bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Hepatocyte Growth Factor Injection and Reinjection
Authors: Garcia Roberta Ismael Dias , Tsuhji Domingos Hiroshi , Imamura Luiz F. , Bissoli Rui , Mauad Thais
Published: September 2011

Objective

The study sought to assess the effects of HGF injection and reinjection coinciding with its peak of activity on collagen density, vessel density, inflammatory reaction in the lamina propria, and mean epithelial thickness in the injured rabbit vocal fold.

Method

Fourteen rabbits were subdivided in group 1 that received HGF injections into the right vocal fold and 2 that received bilateral HGF injections and reinjection into the right vocal fold 10 days after. Left vocal folds were controls. Histological assessment was performed at 30 and 40 days respectively.

Results

In both groups, collagen density was lower in the right vocal folds than in the left folds (P =. 018). Vessel density was higher in the right vocal folds in group 2 (P =. 018). Differences about mean epithelial thickness and inflammatory reaction in the lamina propria are not statistical significance.

Conclusion

In the scarred rabbit vocal fold, HGF injection is associated with decreased collagen density in the lamina propria, whereas reinjection after 10 days produces decreased collagen density and higher vessel density.
Efficacy of Amitriptyline for Chronic Laryngitis
Authors: Stein Daniel , Noordzij Jacob P.
Published: September 2011

Objective

1) Evaluate effectiveness of amitriptyline for the treatment of chronic laryngitis. 2) Compare the effectiveness of amitriptyline by gender, age, and race.

Method

A retrospective chart review identified patients treated with amitriptyline for laryngitis in an academic otolaryngology practice. Subjects who had documented compliance with medication and follow‐up evaluation within three months after initiation were included. Symptoms, demographic information, and response to therapy were abstracted from their records.

Results

A total of 66 subjects were identified, consisting of 48 women and 18 men. Those of African descent constituted 42%, with Hispanic 27%, white 20%, Asian 6%, and other 5%. Response to treatment was complete in 32%, partial in 24% and without improvement in 36%, with the remaining 8% unable to tolerate treatment. Overall, 56% of subjects improved (95% confidence limit 43.3% to 68.3%). No significant differences in response rates were seen based on gender (P =. 289), age (<60 vs 60+) (P =. 149) or race (P =. 254).

Conclusion

We found a substantial rate of improvement with amitriptyline treatment among individuals with chronic laryngitis, with most subjects tolerating this treatment. No significant differences in efficacy were seen among racial, age and gender subgroups. A prospective randomized trial of this therapy appears warranted.
High‐Speed Camera Observations of Vocal Nodules
Authors: Iwata Yoshihiro , Toda Hitoshi , Sakurai Kazuo , Naitou Kensei , Horibe Seji , Yoshioka Satoshi , Okada Tatuyoshi
Published: September 2011

Objective

We compared the vocal fold vibration pattern among normal subjects and vocal nodules. Observation of the movement to the vocal cord mucosa using a high speed camera, examining a mechanism of abnormal vibration by observing the motion of the vocal process was intended to clarify the cause of vocal nodules.

Method

Five normal speech and 8 patients with vocal nodules were compared. High‐speed cameras recorded the vocal cord vibration. Easy phonation, 3000 fps or 3333 fps. We are in the position of the vocal process 3 consecutive images of the period, direction, investigated the symmetry of left and right.

Results

In normal vocal cords vocal process was symmetrical. (5/5 case) Swings from side to side width and vocal process was about the same for both sides. The direction of extension of the vocal process was assembled in the center of the vocal cords membranes. (5/5 case) The midline of the laryngeal vocal nodules vocal process was in a different position on the left and right (7/8 case). Swings were different width of the vocal process (6/8 case). The direction of extension of the right and left vocal process was different.

Conclusion

In the normal group, parallel to the vocal cords vibrate in contact throughout the mucosa. Vocal nodule group was lateralized position of the vocal process. We thought to focus on one part of the mucous membrane contact between vocal cords. It was considered one of the pathogenesis of vocal nodules.
Indications for the Use of Botox in Laryngology: A Review
Authors: Tan Melin , Woo Peak , Chinosornvatana Nina
Published: September 2011

Objective

Botox causes chemical denervation by inhibiting release of acetylcholine from nerve terminals. In laryngology, Botox was initially introduced in patients with spasmodic dysphonia. Since then, its role has expanded to other disorders of laryngeal muscle hyperfunction. We aim to identify expanded indications of Botox in laryngology and review the literature.

Method

We performed a retrospective review of all patients treated with Botox injection in the senior author’s (PW) laryngology practice from 1998 to 2010. Indications were categorized and outcomes were analyzed.

Results

A total of 257 patients received laryngeal injections of Botox. Of these, 57 patients (22.2%) were indicated for reasons other than spasmodic dysphonia. Twenty‐nine (50.9%) were female and 28 (49.1%) were male. Age range was 15 to 72 years with a mean of 40 years. Eighteen (31.6%) patients were treated for paradoxical vocal fold motion, 14 (24.56%) were treated for contact granuloma, and 10 (17.54%) were treated for vocal fold paralysis with aberrant re‐innervation. Other indications included tremor, loud voice, mutational voice disorder, and spasticity. Twenty‐nine (49.15%) patients benefited from multiple injections.

