bluuebunny/crossref_metadata_2025 huggingface dataset:
Foresight in Laryngology and Laryngeal Surgery: A 2020 Vision
Authors: Zeitels Steven M. , Blitzer Andrew , Hillman Robert E. , Anderson R. Rox
Published: October 2014

Laryngology and laryngeal surgery have been in the vanguard of minimally invasive human procedural interventions for approximately 150 years. The natural passages through the oral cavity, nose, and pharynx have provided an accessible gateway to the larynx that has allowed for rapid translation of a variety of diagnostic and therapeutic technologies. Transoral and transcervical laryngeal surgery have been further facilitated by progressive advancements in local, topical, intravenous, and general anesthesia. With rapid developments in engineering disciplines (ie, tissue, chemical, mechanical) and voice science, there are a variety of current and near-term opportunities to advance our field. This report represents a panel at the 2005 American Broncho-Esophagological Association meeting that sought to use present perspectives, combined with cutting-edge research insights, to provide foresight into key aspects of laryngology that we believe will be developed by the year 2020. We hope that aspiring laryngeal surgeons will find elements of this discussion valuable for devising a strategic roadmap for research initiatives in laryngology and laryngeal surgery.
Preliminary Evaluation of Stroboscopy System Using Multiple Light Sources for Observation of Pathological Vocal Fold Oscillatory Pattern
Authors: Deguchi Shinji , Ishimaru Yuuki , Washio Seiichi
Published: October 2014

Objectives:

Laryngostroboscopy is used to check the oscillatory patterns of the vocal folds. However, the use of one single flash timing cannot give a clear view of abnormal vocal fold oscillations that have multiple fundamental frequencies. Visualization of such complex vocal fold movements will be helpful in the diagnosis of diplophonia, a pathological condition in which the vocal folds produce multiple tones at the same time.

Methods:

We developed a new stroboscopy-based technique using multiple light-emitting diodes (LEDs) and image analysis. Specific flash timings for each LED, suitable for accurate visualization, were determined on a computer according to an algorithm based on frequency analysis. The image analysis extracted the necessary parts of the captured images to yield a clear slow-motion view of the oscillations. The series of visualization procedures took advantage of the narrow-spectrum light property of LEDs, thereby yielding a degradation-free picture.

Results:

Feasibility tests using a mechanical vocal fold model demonstrated that this computer-assisted system allows observation of the pathological oscillatory patterns as one single video. They would not be clearly visualized by conventional stroboscopy.

Conclusions:

Because of its relatively simple use and inexpensive construction, the proposed technique can become one potential option for clinical assessment of pathological vocal fold oscillations.
Effect of Experience on Judgments of Adductor Spasmodic Dysphonia
Authors: Eadie Tanya L. , Nicolici Christina , Baylor Carolyn , Almand Kimberly , Waugh Patricia , Maronian Nicole
Published: October 2014

Objectives:

We performed a prospective, exploratory study 1) to determine differences in judgments of overall severity (OS) and vocal effort (VE) in adductor spasmodic dysphonia (ADSD) when judgments are made by experienced listeners, naive listeners, and speakers with ADSD; 2) to determine differences in judgments of listener comfort (LC) in ADSD when judgments are made by experienced and naive listeners; and 3) to determine relationships between auditory-perceptual ratings of voice and speakers' voice handicap.

Methods:

Twenty speakers with ADSD provided speech recordings. They judged their own speech samples for OS and VE and completed the Voice Handicap Index (VHI). Twenty naive and 8 experienced listeners evaluated speech samples for OS, VE, and LC using rating scales.

Results:

No differences were found for judgments of OS, VE, or LC across the groups. However, the strategies used by the speakers seemed to differ from those used by the other listeners in making OS and VE judgments. The speakers' self-judged VE correlated moderately with voice handicap; experienced and naive listeners' judgments were only weakly related to VHI scores.

Conclusions:

Speakers with ADSD and listeners appear to use auditory-perceptual dimensions differently. Voice handicap is best predicted by patient-perceived VE, and not by clinician or naive listeners' judgments.
Morphological Sequence of Plastipore Extrusion in Experimental Otitis Media
Authors: Trinidad Almudena , Vicente Javier , Verdaguer José María , Daza Rosa , García-Berrocal José Ramón , Ramírez-Camacho Rafael
Published: October 2014

Objectives:

Plastipore prostheses are still used by many surgeons, although the functional results are controversial. The aim of this study was the morphological analysis of Plastipore material performance in the middle ear of rats, with special attention to extrusion.

Methods:

Twenty-four Wistar rats were given implants made of commercially available Plastipore and assigned to 3 groups: Group A, with implantation in a healthy middle ear; group B, with implantation and cauterization of the nasopharyngeal orifice of the eustachian tube (hypoventilation); and group C, with implantation, cauterization of the eustachian tube, and bacterial inoculation with Pseudomonas aeruginosa.

Results:

The pathological study showed in nearly all cases the disintegration of the biomaterial. Adhesion between the biomaterial and bone could be seen in 1 rat from group C (hypoventilation and infection). In group C, the Plastipore was in contact with the tympanic membrane in 1 case and was extruding in 2 animals. Different phases of extrusion were defined. No extrusion was observed in the other groups.

