bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Fatal Apnea Responses to Acid Stimulation of the Larynx in Piglets
Authors: Heman-Ackah Yolanda D.
Published: October 2014

Objectives:

This study explores the physiological determinants of laryngeal chemoreflex (LCR) response severity under hypoxic conditions.

Methods:

Thirty-four piglets underwent hypoxic laryngeal stimulation. Physiologic data were collected, and responses were graded as mild, moderate, or profound.

Results:

Prestimulation hypoxia caused respiratory depression and carbon dioxide retention in profound responders and respiratory stimulation in mild and moderate responders (p < .05). Resumption of respiration occurred in all animals when the Paco2 rose by a mean ± SD of 15.1 ± 6.5 mm Hg (p > .05). There was a significant difference between mild, moderate, and severe responders in change in arterial Pao2 and hydrogenated hemoglobin saturation during the LCR-induced response (p < .001 for both).

Conclusions:

Resumption of respiration is associated with accumulation of arterial Paco2. The respiratory response to hypoxia predicts the severity of the LCR response. The severity of the LCR-induced response is associated with changes in arterial Pao2 and hydrogenated hemoglobin saturation during the LCR-inducedapnea.
Diazepam Tolerance Effects on Vestibular Function Testing, Part I: Saccadic Parameters during Electronystagmography
Authors: Blau Patricia A. , Schwade Nathan , Roland Peter
Published: October 2014

Objectives:

Benzodiazepines, particularly diazepam (DZ), are used in clinical practice to suppress acute vestibular symptoms. There have been limited studies looking at the effects of tolerance to DZ on parameters designed to measure the integrity of the vestibular system and its interaction with the oculomotor and balance systems.

Methods:

In a double-blinded, repeated-measures design, we randomized 30 young healthy men into one of two treatment groups (diazepam and placebo) and assessed with electro-oculography the effects of clinical divided doses of DZ on saccadic eye movements and sedation over 16 days.

Results:

Only sedation and saccadic latency were significant (p < .05) for treatment group, indicating selective effects on different central nervous system mechanisms. No significant effect for time was seen in any of the variables measured. Bonferroni t-test comparisons of the DZ group among 3 days were significant (p < .017) between baseline and day 3 for saccadic latency and accuracy and between day 3 and day 16 for self-ratings of sedation.

Conclusions:

Saccadic latency and accuracy and sedation ratings appear to be more sensitive to changes over time and less affected by subject variability than saccadic eye velocity. It remains questionable whether patients who have been on DZ for acute or extended periods of time need to discontinue the drug 48 hours before testing.
Deltopectoral Flap Revisited in the Microvascular Era: A Single-Institution 10-Year Experience
Authors: Andrews Brian T. , McCulloch Timothy M. , Funk Gerry F. , Graham Scott M. , Hoffman Henry T.
Published: October 2014

Objectives:

In 1965, Bakamjian described the deltopectoral (DP) flap as a reconstructive option in head and neck surgery. It served as the premier flap for reconstructing complex head and neck defects until the late 1970s. Today, the DP flap is often overlooked; although its role has diminished, its use is still warranted in certain select clinical situations.

Methods:

A retrospective patient chart review of 25 DP flap procedures performed at the University of Iowa Hospitals and Clinics and Iowa City Veterans Administration Hospital between January 1, 1991, and June 1, 2002, was undertaken. The data collected included patient demographics and assessment of DP flap survival and its ability to accomplish established preoperative reconstructive goals.

Results:

The DP flap was used for the following situations: vascularized skin coverage of the neck, carotid arteries, and face (16 cases), including simultaneous coverage of other reconstructive flaps in 6 cases; controlled orocutaneous fistula development (3 cases) or fistula closure (5 cases); and pharyngoesophageal reconstruction (4 cases). In 3 cases the flap was used for more than one of the preoperative goals described above (n = 25). Minor flap-related complications that required local wound treatment developed in 5 cases (20.0%), but the flaps were successfully salvaged and no subsequent reconstructive procedure was required. In an additional 5 cases (20.0%), the flap failed in some measure to accomplish its preoperative goal, necessitating further surgical reconstruction. Sixteen patients (64%) had undergone previous or simultaneous reconstructive procedures that limited other available reconstructive options.

Conclusions:

The technical simplicity of the DP flap, coupled with its predictable vascular supply, has allowed it to maintain a niche role in contemporary reconstructive surgery. The DP flap provides an excellent method of reconstruction in select cases in which vascularized skin coverage of the neck is needed. The DP flap also provides a valuable salvage option in situations in which other reconstructive techniques are not possible.
Singer's Dystonia: First Report of a Variant of Spasmodic Dysphonia
Authors: Chitkara Ajay , Meyer Tanya , Keidar Anat , Blitzer Andrew
Published: October 2014

Objectives:

We discuss the phonatory characteristics of a previously undescribed focal laryngeal dystonia present in the singing voice.

Methods:

We performed a retrospective chart review of 5 patients with singer's dystonia at a neurolaryngology referral center.