Conclusion

The use of Botox for the intrinsic musculature of the larynx can be considered for a wide spectrum of pathology involving vocal fold hyperfunction.
Investigation of Triamcinolone in Acute Phonotrauma
Authors: Hall Joseph E. , Suehiro Atsushi , Rousseau Bernard , Branski Ryan C. , Garrett C. Gaelyn
Published: September 2011

Objective

Investigate the effects of triamcinolone on transcript levels of the inflammatory markers (COX‐2, TGF‐β1, IL‐1β) and tight junction proteins (zonula occludin‐1 (ZO‐1), occludin, E‐cadherin, β‐catenin) in an in vivo model of acute phonotrauma. We hypothesized that triamcinolone downregulates inflammatory mediator gene expression and upregulates tight junction gene expression.

Method

Eight New Zealand white rabbits received intralaryngeal triamcinolone acetonide at the following concentrations: saline control, 100 µg/25 µL, 400 µg/25 µL, and 800 µg/25 mL followed by 30 minutes of raised intensity phonation. Quantitative polymerase chain reaction (qPCR) was used to investigate gene expression levels of inflammatory markers and epithelial tight junction proteins.

Results

Results of qPCR revealed dose‐dependent changes in COX‐2, TGF‐β1, and IL‐1β. Higher concentrations of triamcinolone showed an inverse relationship with transcription of these gene products. For tight junction proteins, qPCR showed upregulated gene expression of ZO‐1, occludin, and E‐cadherin in rabbits receiving 100 µg/25 µL triamcinolone compared to controls. However, higher concentrations of triamcinolone resulted in decreased levels of tight junction gene expression.

Conclusion

Triamcinolone is used for treatment of laryngeal disorders. However, the anti‐inflammatory properties of triamcinolone have not been demonstrated in the larynx. Results of this experiment provide support for the hypothesis that triamcinolone downregulates inflammatory mediator gene expression and upregulates tight junction gene expression at lower concentrations in acute phonotrauma.
KTP Laser Safety and Efficacy in Benign Laryngeal Lesions
Authors: Sheu Mike C. , Pollack Aron , Amin Milan , Mallur Pavan , Branski Ryan C. , Sridharan Shaum , Paul Benjamin C.
Published: September 2011

Objective

The potassium titanyl phosphate (KTP) laser is increasingly used to treat polyps, granulomas, and similar laryngeal mucosal lesions and has been shown to be safe and effective in case series. In this study we introduce a method to quantify the safety and efficacy of the KTP laser in laryngeal procedures.

Method

Pre‐and post‐KTP laser treatment videos were obtained from 3 institutions. The change in size of the laryngeal lesions was measured using a novel objective computerized method. A select number of videos were evaluated by blinded reviewers and rated for measures of safety.

Results

More than 120 larynges underwent treatment for mucosal lesions including polyps, granulomas, and leukoplakia. Regardless of lesion type, there was a decrease in size based upon objective computer measurements, with all approaching or meeting statistical significance. Long‐term follow‐up was indicative of persistent lesion regression. Interrater reliability was good. Nineteen larynges were evaluated for safety based upon mucosal wave and glottic closure, with >90% of evaluations reporting preservation or improvement. Internal validity was good.

Conclusion

KTP laser in laryngeal mucosal lesions is safe and effective based upon our safety rating instrument and computerized lesion measurement system. This system can be reliably used as an objective measure of lesion of regression post therapy and for scientific evaluation of KTP laser efficacy in laryngeal procedures.
Laryngeal Diseases in Patients Referred to Videolaryngoscopy
Authors: Azevedo Julia , Cruz Camilla , Mury Isabelle , Osorio Marcio , Steffen Ricardo E. , Quintão Everson
Published: September 2011

Objective

The aim of the study was to characterize common laryngeal conditions in patients referred to videolaryngoscopy in the otorhinolaryngology department of a reference tertiary hospital in Rio de Janeiro, Brazil.

Method

Patients’ records from a database of laryngeal endoscopic records from January 2000 to January 2010 were reviewed for the diagnosis of the common conditions: vocal paralysis/paresis, laryngopharyngeal reflux, laryngotracheal stenosis and, benign or malignant neoplasms, including papilloma and laryngeal dystonia/spasmodic dysphonia. Patients’ age, gender, profession, and smoking status were analyzed.

Results

A total of 3755 patient records were analyzed. Median age was 56 years (IQR 45‐66). The majority of patients was female (63.7%). Smoking habits were reported by 23.6% of patients. Voice professionals accounted for 10.9% of all patients. The most common condition found was benign/malignant neoplasms, which accounted for 15.5% of all the diagnoses, followed by laryngopharyngeal reflux (13.8%) and vocal cord and laryngeal paralysis (6.4%). Other disorders accounted for the remainder of diagnoses.

Conclusion

Benign and malignant neoplasm was the most common diagnosis found, accounting for 15.5% of the disorders diagnosed. Prompt diagnosis and treatment is essential for improved patient prognosis. Smoking was also found in a high number of patients. Smoking cessation programs should work closely with otorhinolaryngology services.
Narrow Band Imaging
Authors: Kim Grace G. , Leahy Kevin , Mirza Natasha
Published: September 2011

Objective

1) Investigate a novel technology called narrow band imaging (NBI) in the detection of laryngopharyngeal reflux (LPR). 2) Compare mucosal abnormalities using NBI to conventional fiberoptic white‐light laryngoscopy.

Method

A prospective case‐control pilot study on the usage of NBI to identify mucosal abnormalities in patients with LPR at a tertiary referral center from July 2010 to February 2011. RFS scores were calculated using white‐light endoscopy. NBI was used to characterize endoscopic findings. Video images were reviewed by two blinded laryngologists.

