bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Decision Making of the Unilateral Vocal Cord Palsy after Thyroidectomy Using Thyroidectomy‐Related Voice Questionnaire
Authors: Chun Byung‐Joon , Park Jun‐Ook , Nam Inn‐Chul , Kim Chung‐Soo , Cho Kwang‐Jae , Park Young‐Hak , Sun Dong‐Il
Published: September 2014

Objectives:

Investigate the efficacy of early management of post‐thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy‐related voice questionnaire (TVQ) when planning UVCP treatment.

Methods:

The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre‐thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post‐thyroidectomy. Twenty‐five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure.

Results:

The average total TVQ scores 2 weeks afterthyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months (P <. 01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post‐intervention (P <. 01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cutoff distinguishing the 2 groups was 45 (68.0% sensitivity, 78.3% specificity).

Conclusions:

Early management following timely diagnosis of post‐thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.
Use of Mohs Technique and Immediate Reconstruction for Advanced Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Sumiyoshi Mika , Cruz Raul M. , Iaquinta Salvatore
Published: September 2014

Objectives:

(1) Report the outcome of patients with cutaneous squamous cell carcinoma (SCCs) of the head and neck treated with Mohs micrographic surgery in the operating room. (2) Describe the method and benefits of a single operation for extirpation of cutaneous SCC and reconstruction in the operating room with the use of intraoperative Mohs margins.

Methods:

A total of 104 patients with cutaneous SCCs of the head and neck were retrospectively reviewed in a single‐center retrospective study, considering recurrence, metastasis, and death between January 2002 and December 2008. The secondary aim was to describe the demographic and tumor characteristics, type of closure of defect, adjuvant therapies, immunocompromised status, bony or perineural invasion, and regional and local recurrence of SCC cases.

Results:

Twenty‐one (20%) of the lesions were recurrent SCC. Ten (10%) patients had bony or perineural invasion. Additional extirpative procedures performed by the head and neck surgeons included 8 bone excisions (8%), 2 parotidectomies and neck dissections (2%). Eleven percent had local and 13% had regional recurrences. Nine percent of the total patient population died of disease. Disease‐specific survival was 88%.

Conclusions:

Mohs micrographic surgery in the operating room for high‐risk cutaneous SCC is effective. Using Mohs technique in the operating room permits a combined extirpation and reconstruction as a single procedure. This approach combines Mohs’ proven superior ability to produce clear margins with immediate reconstruction offered by the same surgeon. This offers patients many benefits, and extirpation with forethought of reconstruction offers potential superior outcomes, reduced hospitalizations and anesthetic exposures, and patient convenience.
Usefulness of Endoscopic Screening for Synchronous Cancer in HNSCC as Initial Baseline Study
Authors: Baek Seung Jae , Suh Michelle J. , Bong Jeong Pyo
Published: September 2014

Objectives:

Determine the usefulness of endoscopic screening methods for detecting synchronous malignancies in patients with head and neck carcinoma.

Methods:

We retrospectively reviewed the medical records of patients who were diagnosed with head and neck mucosal squamous cell carcinoma (oral cavity, oropharynx, nasopharynx, larynx, hypopharynx) between January 2003 and July 2013 in the Department of Otorhinolaryngology, Head and Neck Surgery, Yonsei University Wonju Christian Hospital.

Results:

Among 285 patients who underwent esophagogastroduodenoscopy and bronchoscopy as initial baseline study, 23 synchronous cancers were diagnosed. Esophageal cancer and lung cancer were diagnosed as the most synchronous cancers (10 lesions each), followed by gastric cancer (2 lesions), and colon cancer (1 lesion). Among these 23 patients, positron emission tomography (PET) or PET/computed tomography (CT) was performed in 14 patients. Of these 14 patients, PET or PET/CT detected 7 of the synchronous cancers.

Conclusions:

As to their ability in detecting synchronous cancer in head and neck carcinoma, PET or PET/CT showed unsatisfactory detection rate. PET and PET/CT have limitations in the detection of superficial lesions. As initial baseline modality, PET or PET/CT needs supplementary endoscopic studies for the detection of superficial lesions.
Voice and Swallowing Outcome following Radiotherapy for Head and Neck Squamous Carcinoma of Unknown Primary
Authors: Oozeer Nashreen B. , Harrison Anna , James Allan
Published: September 2014

Objectives:

Patients with head and neck squamous cell carcinoma (HNSCC) of unknown primary present without voice or swallowing symptoms. This study aims to analyze the impact of radiotherapy on the voice and swallowing function in this subgroup of HNSCC patients.

Methods:

This was an original cross‐sectional study. All patients with treated HNSCC of unknown primary identified from the head and neck cancer database in August 2012 in Greater Glasgow and Clyde had their voice assessed using the Voice Symptoms Scale (VoiSS) and their swallowing function assessed using the MD Anderson Dysphagia Inventory (MDADI).

Results:

Questionnaires were sent to 30 patients. A 67% response rate was obtained. There were 5 females and 15 males with a mean age of 61 years (range, 49‐81 years). Six patients had no surgical intervention and oncological treatment alone. All patients were free of disease at the time of the study. The mean VoiSS score was 29.45 (range, 4‐62) and mean MDADI score was 63.94 (range, 26‐100). One patient did not complete the MDADI form so was excluded from this analysis. There was no statistically significant change in patient voice and swallowing function. There was a trend for improved function with longer duration since treatment.

