone silastic medialization laryngoplasty. Patients who undergo resection and immediate reconstruction of the RLN are able to regain self‐perceived functional and pleasing voices.
A Meta‐analysis of Injection Laryngoplasty vs Thyroplasty
Authors: Shen Tianjie , Morzaria Sanjay
Published: September 2011

Objective

Compare the long‐term voice outcome following calcium hydroxylapatite injection laryngoplasty (IL) vs silicone medialization laryngoplasty (ML) as the long‐term treatment modalities for the treatment of unilateral vocal fold paralysis (UVFP) through a meta‐analysis study.

Method

A systematic literature review was performed from MEDLINE, Google Scholar, Web of Science, Scopus, and Cochrane between January 1, 1980, and December 31, 2010. Studies reporting voice outcome after IL with calcium hydroxylappatite and/or ML with silicone for the treatment for UVFP were included. The primary outcome measure was change in Voice Handicap Index (VHI).

Results

Seven hundred and forty‐two abstracts were screened for relevancy. Seventy‐one articles were reviewed in detail. Twelve studies satisfied the inclusion criteria. The mean VHI score, following IL (n = 209), improved from 68.36 (±6.88) to 32.24 (±7.33). The mean VHI score, following ML (n = 110), improved from 72.22 (±11.06) to 34.02 (±6.48). The improvement in VHI following both techniques was statistically significant.

Conclusion

Injection laryngoplasty with calcium hydroxylapatite and medialization laryngoplasty with silicone offer comparable voice improvement as long‐term treatment modalities for UVFP. The choice of procedure should be based on planned duration of medialization, patient’s preference, and physician’s preference.
Complications of Thyroplasty Type I with Montgomery Implant
Authors: Laccourreye Ollivier , Ménard Madeleine
Published: September 2011

Objective

Document the incidence and risk factors for significant complications in patients with a unilateral laryngeal nerve paralysis managed with thyroplasty type I and Montgomery implant insertion.

Method

Inception cohort of 181 patients with 104 patients followed for a minimum of 12 months or until death. Data regarding significant complication were obtained at regular visits to our clinic. Univariate analysis was performed for potential statistical relation between the complications noted and various variables.

Results

The intraoperative and postoperative course was unremarkable in 85.6% and 92.3% of cases. No patient died from the procedure. Significant complications included Montgomery implant replacement by a Gore‐tex implant (7), difficulty to stabilize the implant (8), misplacement of the implant (3), hematoma (8), severe dyspnea (5), and extrusion of the implant (5). A 5.5% revision rate was found (10/181). No significant statistical relation was noted between the complications noted and the variables under analysis.

Conclusion

The reported data suggest that the Montgomery implant insertion is a safe technique with a low incidence for complication. The lack of a statistically significant difference between senior and junior surgeons also suggests the absence of a learning curve in this procedure.
Enhanced Laryngeal Suspension: A Preliminary Experience
Authors: Al Yaghchi Chadwan , Ferguson Louisa , Sandhu Guri
Published: September 2011

Objective

Describe and evaluate the effectiveness of enhanced laryngeal suspension on dyspagia and aspiration secondary to skull base surgery and lower cranial nerve injuries.

Method

Prospective study in a tertiary ENT unit between 2007 and 2010 of patients who underwent enhanced laryngeal suspension. Demographics, pathology, and cranial nerve injuries were documented. Nutrition, oral intake, and aspiration risk grade (G 0‐3) were compared pre‐ and postoperatively. All patients had videofloroscopy evaluation, and aspiration‐penetration scale changes were documented.

Results

Enhanced laryngeal suspension involves removal of the thyroid cartilage above the vocal folds and suture suspension to the hyoid bone. It can be combined with a medialization thyroplasty and botox to cricopharyngeus if indicated. To date we performed this procedure on 9 patients. At first presentation, 77% (n = 7) were nil by mouth. Today, only 22% (n = 2) remains NBM. Gastrostomy tube dependance dropped from 77% (n = 7) to 44% (n = 4), and of those only 2 are on total enteral feed. Aspiration risk improved through the follow‐up period (from 66% grade 3 down to 11%).