Results

Twelve adult patients with LPR based on RSI scores and 11 normal adult controls were included. Reflux symptom index (RSI) greater than 13 and reflux finding score (RFS) greater than 11 were significantly correlated. NBI findings were graded on 2 vascular patterns and number of laryngeal sites involved. NBI was scored on a scale of 0 to 2 based on degree of color compared with background. Subsites were graded as 1 for 1 subsite and 2 for 2 or more subsites. Higher RFS were associated with lacey and punctuate patterns, as well as increased number of laryngeal sites involved.

Conclusion

This pilot study has demonstrated various vascularity and morphologic patterns in mucosa visualized on NBI examination of patients with LPR. Preliminary results indicate that NBI may be a useful aid in the diagnosis of LPR, but a larger study size and standardized methods of quantification of LPR changes are recommended.
Nasalance Scores for Normal‐Speaking Turkish Population
Authors: Akcam Timur , Birkent Hakan , Arslan Huseyin , Gerek Mustafa , Karakoc Omer
Published: September 2011

Objective

Obtain normative nasalance scores for adult and children subjects speaking Turkish language, and obtain a reference for normality when nasality is evaluated.

Method

Mean nasalance scores were obtained from 35 normal‐speaking children and 125 adults during the repetition of 3 passages that were categorized according to the amount of nasal consonants (oral, oro‐nasal, and nasal passages). The Nasometer (model 6200) was used to obtain nasalance scores for the three reading passages.

Results

Group mean ± standard deviation nasalance scores of children for oral passage, oronasal passage, and nasal passage were 15.23 ± 4.87, 37.69 ± 4.42, and 49.00 ± 6.99, respectively. Nasalance scores for the adult group were 15.77 ± 13.15, 38.46 ± 11.11, and 49.49 ± 10.28, respectively. There were significant differences in mean nasalance scores for oral versus nasal materials both for children and adult groups.

Conclusion

The present study provides normative nasalance scores for Turkish‐speaking children and adults. The results indicated acceptable differentiation between oral and nasal materials.
NBI HDTV Magnifying Endoscopy in Laryngeal Papillomatosis and Laryngeal Spinocellular Cancer
Authors: Zabrodsky Michal , Betka Jan , Plzak Jan , Lukes Petr
Published: September 2011

Objective

NBI (Narrow Band Imaging) helps to visualize subtle changes in microvascular architecture linked to neoangiogenesis. Combination of NBI with HDTV (high‐definition television) and magnifying endoscopy provides best sensitivity and specificity. The most frequent false positive results were reported in laryngeal papillomatosis where the micro‐vascular pattern could be misinterpreted as neoplastic.

Method

Patients with clinical diagnosis of papillomatosis or laryngeal cancer were included in the study. NBI HDTV camera head was used in combination with rigid magnifying telescope during microlaryngoscopy. Type and extent of micro‐vascular mucosal changes were recorded. Mucosal lesions were removed radically and histologically evaluated and correlated with clinical findings.

Results

Preliminary results show that increased neoangiogenesis is present in both laryngeal papillomatosis and laryngeal SCC. The presence of prolonged and enlarged capillary loops was observed in both groups. This yields difficulties in differentiation between both entities.

Conclusion

The discrimination of papillomatosis and early stage of laryngeal SCC is difficult even when NBI HDTV magnifying endoscopy is used. Creation of special classification of capillary loop changes in laryngeal mucosa is needed.
Nasoseptal Flap Reconstruction of Secondary Palatal Defects
Authors: Kim Grace G. , Zanation Adam M. , McKinney Kibwei A. , Stadler Michael E.
Published: September 2011

Objective

1) Describe a novel operative technique using a posteriorly pedicled nasoseptal flap (NSF) for reconstruction of secondary palatal defects. 2) Report initial outcomes of patients with secondary palatal defects who underwent NSF palatal reconstruction.

Method

Case series of 5 patients who underwent NSF for repair of secondary palatal defects at a tertiary referral center from October 2008 to October 2010. A NSF pedicled on the posterior nasoseptal artery was used for coverage of palatal defects. Clinical outcomes and images will be presented.

Results

Two patients had secondary palatal defects from prior tumor resection, 1 patient had a traumatic injury, 1 patient had granulomatous disease, and 1 patient had a palatal defect after Le Fort I advancement. Area of defects ranged from 0.5 to 7cm2. Initial outcomes reveal that all defects less than 1cm in width (n = 3) closed successfully and defects larger than 2cm in width (n = 2) did not completely close. There were no intraoperative complications. All patients had complete intranasal healing by 6 weeks postoperatively. There were no postoperative bleeding, infectious, or wound complications, as well as no cerebrospinal fluid leaks.

Conclusion

Secondary palatal defects are challenging and reconstruction with vascularized tissue is desirable. A posteriorly pedicled nasoseptal flap offers a novel option to repair palatal defects. The success rate for small defects is promising with minimal donor site morbidity.
Pharyngeal Pooling in Patients with Zenker’s Diverticulum
Authors: Onkasuwan Julina , Yung Katherine , Courey Mark S.
Published: September 2011

Objective

Determine if patients with a diagnosis of Zenker diverticulum are more likely to have pooling of secretions in the left piriform sinus on in‐office endoscopy compared with patients with non specific dysphagia without motion abnormality or known neurologic disorder.

Method

A retrospective review was performed of patients evaluated at a subspecialty swallowing clinic, over a 5‐year period, with radiographically confirmed Zenker’s diverticulum. A control group with dysphagia due to radiographically confirmed esophageal dysmotility, prominent cricopharyngeal bar, or stricture was identified. Two blinded laryngologists reviewed the recorded laryngoscopies.