Conclusions:

The sequential stages of Plastipore extrusion are demonstrated. Infection seems to be the most important factor in Plastipore extrusion in our model.
Prenatal Vitamin a Deficiency Causes Laryngeal Malformation in Rats
Authors: Tateya Ichiro , Tateya Tomoko , Surles Rebecca Lynn , Tanumihardjo Sherry , Bless Diane M.
Published: October 2014

Objectives:

Our previous research demonstrated that vitamin A might be related to vocal fold development. The purpose of this study was to determine whether vitamin A deficiency affects prenatal laryngeal development in rats.

Methods:

Two considerations were necessary in designing a study using a rat model: For embryonic survival, vitamin A is necessary through day 10 of gestation, and laryngeal formation occurs primarily after day 11. Thus, we created a rat model that developed vitamin A deficiency after embryonic day 11. Ten pregnant rats (5 vitamin A-deficient rats and 5 control rats) were studied. Embryos were collected at embryonic day 18.5 and analyzed histologically.

Results:

Eighteen percent of the vitamin A-deficient embryos were alive and demonstrated laryngotracheal cartilage malformation, incomplete separation of the glottis, and/or laryngoesophageal clefts.

Conclusions:

These results document the important role played by vitamin A in laryngeal development.
Noninvasive Assessment of Benign Lesions of Vocal Folds by Means of Ultrasonography
Authors: Sirikci Akif , Karatas Erkan , Durucu Cengiz , Baglam Tekin , Bayazit Yildirim , Ozkur Ayhan , Sonmezisik Serdar , Kanlikama Muzaffer
Published: October 2014

Objectives:

Although ultrasonography (US) has been widely used in various parts of the body, its application in laryngeal examination has been limited. Our objective was to evaluate the significance of US examination in benign lesions of the vocal folds.

Methods:

Ultrasonographic examination of the vocal folds was performed in 14 patients in whom benign lesions of the vocal folds had been diagnosed by videolaryngoscopy and microlaryngoscopy. Microlaryngoscopic surgery was performed after US examination. Each lesion was analyzed for the following US features: Shape, size, and echotexture (echogenicity and homogeneity).

Results:

In total, 16 lesions were diagnosed in 14 patients by means of videolaryngoscopy and microlaryngoscopy. Ultrasonographic examination was capable of diagnosing 14 of the 16 lesions (87.25%). Ultrasonography mainly helped in the diagnosis of sessile polyps, nodules, and leukoplakia that were larger than 2 mm. The lesions were linear hyperechoic, heterogeneous hyperechoic, hypoechoic, and isoechoic if they were leukoplakia, nodules, hemorrhagic polyps, and other polypoid lesions, respectively. The results are better if the diagnosis follows the corresponding US echotexture pattern rather than videolaryngoscopy and microlaryngoscopy.

Conclusions:

Laryngeal US examination appears to be a useful diagnostic tool for supplementing microlaryngoscopy in the assessment of benign lesions of vocal folds. In contrast to these currently used imaging techniques, anesthesia is not necessary in laryngeal US examination. In addition, US is noninvasive, painless, and much less expensive than the other techniques.
Dysphagia after Chemoradiation: Analysis by Modified Barium Swallow
Authors: Bleier Benjamin S. , Levine Marc S. , Mick Rosemarie , Rubesin Stephen E. , Sack Stephen Z. , McKinney Kibwei , Mirza Natasha
Published: October 2014

Objectives:

We sought to describe the findings of modified barium swallow study after chemoradiation in patients with head and neck cancer and to correlate these findings with clinical variables, including gastrostomy tube dependence and clinical pneumonia.

Methods:

We retrospectively reviewed 49 patients at a tertiary care center who underwent modified barium swallow study for dysphagia after chemoradiation.

Results:

Patients with nonlaryngeal lesions had increased cricopharyngeal impairment (27.8% versus 0.0%; p = .04). Patients who underwent concomitant chemotherapy had increased epiglottic changes relative to those who had radiotherapy alone (66.7% versus 30.8%; p = .05). Clinical pneumonia developed in 31.9% of the patients, and 79.6% required gastrostomy tube placement for a mean duration of 18.1 months.

Conclusions:

Chemoradiation effects deglutition at multiple levels. A large percentage of patients will develop pneumonia and feeding tube dependence. This study is among the largest to correlate the results of modified barium swallow studies to clinical variables in this patient population. This study highlights the significant incidence of gastrostomy tube dependence and pneumonia in these patients.
Side Population Cells in the Human Vocal Fold
Authors: Yamashita Masaru , Hirano Shigeru , Kanemaru Shin-Ichi , Tsuji Shunichiro , Suehiro Atsushi , Ito Juichi
Published: October 2014

Objectives:

The regenerative processes of the vocal fold, or the existence of stem cells in the folds, are unknown. Side population (SP) cells are defined as cells that have the ability to exclude the DNA binding dye, Hoechst 33342. They are regarded as a cell population enriched with stem cells and can be isolated from non-SP cells by a fluorescence-activated cell sorter. This study was designed to determine whether SP cells exist in the human vocal fold, as a first step in elucidating the regenerative mechanisms of the vocal fold.

Methods:

Seven human excised larynges were used in this study. Two were used for fluorescence-activated cell sorter analysis, and 5 were subjected to immunohistochemical analysis with antibodies against an adenosine triphosphate binding cassette transporter family member, ABCG2, which is expressed in SP cells.