Conclusion

Enhanced laryngeal suspension is an important tool in the multimodality approach to management of dyspagia and aspiration caused by skull base surgery and lower cranial nerve injuries. This is a preliminary study with a small sample, and results must be interpreted with this in mind.
Evaluation of Safety of Endoscopic Harmonic Diverticulostomy
Authors: Whited Chad , Scher Richard L.
Published: September 2011

Objective

Review a series of patients with Zenker diverticulum who were treated with endoscopic diverticulostomy using Harmonic Ultrasonic Surgical Instrumentation (Ethicon Endosurgery, Cincinnati, Ohio) in order to evaluate the safety and optimal application of this technology to the treatment of patients with this disorder.

Method

Retrospective chart review of patients undergoing endoscopic surgical correction of Zenker diverticulum with Harmonic Ace curved shears between July 1, 2009 and November 1, 2010. Presenting symptoms, size of diverticulum, operative times, length of hospital stay, outcomes, and complications were reviewed.

Results

A total of 60 endoscopic diverticulostomies were performed, and 24 were Harmonic‐assisted. Eight required hospital stays, with their average stay being 2.13 days (0.7 days for all Harmonic patients). There were 6 complications with Harmonic treatments (25%). Two patients had chest pain with negative work‐ups. Two patients had subcutaneous air. One had a documented salivary leak. One patient had diverticulum recurrence. No patients had hemorrhage, mediastinitis, or death. The average diverticulum size was 3.24 cm, and there were no complications with diverticula less than 2 cm. There were two complications with the staple technique (6.45%).

Conclusion

Endoscopic staple diverticulostomy is a proven safe treatment for Zenker diverticulum with few limitations. Harmonic instrumentation may be effective with diverticula less than 2 cm. However, based on observed complication rates, additional evaluations are warranted before endoscopic Harmonic diverticulostomy can be recommended as treatment for the majority of cases.
Histologic vs pH Probe Results in Laryngopharyngeal Reflux
Authors: Andrews Thomas
Published: September 2011

Objective

Laryngopharyngeal reflux (LPR) is well documented in children. However, methods of obtaining accurate diagnosis are controversial. As a prelude to establishing normative values in children, we retrospectively reviewed comparison data of 63 consecutive children tested by pH probe and post‐cricoid biopsy.

Method

Sixty‐three consecutive patients with symptoms of reflux without evidence of sinusitis, allergic rhinitis, or adenoid disease were studied by pH probe (Restech Dx Measurement System, San Diego, California) simultaneous with posterior cricoid biopsy (our previous diagnostic method). All testing was done through outpatient ambulatory surgery under general anesthesia.

Results

Of the 63 total patients (age 6 months‐17 years), 37 (60%) were positive for reflux by probe with a negative biopsy. Eleven (17%) tested negative to probe and biospy. Ten (15%) were excluded (pulled probe). Five (8%) were positive by probe and biopsy.

Conclusion

Normative values in children have not been determined in this instrument. We believe it may offer a satisfactory diagnostic tool. These results, and previous studies, suggest that pH probe testing is superior to histologic diagnosis in determining LPR. However, normative values must be determined in children prior to further comparative studies.
Long‐Term Repeated Cricopharyngeal Dilatation for OPMD
Authors: Manjaly Joseph G. , Corlett Jonathan C. , Dale Oliver , Vaughan‐Shaw Peter G. , Frost Roger
Published: September 2011

Objective

Oculopharyngeal muscular dystrophy (OPMD) is a rare, autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. Cricopharyngeal myotomy improves symptoms, yet dysphagia frequently recurs, failing to prevent aspiration and enteral feeding. The objective is to evaluate safety and efficacy of repeated endoscopic dilatation for OPMD over a 15‐year period.

Method

All patients at our unit with genetically confirmed OPMD were included. Cricopharyngeal dilatation was performed with a wire‐guided 18 mm Savary‐Gilliard bougie. Repeat dilatation was offered when symptoms recurred. Symptom severity prior to initial dilatation and at follow‐up was evaluated using the Sydney Swallow Questionnaire (SSQ).

Results

Nine patients (7 female, 2 male) were included. Median total treatment period was 13 years (range, 3‐15 years), median number of dilatations per patient was 7.2 (1‐16), and median interval between treatments was 15 months (range, 4.5‐45 months). All patients recorded sustained symptom improvement. Mean SSQ score was 1108 out of 1700 (SD ± 272.9) prior to first dilatation and 298 out of 1700 (SD ± 189.1) at last follow‐up, representing a 73% decrease (95% CI 52‐94) in degree of dysphagia symptoms (Paired t test, P =. 0001). All mean scores for individual questions also showed significant improvement (P <. 05). No adverse events were reported with all patients maintaining oral feeding at last follow‐up.