Results

A total of 29 Zenker patients were identified; 7 were excluded due to previous surgery. Of the 22 remaining patients, the mean age was 68.45 years (range, 26‐95 years). Fourteen (59.09%) of the Zenker diverticulum patients had greater pooling in the left versus right piriform sinus. The average age of the 16 control patients was 61.31 years (range, 18‐84 years). One of the 16 (6.25%) had greater pooling in the left piriform (2‐tailed t test, P < less than. 0005). While the sensitivity of this physical examination finding in identifying patients with Zenker diverticulum is 60.09%, specificity is 93.75% and the positive predictive value is 92.86%.

Conclusion

Increased pooling in the left compared with the right piriform, on in‐office endoscopy, is significantly associated with the presence of a Zenker diverticulum. This information can sharpen clinical acumen in evaluating patients with dysphagia. In turn, it will help the clinician counsel the patient regarding diagnosis and radiographic imaging.
Posterior Glottic Stenosis: Is Remobilization Possible?
Authors: Eisenbeis John Francis , Zaveri Rishi
Published: September 2011

Objective

Surgical management of posterior glottic stenosis (PGS) should ideally result in vocal cord remobilization, rather than airway expansion via destructive glottic procedures. This study (1) presents surgical management of 10 cases of PGS, and (2) discusses a treatment algorithm for PGS which focuses on vocal cord remobilization.

Method

Ten cases of PGS with bilateral vocal fold immobility were retrospectively reviewed. Tracheotomy was initially performed to provide an adequate airway. Further interventions instituted focused on vocal cord remobilization. The main outcomes considered included decannulation, number and type of procedures performed, vocal cord mobility, voice quality, and exercise tolerance.

Results

Ten cases were reviewed. One patient was successfully decannulated without surgical intervention. Of the 9 patients requiring surgical intervention, 4 patients required a single procedure to be decannulated, and 4 patients required multiple interventions to be decannulated. The one patient not decannulated had an adequate glottic airway with limited arytenoid mobility, however, was not decannulated due to pending renal transplant. Six patients underwent midline thyrotomy with resection of posterior glottic scar and arytenoid remobilization. In all 6 of these patients some degree of vocal fold mobility was reestablished. Voice quality and exercise tolerance was adequate to excellent in all patients.

Conclusion

Patients with PGS can be decannulated through surgical intervention; however, following a treatment algorithm focusing on vocal cord remobilization may establish vocal fold mobility, and thus improve voice and airway dynamics.
Primary Natural Killer T Cell Lymphoma of the Supraglottis
Authors: Friedmann David , Troob Scott H. , Suurna Maria V. , Liu Cynthia
Published: September 2011

Objective

Describe an especially rare case, primary natural killer (NK) T Cell lymphoma of the supraglottis. Because of its unique presentation and infrequent occurrence, treatment in this case was delayed while awaiting a definitive diagnosis. Presentation of this case and the review of the literature should aid in the differential diagnosis.

Method

The patient’s medical records including his clinical history, laboratory, radiologic, and pathologic data were reviewed. Additionally, a literature search was performed for cases of laryngeal lymphoma, with special attention to NK T‐cell type.

Results

A 22‐year old male from South America presented with 2 months of odynophagia, hoarseness, fever, hemoptysis, night sweats, and a 70‐pound weight loss. Work up for tuberculosis, HIV, and serologies for systemic granulomatous conditions were negative. Otolaryngologic evaluation demonstrated normal‐appearing nasal mucosa and oral cavity. Laryngoscopy revealed a thickened epiglottis with polypoid mucosa of the vallecula and the supraglottis. Biopsy of the epiglottis demonstrated NK T cell lymphoma, nasal‐type with CD3 and CD56 positivity and histologic features of an aggressive EBV‐associated form. Imaging and bone marrow biopsy confirmed its confinement to the supraglottis. He is currently undergoing concurrent chemo‐radiation therapy.

Conclusion

Lymphoma of the larynx represents 1% of malignant laryngeal tumors. Primary laryngeal NK T cell lymphoma with disease isolated to the larynx is exceptionally rare and has not previously been reported. Medical work up to rule out infectious or inflammatory lesions along with directed biopsies should help in the diagnosis.
Quality of Voice and Quality of Life after Injection Augmentation of the Vocal Cord with Polydimethylsiloxane (VOX‐Implants)
Authors: Weber Nathalie Isabelle , Sittel Christian , Koelmel Jan‐Constantin , Stegmann Monika
Published: September 2011

Objective

Evaluate quality of life as well as quality of voice before and after endoscopic injection augmentation with Polydimethylsiloxane (VOX‐Implants) for unilateral neurogenic vocal fold immobility.

Method

Prospective study. Evaluation of 14 patients undergoing injection laryngoplasty (VOX‐Implants) under general anesthesia. Evaluation of the following parameters concerning the patients voice (preoperatively, postoperatively): glottic closure (videostroboscopic and flexible‐videoendoscopic), voice range profile, maximum phonation time, Dysphonia index (according to Friedrich) and Roughness‐Breathiness‐Hoarseness‐Scale (RBH‐Scale). Quality of life was assessed using Voice‐Handicap‐Index (VHI‐12).