Conclusions:

Functional assessment should form an integral part of the assessment of HNSCC patients. This cohort of patients did not have a significant voice and swallowing functional impact secondary to their treatment.
Acquired Choanal and Subglottic Stenosis Associated with MYHRE‐LAPS Syndrome: A Case Report and Literature Review
Authors: Oldenburg Michael , Frisch Christopher D. , Kirmani Salmann , Kasperbauer Jan L. , O'Brien Erin K.
Published: September 2014

Objectives:

MYHRE‐LAPS syndrome (MLS) is a recently recognized disease caused by a mutation in the SMAD4 gene that alters the transforming growth factor (TGF)–beta pathway. This results in a wide range of pathology including laryngotracheal stenosis, arthropathy, prognathism and short stature, or LAPS syndrome. We present a unique case of MLS associated with both acquired choanal stenosis (CS) as well as subglottic stenosis (SGS) and perform a systematic review of all MLS associated airway pathology.

Methods:

Single case reviewed via the medical record. Literature review.

Results:

MLS was reported in 32 patients, and 5 had clinical airway symptoms. We added the case of a 43F who presented with 9 months of progressive nasal obstruction and was found to have bilateral CS and SGS on endoscopic examination. The patient had no recent airway instrumentation but had two prior operations requiring intubation. Genetic testing revealed SMAD4 mutation consistent with MLS and Losartan was initiated to inhibit TGF‐beta signaling. Most patients with MLS develop airway symptoms as a late sequela of disease with a median onset of 22 years old. Attempts to surgically address airway stenosis invariably results in recurrence secondary to robust scar formation. All patients who have undergone surgical management of airway stenosis were tracheostomy dependent (4/4).

Conclusions:

MLS is a newly recognized disorder characterized by progressive systemic fibrosis. Airway management is complicated by prognathism, trismus, and limited neck extension as well as invariable restenosis of the airway after instrumentation. Caution should be exercised when surgical intervention is entertained in these patients.
Characterizing the Vocal Fold Epithelial Response to Recovery following Phonation‐Induced Trauma at the Transcriptional Level
Authors: Valenzuela Carla V. , Kojima Tsuyoshi , Greene Scott M. , Dharamsi Latif M. , Novaleski Carolyn K. , Garrett C. Gaelyn , Rousseau Bernard
Published: September 2014

Objectives:

It is unknown how acute episodes of phonotrauma affect the recovery of the vocal fold epithelial barrier. The epithelial barrier is characterized by specialized adhesive structures. Our objective was to evaluate the gene expression of junctional complex proteins and inflammatory mediators following phonation‐induced trauma in an in vivo rabbit model.

Methods:

Sixty‐five New Zealand white breeder rabbits were randomized to normal (n = 5), modal intensity (n = 30), or raised intensity (n = 30) phonation for 120 minutes. Larynges were harvested at 0 hours, 4 hours, 8 hours, 1 day, 3 days, or 7 days following phonation and compared with normal. Real‐time polymerase chain reaction was used to evaluate mRNA expression of occludin, zonula occluden‐1 (ZO‐1), E‐cadherin, β‐catenin, interleukin 1β (IL‐1β), cyclooxygenase‐2 (COX‐2), and transforming growth factor β‐1 (TGFβ1).

Results:

Both phonation groups demonstrated a down‐regulation of occludin between 8 hours and 1 day (P <. 016), and ZO‐1 levels at 3 days (P =. 08). β‐catenin and E‐cadherin demonstrated an inverse relationship at 8 hours in the modal phonation group (P =. 08). IL‐1β, COX‐2, and TGFβ1 levels peaked at 8 hours in the modal intensity group (P =. 08), with TGFβ1 peaking at day 1 in the raised intensity group (P =. 08).

Conclusions:

Results revealed a critical time point at 8 hours and 1 day in which most junctional complex and inflammatory markers decreased or peaked. Given the mechanical stresses that the vocal folds must withstand on a regular basis, time‐dependent changes in barrier and inflammatory gene regulation are critical to understanding vocal fold homeostasis and tissue recovery.
Clinical Feasibility Trial for Transtracheal Stimulation of Vocal Fold Closure in Sensate Human Subjects
Authors: Hahn Elizabeth C. , Hadley Aaron , Tyler Dustin J. , Maronian Nicole
Published: September 2014

Objectives:

(1) Apply transtracheal stimulation (TTS) of the recurrent laryngeal nerve (RLN) for vocal fold closure (VFC) in sensate humans. (2) Characterize tracheal sensory response to electrical stimuli.

Methods:

Patients with chronic tracheostomies were selected for a “first‐in‐man” clinical device trial to stimulate the RLN through tracheal tissue for VFC. Etiologies of trach dependence varied, but all subjects had normal laryngeal sensation, vocal cord mobility, and RLN function. Devices were introduced through subjects’ ostomies, and electrodes were subsequently deployed for tracheal contact. Videoendoscopy recorded responses to square wave pulse trains of varying pulse amplitude (PA) and pulse width (PW; 0.5 mA‐5 mA and 60 us‐500 us, respectively). Subjects were surveyed for sensory changes, discomfort, and pain.