Conclusion

Repeated cricopharyngeal dilatation is a safe, effective, well‐tolerated, and long‐lasting treatment for dysphagia in OPMD.
Mometasone Furoate in Patients with Eosinophilic Esophagitis
Authors: Bergquist Henrik , Larsson Helen , Johansson Leif , Bove Mogens
Published: September 2011

Objective

The treatment of patients with eosinophilic esophagitis remains challenging. The effects of the current first‐choice treatment, ie, topical corticosteroids, are still inadequately surveyed. Our aim was to assess dysphagia and health‐related quality of life using validated scales and questionnaires before and after treatment with mometasone furoate.

Method

Newly diagnosed, untreated adult patients with eosinophilic esophagitis were included and given 200 µg of orally administered topical mometasone furoate 4 times daily. Questionnaires, incorporating the Watson Dysphagia Scale, the EORTC QLQ‐OES18, and the SF‐36, were completed before and after 2 months of treatment.

Results

Thirty‐one consecutive patients (22 males, mean age 45, range 18‐89) completed the trial. At inclusion, the mean scores of the Watson Dysphagia Scale, the EORTC QLQ‐OES18 dysphagia scale, eating scale and choking item, and the SF‐36 global health dimension and social functioning dimension were 21.3, 20.4, 35.0, 38.6, 71.1, and 82.3, respectively. Posttreatment, these scores improved to 8.9 (P <. 0001), 4.6 (P <. 00001), 17.8 (P <. 001), 16.0 (P <. 01), 76.1 (P <. 05) and 91.9 (P =. 0001), respectively. Except for one case of oral candidiasis, no significant side effects were reported.

Conclusion

Treatment with 2 months of orally administered mometasone furoate seems to have a beneficial effect on dysphagia and health‐related quality of life in the majority of adult patients with eosinophilic esophagitis. However, a randomized placebo‐controlled trial is warranted in order to verify this.
Pulse Steroid Therapy Inhibits Murine Subglottic Granulation
Authors: Ghosh Ankona , Einhorn Eugene , Lee Jennifer , Mirza Natasha , Singhal Sunil , Leahy Kevin , Cohen Noam A.
Published: September 2011

Objective

Using a functional model of airway granulation tissue in subglottic stenosis, we investigated changes in inflammatory markers within granulation tissue in response to intraperitoneal dexamethasone injections. Changes in inflammatory markers will allow us to identify potential targets for immunological therapy.

Method

Laryngotracheal complexes (LTCs) of donor mice underwent airway injury. Donor LTCs were transplanted into subcutaneous tissue of recipient mice in 2 groups: steroid‐treated and untreated. The steroid‐treated arm received intraperitoneal dexamethasone for 3 weeks. LTCs were then harvested. Granulation formation was measured; mRNA expression of TGF‐beta and IL‐1b was quantified.

Results

At 3 weeks’ posttransplantation, there were statistically significant differences in observable granulation formation as well as mRNA expression of TGF‐beta 1 and IL‐1b in all groups within the steroid treated arm as compared to the untreated arm.

Conclusion

Systemic steroids have been used to prevent formation of granulation tissue. However, the study of immunologic markers and the corresponding changes with steroid treatment has not been well studied in animal models. Using a previously described novel murine model, we begin to delineate inflammatory markers for potential therapeutic targets.
The Effect of Singing on Laryngopharyngeal Reflux
Authors: Fink Daniel Steven , Bhatnagar Sugam , Song Phillip , Bunting Glenn
Published: September 2011

Objective

While there has been widespread conjecture regarding the role of laryngopharyngeal reflux in singing, there remains no objective data demonstrating that voice use causes increased reflux. We attempted to objectively analyze pharyngeal pH changes during singing to better understand how it is affected by singing.

Method

Eight singers underwent 24‐hour pharyngeal pH probe testing with the Restech Dx‐pH measurement systemTM, one hour of which was spent singing. The mean pH and number of pH drops were recorded. A one‐tailed t test was used to compare the mean pH of the time singing with the 2 control values.