Results:

The number of SP cells in the human vocal fold was about 0.2% of the total number of cells. ABCG2-positive cells were identified in both the epithelium and subepithelial tissue throughout the entire vocal fold.

Conclusions:

This preliminary study demonstrated the existence of SP cells in the human vocal fold. Further studies are warranted to clarify how these cells work in the vocal fold, particularly in the regenerative process.
Dysphagia in the Elderly: Preliminary Evidence of Prevalence, Risk Factors, and Socioemotional Effects
Authors: Roy Nelson , Stemple Joseph , Merrill Ray M. , Thomas Lisa
Published: October 2014

Objectives:

Epidemiological studies of dysphagia in the elderly are rare. A non-treatment-seeking, elderly cohort was surveyed to provide preliminary evidence regarding the prevalence, risks, and socioemotional effects of swallowing disorders.

Methods:

Using a prospective, cross-sectional survey design, we interviewed 117 seniors living independently in Utah and Kentucky (39 men and 78 women; mean age, 76.1 years; SD, 8.5 years; range, 65 to 94 years) regarding 4 primary areas related to swallowing disorders: Lifetime and current prevalence, symptoms and signs, risk and protective factors, and socioemotional consequences.

Results:

The lifetime prevalence of a swallowing disorder was 38%, and 33% of the participants reported a current problem. Most seniors with dysphagia described a sudden onset with chronic problems that had persisted for at least 4 weeks. Stepwise logistic regression identified 3 primary symptoms uniquely associated with a history of swallowing disorders: Taking a longer time to eat (odds ratio [OR], 9.5; 95% confidence interval [CI], 2.3 to 40.2); coughing, throat clearing, or choking before, during, or after eating (OR, 3.4; 95% CI, 1.1 to 10.2); and a sensation of food stuck in the throat (OR, 5.2; 95% CI, 1.8 to 10.0). Stroke (p = .02), esophageal reflux (p = .003), chronic obstructive pulmonary disease (p = .05), and chronic pain (p = .03) were medical conditions associated with a history of dysphagia. Furthermore, dysphagia produced numerous adverse socioemotional effects.

Conclusions:

This study provides preliminary evidence to suggest that chronic swallowing disorders are common among the elderly, and highlights the need for larger epidemiological studies of these disorders.
Risk of Meningitis with Cerebrospinal Fluid Rhinorrhea
Authors: Daudia Anu , Biswas Debabrata , Jones Nick S.
Published: October 2014

Objectives:

The annual risk of meningitis in unrepaired fistulas is widely quoted to be approximately 10% per annum. Our aim was to review our experience with cerebrospinal fluid (CSF) leaks and to calculate the overall risk and the annual incidence of meningitis, and to correlate our findings with the causation and the effect of operative intervention in a subgroup of patients who had a history of meningitis.

Methods:

We prospectively collected data on all patients referred with a CSF leak to our tertiary referral center over a 12-year period between 1994 and 2006. We had a follow-up rate of 91%.

Results:

One hundred eleven patients had a proven leak on endoscopy, beta-2 transferrin, imaging, and/or fluorescein lumbar puncture. The accumulated duration of an active CSF leak in the cohort was 190 years. The total number of episodes of meningitis was 57 in 21 patients, giving an overall risk of developing meningitis of 19%, with an overall incidence of 0.3 episodes per year. There was a progressive reduction in the incidence of meningitis with time, and most episodes occurred within the first year following the onset of the CSF leak. However, the risk persisted as long as the CSF leak was active.

Conclusions:

The overall risk of meningitis in patients with persistent CSF rhinorrhea was 19%. The annual incidence of meningitis was 0.3 episodes per year, with most episodes occurring within the first year following the onset of the leak. Endoscopic closure is the treatment of choice in most CSF leaks; if successful, it reduces the risk of meningitis.
Chick Chorioallantoic Membrane as a Model for Simulating Human True Vocal Folds
Authors: Broadhurst Matthew S. , Kobler James B. , Burns James A. , Anderson R. Rox , Zeitels Steven M.
Published: October 2014

Objectives:

Evolving photoangiolytic laser techniques for treating vocal fold lesions motivated the development of a model for research and surgical training. The chick chorioallantoic membrane (CAM), which is composed of a microvasculature suspended within the egg albumen, simulates the vocal fold microcirculation within the superficial lamina propria (SLP). To characterize this model, we compared measurements of vessel diameters to superficial vessels in human vocal folds.

Methods:

The diameters of first-, second-, and third-order CAM vessels were measured in fertilized chicken eggs. The superficial blood vessels of the human vocal fold were measured from intraoperative images.

Results:

According to the branching pattern, vessel segments were identified as first-, second-, or third-order, with average diameters of 0.035 mm (0.02 to 0.1 mm), 0.18 mm (0.12 to 0.41 mm), and 0.8 mm (0.6 to 0.98 mm), respectively. The total vessels measured included 362 first-order, 119 second-order, and 82 third-order vessels. In 10 adult human vocal folds, an average vessel diameter of 0.04 mm (0.015 to 0.1 mm) was observed in 50 vessels.