Results:

Four patients reviewed demonstrated phonatory characteristics consistent with adductor spasmodic dysphonia present in their singing voice. One patient demonstrated abductor spasmodic dysphonia in the singing voice. Each patient initially exhibited normal connected speech in conversational voicing. The treatment protocol and outcome are discussed, including the use of botulinum toxin.

Conclusions:

Singer's dystonia is a previously undescribed neurologic disorder that should be understood by those who treat voice performers and voice disorders.
Natural History of Adult-Onset Laryngeal Papillomatosis following Multiple Cidofovir Injections
Authors: Naiman Ana Nusa , Abedipour Darius , Ayari Sonia , Fresnel Elizabeth , Coulombeau Bruno , Bour Jean-Baptiste , Froehlich Patrick
Published: October 2014

Objectives:

A prospective study was performed to assess the intermediate and long-term efficacy of intralesional cidofovir therapy associated with surgical excision in laryngeal papillomatosis in adults.

Methods:

Endoscopy with intralesional injection of cidofovir 5 mg/mL was performed 3 times at 4-week intervals. The concentration was later increased to 7.5 mg/mL and the interval between injections shortened to 2 weeks. Further treatment was performed at 3 or 6 months, depending on the evolution of the papillomas. After complete remission, the treatment was stopped and the patients were reviewed every 6 months.

Results:

Nineteen patients completed the protocol, with a mean of 4.5 injections each. Complete remission was obtained in 17 cases (89%) after a mean of 3.8 procedures. Remission was stable after a mean follow-up of 24 months (range, 8 to 57 months). With higher cidofovir concentrations at shorter intervals, patients needed fewer injections to achieve remission (mean, 2.1 versus 4.7 injections).

Conclusions:

The effectiveness of intralesional cidofovir therapy in adult-onset recurrent respiratory papillomatosis was impressive. Once obtained, complete remission was stable on intermediate or long-term follow-up. The concentration and the interval between injections seemed to influence the number of injections necessary to achieve remission.
Surgical Repair of Laryngotracheoesophageal Clefts by Tracheoesophagoplasty with Two Overlapping Flaps
Authors: Nicollas Richard , Sudre-Levillain Isabelle , Roman Stephane , Triglia Jean-Michel
Published: October 2014

We report a technique for surgical repair of laryngotracheoesophageal clefts from type II to IV through an anterior approach that involves performing a tracheoesophagoplasty with Two overlapping flaps (TEP-TOF). We offer a technical description, a retrospective study, and a review of the literature. Ten children were operated on for laryngotracheoesophageal clefts of types II, III, or IV of the Benjamin and Inglis classification by the TEP-TOF procedure. After a median follow-up of 58 months (2 months to 12 years), neither complications nor recurrences were observed. All surgical details of the TEP-TOF procedure, including the approach, the kind of sutures, the method of creating the flaps, and the preoperative and postoperative management, are discussed and compared with the data found in the literature.
Age-Related Expression of α-Gustducin in the Rat Larynx
Authors: Nishio Takeshi , Koike Shinobu , Okano Hiroyuki , Bamba Hitoshi , Hisa Yasuo
Published: October 2014

Objectives:

The age-related changes in distribution of α-gustducin–immunoreactive structures in the larynx of Sprague-Dawley rats were studied.

Methods:

For this purpose, tissues obtained from 12 male rats ranging in age from 5 to 21 weeks were compared with respect to the distribution and morphology of laryngeal taste buds immunoreactive for α-gustducin, the α-subunit of a taste cell–specific G protein.

Results:

Three different morphological types of α-gustducin–immunoreactive structures were seen: typical gemmal forms, clusters composed of 2 or 3 cells, and isolated immunoreactive cells not associated with taste buds. α-Gustducin–immunoreactive structures were most abundant in the epiglottis in all age groups. α-Gustducin–immunoreactive cells in rats seem to be located along the lateral food channels, in which they may come in contact with food. The total number of these α-gustducin–immunoreactive structures did not show any age-related changes, but the percentage of solitary immunoreactive cells in 5-week-old rats was significantly larger than the percentages in 8-, 14-, and 21-week-old animals.

Conclusions:

Solitary α-gustducin–immunoreactive cells, which are abundant in 5-week-old rats but are found in fewer numbers along the base of the epiglottis in mature rats, may be nociceptic in function, whereas the chemosensory clusters or buds that contain α-gustducin–positive cells and are distributed along the lateral food channels on the pharyngeal side of the larynx may have a role in gustatory reception.
Management of the Thick-Skinned Nose: A More Effective Approach
Authors: Hafezi Farhad , Naghibzadeh Bijan , Nouhi Amirhossein
Published: October 2014

A bulky nose is a challenging issue to manage, and surgeons have not found the ultimate solution to this problem in the evolution of rhinoplastic surgery. Because of the multiplicity of techniques and controversies published in the literature, it has become confusing for the operating surgeon to find the most appropriate and effective way of solving this frustrating dilemma. The subcutaneous fat is the thickest in the supratip area, and the soft tissue thickness over the tip of the nose varies considerably from patient to patient. The focus of this study was to find a method for reducing the overlying soft tissue of the tip for better re-draping of skin over the nasal skeleton. The hallmark of this technique is to undermine the nasal skin in Two layers. We believe that soft tissue trimming in biplane dissection can minimize the thickness of the tip skin in a relatively safe and homogeneous way. With this report we introduce a new method of dissection of nasal soft tissue and of trimming it in different areas of the nose for different purposes. In the authors' opinion, this approach is one of the most effective ways of handling unpliable, thick nasal skin.
Prospective Study of Positional Nystagmus in 100 Consecutive Patients
Authors: Bertholon Pierre , Tringali Stephane , Faye Mamadou B. , Antoine Jean Christophe , Martin Christian
Published: October 2014

Objectives:

The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus.

