bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue Reconstruction and Remodeling Using Acellular Bladder Matrix
Authors: Fuller James H.
Published: September 2014

Objectives:

Attendees should be able to (1) learn of an innovative new material for full thickness repair utilizing urinary bladder matrix (UBM); (2) understand the basic mechanism of this procedure; (3) apply this technique and material to daily surgical use.

Methods:

Over the past 3 years MatriStem (ACell, Inc.) has been used successfully by the author in multiple head and neck reconstructive procedures, including repair of major, full thickness cancer and osteoradionecrosis cases of the scalp, face, and nose, full thickness oral and mandibular bone defects. MatriStem is derived from porcine UBM. Published studies have shown that UBM may recruit progenitor cells to the injury site and stimulate a constructive remodeling response with site‐specific tissue. Clinically, MatriStem has shown cost benefits and better patient outcomes compared to other therapies. Previous surgical techniques employed by the author have used various synthetic materials and tissue‐derived materials—ranging from cadaveric dermis to bovine tendon—as well as split‐ and full‐thickness autologous skin grafts. However, these techniques did not result in regeneration of full‐thickness tissue. These historical results will provide context for the cases to be presented. In this presentation, the author will display many of these clinical experiences.

Results:

It has even been possible to regenerate partial bone replacement in radiated bone following partial thickness resection. It has been especially useful in repair of head and neck cancer resection defects.

Conclusions:

The use of MatriStem has offered unprecedented solutions to many challenging and complex cases.
Transoral Surgical Anatomy and Clinical Considerations of Lateral Oropharyngeal Wall and Base of Tongue
Authors: Gun Ramazan , Durmus Kasim , Kucur Cuneyt , Carrau Ricardo L. , Ozer Enver
Published: September 2014

Objectives:

(1) Describe key anatomic structures in lateral oropharyngeal wall and tongue base transorally. (2) Determine surgical landmarks to increase intraoperative safety in transoral robotic surgery.

Methods:

Transoral dissections were performed endoscopically in 5 vascular silicone‐injected fresh human cadavers. Anatomic structures were also confirmed with lateral neck dissections.

Results:

Tonsillar bed is largely made by superior pharyngeal constrictor muscle and overlying pharyngobasilar fascia. Palatoglossus and palatopharyngeus muscles limit this tonsillar bed anteriorly and posteriorly, forming tonsillar pillars. Stylopharyngeus and styloglossus muscles and stylohyoid ligament run between superior and middle pharyngeal constrictor muscles contributing to inferior tonsillar fossa. These structures are located just medial to facial, lingual, and internal maxillary arteries in parapharyngeal space. Internal carotid artery lies posterolateral to the branches of external carotid artery. Lingual artery injury might occur during base of tongue or inferior tonsil resections. At its origin, the lingual artery is situated deep to middle pharyngeal constructor muscle between stylohyoid ligament and greater cornu of hyoid bone posteriorly. At the tonsil‐tongue base junction, it courses lateral and deep to styloglossus muscle. Keeping the resection over styloglossus muscle and stylohyoid ligament will prevent lingual artery injury. The glossopharyngeal nerve is positioned between stylohyoid ligament and styloglosus muscle. Its branches travel posteroinferiorly in inferior tonsillar fossa toward the base of tongue. Lingual nerve is vulnerable to injury as it emerges anterior to medial pterygoid muscle.

Conclusions:

A thorough understanding of transoral anatomy is critical for surgeons to perform transoral robotic surgery safely and efficiently.
Tumor‐Induced Osteomalacia of the Head and Neck Region: A 10‐Year Tertiary‐Care Experience
Authors: Mathews Suma S. , Rupa Vedantam , Job Anand , Mathew John , Manipadam Marie T. , Thomas Nihal J. , Paul Thomas V.
Published: September 2014

Objectives:

Oncogenic osteomalacia (OO) is a paraneoplastic syndrome seen in tumors of mesenchymal origin that secrete “phosphatonins,” like fibroblast growth factor‐23 (FGF‐23). They are characterized by hypophosphatemia and osteomalacia. These patients make remarkable recovery once tumors are localized and excised. The authors’ aim was to study retrospectively the clinical, biochemical profile and follow‐up of subjects who presented with the features of OO of the head and neck region.

Methods:

Data of all the patients diagnosed to have OO from 2004‐2013 were collected using the computerized database.

Results:

Among the total 29 presentations of 27 with OO, 12 (44%) were found to have a histopathologically proven identifiable lesion. Nine (75%) of these were found to be in the head and neck region. The most common presenting symptoms in this subgroup were bone pains (78%) and proximal muscle weakness (56%). Rigid nasal endoscopy, blood pool scan, contrast‐enhanced computed tomography, and magnetic resonance imaging of head and neck region picked up 5 out of 6 (83%), 3 out of 7 (43%), 9 out of 9 (100%), and 3 out of 3 (100%) lesions, respectively. All patients underwent surgical excision, of which 56% are in partial and 44% in complete remission. Two patients had a recurrence at the same site after 5 years.