Results:

TTS of the RLN successfully elicited VFC in all subjects. The PA threshold for closure (ThPA; at PW = 200 us) ranged from 1.5 mA to 3.5 mA unilaterally, and 1.0 mA to 2.5 mA bilaterally for all subjects except 1 outlier with thresholds of 0.9 mA and 1.2 mA unilaterally, and 0.7 mA bilaterally. PW thresholds (ThPW) ranged from 100 us to 300 us for all subjects (PA = 0.75 × ThPA). All subjects denied pain, but 3 described mild incremental “tingling” that initiated cough or swallow responses only at suprathreshold levels.

Conclusions:

TTS initiated arytenoid medialization for VFC in all subjects without pain or significant discomfort. This study presents a novel technique for noninvasive restoration of VFC in humans. Further trials will determine full clinical utility of this device component, individually and in conjunction with components targeting swallow detection and laryngeal elevation for coordinated airway protection.
Comparative Effectiveness of Office‐Based 532‐nm Laser‐Assisted Vocal Polypectomy and Phonomicrosurgery: A Matched Cohort Study
Authors: Cheng Po‐Wen , Wang Chi‐Te
Published: September 2014

Objectives:

Office‐based procedures, including indirect laryngoscopic surgery and angiolytic laser photocoagulation, have been proposed to treat hemorrhagic vocal polyps. Our previous research documented good treatment outcomes by combining the 2 aforementioned procedures (laser‐assisted vocal polypectomy [LAVP]). This study intends to further compare the effectiveness of LAVP with the gold standard of phonomicrosurgery.

Methods:

This study retrospectively enrolled 50 age‐, sex‐, and size‐matched patients of hemorrhagic vocal polyps treated by LAVP or phonomicrosurgery at a tertiary teaching hospital from January 2012 to October 2013. Treatment outcomes were evaluated before, 2 weeks after, and 6 weeks after the procedures via perceptual rating of voice quality, acoustic measurement of the speech signal, 10‐item voice‐handicap index (VHI‐10), maximal phonation time (MPT), subjective rating of voice quality, and videolaryngostroboscopic evaluations.

Results:

Both LAVP and phonomicrosurgery demonstrated significant improvements in most measuring parameters, 2 and 6 weeks postoperatively. Comparative effectiveness demonstrated similar objective outcomes (MPT, VHI‐10, perceptual, endoscopic, and acoustic analyses) between LAVP and phonomicrosurgery, while patients who received LAVP reported more symptomatic relief and higher subjective voice quality then phonomicrosurgery 2 weeks postoperatively. Six weeks after the procedures, both objective and subjective effectiveness revealed non‐significant differences between the 2 treatment groups.

Conclusions:

This study demonstrated that office‐based 532‐nm LAVP can be an effective, practical, and safe alternative treatment for small hemorrhagic vocal polyps. Patients who received LAVP experienced rapid symptomatic relief with higher subjective effectiveness than phonomicrosurgery, 2 weeks postoperatively. The overall treatment outcomes showed comparable effectiveness between LAVP and phonomicrosurgery.
Comparison between Essential Vocal Tremor and Dystonic Vocal Tremor Treated with Botulinum Toxin and Propranolol
Authors: Guglielmino Grazzia , Vilanova Luiz C. , Moreti Felipe T. G. , Padovani Marina M. P. , De Biase Noemi G.
Published: September 2014

Objectives:

Determine and compare the response to treatment with intramuscular botulinum toxin and oral propranolol on vocal tremors, essential and dystonic.

Methods:

Randomized clinical trial between January 2012 and September 2013. Fifteen patients with vocal tremor were divided into 2 groups: essential and dystonic vocal tremor. Both groups were treated with botulinum toxin in thyroarytenoid muscle (15 units of Dysport unilaterally) and propranolol (80 to 120 mg daily) at different times. Time to “wash out” after injection of 6 months and after propranolol 2 months. Patients underwent self‐assessment of vocal improvement, nasofibroscopy larynx, perceptual, and acoustic analysis of voice before and after each treatment. Data were compared according to the type of tremor and treatment and subjected to statistical analysis (significance level of. 05).

Results:

There was statistically significant improvement in perceptual measure of vocal instability in patients with dystonic tremor after treatment with botulium toxin, compared with propranolol (P =. 028). The acoustic measurement variabiity of fundamental frequency was also statistically significant, with a decrease in the treatment of dystonic tremor in connection with the botulinum toxin compared with propranolol (P =. 05) and before treatment (P =. 011).

Conclusions:

The dystonic and essential tremors differ in responses to treatment. The dystonic tremor responds positively to the injection of botulinum toxin into the thyroarytenoid muscle, but not to the use of oral propranolol.
Development of a Tissue‐Engineered Vocal Fold Cover Replacement from Rabbit Adipose Stem Cells
Authors: Shiba Travis L. , Long Jennifer L.
Published: September 2014

Objectives:

Tissue engineering of a vocal fold replacement is a promising potential treatment for severe vocal fold scarring. Development and testing of such a tissue construct is an ongoing project. We have previously demonstrated that human adipose‐derived stem cells (ASC) can produce a bilayered construct with suitable properties for implantation and phonation. This phase of the project developed a similar construct for pre‐clinical animal studies, using rabbit cells.