Methods:

Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness.

Results:

One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV.

Conclusions:

A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.
Intermediate-Term and Long-Term Results after Treatment by Cidofovir and Excision in Juvenile Laryngeal Papillomatosis
Authors: Naiman Ana Nusa , Ayari Sonia , Nicollas Richard , Landry Guillaume , Colombeau Bruno , Froehlich Patrick
Published: October 2014

Objectives:

We assessed the intermediate-term and long-term efficacy of intralesional injection of cidofovir used with surgical excision in juvenile-onset recurrent respiratory papillomatosis.

Methods:

The protocol was revised during the study, from endoscopy at 4-week intervals with intralesional injection of cidofovir at 5 mg/mL, to a 2-week interval and a 7.5-mg/mL dosage. Partial surgical excision of hypertrophic papillomas was performed before the initiation of injection. Further injections at 4-week (or 2-week) intervals were performed until complete remission.

Results:

Sixteen patients received a mean 8.9 injections. Complete remission was obtained in 12 patients (75%) after a mean 7.2 endoscopic treatments. Remission was stable at a mean 33.6 months' follow-up. Five of these 12 patients received 5.2 injections and remained disease-free at a mean 39.3 months' follow-up. Seven of the 12 had 1 relapse; they needed complementary treatment to become disease-free, and remained so thereafter over a mean 27.3 months' follow-up. The other 4 of the 16 patients (25%) continued to present active disease.

Conclusions:

Active endoscopic treatment until complete remission led to a higher-than-expected complete remission rate on intermediate-term to long-term follow-up, with or without relapse. Transient relapse was associated with a long delay in initiating cidofovir treatment.
Differential Gene Expression Profiling of Vocal Fold Polyps and Reinke's Edema by Complementary DNA Microarray
Authors: Duflo Suzy M. , Thibeault Susan L. , Li Wenhua , Smith Marshall E. , Schade Goetz , Hess Markus M.
Published: October 2014

Objectives:

Our purpose was to determine whether complementary DNA (cDNA) microarray analysis (MA) can establish distinct gene expression profiles for 2 phenotypically similar vocal fold lesions: Reinke's edema (RE) and polyps. Established transcript profiles can provide insight into the molecular and cellular processes involved in these diseases.

Methods:

Eleven RE specimens and 17 polyps were analyzed with MA for 8,745 genes. Further MA profiling was attempted within each lesion group to identify molecular markers for reflux exposure and smoking. Prediction analysis was used to predict lesion classification for 2 unclassified samples. A real-time polymerase chain reaction was performed to corroborate MA transcript levels for selected significant genes.

Results:

Sixty-five genes were found to differentiate RE and polyps (p = .0088). For RE, 19 genes were differentiated for reflux exposure (p = .016). No genes were found to differentiate smokers from nonsmokers. For polyps, no genes were found to differentiate for reflux (p = .16) and smoking (p = .565). Categorization of unclassified lesions was possible with a minimum of 13 genes.

Conclusions:

We demonstrate the feasibility of benign lesion classification based on MA. Microarray analysis is useful not only for improving diagnosis and classification of such lesions, but also for potentially generating prognostic indicators and targets for therapy.
Effects of Altered Consciousness on the Protective Glottic Closure Reflex
Authors: Sasaki Clarence T. , Yu Ziwei , Xu Jiajun , Hundal Jagdeep , Rosenblatt William
Published: October 2014

Objectives:

The sphincteric function of the larynx, essential to lower airway protection, is most efficiently achieved through strong reflex adduction by both vocal folds. We hypothesize that central facilitation is an essential component of a bilateral brain stem-mediated adductor reflex and that its disturbance by altered consciousness or physiologic sleep could result in weakened sphincteric closure.

Methods:

In 10 adult pigs the glottic closure response was evaluated under light and deep isoflurane anesthesia. The internal branch of the left superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. The force of evoked glottic closure was measured with a pressure transducer positioned between the vocal folds.

Results:

Consistent threshold responses (>90%) were obtained ipsilaterally from 0.5 to 2.0 minimal alveolar concentration (MAC) anesthesia. However, the contralateral reflex responses declined to 6.4% in successive trials as anesthetic levels approached 1.5 to 2.0 MAC. Furthermore, glottic closing force closely reflected these electromyographic changes, declining from 383 mm Hg at 0.5 to 1.0 MAC to 114 mm Hg at 1.5 to 2.0 MAC.