Conclusions:

The head and neck region was the most common site where tumor was localized in patients with OO. In all hypophosphatemic osteomalacia, where oncogenic osteomalacia is suspected, nasal endoscopy and imaging of the head and neck region should be done. Surgical excision remains the mainstay of treatment. These patients warrant long‐term follow‐up as a recurrence can occur several years after the initial response.
The Use of Botulinum A Toxin in Dysphagia
Authors: Amin Nikul , Fu Bertram , De Zoysa Neil , Lew‐Gor Simione
Published: September 2014

Objectives:

(1) Describe our experience with the use of botulinum A toxin (Botox) in a case series of patients with dysphagia with cricopharyngeal spasm on videofluoroscopy. (2) Systematic review of current literature.

Methods:

We present a case series of patients with dysphagia refractory to conventional conservative and medical treatment in whom we administered endoscopic injection of 100 mU of Botox into the cricopharyngeus by a single head and neck surgeon using the same technique. Eight patients with refractory dysphagia were treated with 100 mU of Botox injection into the cricopharyngeus. We excluded patients who previously had a surgical intervention to the upper esophagus or pharynx. The change in dysphagia after Botox administration was assessed using the Mayo Dysphagia Questionnaire‐30 before and approximately 2 weeks, 3 months, and 6 months after Botox administration and with pre‐ and post‐administration videofluoroscopies.

Results:

The Mayo Dysphagia Questionnaire‐30 scores improved significantly at all follow‐up stages postprocedure. This improvement is reflected in the post‐injection videofluoroscopy examinations.

Conclusions:

Dysphagia is often difficult to treat. It may be associated with upper esophageal sphincter dysfunction, where conventional treatment, including anti‐reflux medication and dilatation, may not be sufficient to provide symptomatic relief. A wide range of surgical interventions with associated morbidity have been described with varying success rates. Our method and experience with endoscopic injection of botulinum A toxin to the cricopharyngeus has shown to be an effective minimally invasive option in those who have been assessed as appropriate for the intervention.
Nasal Fractures in Children and Adolescents: Mechanisms of Injury and Efficacy of Closed Reduction
Authors: Liu Clive , Scott Andrew R.
Published: September 2014

Objectives:

(1) Determine the most common causes of traumatic nasal deformities referred to pediatric otolaryngology. (2) Examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents’ and surgeon's ratings of post‐reduction nasal symmetry.

Methods:

Case series and chart review within an urban pediatric otolaryngology practice.

Results:

One hundred cases of traumatic nasal deformity met inclusion criteria over a 3‐year study period. The mean age at presentation was 13 years (4 weeks‐18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports‐related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%), and alcohol‐related (2%). Of these 100 cases, 21% underwent closed reduction within a 14‐day period following injury. All patients achieved symmetry in the operating room immediately following reduction. At the postoperative visit (7‐10 days following surgery), the operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) was satisfied in 81% of cases. Both parent and surgeon were satisfied with postreduction symmetry 33% of the time.

Conclusions:

The most common source of traumatic nasal deformity in children and adolescents differs from the most frequent mechanisms of nasal trauma in adults. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases; however, a result in which both parent and surgeon agree with successful re‐establishment of symmetry occurs in only 1/3 of cases.
Aerodynamic Phonatory Pattern as a New Sign of Superior Laryngeal Nerve Injury
Authors: Fernandez Secundino , Alcalde Juan M. , Baptista Peter M. , Barona Luz
Published: September 2014

Objectives:

Reduced quality of life after thyroid surgery is multifactorial and may include the need of lifelong different treatments. About 1 in 20 patients experience voice changes, and it is very frequent that these changes may not be caused by neural lesions. The purpose of this study is to describe aerodynamic phonatory features in thyroidectomized patients in order to determine what mechanisms are involved in voice changes in these patients and what are the best rehabilitative options.

Methods:

We studied 58 thyroidectomized patients with neither apparent neural cause of thyroidectomy‐related dysphonia nor recurrent laryngeal nerve injury nor external branch of the superior laryngeal nerve (EBSLN) injury. The patients were asked to produce sustained vowels, syllables, and sentences. Three items were recorded in upright and sitting positions. Afterward, acoustic and aerodynamic measurements were made: fundamental frequency, jitter, shimmer, intensity, harmonic/noise ratio, spectrographic analysis, subglottic pressure, mean transglottic flow, and laryngeal resistance. All measurements were made using Voice Plus from Alamed Corporation software. STATA software was used to analyze variables.

Results:

We describe 2 different groups of patients with different aerodynamic pattern in voice production that correlate with voice quality. In 66% of patients there was no change and in 34% the glottal pressure and laryngeal resistance decreased as a result of lower tension in the vocal fold as a consequence of an injury of the EBSLN.

Conclusions:

This aerodynamic phonatory pattern that may be understood by objective aerodynamic measurements could be another new sign of EBSLN injury.
Anterior‐Commissure Laryngoscope Extraction of Esophageal Coins in Children Using an Apnea Technique
Authors: Tarrats Luis A. , Rivera Marinell , Vargas‐Pinto Susana , Garraton Miguel , March Antonio Riera , Quintero Elisa
Published: September 2014

Objectives:

(1) To evaluate the efficacy and safety of coin extraction with the anterior‐commissure laryngoscope during apnea in children less than 10 years old. (2) To present the sociodemographic characteristics of this population and analyze the differences in foreign body features. (3) To describe heart rates (HR), minimal O2 saturation, and end‐tidal CO2 (ETCO2) during the procedure.