Results

Postoperatively an improvement was evident in all observed parameters. A sufficient glottic closure during phonation could be accomplished in all patients. The voice range profile increased about 3.65 half‐tones. After injection laryngoplasty maximum phonation time was 6.9 seconds longer than preoperatively. The Friedrich Dysphonia‐Index was 2.4 before and 1.3 after augmentation. Postoperatively RBH‐scale was lower than before the operation. Voice‐Handicap‐Index (VHI‐12), a parameter for experienced voice handicap in private life, could be declined to 15.7 points postoperatively. In our study no substance‐associated complications were observed.

Conclusion

Injection laryngoplasty with Polydimethylsiloxane (VOX‐Implants) is an effective instrument to improve the quality of voice as well as the quality of life in patients with an unilateral vocal fold paralysis. Polydimethylsiloxane is a safe substance for injection laryngoplasty and provides satisfying results in the reestablishment of patients communication ability.
Orthodromic Temporalis Tendon Transfer: An Anatomic Study
Authors: Parker Noah P. , Dresner Harley S. , Eisler Lindsay S. , Walsh William E.
Published: September 2011

Objective

1) Understand the relationship of anatomic structures at risk for injury during the transfacial orthodromic temporalis tendon transfer procedure (OTTT) for facial reanimation. 2) Define the anatomic limitations of the OTTT without temporal releasing incisions of the muscle origin or perioral lengthening materials.

Method

Ten fresh cadavers were used to perform 20 hemi‐face dissections. Detailed measurements and photographic documentation examined the parotid duct (PD), masseteric artery (MA), inferior alveolar nerve (IAN), and internal maxillary artery (IMA) relative to surgical landmarks. The perioral reach of the mobilized temporalis tendon was measured and photographically documented.

Results

Measurements revealed a consistent relationship between the PD and a reproducible reference line. The PD was located within the superior dissection field in all dissections. The IAN was consistently located over a centimeter from the TT insertion on the medial mandible and from the anterior ascending ramus. The MA consistently coursed within millimeters of the most inferior portion of the sigmoid notch within the substance of the masseter muscle. The IMA consistently coursed superiorly from posterior to anterior just medial to the mandible. All tendons (100%) reached beyond the melolabial crease to the perioral musculature for orthodromic resuspension.

Conclusion

Reproducible PD‐reference line measurements allow for pre‐incision PD localization. Consistent relationships between the tendon, PD, neurovascular structures, and bony landmarks underscore that deliberate soft tissue retraction and subperiostial elevation minimizes injury risk. The mobilized tendon appears to achieve adequate length for resuspension without temporal releasing incisions or perioral lengthening materials.
Thyroid Perichondrial Flaps for Sub‐Glottic Reconstruction
Authors: Prosser John D. , Bush Carrie , Postma Gregory N. , Weinberger Paul M.
Published: September 2011

Objective

Techniques available for reconstruction of the crico‐tracheal region in adults are currently suboptimal. We sought to 1) Understand the anatomic basis for the thyroid perichondrial flap, 2) Describe the technique of harvesting and intraluminal placement, and 3) Learn the limitations of defects for which it can be used.

Method

In fresh cadaveric specimens, the perichondrium of the outer layer of the thyroid cartilage was elevated by tracing the superior, medial and lateral borders of each thyroid cartilage ala. The inferiorly based flap was then placed into the airway through the cricothyroid membrane. The extent of coverage was measured.

Results

Current results are limited to female cadaveric measurements only. The extent of thyroid perichondrial flaps were 1.7 and 1.8 cm on the right and left respectively. The flaps were able to completely cover the cricoid cartilage and extended to but did not cover the first tracheal ring. Once placed intraluminally the flaps extended 2.5 and 2.6 cm below the true vocal cords on the right and left respectively. Using both flaps enabled coverage of the entire anterior 180 degrees of the airway lumen.

Conclusion

The thyroid perichondrial flap is technically feasible and can provide coverage of anterior airway defects up to approximately 2.5 cm below the true vocal cords. This flap could enable transfer of vascularized tissue to aid in crico‐tracheal reconstruction. Further work in male cadavers as well as animal studies are in progress.
Validation of the SVHI into Portuguese from Portugal
Authors: Capucho Maria Clara , Ruah Carlos , da Silva José Madeira , Escada Pedro Alberto
Published: September 2011

Objective

1) Evaluate the validity of the translated and culturally adapted version of the Singing Voice Handicap Index (SVHI) into Portuguese from Portugal. 2) Add another language to the list of the translated versions of this widely used voice questionnaire for singers.

Method

In a parallel group design, 50 singers with different laryngeal pathologies and 25 singers with no laryngeal pathology completed the Portuguese version of the SVHI. Internal consistency reliability, test‐retest reliability and construct validity were assessed as well as group differences.

Results

Statistical analyses demonstrated high internal consistency reliability (Cronbach Alpha r = 0.93), test‐retest reliability (Spearman correlation = 0.84, P <. 01,) and construct validity (Spearman correlation = 0.62, P <. 01) values. The control group received significantly lower scores than the pathological group (P <. 05).

Conclusion

The Portuguese version of the SVHI was shown to be a reliable and valid measure of voice handicap among Portuguese singers and can be added to the list of translated versions of this widely accepted and originally created American English voice evaluation instrument.
Ventricular Fold Phonation: Viscoelastic Properties and HSDI
Authors: Kimura Miwako , Imagawa Hiroshi , Tayama Niro , Chan Roger W. , Mau Ted
Published: September 2011

Objective

Determine the functional biomechanical properties of the human false vocal fold mucosa at phonatory frequencies, in comparison with those of the true vocal fold cover; and to quantify the vibration patterns of ventricular fold phonation with HSDI (high speed digital imaging).