Conclusions:

The CAM microvasculature suspended in albumen provides a useful surgical model simulating the microcirculation within the SLP of the human vocal fold. Although first-order CAM vessels best approximate the size of normal vocal fold subepithelial vessels seen at surgery, second- and third-order vessels resemble the vascular abnormalities frequently encountered during microsurgery for phonotraumatic lesions.
Neonatal Upper Airway Obstruction in Osteogenesis Imperfecta: Series of Three Cases and Review of the Literature
Authors: Johnson Kaalan , Pineda Melissa , Darrow David , Proud Virginia , Derkay Craig
Published: October 2014

Objectives:

Osteogenesis imperfecta (OI) is a genetic disorder characterized by variable degrees of dysfunction in type I collagen formation. We sought to explore an association between OI and upper airway obstruction (UAO) in light of our recent experience.

Methods:

We performed a retrospective chart audit and a review of the literature.

Results:

Three consecutive cases of OI at our institution required otolaryngological evaluation for UAO. The first patient had the mildest mutation type and did well until he developed severe reflux-triggered laryngospasm that improved with Nissen fundoplication and gastrostomy tube placement. He had mild hypotonia on endoscopy. The second patient had severe OI and the greatest acute fracture burden at birth. He required tracheotomy after early respiratory failure, and some mild bronchomalacia was noted. The third patient had severe OI and underwent cesarean section delivery. She developed respiratory failure after 1 month, requiring tracheotomy; mild tracheomalacia and glottic narrowing were noted on endoscopy.

Conclusions:

The UAO consisted of mild hypotonia or malacia in 3 consecutive cases of OI, and may have contributed to pulmonary and mechanical causes of tracheotomy requirement. The greatest predictors of tracheotomy requirement appear to be the severity of the OI mutation and the fracture burden. Elective cesarean section should be considered in severe cases of OI.
Harmonic Scalpel Tonsillectomy Using the Curved Shears Instrument versus Cold Dissection Tonsillectomy: A Retrospective Study
Authors: Gilbey Peter , Gadban Hussain , Letichevsky Vadim , Talmon Yoav
Published: October 2014

Objectives:

We compared operating time, intraoperative blood loss, and rate of postoperative bleeding in harmonic scalpel (HS) tonsillectomy using the curved shears instrument to those in cold dissection (CD) tonsillectomy.

Methods:

The charts of 560 patients who underwent tonsillectomy were retrospectively reviewed. Three hundred nineteen patients underwent CD tonsillectomy between the years 1998 and 1999, and 241 patients underwent HS tonsillectomy using the curved shears instrument between the years 2001 and 2005. For the purpose of evaluation of postoperative bleeding rates, the groups were further stratified by age (11 years of age or less versus 12 years of age or more).

Results:

For the HS group, the mean operating time was shorter (7 minutes versus 17.57 minutes) and the intraoperative blood loss was lower (0 mL versus 42.12 mL). These differences were statistically significant (p < .05). There was no significant difference in the overall postoperative bleeding rates between the two groups. The postoperative bleeding rate in the HS patients 11 years of age or younger was lower than that in the equivalent age group in the CD group (0.56% versus 2%, respectively), although this difference did not reach statistical significance. The postoperative bleeding rate in the HS patients 12 years of age or older was significantly higher than that in the equivalent age group in the CD group (7.93% versus 1%, respectively; p < .05).

Conclusions:

Harmonic scalpel tonsillectomy using the curved shears instrument offers advantages over CD tonsillectomy regarding operating time and intraoperative blood loss. In our patients more than 12 years of age, HS tonsillectomy using the curved shears instrument was associated with an increased postoperative bleeding rate compared to CD tonsillectomy.
Roles of Vitamin a and Macula Flava in Maintaining Vocal Folds
Authors: Tateya Tomoko , Tateya Ichiro , Surles Rebecca Lynn , Tanumihardjo Sherry , Bless Diane M.
Published: October 2014

Objectives:

Vitamin A plays important roles in development, growth, and regeneration. Vitamin A-storing stellate cells have been identified in several organs. The functional roles of vitamin A in the vocal folds are still unknown, although vitamin A-storing vocal fold stellate cells have been observed in the macula flava of human and rat vocal folds. The purpose of this study was to investigate the roles of vitamin A in vocal folds.

Methods:

Vitamin A-deficient rats were generated, and the vocal folds were examined histologically. Messenger RNA was extracted from the vocal folds and analyzed by real-time polymerase chain reaction.

Results:

Immunohistochemical analysis of normal vocal folds revealed expression of retinoic acid receptor α in vocal fold stellate cells. The cells in the macula flava of vitamin A-deficient rats showed a larger nucleus/cytoplasm ratio than did those of vitamin A-sufficient rats, but messenger RNA expression of major extracellular matrix components in the macula flava of vitamin A-deficient rats did not present a remarkable change except for procollagen type I. Expression of hyaluronic acid, collagen types I and III, and elastin did not show a significant change in vitamin A-deficient rat vocal folds.

Conclusions:

These results indicate that vitamin A is not essential to maintaining the extracellular matrix of normal adult vocal folds, although vocal fold stellate cells participate in vitamin A storage.
Comparative Ultrasonographic, Magnetic Resonance Sialographic, and Videoendoscopic Assessment of Salivary Duct Disorders
Authors: Capaccio Pasquale , Cuccarini Valeria , Ottaviani Francesco , Minorati Davide , Sambataro Giuseppe , Cornalba Paolo , Pignataro Lorenzo
Published: October 2014

Objectives:

Salivary duct disorders are the second most common cause of obstruction after calculi. Magnetic resonance sialography has been recently proposed as a means of diagnosing a heterogeneous group of salivary disorders, and so we compared it with sialoendoscopy in evaluating stenoses and sialectasia in 24 patients with obstructive symptoms and ultrasonographic results negative for calculi or masses.