Methods:

In this retrospective chart review study, consecutive patients with a diagnosis of cervical esophageal coin who underwent this procedure between May 2011 and December 2013 at our institution (n = 59) were evaluated and data analyzed. Age (independent variable) was categorized as ≤1, >1 and <5, ≥5 and ≤10 years old.

Results:

The mean and standard deviation (SD) of age was 3.1 ± 2.4 years. The majority were Medicaid participants (87.5%). We successfully removed the coin in 94.9% (n = 59) of our cases with this technique. Among children completing the technique, children ≤1 year of age were more likely to ingest pennies (100%), whereas children ≥5 years old more likely ingested quarters (50%; P =. 01) Younger children showed higher HR than older groups and baseline values were similar to intraoperative ones (P <. 001). The length of apnea was 57.7 ± 25.2 seconds. The median minimum O2 saturation was 99.5% (min 93, max 100), and the media and SD of the ETCO2 at the end of the procedure was 35.7 ± 4.8 mm Hg.

Conclusions:

In properly selected patients the anterior‐commissure apnea technique represents an efficient and secure modality for treatment. If successful, the patient can be safely discharged home after clearance from anesthesia and a PO trial.
Complete Laryngotracheal Separation from Blunt Trauma: A Case Series and Discussion of Surgical Techniques
Authors: Spinner Alycia G. , Wang Robert C.
Published: September 2014

Objectives:

(1) Recognize the often subtle clinical presentation of complete laryngotracheal separation. (2) Address immediate course of action in the event of a total separation. (3) Describe components of a successful surgical repair.

Methods:

Over 3 years at a tertiary care center in Las Vegas, Nevada, 3 cases of complete laryngotracheal separation secondary to blunt trauma were successfully treated with prompt surgical intervention. Various surgical techniques were employed, given the complexity and different characteristics of each patient's presentation, with cartilaginous reduction and fixation favored over soft tissue apposition, along with fenestration tracheostomy procedures to prevent infection of the repair sites. Successful long‐term outcome was defined by tracheostomy tube decannulation and lack of multiple tracheal dilations or other tracheoplasty procedures to maintain a patent airway.

Results:

All 3 patients initially required a tracheostomy due to airway edema, but each made an uneventful recovery with early capping and tracheostomy tube decannulation. None of the patients necessitated further tracheal procedures, and all had serviceable voice and good swallowing function.

Conclusions:

Because of the relative rarity of complete laryngotracheal separations due to blunt trauma, surgical methods for repair are not widely published. We present our experience with the hope that it will assist other surgeons when faced with the challenge of diagnosing and repairing this life‐threatening injury.
Correlation of Reflux Finding Scores on Laryngoscopy to Clinical Outcomes
Authors: Patton Samuel R. , Underbrink Michael P.
Published: September 2014

Objectives:

Evaluate the reflux finding score as a clinical tool to diagnose laryngopharyngeal reflux disease by testing its reliability and reproducibility.

Methods:

Two scorers independently and blindly reviewed 330 videostrobes of patients that were performed from 2005‐2009. Scorers gave each videostrobe a reflux finding score. A chart review was then performed to determine the diagnosis given at the time of the videostrobe, smoking status, whether the patient was treated with anti‐reflux medication, and any abnormalities noted on recent esophagoscopy. The reflux finding scores of the 2 scorers were statistically compared for agreement with each other and to the findings of the chart review.

Results:

A total of 168 out of 330 patients met final criteria for inclusion in the study. The interrater agreement between the 2 scorers had a weighted kappa of 0.30. The c‐statistic scores for correlation of the scorers’ reflux finding scores (RFSs) to the chart diagnosis were 0.554 and 0.609 for scorer 1 and scorer 2, respectively.

Conclusions:

The reflux finding score has a fair inter‐relater reliability in our study. Blinded rater use of RFS in our study did not correlate well with clinical diagnosis of laryngopharyngeal reflux disease. No statistically significant differences in RFS validity were found based on gender, age, or treatment status.
New Experimental Model of Facial Nerve Function and Integrity to Evaluate Regeneration
Authors: Bento Ricardo F. , Costa Heloisa J. Z. R. , Nascimento Silvia B. , Ferreira Ricardo J. R. , Salomone Raquel
Published: September 2014

Objectives:

The ideal animal model for nerve regeneration studies is an object of controversy because all models described by the literature have advantages and disadvantages. Small animals such as rats have been repeatedly used in experimental procedures because of their easy caretaking and handling, resistance to manipulation and infections, and low cost. In this case, rats have the additional benefit of tolerating bilateral facial paralysis. This study aimed to describe the histologic and functional (electroneuromyographic) patterns of the mandibular branch of the facial nerve of Wistar rats in order to create a new experimental model of facial nerve regeneration.

Methods:

Forty‐two male Wistar rats were submitted to neurophysiologic evaluation by a nerve conduction test of the mandibular branch of the facial nerve to obtain the compound muscle action potential. Twelve of these rats had the mandibular branch of the facial nerve surgically removed and submitted to histologic analysis (total axon number, partial axonal density, and axonal diameter) of the proximal and distal nerve segments.

Results:

There was no statistical difference in the functional and histologic variables studied.