Methods:

Rabbit ASCs were isolated, cultured, and embedded in fibrin gels under air‐liquid interface conditions and with epidermal growth factor. After culture periods of 1 to 4 weeks, constructs were harvested, sectioned, and examined with immunohistochemistry.

Results:

Rabbit cells attached and survived within fibrin gels. Differentiation of the cells to epithelial and mesenchymal lineages was determined by microscopic markers. Deposition of extracellular matrix and basement membrane proteins was also examined.

Conclusions:

Rabbit ASCs are suitable for use in a tissue‐engineered vocal fold replacement. This model will be used in future implantation trials in rabbits.
The Impact of Pharyngeal Repair Time and Number of Sutures on Development of Pharyngocutaneous Fistula
Authors: Taskin Umit , Aydin Salih , Orhan Israfil , Altas Bengul , Yucebas Kadir , Ege Sertug S. , Oktay Mehmet F.
Published: September 2014

Objectives:

Pharyngocutaneous fistula (PCF) is the most common postoperative complication following total laryngectomy. The aim of this study was to determine the effects of pharyngeal repair time and number of mucosal sutures used on the development of PCF.

Methods:

The medical records of 47 patients who underwent total laryngectomy were assessed. The pharyngeal repair time and the number of horizontal, vertical, and cricopharyngeal muscle sutures were recorded.

Results:

We observed the appearance of PCF in 14 patients (29.8%). The average time for pharyngeal repair in patients without PCF was 22 minutes, 21 seconds ± 5 minutes, and the average number of vertical, horizontal, and cricopharyngeal muscle sutures was 9.54 ± 2.6, 10.84 ± 2.3, and 7.36 ± 2.7, respectively. The average time for pharyngeal repair in patients with PCF was 22 minutes 59 seconds ± 5 minutes, and the average number of vertical, horizontal, and cricopharyngeal muscle sutures was 8.57 ± 2.6, 11.14 ± 2.1, and 8.45 ± 1.9, respectively. The differences in pharyngeal repair time and number of vertical, horizontal, and cricopharyngeal sutures between the 2 groups were not statistically significant (P >. 05). As the number of vertical sutures increased, the fistulas developed later (P <. 05). In addition, as the number of cricopharyngeal sutures increased, the duration of the fistula decreased (P <. 05).

Conclusions:

Surgeons should not be in a hurry when they are repairing esophageal openings, and more sutures should be used in closing the cricopharyngeal muscle to decrease the duration of PCF. Using more vertical sutures when closing the esophagus delays the onset of fistulas.
Laryngopharyngeal Symptoms in Patients with Chronic Obstructive Pulmonary Disease
Authors: Turfe Zaahir , Kanj Nadim , Sarieddine Doja , Hamdan Abdul Latif
Published: September 2014

Objectives:

Report the prevalence and severity of laryngo‐pharyngeal symptoms in patients with chronic obstructive pulmonary disease (COPD) compared with controls.

Methods:

A total of 27 patients with COPD and 13 controls matched according to age and sex were included. Demographic data included age, sex, history of smoking, and history of allergic rhinitis. The Reflux Symptom Index described by Belafsky et al was used. The frequency and average score of each of the laryngopharyngeal symptoms in both the patient group and controls were computed.

Results:

The mean age of patients was 61.67 years ± 11.09 years. Sixty‐three percent were males and 37% were females. Ninety‐two percent were smokers and 11.1% had allergic rhinitis. The mean of total Reflux Symptom Index in patients was significantly higher compared with controls (12.70 ± 7.06 vs 3.00 ± 2.94, P value <.05). In the COPD group, 18 subjects had a positive Reflux Symptom Index (>11) compared with 1 in the control group (P value <.05). There was also a significant difference between the means of 6 laryngopharyngeal symptoms in patients versus controls. COPD patients had higher degree of hoarseness, throat clearing, excessive throat mucus, cough, and sticking sensation in the throat.

Conclusions:

Laryngopharyngeal reflux is more prevalent in COPD patients versus controls. The frequency and severity of laryngopharyngeal symptoms is significantly higher in COPD patients.
Office‐Based Resection of Large Vocal Process Granulomas
Authors: Lutch Matthew J.
Published: September 2014

Objectives:

(1) Describe techniques to appropriately anesthetize the larynx to facilitate complete resection of large granulomas in an unsedated patient. (2) Implement transnasal and transoral techniques to resect granulomas in conjunction with fiber‐guided lasers.

Methods:

This is a retrospective review of patients undergoing resection of large symptomatic vocal process granulomas in the office environment. Three patients were treated with resection of granulomas with primarily transoral excision, with transnasal resection and laser ablation utilized as adjunct techniques. Botox injections were also used in a subset of patients to optimize healing. All procedures were documented with video. All patients received only topical anesthesia with no periprocedural sedation.

Results:

All patients had resolution of their granulomas or self‐reported their vocal function to have returned to baseline after healing.