Method

Viscoelastic shear properties of false fold specimens were quantified as functions of frequency, with measurements of elastic shear modulus (G′) and dynamic viscosity (h′) at up to 250 Hz using a simple‐shear rheometer. Ventricular fold phonation of three subjects was analyzed by HSDI (high speed digital imaging) through kymography and laryngotopography.

Results

All specimens showed similar frequency dependence of their viscoelastic properties, with G′ gradually increasing with frequency and h′ monotonically decreasing with frequency. G′ and h′ of the false fold mucosa were generally higher than those of the true vocal fold cover, although the differences did not reach statistical significance. Kymographic and laryngotopographic analysis of high speed digital images revealed vibration of the false fold mucosa for subjects undergoing ventricular fold phonation. The vibratory frequencies were lower than typical fundamental frequencies for phonation.

Conclusion

These findings showed false folds could function as a secondary sound source. These preliminary data suggested that the false fold mucosa could serve as replacement material for patients with unrepairable vocal fold cover damage.
3D CT Images of Congenital Anomalies
Authors: Durakovic Nedim , Lee Daniel J.
Published: September 2011

Objective

Retrospectively determine the value of 3D reconstructions in addition to traditional 2D axial and coronal plane CT studies of pediatric cochlear implant candidates.

Method

Pediatric cochlear implant candidates with preoperative CT scans were identified, and 3D reconstructions were created. Three readers were blinded to clinical data and interpreted the 2D axial and coronal scans. A separate set of interpretations was made with the addition of 3D reconstructions.

Results

Between 1995 and 2009, 36 pediatric patients undergoing cochlear implantation with preoperative CT imaging were identified. Structures analyzed included the Vestibular Aqueduct, Cochlear Nerve Canal, Cochlea, and Vestibule. Visualization of congenital malformations was scored on a 3‐point scale (1, visualized; 2, unsure; 3, not visualized). Wilcoxon signed rank test was used to compare the 2 interpretations. The addition of 3D reconstructions to 2D axial and coronal CT images is expected to improve visualization of malformations in cochlear implant candidates. This information is valuable for evaluation of cochlear implant candidates outside of the academic center setting and in resident training.

Conclusion

Three‐dimensional CT reconstructions are complimentary in identification of congenital malformations in cochlear implant candidates.
3D Imaging of the Membranous Labyrinth: Normal Anatomy and Pathological Conditions
Authors: Tanioka Hisaya , Kaga Kimitaka
Published: September 2011

Objective

The standard for studying temporal bone anatomy has been histopathological sectioning for microtome following chemical fixation and deossification of the temporal bone specimen. We can directly synthesize the membranous labyrinth from the conventional CT exam. We evaluated normal anatomy and pathological conditions of the membranous labyrinth.

Method

We studied 20 normal subjects, 20 hyperlipidemias, 20 DMs, 4 Ménière diseases, and 2 congenital malformations. To develop a 3D reconstructed image of the membranous labyrinth based on HR‐CT, the axial data were applied to create 3D images on the CT work station for postprocessing with factory presets.

Results

3D visualization of different structures of the membranous labyrinth allowed display of correct anatomy of high detail in all normal subjects. We could observe the cochlear duct, ductus reuniens, saccule, utricle, and ampullae. Otherwise, pathological conditions were revealed as irregular shape of the cochlear duct and/or small or large saccule or utericle. On unilateral Ménière disease, we could find the enlargement of the utricle. The radiation exposure was 0.15mSv.

Conclusion

Our method shows promise for observation of the membranous labyrinth. The pathological conditional images showed abnormal shape in comparison with normal conditions. We got a new diagnostic method for vertigo, disequilibrium, hearing loss, and tinnitus.
3D Volumetric Conformal Analysis of Vestibular Schwannomas
Authors: Walz Patrick , Robinett Zachary , Kirsch Claudia , Bush Matthew L. , Welling D Bradley
Published: September 2011

Objective

Compare 3D conformal volumetric analysis (3DCVA) versus traditional linear measurements on serial MRI imaging of vestibular schwannomas (VS) for determination and assessment of accurate tumor volume and growth rates.

Method

Retrospectively identified VS patients followed with serial 0.7‐3.0 Tesla MRI were included. Maximal linear dimensions were obtained from gadolinium‐contrasted T1 sequences from 3 serial MRI scans per RECIST guidelines. Volumetric analysis was performed with semiautomated 3DCVA. Annual tumor growth rate and percentage change were compared for linear and volumetric measurements.

Results

The average time span during which the serial MRI scans were obtained was 2.86 years in this initial retrospective analysis of 11 patients. The linear growth measurements averaged 0.5 mm/y, corresponding to a 6.4% average change per year. With 3DCVA the average tumor growth rate was 5mm3/y, corresponding to 3.7 mm/y growth in each dimension. There was an average increase in tumor volume of 29% per year with 3DCVA, compared with 6.4% with linear measurements. The difference in percentage change per year between methods was significant when compared with paired 2‐tailed t‐test (P =. 036).

Conclusion

VS assume complex configurations. In this initial retrospective study, linear measurements may underestimate true tumor growth compared to 3D conformal volumetric analysis. 3DCVA may provide a more robust tool in assessing tumor volume, growth rate, and volume change for a more accurate reflection of tumor progression compared to linear measurements.
A New Electroneurography Method in Facial Palsy
Authors: Haginomori Shin‐ichi , Kanazawa Atsuko , Mori Atsuko , Ichihara Takahiro , Kawata Ryo
Published: September 2011

Objective

We compared electroneurography (ENoG) performed in patients with facial palsy using the new midline method and standard method in terms of the relationship between the ENoG value and clinical course. We also established a new criterion with the midline method for predicting prognosis in facial palsy using the ENoG value.