Conclusion:

These new histologic and functional standards of the mandibular branch of the facial nerve of rats establish an objective, easy, and greatly reproducible model for future facial nerve regeneration studies.
Hand Manometry to Assess Overall Muscle Strength (Frailty) in Dysphagic Patients
Authors: Kim Luke Y. , Farquar Douglas , Mirza Natasha
Published: September 2014

Objectives:

(1) Evaluate whether patients with symptoms of aspiration as assessed by fiberoptic endoscopic evaluation of swallowing (FEES) demonstrate reduced overall muscle weakness, or frailty, as seen by handgrip strength. (2) Determine whether tools such as the Eating Assessment Tool (EAT‐20) and Penetration‐Aspiration Scale (PAS) correlate with muscle strength as seen by handgrip strength.

Methods:

Prospective, single‐blind study on patients with chief complaints of dysphagia who presented to a tertiary referral center over a 4‐month period. Participants completed the EAT‐20 dysphagia questionnaire. FEES was performed by administering standardized boluses of 4 different consistencies (thin liquid, nectar, puree, mechanical soft food) and assessing for spillage, penetration, pharyngeal residue, aspiration, and reflux. Patients were additionally scored using the Penetration‐Aspiration Scale. Aspirators had a score >5. Overall muscle strength was assessed using handgrip strength measured by hand dynamometry.

Results:

Twenty‐seven patients with chief complaints of dysphagia were eligible for enrollment. Average grip strength was 25.9 kg, average EAT‐20 score was 35, and average PAS score was 3. Six out of 27 patients (22%) were found to be aspirators with PAS >5. Average grip strength for nonaspirators and aspirators was 25.9 kg and 25.6 kg, respectively (P >. 05). Controlling for weight, age, and sex, EAT‐20 showed no correlation with grip strength (P >. 05). EAT‐20 demonstrated significance with PAS score (P <. 01).

Conclusions:

Grip strength does not demonstrate association with dysphagia and risk of aspiration. Frailty may not be strongly predicted by grip strength. Other measures of frailty should be investigated with risk of aspiration.
Identifying Occupations at Risk of Laryngeal Disorders in an Academic Laryngology Clinic
Authors: Mori Matthew C. , Song Phillip
Published: September 2014

Objectives:

Identify occupations of new laryngology patients found in high prevalence compared with the occupations of the surrounding general population. Laryngeal disorders have been associated with several occupations, including teachers, singers, and telemarketers. Our study may help identify new groups of patients at risk for laryngeal pathology.

Methods:

Using our laryngology clinic database, we determined prevalence of occupations in employed new patients from 1993 to 2012 and compared this with data from the Bureau of Labor Statistics for the greater Boston area over the same time period. Proportions with confidence intervals were used to establish statistical significance.

Results:

The occupations of 10,119 patients were analyzed. Occupations with statistically significant higher prevalence in laryngology clinic than in the general population included singers, teachers, lawyers, scientists, and clergy. Occupations with lower prevalence included maintenance workers, cleaners, bus drivers, repairmen, and computer programmers.

Conclusions:

This study identified several new occupational groups that may be at higher risk of laryngeal pathology because of their relatively higher prevalence in laryngology clinic.
Management of Tracheo‐esophageal Fistulae with Montgomery T‐Tube
Authors: Tran Christopher M. , Fink Daniel S. , Kunduk Melda , McWhorter Andrew J.
Published: September 2014

Objectives:

(1) Describe a minimally‐invasive technique for management of trachea‐esophageal fistulae. (2) Analyze outcomes of management of trachea‐esophageal fistulae with t‐tube placement.

Methods:

A retrospective case series with chart review was conducted at an academic practice in a regional referral center. Two patients with tracheo‐esophageal fistulae who either were not candidates for open surgical repair or refused open surgical repair were successfully managed with a Montgomery T‐tube to stent the fistula. Outcome measures included resumption of oral diet, need for further procedures, and fistula size.

Results:

Both patients had t‐tubes that were sized to stent the fistula and maintain an airway without esophageal stent or tracheostomy. There were no cases of migration or enlargement of fistula. No patients required revision procedures. Fistulae were successfully controlled in all patients, with full resumption of oral intake and maintenance of voice. No patients had closure of fistula.

Conclusions:

Montgomery T‐tube stenting is a safe and minimally invasive way to manage trachea‐esophageal fistulae in patients who are not candidates for open surgical repair. This technique minimizes soilage of the airway with maintenance of voice that is often difficult in management with cuffed tracheotomy tubes. Neither migration nor enlargement of fistula was noted.
Metastatic Calcification of the True Vocal Folds in the Setting of Renal Failure
Authors: Hardison Scott A. , Schuman Theodore A. , Jakowski Joseph
Published: September 2014

Objectives:

(1) Present a case of metastatic calcinosis of the true vocal cords. (2) Discuss the pathogenesis, diagnosis, and treatment strategies for this condition.

Methods:

This is a case report of a 52‐year‐old male with a history of end‐stage renal disease and tobacco abuse who presented to clinic with complaints of dysphagia, cough, and subtle voice changes. Transnasal fiberoptic laryngoscopy revealed bilateral patches of leukoplakia on the anterior third of the vocal cords. After a 3‐month period of conservative management with a proton pump inhibitor and serial scope examinations, the lesions were noted to be slowly enlarging. It was determined that an excisional biopsy should be performed to rule out malignancy. The patient underwent micro‐suspension direct laryngoscopy with microflap excision of the bilateral vocal cord lesions.