Conclusions:

Large vocal process granulomas can be treated in a single session in the laryngology procedure suite on the unsedated patient. An excellent outcome can be attained with readily available technology to include rigid endoscopy, flexible tranasal laser laryngoscopy, and Botox injections. Consideration should be given to treating these bulky granulomas in the office‐based environment.
Unique Clinical Findings in Laryngeal Leukoplakia to Predict Serious Histopathology in Low‐Risk Nonsmokers
Authors: Uno Kosuke , Saito Koichiro , Ono Takeyuki , Yabe Haruna , Ogawa Kaoru
Published: September 2014

Objectives:

Although most of the laryngeal leukoplakias are temporal inflammatory lesions in non‐smokers, some patients represent serious histopathologies to require careful management. The purpose of this study was to clarify unique clinical features of the patients who require cautious care in this low‐risk group.

Methods:

One hundred fifty‐four consecutive patients referred to our institution with laryngeal leukoplakia from June 2006 to May 2013. Of these, 24 patients without smoking history were incorporated in this study. Retrospective chart reviews and the re‐evaluations of video‐taped laryngeal images were performed. Sequential change of vocal quality (Grade, Roughness, Breathiness, Asthenia, Strain scale) was assessed in each patient. Timings to show improvements of laryngeal images were studied in the patients with spontaneous disappearances of leukoplakias (n = 12). Furthermore, excisional biopsies were performed on 12 patients and their histopathologies and vocal/stroboscopic characteristics were compared with each other.

Results:

Spontaneous disappearances of the lesions were observed 4.6 months after referral to our hospital on average, and these patients presented vocal quality of G1 or G0 at their first visits. Additionally, gradual recoveries in their glottal closure and/or pliability of diseased vocal folds were observed in this group. Furthermore, patients with histopathology of severe dysplasia/cancer presented with either (1) no improvement in their G2 voice for 1 month, (2) incomplete glottal closure coupled with abnormal pliability of diseased vocal folds for 1 month, or (3) abnormal pliability of diseased vocal folds for 4 months.

Conclusions:

Our analyses identified several specific findings to predict serious pathology in laryngeal leukoplakia patients without smoking history.
Voice Outcome and Quality of Life after Trasoral Laser Microsurgery for Glottic Cancer
Authors: Kwak Min K. , Lee Yun Jae , Ji Yong Bae , Song Chang Myeon , Lee Seung Hwan , Park Chul Won , Tae Kyung
Published: September 2014

Objectives:

Transoral laser microsurgery is considered one of the best techniques for the treatment of early stage glottic cancer. But voice outcome and quality of life (QOL) after laser cordectomy has not been fully evaluated. The aim of this study is to evaluate the voice outcome and QOL after transoral laser cordectomy in glottic cancer.

Methods:

We studied 43 glottic cancer patients who underwent transoral laser cordectomy from January 2002 to December 2008, retrospectively. We evaluated objective and subjective voice outcome using acoustic analysis, aerodynamic study, and voice handicap index (VHI). We also assessed QOL using EORTC QLQ‐C30/H&N35 questionnaire at preoperative and postoperative 6 to 12 months. We analyzed the correlation between voice outcome and QOL according to the types of laser cordectomy.

Results:

Postoperative harmonic to noise ratio, maximum phonation time, and VHI score was significantly improved from preoperative scores in patients who underwent type I‐II cordectomy (P =. 010, P <. 001, and P =. 013, respectively). Functional VHI score after Types I‐II cordectomy group (2.25 ± 6.08) was significantly lower than that of Types III‐VI cordectomy group (7.26 ± 6.96; P =. 043). Postoperative QOL score was not different between Types I‐II (73.71 ± 12.96) and Types III‐VI (82.37 ± 27.32) cordectomy groups (P =. 437). However, postoperative QOL score had a positive correlation with postoperative VHI score (Spearman ρ = 0.494, P =. 017).

Conclusions:

Objective and subjective voice outcome after laser cordectomy showed favorable results, especially in patients who underwent Type I or II laser cordectomy.
An Analysis of the Correlation between Tinnitus Characteristics and the Annoyance Caused
Authors: Dalligna Celso , Dalligna Daniela P. , Butzke Bruna , Beduschi Giuliana , Freitas Luiza A. , Jorge Karolina B.
Published: September 2014

Objectives:

Ascertain if there is an association between the pitch and loudness of tinnitus and its impact on patient quality of life.

Methods:

A cross‐sectional study comprising 156 patients (mean age, 57.95 ± 12.53 years) with chronic unilateral disturbing tinnitus was conducted between September 2003 and January 2014. Acufenometry was used to measure the pitch and loudness of tinnitus. We evaluated the impact of the annoyance caused by tinnitus using tinnitus handicap inventory (THI) and the visual analog scale (VAS). Statistical analysis was performed using Pearson's correlation test.

Results:

Overall, 27.3% of the patients evaluated had presbycusis, while 12.2% had noise‐induced hearing loss (NIHL) and 15.1% had Ménière's disease. The correlation coefficient observed between the loudness of tinnitus and THI was R = 0.001, P =. 99, between loudness and VAS was R = 0.001, P =. 99, and between loudness and age of the patients was R = 0.03, P =. 70. When we analyzed the tinnitus pitch and THI was found R = 0.11, P =. 16, and pitch and VAS R = 0.05, P =. 56. Analysis of the tinnitus pitch and the patient's age verified the correlation observed (R = –0.16, P =. 05).