Methods:

All of the patients (19 of whom had recurrent unilateral or bilateral swollen parotid glands and 5 of whom also had recurrent swollen submandibular glands) underwent dynamic color Doppler ultrasonography and dynamic magnetic resonance sialography with lemon juice stimulation of saliva; 18 patients also underwent diagnostic sialoendoscopy.

Results:

Ultrasonography and color Doppler ultrasonography showed duct dilatation in all patients (bilateral in 5 with parotid stenosis). Magnetic resonance sialography confirmed duct dilatation and stenosis in all of the patients, and revealed the simultaneous presence of calculi in 4 cases. A parotid sialocele was found in 4 cases. The magnetic resonance sialographic findings were confirmed in the patients who underwent sialoendoscopy. No side effects were observed.

Conclusions:

Magnetic resonance sialography following prediagnostic ultrasonography allows an adequate diagnosis of salivary duct disorders such as stenosis and sialectasia, as confirmed by objective sialoendoscopic assessment. Magnetic resonance sialography also makes it possible to visualize the salivary duct system up to its tertiary branches and, in this regard, may be considered a valid, noninvasive method for the evaluation of salivary duct disorders.
Assessment of Swallowing Sounds by Digital Cervical Auscultation in Children
Authors: Almeida Sheila T. , Ferlin Elton L. , Parente Maria Alice M. P. , Goldani Helena A. S.
Published: October 2014

Objectives:

There is a lack of studies regarding swallowing sounds in children 3 to 11 years of age. This study aimed to assess swallowing sounds by digital cervical auscultation in children of this age group without symptoms of oropharyngeal dysphagia.

Methods:

Digital cervical auscultation was performed in 118 subjects by use of a piezoelectric microphone. The children swallowed 5 mL of liquid and yogurt. The components of perceptual acoustic analysis were discrete initial signal (DIS), main signal of swallowing sound (MS), discrete final signal (DFS), and expiratory return (ER). Duration in seconds was the objective parameter of the swallowing sound signal analyzed.

Results:

Fifty-six boys and 62 girls were evaluated at a mean (±SD) age of 6.9 ± 2.03 years. A complete DIS-MS-DFS-ER swallowing sequence was found in 60% of the children. There was no significant difference in swallowing sound duration between both food consistencies (p = .189) or between genders either for liquid (p = .327) or yogurt (p = .792). There was no correlation between age and duration of the swallowing sound for liquid or yogurt.

Conclusions:

We concluded that digital cervical auscultation was able to provide objective information about the swallowing process that could contribute to methodological standardization in children.
Pediatric Voice-Related Quality of Life: Findings in Healthy Children and in Common Laryngeal Disorders
Authors: Merati Albert L. , Keppel Kristina , Braun Nicole M. , Blumin Joel H. , Kerschner Joseph E.
Published: October 2014

Objectives:

Although several instruments have been validated to assess voice quality, the incidence and degree of impairment in normal, healthy children has not been widely reported. It is hypothesized that healthy children outside a medical setting do not demonstrate impairment as measured by the Pediatric Voice-Related Quality of Life (PVRQOL) instrument; in contrast, patients with vocal fold paralysis (VFP), vocal nodules (VNs), and paradoxical vocal fold dysfunction (PVFD) have significant impairment as compared to control populations.

Methods:

The PVRQOL was measured prospectively in children with VFP, VNs, and PVFD. The findings were compared to findings in 100 children surveyed at the 2006 Wisconsin State Fair.

Results:

Of the 100 surveys of healthy children and their parents, 95 were completed correctly; their mean (±SD) PVRQOL score was 96.8 ± 5.85. The VFP patients (n = 11; mean PVRQOL score, 70.5 ± 28.6) reported significant impairment (p < .0001, unpaired t-test). This was also true of patients with VNs (n = 13; PVRQOL score, 84.8 ± 9.4; p < .0001) and PVFD (n = 25; PVRQOL score, 86.7 ± 14.3; p < .0001); statistically significant differences were also noted for the Social-Emotional and Physical-Functional domains for each of the 3 disease states compared to the group of healthy children (p < .001).

Conclusions:

The PVRQOL scores of healthy children reveal essentially no self-reported vocal impairment. In contrast, common disorders such as VNs, VFP, and PVFD demonstrate statistically significant impairment in age-matched children for total PVRQOL, as well as for the Social-Emotional and Physical-Functional domains. This is the first report of normative PVRQOL data in children.
Computational Fluid Dynamics Analysis of Upper Airway Reconstructed from Magnetic Resonance Imaging Data
Authors: Mihaescu Mihai , Murugappan Shanmugam , Gutmark Ephraim , Donnelly Lane F. , Khosla Siddarth , Kalra Maninder
Published: October 2014

Objectives:

We performed flow computations on an accurate upper airway model in a patient with obstructive sleep apnea and computed the velocity, static pressure, and wall shear stress distribution in the model.

Methods:

Cartesian coordinates for airway boundaries were determined from cross-sectional magnetic resonance images, and a 3-dimensional computational model of the upper airway was constructed. Flow simulations were then performed within a FLUENT commercial software framework. Four different flow conditions were simulated during inspiration, assuming the steady-state condition. The results were analyzed from the perspectives of velocity, static pressure, and wall shear stress distribution.