Results:

Surgical pathology revealed benign squamous mucosa with calcinosis, parakeratosis, and submucosal hyalinization. These findings were characteristic of metastatic calcification. Review of the patient's medical records confirmed ongoing phosphorous dysregulation. Metastatic calcinosis of the true vocal fold is a very rare finding, with only 2 other reported cases in the literature.

Conclusions:

In patients suffering from end‐stage renal disease, dysregulation of calcium and phosphate levels may lead to deposition of calcium in many types of soft tissue, including the true vocal cords. Examination findings may mimic dysplastic lesions, and this diagnosis should be considered in patients with chronic kidney disease.
Objective Assessment of Postoperative Outcomes in Endonasal Spreader Grafts
Authors: Jeffery Caroline C. , Ansari Khalid , Cote David
Published: September 2014

Objectives:

Use acoustic rhinometry to objectively measure the functional outcomes of endonasal spreader grafts in patients undergoing surgical correction of internal nasal valve collapse.

Methods:

Eighteen adult patients undergoing open septoplasty with unilateral or bilateral endonasal spreader graft placement were recruited. Patients were asked to undergo preoperative and postoperative acoustic rhinometry to measure changes in cross‐sectional area of the internal nasal valve. Postoperative subjective nasal symptoms as measured by SNOT‐22 and NOSE scores were also compared to preoperative values.

Results:

Patients undergoing septoplasty with endonasal spreader graft placement had a statistically significant increase in the cross‐sectional area of the internal nasal valve (P <. 05). This was concomitant with mild improvement in SNOT‐22 and NOSE scores postoperatively (P <. 05).

Conclusions:

This study provides objective evidence of an increase in internal nasal valve area after placement of endonasal cartilage spreader grafts in combination with septoplasty.
Outcomes of Arytenoid Adduction under Laryngeal Mask Mechanical Ventilation for Unilateral Vocal Fold Paralysis
Authors: Kawamoto Ai , Honkura Yohei , Watanabe Kenichi , Katori Yukio
Published: September 2014

Objectives:

Arytenoid adduction surgery for the unilateral vocal fold paralysis is usually carried out under intravenous sedation because improvement of the voice evaluable during surgery. In patients preferred for surgery under general anesthesia due to their physical or mental condition, we selected general anesthesia using laryngeal mask mechanical ventilation, and we confirmed the location of the vocal fold during surgery using a flexible fiberscope. To evaluate this procedure of anesthesia, we compared outcomes of the adduction surgeries between intravenous sedation and general anesthesia.

Methods:

From September 2012 to August 2013, adduction surgeries were performed in 17 cases under intravenous sedation with spontaneous breathing, and in 5 cases under general anesthesia using laryngeal mask. Pre‐ and postoperative maximum phonation time (MPT), mean flow ratio (MFR), and voice handicap index‐10 (VHI‐10) were evaluated.

Results:

MPT, MFR, and VHI‐10 were remarkably improved in all adduction surgery with intravenous sedation cases. In the general anesthesia group, improvement of the factors was also recognized in most cases, but not in all.

Conclusions:

Adduction surgery under general anesthesia with laryngeal mechanical mask ventilation is a useful tool for the unilateral vocal fold palsy patient. However, even though we checked the position of the vocal fold in surgery, the efficacy of the surgery is not guaranteed in a few cases because the actual voice cannot be evaluated in general anesthesia.
Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross‐Sectional Controlled Study
Authors: Turfe Zaahir , Kasti Maher M. , Beydoun Nour , Hamdan Abdul Latif
Published: September 2014

Objectives:

Investigate the prevalence of phonatory symptoms, perceptual, acoustic, and aerodynamic findings in patients with asthma compared to a control group.

Methods:

A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and sex, were enrolled in this study. All subjects were asked about the presence or absence of cough, dyspnea, respiratory failure, dysphonia, degree of vocal fatigue, and phonatory effort. Perceptual evaluation, acoustic analysis, and aerodynamic measurements were also performed. Patient self‐assessment using the Voice Handicap Index 10 was reported.

Results:

The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the 2 groups (32.3% vs 5.3%, P =. 025) with a significant difference in the mean score of respiratory effort and vocal fatigue (P =. 019,. 041, respectively). The overall grade of dysphonia was significantly higher in asthmatics compared to controls (P =. 002). Patients with asthma also had significantly higher degree of asthenia and straining with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for jitter. There was also no significant difference in the maximum phonation time between the 2 groups.

Conclusions:

Phonatory symptoms are significantly more prevalent in patients with asthma compared to controls.
Postoperative Glottal Function and Voice‐Related QOL after Type1 and Type2 Cordectomy against Laryngeal Leukoplakia
Authors: Kono Takeyuki , Saito Koichiro , Yabe Haruna , Uno Kosuke , Ogawa Kaoru
Published: September 2014

Objectives:

Recent progress in phonomicrosurgical technique and equipment enabled one to precisely differentiate the subepithelial (type1) and subligamental (type2) cordectomy concept as needed. The purpose of this study was to compare postoperative glottal function and voice‐related quality of life (QOL) between these 2 surgical concepts against laryngeal leukoplakia.