Results

The mean pH for the control time was 6.8347, for the control time without the time supine was 6.9164, and for the time singing was 7.0286. We were thus able to reject the null hypothesis that singing decreases laryngeal pH (P =. 035). There was an increase in mean pH during the time singing as compared with the 2 control groups.

Conclusion

While singers may have increased reflux complaints, our data suggest that the singing itself does not cause an increase in acid exposure to the laryngopharynx.
Validation of a Theater‐Based Immersive Microlaryngoscopy Simulator
Authors: Fleming Jason , Sevdalis Nick , Harries Meredydd , Kapoor Karan
Published: September 2011

Objective

Assess the face and construct validity of 2 assessment tools: a Checklist Assessment for Microlaryngeal Surgery (CAMS) and a Global Rating Assessment for Microlaryngeal Surgery (GRAMS) on a new theater‐based immersive microlaryngscopy simulator.

Method

Fifteen candidates were divided into the novice or experienced group depending on their previous microlaryngoscopy experience. Each candidate undertook a 10‐minute simulation of a microlaryngoscopy and excision biopsy, and 2 blinded experts rated their performance live. Candidates subsequently completed a questionnaire on their opinion of the simulator.

Results

The model demonstrated good face validity across all levels of experience. The GRAMS demonstrated excellent interrater reliability (0.9) compared with the CAMS (0.7). The CAMS assessment was able to differentiate experienced and novice candidates and, therefore, demonstrated construct validity. The GRAMS tool, however, was unable to differentiate candidates. There was a significant correlation between the 2 assessment tools (correlation coefficient = 0.624).

Conclusion

This study is the first reported trial of a high fidelity microlaryngoscopy simulator with task‐specific rating tools. Use of these tools is recommended within otolaryngology training programs, with GRAMS for use as a frequently used feedback tool and CAMS as a confirmatory evaluation of competency at transitions of professional training.
Vocal Cord Lesions in Professional Voice Users
Authors: Azevedo Julia , Cruz Camilla , Mury Isabelle , Osorio Marcio , Steffen Ricardo E. , Quintão Everson , Rangel Gustavo
Published: September 2011

Objective

The aim of this study was to survey professional voice users referred to an otorhinolaryngology center in a tertiary hospital in Rio de Janeiro, Brazil, and evaluate the incidence of vocal cord diseases in these patients.

Method

Professional voice users’ records were analyzed using database from a videolaryngoscopic service in a tertiary hospital, from January 2000 to 2010. Patients’ diagnoses were divided into the following categories: nodules, polyps, minor structural changes, Reinke edema, papilloma, neoplasm, vocal fold palsy, functional dysphonia, vocal cord paralyis, and laryngitis. Age, gender, and smoking habit were also annotated.

Results

A total of 409 professional voice users were referred to the otorhinolaryngology service. The majority of patients were female (69.3%). Dysphonia was the most common complaint, found in 76.3% of patients. The most common vocal cord lesions were polyps, found in 13.7% of patients. Laryngitis due to laryngopharyngeal reflux was found in 11.3% of patients, followed by vocal cord cysts, found in 8.1% of patients. Reinke edema was found in 5.6% of patients. The examination was normal in 45.2% of patients. Smoking was found in 19.7% of patients with any abnormal finding and only 9.7% of patient with no visible alterations (OR = 2.3, CI = 1.3‐4.1).

Conclusion

Professional voice users are at increased risk of vocal cord lesions. In this study, the most common lesions identified were polyps. Followed by laryngitis due to laryngopharyngeal reflux disease. Smoking was higher in the group with abnormal findings. Smoking cessation is an important aspect of the treatment of professional voice users.
Voice Quality of Life after Type II Thyroplasty for Spasmodic Dysphonia
Authors: Sanuki Tetsuji , Kodama Narihiro , Yumoto Eiji
Published: September 2011

Objective

1) Determine the effectiveness of type II thyroplasty for adductor spasmodic dysphonia (AdSD), through perceptual and accoustic analysis. 2) Assess the pre‐ and postoperative quality of life of AdSD patients using the Voice Handicap Index‐10 (VHI‐10).