Conclusions:

The findings of this study did not reveal a statistically significant correlation between tinnitus characteristics and its impact on patient quality of life. However, a weak negative relationship was observed between the tinnitus pitch and the age of the patients.
Analysis of Dizzy Patients with High Depression and Anxiety Index
Authors: Hong Seok Min , Choi Sung Ho , Park Il‐Seok , Kim Yong Bok , Park Se‐Jin
Published: September 2014

Objectives:

Some patients with dizziness often show psychological distress. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated the incidence of high depression and anxiety index in patients who complained of dizziness, their dizziness severity, and the distribution of disease to induce dizziness.

Methods:

In 562 patients with dizziness, dizziness and the psychological distress of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State‐Trait Anxiety Inventory (STAI). We examined the incidence of patients having high depression and anxiety using a cutoff value (BDI ≥21, STAI ≥57). We divided patients into a high psychological distress index group and a moderate to low index group on the basis of cut‐off value and compared the type of disease and DHI score between the 2 groups.

Results:

The incidence of high BDI and STAI scores were 11% and 13.5%, respectively. The high BDI and STAI group showed the higher DHI scores, including functional, emotional and physical subscales, and the higher STAI and BDI scores, respectively. The mean age, sex and the distribution of the type of disease between high psychological distress index group and moderate to low index group showed no difference.

Conclusions:

Of patients with dizziness, about one‐tenth have serious psychological distress, various vestibular diseases, and more dizzy symptoms. Thus, we should keep in mind the psychological factor in dizzy patients and the necessity of psychological support in the patients.
Preoperative MRA for Patient Selection in Free Fibula Flap: Is a Venous Phase Indicated?
Authors: Lawson Bradley R. , Ram Roopa , Pandey Tarun , Jambhekar Kedar , Moreno Mauricio A.
Published: September 2014

Objectives:

We present our institutional experience with dynamic time‐resolved magnetic resonance angiography (DTR MRA) with delayed venous imaging for free fibula flap (FFF) patient selection. We sought to (1) determine the sensitivity of the test for vascular anomalies predisposing to limb‐threatening complications and (2) assess the impact of the venous phase findings in patient selection.

Methods:

Retrospective review of 46 patients considered for mandibular reconstruction with FFF in an academic tertiary setting from 2009‐2012. A DTR MRA was performed preoperatively in all cases. Both imaging and physical examination findings were used to determine patient eligibility for the procedure.

Results:

Thirteen patients (28.2%) had findings on DTR MRA excluding flap harvesting from the preferred leg, with atherosclerosis (n = 8) and anatomic variations (n = 4) being the most common findings. Eight of these patients (61.5%) underwent harvesting from the opposite leg, while 5 underwent reconstruction with a different bony flap. Only 2 of these 13 patients (15.3%) had physical examination findings excluding reconstruction with FFF. DTR MRA was significantly more likely to detect potentially limb threatening vascular anomalies than physical examination (P =. 004). There was 1 patient with an anomaly on delayed venous imaging (asymptomatic deep venous thrombosis–thrombophlebitis) which excluded flap harvesting from the affected leg. Both arterial phase imaging and physical examination were normal in this patient.

Conclusions:

DTR MRA is significantly more sensitive than physical examination in detecting limb‐threatening anatomic variations and vascular pathology prior to FFF reconstruction. The venous phase allows identification of oligosymptomatic venous anomalies that, while uncommon, may predispose to significant morbidity. These findings justify routine use of this imaging modality.
Comparison of the Vestibular Aqueduct between Acute Low‐Tone Sensorineural Hearing Loss and Ménière's Disease
Authors: Nishimura Masahiko , Kuwashima Shigeru , Sato Hiroaki , Nakasato Tatsuhiko
Published: September 2014

Objectives:

Most acute low‐tone sensorineural hearing loss without vertigo (ALHL) improves over time; however, some cases develop into typical Ménière's disease (MD), suggesting an association between ALHL and MD. This study aimed to investigate associations between ALHL and MD from the perspective of development of the vestibular aqueduct.

Methods:

Prospective case‐control study at a tertiary referral center. In 51 patients with unilateral ALHL (15 males, 36 females; mean age, 52.3 years), 35 patients with unilateral MD (14 males, 21 females; mean age, 43.1 years) and 11 healthy controls (11 males; mean age, 33.3 years), length of the external aperture of the vestibular aqueduct (EAVA) was measured on 3‐dimensional computed tomography. Results were then compared among ALHL patients, MD patients, and controls.

Results:

On the affected side, mean length of the EAVA was 5.8 ± 2.7 mm in ALHL patients, 4.3 ± 2.0 mm in MD patients, and 6.5 ± 1.5 mm in controls. The EAVA was significantly shorter in MD than in ALHL or controls. Among ALHL patients, length of the EAVA was significantly shorter in patients with recurrence (4.5 ± 1.9 mm) than in those without recurrence (6.4 ± 2.5 mm).

Conclusions:

Hypoplasia of the endolymphatic sac may represent a predisposing factor for recurrence of ALHL and/or MD, as development of the endolymphatic sac is known to correlate with length of the EAVA.
Regional Variation in Procedures and Charges for Ambulatory Endoscopic Sinus Surgery
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: September 2014

Objectives:

(1) Determine if there is significant geographic variation in surgical charges for endoscopic sinus surgery (ESS) across states. (2) Understand factors that influence charges.