Conclusions:

Alteration of central facilitation by progressively deeper loss of consciousness abolishes a lower brain stem-mediated crossed adductor reflex, predisposing the subject to a weakened glottic closure response.
Office-Based and Microlaryngeal Applications of a Fiber-Based Thulium Laser
Authors: Zeitels Steven M. , Burns James A. , Akst Lee M. , Hillman Robert E. , Broadhurst Matthew S. , Anderson R. Rox
Published: October 2014

Objectives:

The carbon dioxide (CO2) laser is the premier dissecting instrument for hemostatic cutting and ablation during endolaryngeal surgery. However, microlaryngeal tangential dissection and office-based photoablation have been limited by the lack of a fiber-based delivery system. To address this limitation, a new laser was designed, which is a diode-pumped solid-state laser with a thulium-doped yttrium-aluminum-garnet laser rod. It produces a continuous-wave beam with a wavelength of 2,013 nm and a target chromophore of water. This new laser functions similarly to a CO2 laser with the benefit of being delivered through a small glass fiber (0.365 to 0.550 mm).

Methods:

A prospective pilot trial was done in 74 cases to explore applications of the new thulium laser. Thirty-two procedures were done with the laser used as an ablating instrument and topical anesthesia through a flexible laryngoscope (papillomatosis, 20; microinvasive carcinoma, 6; benign supraglottic lesions, 3; edema, 2; granuloma, 1). Forty-two procedures were done with the laser used as a cutting or ablating instrument for microlaryngeal dissection and general anesthesia. These included 27 partial laryngeal resections (supraglottis, 15; glottis, 10; subglottis, 2) and 8 posterior glottic laryngoplasties. The laser was also used as an ablative instrument during microlaryngoscopy in 7 cases.

Results:

The thulium laser was used effectively in all cases, under both local and general anesthesia. In microlaryngeal dissection, electrocautery was not needed to control bleeding, even during cutting in the highly vascular paraglottic space. No complications related to the use of the thulium laser were experienced in any case.

Conclusions:

Because of the fiber-based delivery system, the 2,013-nm continuous-wave thulium laser shows substantial promise for tangential dissection during microlaryngoscopy and soft tissue photoablation during office-based flexible laryngoscopy. Hemostasis was judged to be superior to experiences with the CO2 laser. In this pilot study, performing en bloc laryngeal cancer resection procedures was facilitated by use of the thulium laser.
Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) Curative Therapy for Severe Dysphagia: Myth or Reality?
Authors: Shaw Gary Y. , Sechtem Phillip R. , Searl Jeff , Keller Kristina , Rawi Taib A. , Dowdy Emily
Published: October 2014

Objectives:

VitalStim therapy was approved by the US Food and Drug Administration in 2001 for the treatment of dysphagia through the application of neuromuscular electrical stimulation to cervical swallowing muscles. This approval was based upon submission of data on more than 800 patients who received this therapy collected by the principal developer and patent-holder of the device. The therapy is marketed as successful in restoring long-term swallowing function in 97.5% of dysphagic patients past the point of requiring a feeding tube and as significantly better than existing therapies. More than 2,500 speech-language pathologists have taken the certification course, and thousands of devices have been sold. To date, however, aside from the developer's own studies, there are no peer-reviewed publications supporting these claims. We sought to evaluate the effectiveness of VitalStim therapy in a heterogeneous group of dysphagic patients.

Methods:

We performed a retrospective analysis of 18 patients who received this therapy at an urban tertiary referral center. All patients underwent pretherapy evaluation by speech-language pathologists, including modified barium swallow and/or functional endoscopic evaluation of swallowing and clinical evaluation of swallowing that included assessment of laryngeal elevation, diet tolerance, and swallowing delay, and were then assigned an overall dysphagia severity score. After therapy, all patients underwent the same assessments. Twelve of the 18 also underwent a functional swallowing telephone survey months (range, 1 to 21 months) after their therapy to assess whether the improvement was worthwhile and sustained.

Results:

Eleven of the 18 patients (61%) demonstrated some improvement in their swallowing. Six of the 18 patients (33%) were improved enough to no longer require a feeding tube. However, of the 5 patients categorized as having “severe dysphagia” before therapy, only 2 showed any improvement, and these patients still required a feeding tube for adequate nutrition. Telephone surveys did confirm that those who improved with their therapy seemed to maintain their progress and that most patients were satisfied with their therapy.

Conclusions:

VitalStim therapy seems to help those with mild to moderate dysphagia. However, the patients with the most severe dysphagia in our study did not gain independence from their feeding tubes. The authors conclude that VitalStim therapy clearly has a place in the management of dysphagia, but that the most severely afflicted are unlikely to gain dramatic improvement.
Height and Shape of the Skull Base as Risk Factors for Skull Base Penetration during Endoscopic Sinus Surgery
Authors: Lee Jong Cheol , Song Yong Jin , Chung Yoo-Sam , Lee Bong-Jae , Jang Yong Ju
Published: October 2014

Objectives:

Computed tomography (CT) and magnetic resonance imaging have identified several risk factors for life-threatening complications of skull base penetration during endoscopic sinus surgery (ESS). We compared these risk factors between groups of patients with and without penetration.