Method

ENoG was performed using the midline method, in which the recording electrodes were placed on the midline of the face, and the standard method, which has been used universally. The relationship between the ENoG values and the period to full recovery from the facial palsy was compared.

Results

Sixty‐four patients with facial palsy were enrolled. The midline method had a stronger negative correlation in the relationship between the ENoG value and period to full recovery from palsy than the standard method. We also proposed a new ENoG value‐based criterion for prognostic diagnosis using the midline method: 1) ENoG value of > 60% predicts complete recovery from the palsy within 2 months; 2) ENoG value of > 10% and < 60% predicts recovery from the palsy within 6 months; and 3) ENoG value of <10% forecasts 50% of patients cannot reach complete recovery.

Conclusion

The novel midline ENoG method we proposed here has advantages over the standard method in terms of ease of electrode setting, and the ENoG value may be a useful prognostic factor.
A New Landmark for the Middle Fossa Craniotomy Approach to the IAC
Authors: Westbrook Benjamin James , Crawford James V.
Published: September 2011

Objective

Document measurements of the bony operculum of the petrous ridge as it relates to surgical anatomy of the temporal bone and thereby establish a new surgical landmark for the middle fossa craniotomy approach to the internal auditory canal.

Method

We analyzed 25 cadaveric temporal bones. Precise measurements were taken to identify the relationship of the bony operculum of the petrous ridge to: foramen spinosum, foramen of the greater superficial petrosal nerve, arcuate eminence, porus acousticus, and inner table of the calvarium.

Results

The following measurements of the operculum in relation to well established surgical landmarks of the floor of the middle cranial fossa were identified: operculum to foramen spinosum, 26.3mm [24.6‐28.0]; operculum to foramen of greater superficial petrosal nerve, 16.8mm [14.0‐19.7]; operculum to arcuate eminence, 17.3mm [15.1‐19.4]; operculum to superior border of porus acousticus, 5.3mm [3.5‐7.1]; distance from inner table of calvarium to operculum, 37.0mm [33.5‐40.5]; width of the operculum, 13.5mm [11.3‐15.7].

Conclusion

This consistently present bony ridge can be used reliably to help safely identify the IAC when approached via middle fossa craniotomy, as it indicates the appropriate vertical plane of dissection.
An Avatar to Measure Vestibular Sensations of Movement
Authors: Cevette Michael , Galea Anna M. , Smith Benn , Wagner Linsey , Oakley Sarah , Stepanek Jan , Zapada David
Published: September 2011

Objective

1) Report a novel method for measuring vestibular sensations of movement induced by galvanic vestibular stimulation (GVS). 2) Introduce a new approach to quantify vestibular symptoms in patients with vertigo and related disorders.

Method

We created a software program using a Logitech wireless joystick to measure and display in three dimensions the manner in which subjects felt movement in response to GVS. Each subject underwent thirty 20‐second protocols utilizing ten different combinations of GVS scalp electrode pairs.

Results

Three dimensional avatar displays of subject responses to GVS indicated the direction and magnitude of pitch, roll, and yaw as well as the angular velocity of motion. As evident on the avatar display in response to a 2.5 mA GVS pulse, the majority of subjects reported sensation of movement, 19 out of 21 (90%) reporting pitch, 17 out of 21 (81%) reporting yaw, and 17 out of 21 (81%) reporting roll sensations.

Conclusion

1) These data demonstrate a software‐based 3 dimensional avatar display system to represent perceived vestibular sensation in response to GVS. 2) This technology may play a role in clinical practice by providing the ability to quantify vestibular symptoms in the assessment of patients with vertigo and related disorders.
An Exercise Therapy for the Cupulolithiasis of BPPV
Authors: Yamanaka Toshiaki , Hosoi Hiroshi , Fujita Nobuya , Sawai Yachiyo
Published: September 2011

Objective

Determine if an exercise therapy was effective for cases with benign paroxysmal positional vertigo (BPPV) suggesting cupulolithiasis of the horizontal semicircular canal as characterized by apogeotropic direction‐changing nystagmus.

Method

We describe herein our head tilt‐hopping (HtH) exercise designed to release and move otoconia adhesive to the cupula. HtH exercises were performed in 14 subjects who were trained to hop with their heads tilted laterally and completed 3 to 5 training sessions a day over a 4‐week period.

Results

The nystagmus beating toward the uppermost ear disappeared or decreased immediately after the first trial with the exercise in 3 (21.4%) or 2 (14.3%) of 14 cases, respectively. The number of subjects showing improvement as assessed by the disappearance or decrease of the nystagmus were in 9 (64.3%) and 11 (78.6%) of all cases tested at 1 and 4 weeks’ time, respectively. However, the remaining 3 subjects were not affected by this treatment program after 4 week of the training.

Conclusion

These results suggest that HtH exercises based on the concepts of release of otoconia from the cupula would appear to be feasible as a new therapy for cupulolithiasis associated with intractable horizontal canal BPPV.
Association between Type 2 Diabetes Mellitus and Deposits in the Semicircular Canals: a Human Temporal Bone Study
Authors: Yoda Shigetoshi , Fukushima Hisaki , Paparella Michael , Morita Norimasa , Cureoglu Sebahattin , Harada Tamotsu
Published: September 2011

Objective

Compare the prevalence of cupular and free‐floating deposits in the semicircular canals between temporal bones of type 2 diabetes mellitus patients and normal controls.