Method

Retrospective study. Twelve patients with AdSD underwent type II thyroplasty between March 2007 and December 2010. Measured outcomes included perceptual assessment, acoustic analyses (DVB, SDF0, jitter, shimmer, and HNR), and VHI‐10 and were performed prior to and six months or more after surgery. VHI‐10 and acoustic evaluation scores were compared.

Results

Average follow‐up interval was 12.6 months. In perceptual analysis (GRBAS), overall grade and strain significantly improved after surgery (P =. 0017, P =. 0002). There were no significant difference in roughness, breathiness, and asthenia. In acoustic analysis, DVB, SDF0, jitter, shimmer, and HNR (P =. 039, P =. 0003, P =. 0016, P =. 0011, P =. 0003) improved significantly after surgery. Mean VHI‐10 scores significantly improved from a mean of 26.5 to 3.75.

Conclusion

Treatment of AdSD with type II thyroplasty significantly improved voice‐related quality of life and acoustic findings. The study revealed a significant relationship between the acoustic parameters and the VHI‐10. The results confirmed that VHI‐10 can be a valuable tool for assessing type II thyroplasty for AdSD.
Comparing Facial Nerve Grading Systems: House‐Brackmann to Automated
Authors: Lee Linda N. , Henstrom Douglas , Cheney Mack , Hadlock Tessa
Published: September 2011

Objective

1) Evaluate the feasibility of an automated zonal facial function grading system through comparison with the House‐Brackmann II (HBII) scale. 2) Determine whether such a computerized tool for facial analysis patients can provide objective, accurate, and reproducible assessment in both global and zonal regions of the face.

Method

A prospective clinical trial was performed with 77 consecutive new facial paralysis patients undergoing standardized facial videography. Videos were independently scored by 3 facial nerve specialists using the HBII scale. Subsequent digital analysis was performed with Facogram software, and computer‐generated scores were recorded and compared.

Results

Interobserver correlation was high using the HBII scale, with correlation coefficients of 0.81, 0.86, and 0.84. Automated Facogram scores correlated well with manual HBII (scores were within 1.0 ± 0.59, 1.4 ± 1.1, 1.1 ± 1.0, 1.1 ± 0.8, and 1.4 ± 0.8 for overall grade, brow, eye closure, nasolabial fold, and oral commissure, respectively). The HBII required more clinician time to calculate, with an average of 72 ± 21 seconds per case, compared with the Facogram which did not require any clinician time. Specific patient characteristics and video techniques that improved accuracy of the software were identified.

Conclusion

An automated, zone‐specific facial analysis tool would eliminate inter‐rater subjectivity and allow assessment of facial paralysis patients in a standardized manner across geographic regions and medical specialties. Facogram correlates well with the HBII system. Clinicians should understand the ideal patient population and videotaping technique to optimize accuracy of the program.
A Study of Antibacterial and Antifungal Properties of Human Cerumen
Authors: Singh Rohit , Bairey Indira , Gupta Sumit
Published: September 2011

Objective

This study investigates the effect of human cerumen on the growth of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans and describes the order of inhibition of the bacteria and fungi.

Method

Prospective study on 100 cerumen samples using Nutrient agar and SDA as culture medium was performed. Serial 10‐fold dilutions using 3.5% cerumen suspension was incubated at 37°C for 12 hours. Ten microliters of each dilution were inoculated on blood agar and incubated for 24 hours.

Results

Of 100 samples, only sterile samples were taken. At dilutions of 103 there was no growth of Escherichia coli and Pseudomonas aeruginosa in all samples, no growth of Staphylococcus aureus in 81.25% samples, and Candida albicans in 87.50% samples. After analysis, the order of inhibition was noted as Escherichia coli greater than Pseudomonas aeruginosa greater than Staphylococcus aureus greater than Candida albicans.

Conclusion

Human cerumen has antibacterial and antifungal properties in descending order as shown: Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans. Hence, wax acts as a protective coating over the external auditory canal. Thus, routine wax removal is not mandatory unless impacted wax is leading to earache or conductive hearing loss.
Audiometric Protocols for MRI Screening of Acoustic Tumors
Authors: Cheng Teddy C. , Wareing Michael
Published: September 2011

Objective

1) Evaluate audiometric protocols and recommend the protocol with best sensitivity and specificity for MRI Screening of acoustic neuroma and meningioma tumors. 2) Determine the clinical “risks” of missing tumors and financial “wastes” in screening nonacoustic tumors and nonpathological cases. 3) Identify decision‐making parameters in best‐performing protocols.