Methods:

From January 2007 to August 2013, 42 consecutive laryngeal leukoplakia patients had excisional biopsies using type1 procedures. Of these, cancer patients (n = 10) had additional type2 laser surgeries. Furthermore, some severe dysplasia/carcinoma in situ patients (n = 11) preferred additional type2 surgery aiming at relatively safe surgical margins. Sequential pre‐ and postoperative measurements of Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale and evaluations of laryngeal videostroboscopic images were performed. Acoustic measurements and voice‐related QOLs (VHI and V‐RQOL) were examined at the patients’ last visits. All data were compared between type1 and type2 groups.

Results:

Vocal quality was well‐preserved in type1 group after surgery. Although immediate postoperative deterioration of GRBAS score was observed in type2 group, vocal recovery was obtained in 6 months to present no significant difference compared with type1 group. Impaired glottal closure and pliability were observed in both groups after surgery. While videostroboscopic findings of type1 group recovered to normal in 3 months, impaired glottal findings remained for 1 year in half of the type2 patients. Moreover, voice‐related QOLs were significantly better in type1 group.

Conclusions:

Our study proved that advanced phonomicrosurgical technique and equipment could offer a well‐preserved vocal quality even in the type2 group. However, subjective voice‐related QOLs were better in the type1 group with superior videostroboscopic findings.
Prevalence of Phonatory Symptoms and Acoustic Findings in Patients with Chronic Obstructive Lung Disease
Authors: Turfe Zaahir , Kanj Nadim , Jaffal Hussein , Attallah Jane , Hamdan Abdul Latif
Published: September 2014

Objectives:

Investigate phonatory symptoms and acoustic and aerodynamic findings in patients with chronic obstructive lung disease (COPD) compared to a control group.

Methods:

A total of 40 subjects, 27 COPD and 13 control subjects matched according to age and sex, were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, degree of vocal fatigue, and phonatory effort. Perceptual evaluation, acoustic analysis, and aerodynamic measurements were also performed. Patient self‐assessment using the Voice Handicap Index 10 was reported.

Results:

There was a statistically significant difference in the prevalence of dysphonia between the 2 groups (12% vs 0%, P <. 05) with a significant difference in the mean score of respiratory effort and vocal fatigue (P =. 011,. 012, respectively). There was no significant difference in any of the perceptual parameters between the 2 groups except for roughness (P =. 009). There was no significant difference in the means of any of the acoustic parameters between patients and controls. There was also no significant difference in the maximum phonation time between the 2 groups (P =. 916).

Conclusions:

Dysphonia is significantly more prevalent in patients with COPD compared to controls.
Revision Endoscopic Stapler Zenker's Diverticulotomy
Authors: Oestreicher‐Kedem Yael , Wasserzug Oshri , Sagi Boaz , Fliss Dan M. , Zikk Daniel
Published: September 2014

Objectives:

Endoscopic stapler Zenker's diverticulotomy (ESD) has become a well‐accepted treatment of Zenker's diverticulum (ZD). A small percentage of ZDs may recur after ESD. We sought to evaluate the technical feasibility, safety, and effectiveness of revision endoscopic stapler diverticulotomy (RESD) for recurrent ZD.

Methods:

A retrospective case study conducted in Tel‐Aviv Sourasky Medical Center. The records of all patients who underwent ESD between the years 2002 and 2013 were reviewed. The records of patients who underwent RESD were identified and screened for primary surgical history, symptoms of recurrent ZD, time to recurrence, intraoperative and postoperative RESD course, complications, and symptom resolution.

Results:

Eighty‐nine ESD were performed. Twenty were RESD for recurrent ZD and 69 were primary ESD (PESD). Nine RESD were performed for recurrent ZD after open trans‐cervical Zenker's diverticulectomy, 10 ESRD were performed for recurrent ZD after ESD, and 1 initial surgical approach was unknown. Mean patient age at revision was 66.1 years and mean time from first operation for ZD to RESD was 4.7 years. Average ESRD surgery time and hospital stay were 21.4 minutes and 2.8 days, respectively. Endoscopic stapling of the ZD was achieved in 19 of 20 RESD. Relief of symptoms without recurrence was achieved after 18 RESD. Four RESD patients experienced minor postoperative complications. We found no significant differences between the RESD and PESD groups regarding age, operative time, technical feasibility, hospital stay, and complication rate (P >. 05).

Conclusions:

RESD for ZD is technically feasible, safe, and effective. Results compare to PESD.
A Study of Injection Therapy Using bFGF by High‐Speed Imaging and Acoustic Analysis
Authors: Suzuki Hirotaka , Makiyama Kiyoshi , Takane Tomoyuki , Matuzaki Hiroumi
Published: September 2014

Objectives:

Some authors have reported effects of some materials used for injection. Their effects that reduce the size of glottal gap do not last because the materials are usually absorbed. Thus, patients with deficient glottal closure must be repeatedly injected. To reduce the number of treatments, we injected basic fibroblast growth factor (bFGF) into our patients. The purpose of this study was to examine the effect of bFGF injection by high‐speed imaging and acoustic analysis.