Method

Forty‐eight temporal bones from 24 patients with type 2 diabetes mellitus and 48 age‐matched normal temporal bones from 24 individuals were histopathologically examined. The cupula and lumina of the semicircular canals were examined for evidence of deposits.

Results

The prevalence of cupular and free‐floating deposits in the posterior semicircular canal were significantly higher in type 2 diabetes mellitus cases compared with normal temporal bones. The prevalence of cupular deposits in all 3 canals combined had a tendency to be higher in patients treated with insulin therapy than in patients treated via oral hypoglycemic agents. The prevalence of these deposits was not associated with either aging or duration of disease.

Conclusion

Our findings suggest that type 2 diabetes mellitus can cause cupular and free‐floating deposits in the semicircular canals. Patients with type 2 diabetes mellitus may suffer from benign paroxysmal positional vertigo, unrelated to duration of disease.
Audio‐Vestibular Function in HIV Infected Patients in India
Authors: Mathews Suma Susan , Albert Rita R. , Job Anand
Published: September 2011

Objective

The impact of HIV/AIDS is felt more in developing countries because of socioeconomic reasons. There is risk of audio vestibular dysfunction with the use of anti‐retroviral therapy, which may be ototoxic. This study was to determine the difference between audio‐vestibular function in asymptomatic HIV infected and AIDS patients.

Method

In this prospective cross sectional study conducted in a tertiary care hospital in South India, the audio‐vestibular system of 30 AIDS subjects (group 1) and 30 asymptomatic HIV positive subjects (group 2) and age‐matched 30 healthy controls (group 3) were assessed using pure tone audiometry and cold caloric test.

Results

Sixteen patients each, in group 1 and group 2, were detected to have hearing loss. In the control group, 4 were detected to have hearing loss. Comparing patient groups 1 and 2 with that of group 3, the p‐value was significant (P =. 001). Kobrak’s (modified) test showed 27% of patients in group 1 and 33% of patients in group 2 had a hypofunctioning labyrinth.

Conclusion

It was found that the human immunodeficiency virus does affect the audio‐vestibular pathway. There was a significant incidence of audio‐vestibular dysfunction in both study groups compared to the controls. There was no significant difference between the HIV seropositive asymptomatic patients and patients with AIDS. The majority of the patients had no otological symptoms.
Auditory Tube Dysfunction after Plastic Surgery of Mandible
Authors: Aoki Hideaki , Mohri Daisuke , Musunuru Swapna
Published: September 2011

Objective

Some patients with jaw anamorphosis symptom who underwent orthognathic surgery for lower jaw. By conducting auditory tube function tests before and after orthognathic surgery for the lower jaw, studied were the pathophysiology, incidence, causes and treatment of auditory tube dysfunction occurring following orthognathic surgery for lower jaw.

Method

Regarding auditory tube function tests, the impedance test, or tympanometry, was sonotubometry, and TTAG were conducted. Patients whose auditory tubes conducted dysfunction was found to be aggravated were observed with daily TM testing until the function recovered to the preoperative level.

Results

1) Postoperative auditory tube dysfunction was noted subjectively in 18.3% and determined by TM in 60.4%. Lowered auditory tube function was found by TM at a high rate following orthognathic surgery for the lower jaw. Approximately 30% of patients with TM aggravation complained of ear symptoms. Among subjective ear symptoms, the most prevalent was a feeling of ear obstruction, and the second most prevalent was dysacusis. 2) It was suggested that TTAG could be a useful test for prediction of postoperative TM aggravation.

Conclusion

Postoperative auditory tube dysfunction correlated with preoperative TTAG values, indicating that TTAG was a useful test for the prediction of TM aggravation. There was no correlation between postoperative auditory tube dysfunction and sonotubometry values. Postoperative auditory tube dysfunction recovered spontaneously in an average of 3.48 days without provision of ventilation treatment.
Cognitive Function in Nonbothersome Tinnitus
Authors: Wineland Andre , Pierce Kathy , Piccirillo Jay F.
Published: September 2011

Objective

Tinnitus is a ubiquitous problem with no effective cure, yet only a minority of sufferers are “bothered.” Neurocognitive testing of these “bothered” patients reveals poor performance in verbal learning and attention. The goal of the present investigation was to assess the effects of non‐bothersome tinnitus on standardized neurocognitive tests.

Method

Cross‐sectional study of 13 nonbothersome tinnitus participants (age 18‐60 years) with subjective, unilateral or bilateral, non pulsatile tinnitus for at least 6 months’ duration, and a score 38). Each participant underwent comprehensive neurocognitive assessment.

Results

Thirteen participants (9 male) with a mean age of 55 years (range, 47‐60 years) were enrolled. Median THI was 9 (range, 0‐20), median tinnitus duration was 11 years (range, 2‐35 years), and all had hearing loss. A comprehensive neurocognitive battery was performed. Participants were found to score higher than a vetted normative sample on the Stroop Color Test (P =.002) and Conners Continuous Performance Test (CCPT) Perseverations (P =.032). However, this group performed worse on Stroop Word (P =. 03) and Color‐Word (p =. 036) as well as CCPT‐Hit Reaction Time (P =. 01), and Hit Standard Error Block Change (P =. 041).

Conclusion

In this small sample of non‐bothersome tinnitus patients, neurocognitive testing revealed deficits in attention and processing speed, an increase in inattentiveness, and decline in performance over time.