Method

Retrospective review of 3‐year cohort (September 2006 to October 2009) of 1,751 ENT patients who underwent puretone audiometry and acoustic‐tumor MRI‐screening in a tertiary center. Audiometric protocols were ranked— sensitivity to acoustic tumors; specificity (A and B rates) to nonacoustic tumors and nonpathologies. False negatives indicated clinical risks; false positives determined financial wastes.

Results

No audiometric protocols achieved 100% sensitivity or specificity rates. Only 2 protocols achieved >90% sensitivity rates—the AMCLASS‐A‐Urben protocol (93.16%) and the Mangham protocol (91.58%). Eleven of 15 protocols for Specificity‐A and 12 of 15 protocols for Specificity‐B achieved ≥ 50%. Clinical risks were 6.84% to 18.95% while financial wastes were 33.56% to 68.37% for Specificity‐A and 31.76% to 66.86% for Specificity‐B. Interaural difference parameters indicating highest mean sensitivity rates in the order of ≥ 10dB, ≥ 15dB, and ≥ 20dB, while frequency‐comparison parameters were in the order of “two adjacent frequency,” “single frequency,” and “averaged multi‐frequency” comparison. Mean specificity patterns were the exact opposite.

Conclusion

Mangham protocol, proposing ≥ 10dB interaural difference averaged 1 to 8khz, is the preferred recommendation (sensitivity 91.58%; specificity‐A 44.23%; specificity‐B 44.91%). As representation of the local patient population and clinical resource allocation priorities, each center is encouraged to conduct audiometric protocol and symptomatology analysis of its own clinical cohort in deciding diagnostic protocol policy.
Biofilm Potential of Common Otopathogens
Authors: Ojano‐Dirain Carolyn P. , Antonelli Patrick J.
Published: September 2011

Objective

Posttympanostomy tube (TT) otorrhea has been linked to microbial biofilms. TTs may be exposed to a wide range of microbes. The purpose of this study was to compare the TT‐biofilm forming propensity of common otopathogens, Pseudomonas aeruginosa (PA), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Streptococcus pneumoniae (SP).

Method

Fluoroplastic coupons were exposed to plasma and cultured with 3 strains of PA, SA, HI, or SP for 2, 4, or 7 days. Half of the coupons were treated with antibiotics to kill planktonic bacteria. Total and biofilm colony counts and electron microscopy were performed.

Results

SA formed mature biofilm after 2 days, not different from 4‐ or 7‐day biofilms (P >. 05), and was most tolerant to antibiotic treatment. PA also formed biofilms at 2 days, reached a plateau at 4 days (P >. 05), and decreased at 7 days (P <. 01). HI formed biofilm only after 4 days (P ≤. 04). SP did not form biofilm without catalase supplementation. With catalase, one SP strain showed a delay in biofilm formation similar to HI (P <. 0001) while the other 2 strains formed biofilms after 2 days.

Conclusion

TT biofilm formation occurs with common middle ear pathogens, but most readily with SA and PA. Further investigation is needed to determine if these findings may in part explain the occasionally refractory nature of post‐TT otorrhea associated with SA and PA.
Cadaveric Percutaneous CI with AB, Cochlear, and Medel Electrodes
Authors: McRackan Theodore R. , Dawant Benoit , Blachon Grégoire S. , Labadie Robert F. , Noble Jack , Balachandran Ramya
Published: September 2011

Objective

1) Describe advances made in percutaneous cochlear implantation (PCI) that involves a minimally invasive approach to the cochlea via a single, image‐guided drill pass from the lateral cranium through the facial recess. 2) Demonstrate implementation of PCI in cadavers using Advanced Bionics (AB), Cochlear, and Medel electrodes.

Method

PCI was performed on 7 cadaveric temporal bones with 2 AB, 2 Cochlear, and 3 Medel electrodes. This included preoperative CT scanning and PCI trajectory planning, placement of bone‐implanted fiducial markers, intraoperative CT, CT registration, creation and attachment of customized microstereotactic frame, drilling from cortex to cochlea, and CI insertion.