Methods:

We performed a retrospective review of direct coronal paranasal sinus CT scans. Using preoperative CT scans of 100 patients without and 7 patients with penetration, we classified height into 4 groups and contour into 2 groups. The frequencies of shape and height differences of the right and left halves of the skull base were calculated in each group.

Results:

In 6 of the 7 patients who had skull base penetration, ESS was performed by a resident or junior staff member who had less than 3 years of experience with this technique. Shape asymmetry was seen in 4 of the 7 patients (57%) with penetration, which was a significantly higher rate than in patients without penetration (18 of 100; p = 032). The frequencies of a low skull base and a height difference were 15% and 28%, respectively.

Conclusions:

The most important risk factor for skull base penetration was the surgeon's inexperience. An asymmetry of shape of the right and left halves of the skull base was significantly related to inadvertent skull base penetration during ESS.
Differential Expression of Human Beta Defensin 2 and Human Beta Defensin 3 in Human Middle Ear Cholesteatoma
Authors: Song Jae-Jun , Chae Sung-Won , Woo Jeong-Su , Lee Heung-Man , Jung Hak-Hyun , Hwang Soon-Jae
Published: October 2014

Objectives:

The purpose of this study was to investigate the differential expressions of human beta defensin ( hBD) 2 and hBD-3 in human middle ear cholesteatoma epithelium.

Methods:

The expressions of hBD-2 and hBD-3 were analyzed by quantitative real-time reverse transcription-poly-merase chain reaction (RT-PCR), Western blotting, and immunohistochemical staining. Samples were obtained from 10 patients who underwent middle ear surgery for middle ear cholesteatoma.

Results:

Real-time RT-PCR and Western blot analysis showed that the messenger RNAs and proteins of hBD-2 and hBD-3 were higher in the cholesteatoma epithelium than in normal external auditory canal skin. In cholesteatoma epithelium, hBD-2 and hBD-3 activities were present in the upper granular layer and in the prickle cell layer, but in the normal skin they were poorly expressed in all layers.

Conclusions:

Increased expressions of hBD-2 and hBD-3 in cholesteatoma epithelium suggest that cholesteatoma, a chronic inflammatory state of middle ear keratinocytes, may induce an innate immune response. That the induction of hBD-2 was found to be more intense than that of hBD-3 in cholesteatoma epithelium implies that hBD-2 is the major effector in terms of chronic epithelial inflammatory responses.
In Vivo Estimates of the Position of Advanced Bionics Electrode Arrays in the Human Cochlea
Authors: Skinner Margaret W. , Holden Timothy A. , Whiting Bruce R. , Voie Arne H. , Brunsden Barry , Neely J. Gail , Saxon Eugene A. , Hullar Timothy E. , Finley Charles C.
Published: October 2014

Objectives:

A new technique for determining the position of each electrode in the cochlea is described and applied to spiral computed tomography data from 15 patients implanted with Advanced Bionics HiFocus I, Ij, or Helix arrays.

Methods:

ANALYZE imaging software was used to register 3-dimensional image volumes from patients' preoperative and postoperative scans and from a single body donor whose unimplanted ears were scanned clinically, with micro computed tomography and with orthogonal-plane fluorescence optical sectioning (OPFOS) microscopy. By use of this registration, we compared the atlas of OPFOS images of soft tissue within the body donor's cochlea with the bone and fluid/ tissue boundary available in patient scan data to choose the midmodiolar axis position and judge the electrode position in the scala tympani or scala vestibuli, including the distance to the medial and lateral scalar walls. The angular rotation 0° start point is a line joining the midmodiolar axis and the middle of the cochlear canal entry from the vestibule.

Results:

The group mean array insertion depth was 477° (range, 286° to 655°). The word scores were negatively correlated (r = −0.59; p = .028) with the number of electrodes in the scala vestibuli.

Conclusions:

Although the individual variability in all measures was large, repeated patterns of suboptimal electrode placement were observed across subjects, underscoring the applicability of this technique.
Voice Handicap Evaluation of Patients with Pathologic Sulcus Vocalis
Authors: Welham Nathan V. , Dailey Seth H. , Ford Charles N. , Bless Diane M.
Published: October 2014

Objectives:

The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI).

Methods:

The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar.

Results:

The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone.

Conclusions:

These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.
Mass Psychogenic Illness Presenting as Acute Stridor in an Adolescent Female Cohort
Authors: Powell Scott A. , Nguyen Chau T. , Gaziano Joy , Lewis Vicki , Lockey Richard F. , Padhya Tapan A.
Published: October 2014

Objectives:

We describe a cohort of patients with an unusual presentation of stridor, their evaluation and management, and their outcome. We review the pertinent English-language literature.