Methods:

Fifteen patients (8 men and 7 women, mean age 65 years) were enrolled in this study. Four or 8 µg of bFGF were injected into each treated vocal cord. The injection was made into the unilateral or bilateral vocal cord according to the size of glottal gap. All patients were followed up every 3 months. Using high‐speed imaging and PS77E, we analyzed the following factors: KEA (kimograph edge analysis), GAW (glottal area wave form), phase shift analysis, PPQ (period pertubation quotient), APQ (amplitude perturbation quotient), MFR (mean flow rates). The effect of the treatment was assessed by high‐speed imaging and acoustic analysis.

Results:

Data both from the imaging analysis and acoustic analysis showed significant improvement in all subjects after 6 months. No allergic or long‐term adverse effects were noted.

Conclusions:

The result of this study suggests bFGF may be effective long‐term and safe as a regenerative agent for aged vocal folds.
A Pilot Study of Muscle‐Nerve‐Muscle Grafting for Facial Reanimation in Rats
Authors: Hotaling Jeffrey M. , Charous Steven , Sappington Joshua M. , Foecking Eileen
Published: September 2014

Objectives:

(1) Describe the muscle‐nerve‐muscle (MNM) reinnervation technique, which involves implanting a graft to serve as a conduit between an innervated donor muscle and a denervated recipient muscle. (2) Analyze the effects of MNM reinnervation with and without electrical stimulation and exogenous testosterone on functional recovery following rat facial nerve injury.

Methods:

A prospective controlled animal study. Facial nerve branches to the whisker pads of 24 adult male Sprague Dawley rats were harvested and each rat was then randomly assigned to 1 of 3 treatment groups of 8 rats each: no graft (control), MNM grafting alone (MNM), or MNM grafting + electrical stimulation (ES) and testosterone propionate (TP) (MNM+). MNM grafts were implanted from the functioning to the nonfunctioning whisker pads in the experimental groups. One experimental group underwent an ES and TP protocol. Whisker movement was assessed by behavioral observations, electromyographic recordings, and video analysis.

Results:

Recovery of coordinated movement was displayed at 16 weeks by 0% of the control animals, 71% of the MNM animals, and 85% of the MNM+ animals. Electromyographic recordings demonstrated electrical conductance across grafts in both MNM and MNM+ animals. Histologic analysis of the MNM grafts demonstrated growth of myelinated fibers across nerve grafts in both MNM and MNM+ animals.

Conclusions:

This study demonstrated not only that reinnervation following MNM grafting can improve tone and movement in a selected muscle following a facial nerve injury, but also that therapy with electrical stimulation and exogenous gonadal steroids further enhances the recovery of these functional measures.
Association of Endolymphatic Hydrops and Otosclerosis
Authors: Terao Kyoichi , Doi Katumi , Cureoglu Sebahattin , Paparella Michael M.
Published: September 2014

Objectives:

Study the correlations of endolymphatic hydrops and vestibular symptoms with otosclerotic foci.

Methods:

Comparative study of human temporal bone histopathology. In addition to areas of the stria vascularis and spiral ligament and the presence of endolymphatic hydrops, locations and degree of endosteal involvement and size of otosclerotic foci were examined in 132 temporal bones from 95 subjects with otosclerosis. The degree of endolymphatic hydrops was classified as mild, moderate and severe.

Results:

Fifty temporal bones (37.9%) from 39 subjects with otosclerosis had a histopathological finding of endolymphatic hydrops. The most common location of endosteal involvement was the endosteum of the perilymphatic space of the vestibule. In terms of locations and degree of endosteal involvement and size of otosclerotic foci, there was a significant increase in subjects with otosclerosis with endolymphatic hydrops compared with subjects with otosclerosis without endolymphatic hydrops. Twenty five subjects (26.3%) had a documented history of vestibular symptoms in patients with otosclerosis. In addition to the presence of endolymphatic hydrops, locations and degree of endosteal involvement and size of otosclerotic foci were significantly greater in subjects with otosclerosis with vestibular symptoms compared with subjects with otosclerosis without vestibular symptoms.

Conclusions:

Endolymphatic hydrops is more common than previously realized in patients with otoslerosis. The common association of these 2 otologic conditions encourages researchers. Clinicians should keep in mind the common association of these 2 otologic conditions when encountering a patient with either of these conditions.
Association of Hearing Impairment and Frailty in Older Adults
Authors: Kamil Rebecca J. , Li Lingsheng , Lin Frank R.
Published: September 2014

Objectives:

Frailty is a state characterized by decreased physiologic reserve and weakness that is associated with poor health outcomes. Whether hearing impairment, which is associated with physical and cognitive decline, is associated with frailty, is unknown.

Methods:

We analyzed 2109 individuals 70 years and older in the 1999‐2002 cycles of the National Health and Nutrition Examination Survey (NHANES). Hearing impairment was measured by self‐report (good, little trouble, lot of trouble). Frailty was defined as the presence of at least 3 of the following: 5% unintentional weight loss in the past year and/or body mass index <18.5 kg/m2, slow walking speed, weakness, exhaustion, and low physical activity. Logistic regression models were adjusted for demographic characteristics, cardiovascular risk factors, hearing aid use, and health status.