Results

PCI was successfully performed on all 7 specimens using the AB insertion tool for AB electrodes and via manually threading and endaural advancement for Cochlear and Medel electrodes. Postoperative electrode position was assessed by CT scanning and histopathology. CT correctly predicted 6 of the 7 electrodes to be in scala tympani and 1 in scala vestibuli. Histopathology revealed minimal insertion trauma with preservation of the osseous spiral lamina and basilar membrane and complete scala tympani insertion in 6 of 7 specimens. One specimen, due to violation of the basilar membrane at the round window cochleostomy, had complete scala vestibuli insertion.

Conclusion

This is the first description of complete PCI using AB, Cochlear, and Medel electrodes. Using various insertion techniques, atraumatic electrode insertion was achieved in the majority of specimens, similar to results clinically reported for traditional CI surgery. Building on this, we anticipate clinical implementation of PCI in the near future.
Can Computerized Tests Serve as an Objective Measure and Improve Cognitive Abilities in Tinntius?
Authors: Kallogjeri Dorina , Katta Nikta , Wineland Andre , Piccirillo Jay F.
Published: September 2011

Objective

Examine the relationship between severity of tinnitus, as measured by the Tinnitus Handicap Inventory (THI), and performance on a computer‐based objective test of cognition (ie, Brain Speed Test (BST)) and investigate the impact of a Brain Fitness Program (BFP) on tinnitus patients.

Method

Cross‐sectional study of 60 adults with tinnitus. BST was completed by all participants. Results were transformed to z scores (BSTZ) based on age‐matched control data. Fifteen subjects continued in a longitudinal study using BFP. Attention, memory, and bother scores were assessed in addition to THI score and BST post‐training.

Results

Duration of tinnitus for the 60 participants (average age, 54 years; 51% males) ranged from 6 months to 47 years (median, 7 years). THI ranged from 0 to 80 (median, 26). Severe tinnitus was present in 27 (46%) of participants. A significant relationship between severity of tinnitus and BSTZ was identified in the group of participants with severe tinnitus (Spearman rho = 0.52, P =. 006). Thirteen subjects completed BFP. All subjects with bothersome tinnitus (n = 6) reported a subjective improvement in attention and memory.

Conclusion

These results suggest that BST could serve as the first objective measure of the cognitive impairment associated with tinnitus. These data also suggest that Brain Fitness Program can be a potential aid to patients with severe tinnitus, as it seems to improve attention, memory, and ability to comprehend.
Composite Mandibulectomy: A Novel Animal Model
Authors: Sidell Douglas R. , Bezouglaia Olga , Tetradis Sotririos , Aghaloo Tara , St. John Maie
Published: September 2011

Objective

The safe and reliable reconstruction of composite mandibulectomy defects is a topic of significant interest. Unfortunately, a well‐established small‐animal model of the segmental composite mandibulectomy does not exist. We describe a reliable animal model that can be utilized to study mandibular reconstruction techniques, including atuogenous bone grafts and biomaterials.

Method

Prospective analysis of survival‐operations in the rat model (4‐month Sprague Dawley Rattusnorvegicus). A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented, utilizing photographic and radiographic images. Postoperative management, early pitfalls, surgical complications and future applications are discussed.

Results

A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and seven postoperative complications were recognized. There were 4 orocutaneous fistulas, 1 abscess, and 1 seroma. There were 3 fatalities; deaths were attributed to anesthetic complications (2, intraoperative) and foreign‐body aspiration (1, postoperative).

Conclusion

The novel animal model described here, reliably replicates the en‐bloc segmental mandibular defects seen in our patient population. It can be manipulated to achieve a wide variety of research objectives, including the evaluation of biomaterials and tissue engineering techniques.
Characteristics of Distortion‐Product Otoacoustic Emissions Level Decrease at High Altitude
Authors: Olzowy Bernhard , Gleichenstein Gregor , Ripfel Simon , Mees Klaus
Published: September 2011

Objective

1) Understand the characteristics of Distortion‐Product Otoacoustic Emissions (DPOAE) level decrease during ascent to high altitudes. 2) Learn whether DPOAE might provide information about the state of acclimatization and the risk of acute mountain sickness (AMS).

Method

From March 12, 2006, until April 23, 2006, DPOAE (f2 = 1, 1.5, 2, 3, and 4kHz), blood oxygen saturation (SaO2), and the Lake Louise score (LLS) to assess AMS were measured in 187 trekking tourists on the Mt Everest trek in Nepal at 2610 m and 5170 m.