Results:

We observed that the highest axial velocity was at the site of minimum cross-sectional area (retropalatal pharynx) resulting in the lowest level of wall static pressure. The highest wall shear stresses were at the same location. The pressure drop was significantly larger for higher flow rates than for lower flow rates.

Conclusions:

Our results indicate that the presence of airway narrowing, through change in the flow characteristics that result in increased flow velocity and reduced static pressure, can itself increase airway collapsibility. Additionally, the effects of wall shear stress on airway walls may be an important factor in the progression over time of the severity of obstructive sleep apnea.
Tone Perception in Cantonese-Speaking Children with Hearing Aids
Authors: Lee Kathy Y. S. , van Hasselt Charles Andrew , Tong Michael C. F.
Published: October 2014

Objectives:

In this study we investigated the benefit of using hearing aids for Cantonese tone perception among children with various degrees of hearing impairment.

Methods:

Forty-eight children with moderate to profound hearing loss were investigated. They were required to perform a lexical tone perception test with recorded test stimuli presented at 65 dB in soundproof booths. To allow for comparison, the subjects performed the test under 2 conditions: With their hearing aids turned off (unaided condition) and with them turned on (aided condition).

Results:

The mean tone perception scores for the aided condition were higher than those for the unaided condition across all of the subject groups. Paired sample t-tests showed statistically significant improvement in tone perception in the moderate and severe hearing loss groups (p = .02 and p = .03, respectively). The result obtained from the moderately severe hearing loss group was marginally significant (p = .058). The improvement in tone perception in the profound hearing loss group was insignificant (p = .55).

Conclusions:

The use of a hearing aid is beneficial for Cantonese tone perception in children who have moderate to severe hearing impairment. When a hearing loss is greater than 90 dB, ie, in children who are classified as having profound hearing loss, a hearing aid is not effective in aiding Cantonese tone perception.
Results of Sonotubometry in Testing Eustachian Tube Ventilatory Function in Children with Cleft Palate
Authors: van der Avoort Stijn J. C. , van Heerbeek Niels , Admiraal Ronald J. C. , Zielhuis Gerhard A. , Cremers W. R. J.
Published: October 2014

Objectives:

In previous studies, an updated sonotubometry setup was tested in healthy adults and children to test its validity and reproducibility in the assessment of the ventilatory function of the eustachian tube (ET). The results were promising, but further investigations were needed to confirm the discriminative potential of this sonotubometry setup. Our objective in the present study was to test the discriminative potential of an updated sonotubometry setup in children with cleft palate.

Methods:

The ET ventilatory function was tested in 56 children with cleft palate, ie, children with impaired ET function, and compared to the outcomes in 61 healthy children who served as a control group. All of the children were between 5 and 9 years of age. To test the reproducibility, we performed the sonotubometric testing in 2 sessions of 10 acts of swallowing each. Spearman's coefficient was used to test the correlation between the 2 sets of measurements. The results of measurements in the cleft palate group were compared with those in the otologically healthy control group and analyzed by means of a Mann-Whitney U test.

Results:

Opening of the ET was recorded in at least 1 of the 2 measurement sessions in 57% of the children with cleft palate, as compared to 82% in the control group. The mean number of openings was lower in the cleft palate group than in the control group (respectively, 2.3 versus 3.7 out of 10; p < .01). The first and second sessions were highly correlated in both the cleft palate group and the control group, with Spearman's coefficients of, respectively, 0.96 and 0.89.

Conclusions:

The results of this study show that this updated sonotubometry setup has the potential to discriminate between these groups of children with various states of ET ventilatory function. Furthermore, the results of this study once again show that this updated sonotubometry setup is capable of assessing ET ventilatory function in both healthy children and children with cleft palate and that the measurements are highly reproducible. A persistent disadvantage remains that in 18% of the 61 healthy children there was no ET opening that could be registered, which still prohibits a definite assessment at the individual level.
Regeneration of Tracheal Epithelium Utilizing a Novel Bipotential Collagen Scaffold
Authors: Tada Yasuhiro , Suzuki Teruhisa , Takezawa Toshiaki , Nomoto Yukio , Kobayashi Ken , Nakamura Tatuo , Omori Koichi
Published: October 2014

Objectives:

The purpose of the present study was to evaluate the effectiveness of a novel bipotential collagen scaffold as a bioengineered trachea for the regeneration of the tracheal epithelium.

Methods:

The bipotential collagen scaffold was developed by conjugating a collagen vitrigel membrane to a collagen sponge in order to promote both epithelial cell growth and mesenchymal cell infiltration. The bipotential collagen scaffold was transplanted into tracheal defects in rats, and a conventional collagen sponge was implanted as a control model. Histologic examinations were undertaken to evaluate the results.

Results:

The bioengineered trachea was covered with epithelium in the vitrigel model, but not in the control model, at 7 days after implantation. At 14 days after implantation, the bioengineered trachea was covered with epithelium involving the basal cell layer in the vitrigel model. At 28 days after implantation, a columnar ciliated epithelium was observed only in the vitrigel model.