Methods:

We performed a retrospective review of the records of 12 adolescent patients treated for acute-onset inspiratory stridor at the Departments of Otolaryngology-Head and Neck Surgery and Allergy and Immunology at the University of South Florida and the Department of Speech Pathology at the H. Lee Moffitt Cancer Center and Research Institute. Two additional patients received treatment elsewhere. Demographic, historical, and laboratory data, physical examination findings, and follow-up information were extracted. A review of both the Hillsborough County Department of Health epidemiological report and the English-language literature was performed.

Results:

Fourteen female patients who attended a local high school developed audible inspiratory noise. Twelve of the 14 were seen at the University of South Florida Ear, Nose and Throat Center. The remaining 2 patients were evaluated by outside otolaryngologists but were included in all reports from the Department of Health. Environmental studies did not find noxious chemical or biological agents in the students' environments to explain the development of the symptoms. Physical and videostroboscopic examination identified two distinct laryngeal findings causing the audible stridor. One involved paradoxical vocal fold movement, and the other, supraglottic mucosal collapse into the airway. All patients underwent rigorous speech pathology intervention and structured treatment with either complete resolution or significant improvement, seen both clinically and on videostroboscopic evaluation.

Conclusions:

Audible stridor can arise from numerous disease processes. In the vast majority of presentations it occurs sporadically and on an individual basis. Our cohort is especially unusual because of the sheer number of patients. Our presentation of a case of mass psychogenic illness as the cause of vocal cord dysfunction with additional findings of laryngomalacia within a group of adolescent girls is the first in the English-language literature. The key to the diagnosis is recognition of the disorder and susceptible individuals by using a thorough physical examination with emphasis on the laryngoscopic and videostroboscopic findings. The systematic approach, undertaken by a team including an otolaryngologist, an allergist, a speech pathologist, and an epidemiologist, proved to be effective in the management of this complex disorder and highly unusual situation.
Myosin Heavy Chain Composition and Fiber Size of the Cricopharyngeus Muscle in Patients with Achalasia and Normal Subjects
Authors: Davis Melinda V. , Merati Albert L. , Jaradeh Safwan S. , Blumin Joel H.
Published: October 2014

Objectives:

Cricopharyngeal achalasia (CA) can be defined as inadequate opening of the cricopharyngeus muscle (CPM) resulting in dysphagia. Myosin heavy chain (MHC) isoform fiber type composition and size are key determinants of muscle function. These parameters have not been described in CA. It is hypothesized that there is a difference between the MHC isoform composition of the CPM in patients with the clinical diagnosis of CA and that in normal subjects.

Methods:

Patients who had received prior botulinum were excluded. The MHC fiber type composition and size in patients and cadaveric controls were determined by adenosine triphosphatase staining and image analysis.

Results:

The CPMs of 12 CA patients (6 male, 6 female; mean age, 61 years) and 5 control cadaveric subjects (3 male, 2 female; mean age, 67 years) were analyzed. There were relatively fewer type I fibers (67%) in patients with CA than in controls (81%), but the difference was not significant (p = 18). Type I fibers were slightly smaller in CA patients (38.7 μm) than in controls (47.2 μm), but this was not significantly different (p > 05). Of the 12 CA patients, 3 had type II predominance, a feature not seen in normal subjects.

Conclusions:

Patients with CA had relatively fewer type I fibers, although the difference was not statistically significant. The MHC isoform composition and fiber size were not different between CA patients and normal subjects. This is the first report to characterize the CPM in patients with CA.
Thermal Damage during Thulium Laser Dissection of Laryngeal Soft Tissue is Reduced with Air Cooling: Ex vivo Calf Model Study
Authors: Burns James A. , Kobler James B. , Heaton James T. , Lopez-Guerra Gerardo , Anderson R. Rox , Zeitels Steven M.
Published: October 2014

Objectives:

The 2-μm-wavelength thulium laser has recently been shown to be an effective cutting instrument in endolaryngeal surgery, although there is increased thermal trauma as compared with the carbon dioxide laser. This study investigated temperature changes and thermal trauma during thulium laser dissection of laryngeal tissue, with and without air cooling, in an ex vivo model.

Methods:

A continuous-wave thulium laser (400-μm fiber, 4-W continuous power, 4-second duration) was used to incise 10 calf vocal folds. Paired cooled and uncooled cuts were made in each fold with a dermatologic cooling device. A thermistor inserted into the glottic subepithelium was used to measure tissue temperatures. Thermal damage was analyzed histologically by measuring the depth of the zone of lactate dehydrogenase inactivation surrounding the mucosal incision.

Results:

The initial vocal fold temperature averaged 24.3°C without cooling and 4.4°C with cooling. The peak temperature during cutting averaged 59.1°C without cooling and 28.0°C with cooling. The thermal damage zone surrounding the cooled incisions was approximately 27% less than that surrounding the uncooled incisions.

Conclusions:

Air cooling can reduce the extent of thermal trauma associated with thulium laser surgery of the vocal folds, and the high-temperature plume generated during laser cutting is effectively cleared.
Adjunctive Neuromuscular Electrical Stimulation for Treatment-Refractory Dysphagia
Authors: Carnaby-Mann Giselle D. , Crary Michael A.
Published: October 2014

Objectives:

Neuromuscular electrical stimulation (NMES) has been proposed as an adjunctive modality for the treatment of swallowing disorders. We present data from a prospective case series to define and measure effects of a systematic therapy for chronic pharyngeal dysphagia using adjunctive NMES.