Results

Mean DPOAE level decrease at 5170 m compared with 2610 m was ‐5.1dB (1kHz), ‐3.7dB (1.5kHz), ‐4.0dB (2kHz), ‐4.6dB (3kHz) and ‐3.7dB (4kHz). Mean SaO2 was 94.8% at 2610 m and 79.0% at 5170 m. The LLS indicates AMS when >2. While at 2610 m none of the study subjects had AMS (mean LLS 0.04), and at 5170 m 82 (43.9%) had AMS (mean LLS 2.8). Low SaO2 correlated with high LLS.

Conclusion

DPOAE levels decrease during ascent to high altitudes across all frequencies. This phenomenon might be due to cochlear hypoxia. While low SaO2 seems to indicate an increased risk of AMS, a decrease of DPOAE levels is not correlated with AMS.
Characterization of Vestibulocerebellar Degeneration
Authors: Pothier David D. , Ranalli Paul , Rutka John A.
Published: September 2011

Objective

1) Report the largest series to date of patients with cerebellar ataxia with bilateral vestibulopathy (CABV). 2) Understand the unique balance problems in this disorder; we studied the eye movements crucial for gaze stabilization.

Method

From over 16 years at a multidisciplinary neuro‐otology clinic, 32 patients (mean age, 51.7 (SD = 19.3)) with symptoms of CABV syndrome over a median of 5 (IQR = 2‐10) years were selected for both clinical and oculographic analysis of their central and peripheral vestibular function.

Results

Vestibulo‐ocular reflex (VOR) function was impaired on Halmagyi head thrust testing in 74% of patients; patients studied by oculography revealed a subnormal mean VOR gain of 0.67. Impaired dynamic visual acuity was abnormal in 88%. Importantly, this impairment would have been underestimated by bithermal caloric testing, in which only 22% were subnormal. Gaze‐evoked nystagmus (70%), impaired smooth pursuit (88%), and impaired cancellation of the VOR (93%) revealed the associated vestibulocerebellar dysfunction. Impaired saccular otolithic function (44% abnormal VEMP) added to patient imbalance. 77% of patients displayed obvious gait ataxia, and a further 41% had dysmetric limb function.

Conclusion

The unique double‐pathway balance impairments in patients with CABV are evident in the high prevalence of subnormal function of both peripheral and central vestibular signals seen in their dysfunctional eye movements. This is an easily missed clinical entity that is often associated with normal caloric investigations.
Cochlin Expression in Patients with Ménière Disease
Authors: Calzada Audrey , Beltran‐Parrazal Luis , Ishiyama Akira , Ishiyama Gail , Lopez Ivan A.
Published: September 2011

Objective

1) Determine the distribution of cochlin in the vestibular endorgans of patients with Ménière disease (MD) through quantitative immunohistochemistry and real‐time PCR (RT‐PCR). 2) Compare cochlin expression in the vestibular endorgans in normal vs MD patients. 3) Correlate changes in cochlin expression with underlying pathophysiology in MD.

Method

Vestibular endorgans were obtained from 8 patients with MD who underwent ablative labyrinthectomy from 1997 to 2010. Control specimens were obtained from 8 patients undergoing labyrinthectomy for acoustic neuroma excision and 5 autopsy specimens with normal audiovestibular function. Quantitative immunohistochemistry of cochlin expression and RT‐PCR were performed in vestibular endorgans.

Results

In the normal control specimens, cochlin immunoreactivity (IR) was found evenly distributed in the stroma of the cristae ampullaris and maculae of the utricle. In the MD specimens, cochlin IR was markedly increased and intense. Diffuse cochlin precipitate was found within the stroma and basement membrane underlying the sensory epithelium in both the maculae of the utricle and the cristae ampullaris in vestibular endorgans from MD patients. Increased cochlin expression in MD specimens was confirmed with RT‐PCR.

Conclusion

Cochlin upregulation has been implicated in DFNA9, a hereditary audiovestibulopathy with similar symptomatology to MD. The overexpression of cochlin in vestibular endorgans of MD patients may contribute to dysfunctional inner ear homeostasis. These findings warrant the future study of cochlin and its associated extracellular matrix molecules in MD pathology.