Conclusions:

Our technique for trachea reconstruction using a novel bipotential collagen scaffold affords a feasible approach for accelerating epithelial regeneration on the intraluminal surface of the host tracheal defect.
Auditory Evaluation in Patients with Type 1 Diabetes
Authors: Pessin Adriana Bueno Benito , Martins Regina Helena Garcia , de Paula Pimenta Walkyíria , Simões Antônio Caetano Pereira , Marsiglia Alessandra , Amaral Amanda Vieira
Published: October 2014

Objectives:

We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes.

Methods:

Group 1 consisted of 40 patients with type 1 diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests).

Results:

Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group 1 and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group 1 ears. All patients of group 2 presented normal audiograms and ABR tests.

Conclusions:

In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group 1 who had normal audiometric thresholds.
Intrinsic Laryngeal Muscle Reinnervation Using the Muscle-Nerve-Muscle Technique
Authors: Debnath Indranil , Rich Jason T. , Paniello Randal C.
Published: October 2014

Objectives:

This study was performed to investigate the muscle-nerve-muscle reinnervation technique in the larynx, in which a nerve conduit implanted into an innervated muscle conducts axonal sprouting into a denervated muscle while maintaining function of the donor muscle.

Methods:

In this study, the muscle-nerve-muscle technique was used to direct superior laryngeal nerve axons to reinnervate intrinsic laryngeal muscles by implanting the recurrent laryngeal nerve stump into the cricothyroid muscle in 8 dogs. In 4 of the dogs, the recurrent laryngeal nerve trunk to the adductor muscles was divided so that all axonal sprouting was directed to the posterior cricoarytenoid muscle. Six-month electromyography data were obtained from 6 of the 8 dogs.

Results:

All 6 dogs showed evidence of successful reinnervation of the thyroarytenoid or posterior cricoarytenoid muscles with action potentials that corresponded to spontaneous respiratory efforts, while the donor cricothyroid muscles retained their phasic contraction. These responses were obliterated when the recurrent laryngeal nerve conduit was divided. Histologic examination of the intrinsic laryngeal muscles demonstrated successful reinnervation.

Conclusions:

The results confirm that intrinsic laryngeal muscles may be successfully reinnervated by the superior laryngeal nerve with the muscle-nerve-muscle technique, without sacrifice of function of the cricothyroid muscle. This method offers an alternative source of appropriately firing axons for laryngeal reinnervation procedures.
Treatment of Sinusitis with Corticosteroids in Combination with Antibiotics in Experimentally Induced Rhinosinusitis
Authors: Sütbeyaz Yavuz , Aktan Bülent , Yoruk Ozgur , Özdemir Hasan , Gundogdu Cemal
Published: October 2014

Objectives:

The objective of this study was to investigate the effects of corticosteroids, antibiotics, and their combination in the therapy of experimental bacterial rhinosinusitis.

Methods:

Twenty-eight rabbits underwent experimental induction of bacterial rhinosinusitis with Staphylococcus aureus. The animals were assigned randomly to 1 of 4 treatments (saline solution, methylprednisolone, cefazolin sodium, methylprednisolone–cefazolin sodium) for 7 days. After the treatment period, sinus mucosa samples of the animals were examined stereologically. In addition, mucosa samples were used in the determination of myeloperoxidase (MPO) activity.

Results:

Methylprednisolone, cefazolin, and methylprednisolone-cefazolin had a positive effect on the reduction of neutrophil infiltration to the sinus mucosa in experimental bacterial rhinosinusitis as compared to the group treated with saline solution. However, the effects of methylprednisolone, cefazolin, and methylprednisolone-cefazolin did not significantly differ (p > .05). Similarly, the use of methylprednisolone, cefazolin, and methylprednisolone-cefazolin decreased MPO activity as compared to the group with saline solution (p < .05), and the difference among methylprednisolone, cefazolin, and methylprednisolone-cefazolin was statistically significant (p < .05). The most significant decrease in MPO (neutrophil marker enzyme) activity was determined in the animals treated with methylprednisolone-cefazolin (p < .05).

Conclusions:

Administering corticosteroids as an adjunct to antibiotics may accelerate the healing process in experimentally induced rhinosinusitis. In this model of rhinosinusitis, an MPO assay was supportive of this hypothesis, although stereological examination showed no statistically significant difference.
Comparison of High-Speed Digital Imaging with Stroboscopy for Laryngeal Imaging of Glottal Disorders
Authors: Patel Rita , Dailey Seth , Bless Diane
Published: October 2014

Objectives:

High-speed digital imaging (HSDI), unlike stroboscopy, is a frequency-independent visualization technique that provides detailed biomechanical assessment of vocal physiology due to increased temporal resolution. The purpose of this study was to investigate the clinical value of HSDI compared to that of stroboscopy across 3 disorder groups classified as epithelial, subepithelial, and neurologic disorders.

Methods:

Judgments of vibratory features of vocal fold edge, glottal closure, phase closure, vertical level, vibratory amplitude, mucosal wave, phase symmetry, tissue pliability, and glottal cycle periodicity from 252 participants were performed by 3 experienced raters.

Results:

The results revealed that 63% of the data set was noninterpretable for assessment of vibratory function on stroboscopic analysis because of the severity of the voice disorder (100% of participants with severe voice disorders and 64% of participants with moderate voice disorders), whereas HSDI resulted in analysis of 100% of the data. The neuromuscular group (74%) was the most difficult to analyze with stroboscopy, followed by the epithelial (58%) and subepithelial groups (53%), secondary to the severity of hoarseness.