Methods:

The State Ambulatory Surgery Databases (2010) for Florida, Iowa, New York, and North Carolina were analyzed, extracting cases of adult endoscopic sinus surgery. Demographic, diagnostic, procedural, insurance, and charge data were tabulated. Extent of surgery was quantified by number of sinusotomies and other nasal procedures (eg, septoplasty) performed. Variation in state‐to‐state total charges for ESS was determined adjusting for demographic and procedural parameters.

Results:

A total of 22,350 ambulatory ESS cases were examined across 4 states (mean age, 48.5 years; 51.6% female). Private insurance and Medicare were the primary payers in 69.5% and 19.3% of cases, respectively. Image guidance was utilized in 21.0% and polyps were present in 26.8% of cases. There was wide variation in the distribution of sinusotomies per case performed: Florida had the highest percentage of 5 sinusotomy cases (18.8%) versus 15.9% for New York and only 7.0% for Iowa (P <. 001). Adjusting for image guidance, polyposis, other nasal surgery, number of sinusotomies, and payer and median household income, there was a significant difference in mean total charges for ESS by state: Florida ($22,403), Iowa ($17,574), North Carolina ($14,650), and New York ($12,641; P <. 001 analysis of variance).

Conclusions:

Considerable state‐to‐state variation in charges for ambulatory ESS exists. These data will become increasingly important as mandates for charge and cost transparency for the healthcare consumer manifest nationally. Efforts to determine reasons for these cost variances should be undertaken.
Considering Statistical Logic in Otology
Authors: Blakley Brian W.
Published: September 2014

Objectives:

Illustrate strong and weak statistical concepts used in otolaryngologic papers submitted for publication regardless of acceptance.

Methods:

For 1 calendar year, the type and number of statistical concerns were recorded for 56 otologic papers submitted for publication to 1 of 5 journals.

Results:

Ninety‐nine concerns were found in 32 of the 56 papers. Reviewers identified several concerns in many papers. For some papers, data reanalysis was possible with different statistical tests, but in none was the conclusion altered. A summary of the findings with some overlap of the categories follows. Conclusions not supported by data – 13. Confusion of correlation with causation – 13. “Fishing trip” – 12. Overgeneralization – 9. Multiple t tests for related outcomes – 8. Multiple tests ‐ inappropriate tests – 8. Parametric tests were used but underlying assumptions clearly violated – 7. Conclusion inappropriate or absent – 7. Lack of required power analysis – 4. Inappropriate assignment to groups when assessing group differences – 3. Partial data analysis – 3. Reviewer requests power analysis when not needed – 2. Reviewer requests inappropriate tests ‐ 2.

Conclusions:

Application of statistics in otology papers was surprisingly good. The most common flaws in statistical interpretation in submitted papers were (1) that the conclusion reported was not supported by the data or (2) confusion between association and causation. Even if statistics were applied inappropriately, thoughtful reviewers were generally able to detect errors in statistical logic even if they did not feel that they were qualified as statisticians.
Current Landscape of Social Media and Blogosphere in the Cochlear Implant Community
Authors: Saxena Rajeev C. , Lehmann Ashton E. , Hight Ariel E. , Kozin Elliott D. , Lee Daniel J.
Published: September 2014

Objectives:

Over 200,000 individuals worldwide have received a cochlear implant (CI). Social media websites may provide a paramedical community for CI users, although their utilization patterns have not been thoroughly investigated. Herein, we aim to (1) analyze how CI users exchange information online and (2) quantify and characterize participation in social media.

Methods:

Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned 1 of 6 functional categories based on its description. Using standard search engines, such as Google, we used the search terms cochlear implant, auditory implant, forum, and blog to identify relevant blogs and online forums. Website participation was quantified.

Results:

Over 350 sources were identified, including 122 YouTube videos, 111 blogs and forums, 57 Facebook groups, 32 Facebook pages, and 50 Twitter accounts. The most active online communities were Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum had ~9500 topics with ~127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%).

Conclusions:

This is the first known comprehensive review of utilization patterns of social media in the CI community. CI users engage in a wide range of online platforms predominately to provide general information and share personal stories. Analyses of how CI users participate in social media may enable clinicians to identify key concerns of this specialized patient population.
Defaulters of Universal Newborn Hearing Screening Program at Tertiary Hospital, Malaysia: The Associated Factors
Authors: Abdullah Asma , A. Madzhi Dayang S. , Jaafar Rohana , Sazari Fatimah , Rahman Roslenda A. , Ying Lim Bee , Ismail Aniza
Published: September 2014

Objectives:

Describe the sociodemographic of defaulters in the Universal Newborn Hearing Screening Program at UKMMC and to identify the associated factors.

Methods:

A cross‐sectional study was conducted at UKMMC from December 2011 until May 2013. Defaulter was defined as a patient who failed to attend the first stage hearing screening at UKMMC and also defaulted follow‐up at the Audiology Unit between January 2010 and May 2011. The information was obtained through telephone inquiries to parents using the set of questionnaires. The factors studied were awareness of hearing loss, distance to the hospital, appointment date, and financial and transportation difficulties.