Methods:

Six adult patients with pharyngeal dysphagia received 15 sessions of a standardized protocol of swallowing exercises with adjunctive NMES. The patients completed clinical and instrumental baseline, posttreatment, and 6-month follow-up evaluations. Outcome measures included the proportion of patients who improved in clinical swallowing ability, functional oral intake, and change in body weight; patient perception of swallowing ability; and changes in kinematic aspects of swallowing.

Results:

Significant change was demonstrated for clinical swallowing ability (p < .042), functional oral intake (p < .02), weight gain (p < .026), and patient perception of swallowing ability (p < .043). Hyoid and laryngeal elevation during swallowing demonstrated bolus-specific patterns of change. No patient experienced a treatment-related or swallowing-related complication. Patients (4 of 5) who were followed out to 6 months after treatment maintained functional gains.

Conclusions:

A systematic therapy for chronic pharyngeal dysphagia using adjunctive NMES produced improvement in clinical swallowing ability and functional oral intake without significant weight loss or complications.
Endoscopic Management of Zenker's Diverticulum: Factors Predictive of Success or Failure
Authors: Visosky Ann Marie B. , Parke Robert B. , Donovan Donald T.
Published: October 2014

Objectives:

We review our experience with endoscopic management of Zenker's diverticulum. We sought to analyze and determine risk factors for success or failure of endoscopic diverticulum treatment.

Methods:

We performed a retrospective review of 72 consecutive patients who underwent attempted endoscopic management of a Zenker's diverticulum between January 2000 and April 2006. The procedures were performed by either of 2 otolaryngologists. There were 50 men and 22 women ranging in age from 44 to 93 years. A total of 85 procedures were performed. The medical records were reviewed for preoperative diverticulum size (small, 1 to 2 cm; moderate, 2.1 to 3.0 cm; and large, more than 3.0 cm), intraoperative diverticulum characteristics, patient anatomic limitations that prevented adequate endoscopic visualization, surgical complications, and management of recurrences.

Results:

Of our 72 patients, 61 (85%) were able to undergo endoscopic cricopharyngeal myotomy with diverticulum elimination. Of the 61 endoscopic procedures, 47 (77%) resulted in complete symptom resolution. The most common risk factors for recurrence were diverticulum size (more than 3 cm) and amount of redundant mucosa. Of the 14 patients with a recurrence, 10 (71%) underwent a repeat procedure. Six of the 14 (43%) had a successful excision via a cervical approach, and 4 of the 14 (29%) underwent a repeat endoscopic myotomy. There was 1 major complication (esophageal tear), and there were 3 minor complications (mucosal abrasions).

Conclusions:

Most patients with a Zenker's diverticulum are good candidates for endoscopic management. In our series, 84% of those who underwent endoscopic treatment ultimately achieved relief of symptoms. The patient morbidity is minimal. A large diverticulum with redundant mucosa is a risk factor for recurrence after endoscopic treatment.
Phonation Threshold Flow in Elongated Excised Larynges
Authors: Jiang Jack J. , Regner Michael F. , Tao Chao , Pauls Steven
Published: October 2014

Objectives:

This study proposes the use of a new parameter of vocal aerodynamics, phonation threshold flow (PTF). The sensitivities of the PTF and the phonation threshold pressure (PTP) were quantitatively compared to the percent of vocal fold elongation from physiologic length.

Methods:

Ten excised canine larynges were mounted on a bench apparatus capable of controlling vocal fold elongation. Subglottal airflow was gradually increased until the onset of phonation. Elongation of the vocal folds was varied from +0% (physiologic length) to +15%, and the PTF and PTP were measured.

Results:

The mean PTFs at physiologic vocal fold length ranged from 101 to 217 mL/s. No statistically significant relationship was found to exist between the size of the larynx and the measured PTF values (p = .404). The average percent change of PTF compared to the magnitude of elongation was found to be statistically significant (p < .001). The data indicated that the PTF was proportional to the percent of vocal fold elongation.

Conclusions:

The PTF was positively correlated with vocal fold elongation and the PTP for small magnitudes of elongation. The results suggest that the PTF may be indicative of the biomechanical properties of the vocal folds, thus providing a possibly valuable tool in the clinical evaluation of laryngeal function.
Study of Wound Healing in Rats Treated with Topical and Injected Mitomycin C
Authors: Ribeiro Fernando de Andrade Quintanilha , Guaraldo Lusiele , de Pádua Borges Janaina , Vianna Maria Regina , Eckley Claudia A.
Published: October 2014

Objectives:

Mitomycin C, a widely used chemotherapeutic drug, has been proposed as a potential adjuvant for the control of scar tissue in surgical wounds because of its capacity to inhibit fibroblast proliferation. The current study used a combination of topical and injected mitomycin C to slow the healing process of surgical wounds in rats.