Results:

Among all individuals, self‐reported hearing impairment was significantly associated with frailty in fully adjusted models (odds ratio [OR] 1.68 [95% confidence interval {CI} 1.00, 2.82]). Analyses stratified by sex demonstrated that this association was observed in women (OR 3.79 [95% CI 1.69, 8.51]) but not men (OR 0.85 [95% CI 0.44, 1.66]).

Conclusions:

In these cross‐sectional analyses, self‐reported hearing impairment was significantly associated with frailty in women. Further research using objective hearing measures and longitudinal assessment of frailty are needed.
Betahistine Effects on Tinnitus in Patients with Ménière's Disease
Authors: Azadarmaki Roya , Prasad Sanjay
Published: September 2014

Objectives:

Analyze the effects of betahistine on tinnitus in patients with Ménière's disease.

Methods:

Retrospective review of the effects of betahistine on tinnitus in patients with Ménière's disease treated from January 2010 to January 2014. Patients included in this study received therapy with 8 to 64 mg/d of betahistine. Clinical improvement in tinnitus symptoms was defined as a partial or total response.

Results:

A total of 764 patients with Ménière's disease were identified in our electronic database. Forty seven of these patients were treated with betahistine for vestibular symptoms. Duration of therapy varied from 1 week to 4 years. Twenty‐seven patients were successfully contacted for a phone interview or via email. Twenty‐three patients reported tinnitus as a symptom. Only 13 of the 23 reported tinnitus as a disturbing symptom. One patient stopped betahistine therapy after the first week because of palpitations, another stopped the betahistine after 2 weeks because of increased dizziness and nausea, and a third briefly stopped treatment while using albuterol for an episode of bronchitis. Only 3 patients had clinical improvement of their tinnitus (3/23; 13%). Sixteen patients reported improvement in their vestibular symptoms (16/27; 59.2%).

Conclusions:

Betahistine does not significantly reduce tinnitus in Ménière's patients treated for vestibular symptoms. Improvement in tinnitus may occur in some patients.
Bone‐Anchored Hearing Aid Implantation Using the Cochlear BA400 System: Early Experience and Patient‐Reported Outcomes
Authors: Wilkie Mark D. , Chakravarthy Kalyan M. , Mamais Costas , Temple Robert
Published: September 2014

Objectives:

Several contemporary bone‐anchored hearing aid (BAHA) surgical techniques have been described with the common goal of minimizing soft‐tissue reduction, which may benefit patients, surgeons, and audiologists alike. Recently, the hydroxyapatite coated Cochlear BA400 abutment was introduced, the first designed specifically for soft tissue preservation. We present our early experience of this system with corresponding patient‐reported outcomes.

Methods:

Data were collected prospectively on the first 25 patients implanted with the BA400 system at our institution (February‐September 2013). The Glasgow Benefit Inventory (GBI) was subsequently used to evaluate patient‐perceived quality of life in all patients 4 months following sound processor fitting.

Results:

Mean patient age was 61 years (range, 23‐91 years). BAHA was indicated for single‐sided deafness in 6 cases (24%) and for conductive or mixed loss when a conventional aid was contraindicated in the remainder. Procedures were performed under local anaesthetic in all but 1 case. Mean operating time was 14 minutes (range, 9‐22 minutes). Four patients (16%) suffered implant site soft tissue reactions which were all successfully managed conservatively and graded as follows: Holger's grade 1 (n = 2), 2 (n = 1), and 3 (n = 1). No other complications were observed. Respective overall, general health, social support, and physical health GBI benefit mean scores were +33 (95% confidence interval [CI]; 27‐39), +46 (95% CI; 37‐55), +15 (95% CI; 5‐25), and 0 (95% CI; –8 to 8).

Conclusions:

Our data support use of the soft tissue preserving Cochlear BA400 implant system, with shorter operating times, comparable soft‐tissue outcomes, and favorable patient‐reported quality‐of‐life when compared with conventional BAHA implantation techniques.
Bonebridge Implantation with Image Guidance Localization
Authors: Tan Amanda En‐Pei , Pang Jing‐Ying , Tan Tiong‐Yong , Yuen Heng‐Wai
Published: September 2014

Objectives:

The Bonebridge implant (BBI) is a bone‐conduction hearing implant with a relatively large floating mass transducer (FMT), which is seated within a bony well. This well is drilled in the mastoid process and the FMT is anchored onto the bony cortex with screws on the side of the well. The location of the well has to avoid vital structures, such as the posterior canal wall, the dura mater of the middle cranial fossa, and the sigmoid sinus. The size of the well must be sufficient to accommodate the size of the FMT. This becomes more important in patients with contracted mastoids.

Methods:

This case series aims to review the use of image guidance localization (IGL) in planning the site of the well. Under general anaesthesia, the patient was positioned supine, with the head turned away from the site of the BBI. Local anaesthetic was administered and a postauricular incision was made and deepened down to bone. The subperiosteal flap was elevated and the surgeon determined the location of the FMT, with the help of the IGL. A conservative cortical mastoidectomy was performed to create a well for the FMT to sit in. A subperiosteal pocket for the receiver coil was created posterior‐superior to the well.

Results:

Five patients underwent BBI surgery with IGL. Rapid and accurate localization of the site of the well for the FMT was possible in each case.

Conclusions:

The authors recommend IGL as a safe, rapid, and reproducible technique in localization of the site for the well of the BBI.