Conclusions:

Because it is desirable in clinical examination to observe vocal fold vibrations, which cannot be done in cases of severe dysphonia, HSDI may aid in clinical decision-making when patients exhibit values exceeding 0.87% jitter, 4.4% shimmer, and a signal-to-noise ratio of less than 15.4 dB on acoustic analysis. These measures could serve as minimal indications for use of HSDI. The data suggest that HSDI can be viewed as augmentative to stroboscopy, particularly in cases of moderate to severe aperiodicity, in which HSDI may aid clinical decision-making.
Collagen Injection as a Supplement to Arytenoid Adduction for Vocal Fold Paralysis
Authors: Kimura Miwako , Nito Takaharu , Imagawa Hiroshi , Tayama Niro , Chan Roger W.
Published: October 2014

Objectives:

Dysphonia associated with vocal fold paralysis can persist even after successful medialization procedures, including arytenoid adduction. It is hypothesized that laryngeal collagen injection could improve phonation following arytenoid adduction in selected patients. Our objective was to evaluate how collagen injection could result in measurable improvements in vocal function and voice quality.

Methods:

Forty patients with unilateral vocal fold paralysis who had undergone arytenoid adduction underwent transoral injection of non—cross-linked bovine dermal collagen by means of indirect laryngoscopy and a curved injection device. A control group of 40 patients underwent arytenoid adduction but not collagen injection. The patients' voice quality was assessed perceptually with the GRBAS scale, and vocal function was assessed by acoustic and aerodynamic measures (maximum phonation time and transglottal DC flow). The relative glottal area was also assessed by videostroboscopy.

Results:

Significant improvements in vocal function and voice quality were observed with collagen injection for those patients who did not achieve satisfactory glottal competence with arytenoid adduction alone. Glottal area measurements revealed that glottic insufficiency was significantly reduced after arytenoid adduction as well as after collagen injection.

Conclusions:

The findings suggest that collagen injection could be an effective supplementary treatment for improving voice following arytenoid adduction. It has the advantage of being a minimally invasive outpatient office procedure. The long-term efficacy of the procedure should be explored.
Assessment of Trends in Antimicrobial Resistance in Chronic Rhinosinusitis
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: October 2014

Objectives:

We performed a cross-sectional review of a prospective database to determine the contemporary incidence and temporal patterns of antimicrobial resistance in chronic rhinosinusitis (CRS).

Methods:

A microbiological database was retrospectively reviewed to extract all endoscopically obtained paranasal sinus cultures from 2001 through 2005 in adult patients with CRS. The culture data were tabulated according to bacterial species and representative antibiotic resistances for methicillin, erythromycin, clindamycin, gentamicin, tetracycline, sulfamethoxazole, and levofloxacin. The data were analyzed to determine whether increasing rates of antibiotic resistance developed over the study years. Further analysis was conducted for methicillin-resistant Staphylococcus aureus (MRSA) species to determine prevalence trends and antibiotic resistance trends for MRSA versus other species.

Results:

We analyzed 701 bacterial isolates among 392 culture samples. Staphylococcus aureus was the most commonly isolated organism (19.0%). Antibiotic resistance significantly increased for erythromycin over the study (maximum resistance rate, 69.7% in 2005; p = .009), remained unchanged for methicillin, clindamycin, levofloxacin, and sulfamethoxazole (p = .366 to p = .397), and trended downward for gentamicin (p = .180) and tetracycline (p = .120). Nineteen percent of S aureus species were found to be MRSA, but MRSA-specific antibiotic resistance rates did not change over the course of the study (all p ≥ .222). In aggregate, MRSA species exhibited statistically significant higher rates of resistance to each antibiotic tested than did non-MRSA bacteria.

Conclusions:

Antibiotic resistance seems to be emerging for erythromycin at a rate higher than for other antibiotics. Although not increasing in prevalence, MRSA maintains a significant presence in CRS with associated increased levels of antibiotic resistance.
Regeneration of the Trachea Using a Bioengineered Scaffold with Adipose-Derived Stem Cells
Authors: Suzuki Teruhisa , Kobayashi Ken , Tada Yasuhiro , Suzuki Yukie , Wada Ikuo , Nakamura Tatuo , Omori Koichi
Published: October 2014

Objectives:

Our group has developed and clinically applied an artificial graft made from a collagen sponge scaffold for the regeneration of tracheal tissue. However, the artificial graft requires about 2 months for epithelial regeneration. The purpose of the present study was to accelerate the regeneration process of the trachea through the effective use of a bioengineered scaffold. Adipose-derived stem cells (ASCs) with multilineage differentiation capability were used. In our study, we implanted a bioengineered scaffold that included autologous ASCs into tracheal defects in rats.

Methods:

Collagen gel, including ASCs labeled with monomeric yellow fluorescent protein, was layered onto the surface of the collagen sponge to form a bioengineered scaffold. This scaffold was implanted into the tracheal defects in rats. A control scaffold without ASCs was also implanted.

Results:

On day 14 after implantation, a pseudostratified columnar epithelium with well-differentiated ciliated and goblet cells and neovascularization was observed in rats that received the implant with the bioengineered scaffold that included ASCs.

Conclusions:

These results suggested that implanted ASCs accelerated neovascularization and epithelialization on the regenerated trachea. Thus, our newly developed bioengineered scaffold contributes to tracheal regeneration.