Methods:

An experimental model of surgical wounding at the dorsum of rats was used. A total of 43 animals were subdivided into 3 groups: Control, topical mitomycin C, and a combination of topical treatment and intradermal injections of the drug at 30 and 60 days after the initial topical treatment. After 3 months, the animals were painlessly sacrificed and the surgical scars were removed for microscopic analysis.

Results:

The group that received only topical mitomycin C presented milder inflammatory signs and consequently had a less intense healing process than the control group. The group treated with a combination of both topical and injected mitomycin C presented results comparable to those of the control group.

Conclusions:

The toxic characteristics of mitomycin C were most likely responsible for the greater tissue damage that occurred when it was used in the injected form, causing increased scar tissue formation. Mitomycin C slows the healing process of surgical wounds when used topically, but causes enhanced scar tissue formation when injected.
Benign Paroxysmal Positional Vertigo: Concomitant Involvement of Different Semicircular Canals
Authors: Tomaz Andreza , Ganança Maurício Malavasi , Ganança Cristina Freitas , Ganança Fernando Freitas , Caovilla Heloisa Helena , Harker Lee
Published: October 2014

Objectives:

We evaluated the simultaneous ipsilateral or contralateral involvement of the posterior and lateral, anterior and lateral, or posterior and anterior semicircular canals in patients with benign paroxysmal positional vertigo (BPPV).

Methods:

The files of 2,345 patients with BPPV were analyzed.

Results:

Single-canal BPPV occurred in 2,310 cases (98.5%) — Unilaterally in 2,058 (89.1%) and bilaterally in 252 (10.9%). Multiple-canal BPPV occurred in 35 cases (1.5%). Of these 35 cases, there was simultaneous involvement of the posterior and lateral canals on the same side (23) or on opposite sides (9) in 32 cases (91.4%). Simultaneous involvement of the anterior canal on one side and the posterior canal on the opposite side occurred in 2 cases (5.7%), and that of the anterior canal on one side and the lateral canal on the opposite side occurred in 1 case (2.9%). All cases represented canalithiasis.

Conclusions:

Multiple-canal BPPV was rare, and usually involved canals on the same side; simultaneous involvement of the posterior and lateral canals was much more common than involvement of the anterior and posterior canals or the anterior and lateral canals. Trauma increased the risk for multiple-canal BPPV, but not the risk for bilateral single-canal BPPV. Cupulolithiasis was not a factor in multiple-canal BPPV.
Penetration and Aspiration in Healthy Older Adults as Assessed during Endoscopic Evaluation of Swallowing
Authors: Butler Susan G. , Stuart Andrew , Markley Lisa , Rees Catherine
Published: October 2014

Objectives:

A previous article from our group presented data on normal swallowing as assessed during simultaneous manometry and flexible endoscopic evaluation of swallowing (FEES). Because penetration and aspiration events were identified in healthy adults, the question arose, could the presence of the manometric catheter confound normal FEES findings? Thus, a follow-up study was designed to address the effects of catheter condition on healthy older adults as assessed during FEES.

Methods:

Twenty older adults (mean, 78.9 years of age) participated. The participants each contributed 28 swallows, affording a study total of 560 swallows for analyses.

Results:

The older adults demonstrated penetration on 82 (15%) and aspiration on 18 (3%) of 545 swallows. The numbers of participants who had penetration and aspiration during the study protocol were 75% and 30%, respectively. The older adults demonstrated both penetration and aspiration events irrespective of the presence of a catheter; whether they were drinking milk, water, or barium; whether the bolus was 5 or 10 mL; and whether they took the bolus via syringe or self-administered the bolus with a cup. However, significantly more aspiration was found on thin liquids than on puree or solids.

Conclusions:

Endoscopic data on normal swallowing physiology were generated. These may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.
Equine versus Bovine Pericardium in Transmeatal Underlay Myringoplasty
Authors: Albera Roberto , Dagna Federico , Lacilla Michelangelo , Canale Andrea
Published: October 2014

Objectives:

Many different grafting materials have been proposed in myringoplasty. The aim of this study was to evaluate the results obtained in transmeatal underlay myringoplasty using bovine and equine pericardium. The results were compared with those obtained by using autologous temporalis fascia.

Methods:

The study group consisted of 52 patients with tympanic perforation. Twenty-nine patients were randomly selected for treatment with bovine pericardium and 23 for equine pericardium. A group of 14 patients was treated with autologous temporalis fascia.

Results:

Closure of the perforation was achieved in 19 of 29 patients (66%) treated with bovine pericardium, in 19 of 23 (83%) treated with equine pericardium, and in 13 of 14 (93%) treated with autologous fascia. The best functional results in patients who gained closure of the perforation were obtained by means of equine pericardium.

Conclusions:

The overall long-term tympanic closure rate demonstrates that equine pericardium has a greater take rate than bovine pericardium. The results obtained are inferior to those obtained with autologous fascia, but this technique is less aggressive. The higher success rate with equine pericardium may be due to the fact that it is thinner and easier to handle and model than bovine pericardium.