Results:

A total of 280 respondents were interviewed. The majority of the respondents were Malays (71.79%) in the middle income category. Nonawareness of the child's hearing loss was the main associated factor (n = 205, 73.21%). The other associated factors were: appointment date was not given (n = 173, 61.8%), distance to the hospital (n = 126, 45%), appointment date given is too far away (n = 57, 20.4%), financial difficulties (n = 59, 21.1%), followed by respondents who do not have their own transport (n = 46, 16.4%).

Conclusions:

Nonawareness of the child's hearing loss by his or her parents was the major factor to the high default rate. Therefore, education and empowerment programs should be introduced and implemented at UKMMC in order to improve awareness among parents.
Does Endolymphatic Sac Decompression Surgery with Local Steroids Prevent Bilateral Development of Ménière's Disease?
Authors: Kitahara Tadashi , Inohara Hidenori
Published: September 2014

Objectives:

Elucidate whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent unilateral Ménière's disease (MD) from becoming bilateral.

Methods:

Prospective case‐control study. Between 1996 and 2008, we performed a glycerol test (G‐test) and electrocochleography (ECoG) on 237 patients with intractable MD at a tertiary referral center. We performed ESDS on 179 patients (144 without endolymphatic hydrops and 35 with silent endolymphatic hydrops in the contralateral ear). The other 58 patients (40 without endolymphatic hydrops and 18 with silent endolymphatic hydrops in the contralateral ear) were given available medical treatments. All underwent regular follow‐up for at least 5 years.

Results:

Altogether, 22.4% (53/237) of patients with clinically diagnosed unilateral intractable MD had silent endolymphatic hydrops in the contralateral ear using G‐test and ECoG. In the nonsurgical group, 6 of 40 patients with unilateral MD without endolymphatic hydops in the contralateral ear developed bilateral disease, whereas in the surgical group, 12 of 144 patients did so (P >. 05). In the nonsurgical group, 9 of 18 patients with unilateral MD and silent endolymphatic hydrops developed the disease in the contralateral ear, whereas in the surgical group, 6 of 35 patients developed bilateral disease (P <. 05).

Conclusions:

The present findings suggest that ESDS may decrease the incidence of developing MD in silent endolymphatic hydronic contra lateral ears diagnosed with G‐test and ECoG within the first 5 postoperative years.
The Effect of Transplantation of Tissue‐Engineered Cell‐Sheets after Middle Ear Surgery in a Rabbit Model
Authors: Yamamoto Kazuhisa , Kojima Hiromi , Yaguchi Yuichiro , Hama Takanori
Published: September 2014

Objectives:

Postoperative regeneration of the middle ear mucosa and pneumatization of the middle ear cavity are of great importance after middle ear surgery. This study developed a new method to transplant autologous nasal mucosal epithelial cell‐sheets into the damaged middle ear cavity. The aim of this study was to evaluate postoperative healing after the transplantation of the cell sheets in rabbits.

Methods:

Rabbit nasal mucosal epithelial cell‐sheets were fabricated from a temperature‐responsive culture dish and transplanted into the damaged middle ear of the rabbit, which was surgically created. The healing of middle ears was evaluated with histological methods and computed tomography findings at 8 weeks after transplantation. Functional evaluation was performed by measuring the maximum middle ear total pressure reflecting a trans‐mucosal gas exchange function. Two control groups were used: the normal control group and the mucosa‐eliminated control group.

Results:

Transplantation of nasal mucosal epithelial cell‐sheets suppressed the bone hyperplasia and the narrowing of pneumatic space in the middle ear cavity more clearly than the mucosa‐eliminated control group. The mucosal gas exchange function was also found to be good in the cell sheet‐transplanted group. These results suggest that posttransplanted middle ear cavity is not only morphologically but also functionally similar to the normal middle ear cavity.

Conclusions:

Nasal mucosal epithelial cell‐sheet is confirmed to be useful as an effective graft material after middle ear surgery, and will hopefully become a novel therapy in the future.
Effective Management of Ménière's and Vestibular Disorders with Photo‐Biostimulation Light Laser
Authors: Hack Eugenio , Prosper Joaquin
Published: September 2014

Objectives:

Laser irradiation applied inside the inner ear has been investigated to observe the therapeutic effectiveness in cochlear injury and vestibular dysfunction. The positive influence of light irradiation with low level laser therapy on the treatment of vascular disorders, ischemic arteriolar disease, activation of microcirculation, and tissue regeneration is well known and has been published by several authors from medical research groups. The aim of this study was to determine the effects and benefits for patients with Ménière's disease and other vestibulopathies who received an irradiation dose into the inner ear by using a protocol of irradiation.

Methods:

A laser device with double wavelength and independent light beams was used to irradiate through the ear canal with power irradiance of 90 to 300 mw/cm2 at different dose rate according to patient symptoms. A prospective study of a group of sixty five (65) patients who were suffering peripheral vestibular disorder were treated from January 2010 to July 2011 in a random selection with no exclusions for other pathologies. Method of irradiation was direct beam over “meatus acusticus” at 1.5 cm distance of ear drum membrane.

Results:

Fifty patients of the 65 were considered final group control. According to American Academy of Otolaryngology—Head and Neck Surgery guideline criteria, 64% were classified as Category A on their vertigo management and 36% were Category A+B. After the treatment period, both categories confirmed that crises were shorter, less severe and with lower intensity.

Conclusions:

Laser irradiation has no risk for patients and can be considered both effective and an alternative therapy.