bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Resolution Manometry of Pharyngeal Swallow Pressure Events Associated with Head Turn and Chin Tuck
Authors: Mcculloch Timothy M. , Hoffman Matthew R. , Ciucci Michelle R.
Published: May 2017

Objectives

We quantified the effect of swallowing maneuvers on pharyngeal pressure events using high-resolution manometry.

Methods

Seven subjects swallowed multiple 5-mL water boluses in 3 different postural conditions: neutral, head turn, and chin tuck. Pressure and timing events were recorded with a 36-sensor high-resolution manometry catheter. We analyzed the regions of the velopharynx and the base of the tongue for maximum pressure, rate of pressure increase, pressure gradient, and duration of pressure above baseline. In the region of the upper esophageal sphincter (UES), we analyzed the duration of pressure declination, minimum pressure during UES opening, and maximum pressures before and after UES opening.

Results

The maneuvers did not have a significant effect on maximum pressure, rate of pressure increase, or pressure gradients in the velopharyngeal or tongue base regions. The duration of pressure above baseline was significantly longer in the velopharynx for head turn. The preswallow maximum UES pressure was significantly greater for neutral swallows than for head turn, and the postswallow maximum pressure was significantly lower for chin tuck. Both maneuvers appeared to prolong UES pressure declination duration, but neither prolongation reached significance.

Conclusions

High-resolution manometry allows for optimal spatial and temporal resolution during recording of pressure events along the length of the pharynx, and revealed previously undetected task-dependent pressure and timing differences during chin tuck and head turn in healthy adults. These maneuvers appear to influence the UES to a greater degree than the velopharynx or the tongue base. Further studies designed to quantify the effect of other maneuvers and bolus consistencies on the generation of pharyngeal pressure events both in normal and in disordered subjects may lead to hypothesis-driven, optimal, individualized swallowing therapies.
Fatal Case of Tumor-Associated Hemorrhage in a Large Vestibular Schwannoma
Authors: Yates Charles W. , Weinberg Mitchell , Packer Mark J. , Jacob Abraham
Published: May 2017

Vestibular schwannomas are benign neoplasms that arise from Schwann cells of the eighth cranial nerve. Most manifest clinically with tinnitus, unilateral sensorineural hearing loss, and disequilibrium secondary to compression of the vestibulocochlear nerve; major adverse events such as intratumoral hemorrhage causing acute neurologic deterioration are rare. We report the case of a 69-year-old man with a large vestibular schwannoma who required anticoagulation for several medical comorbidities. The patient began having progressively worsening neurologic symptoms, including facial nerve paralysis and dysequilibrium, which confined him to a wheelchair. After presentation, the patient was admitted to the hospital. Several days after alteration of his anticoagulation therapy in preparation for surgery, he developed intracranial hemorrhage. Attempts were made to stabilize the patient, including posterior fossa craniectomy and evacuation of hematoma; however, the intracranial hemorrhage ultimately resulted in a fatal outcome. During this procedure, a biopsy specimen was obtained, showing benign vestibular schwannoma. The literature for intratumoral hemorrhage into vestibular schwannoma and the pathologic findings in our case are reviewed.
Effect of Nitric Oxide Synthase Inhibitor on Increase in Nasal Mucosal Blood Flow Induced by Sensory and Parasympathetic Nerve Stimulation in Rats
Authors: Ogawa Fumio , Hanamitsu Masakazu , Ayajiki Kazuhide , Aimi Yoshinari , Okamura Tomio , Shimizu Takeshi
Published: May 2017

Objectives

Neural control of nasal blood flow (NBF) has not been systematically investigated. The aim of the present study was to evaluate the effect of electrical stimulation of both sensory and parasympathetic nerves innervating the nasal mucosal arteries on NBF in rats.

Methods

In anesthetized rats, nasociliary (sensory) nerves and postganglionic (parasympathetic) nerves derived from the right sphenopalatine ganglion were electrically stimulated. We measured NBF with a laser-Doppler flowmeter.

Results

The nerve stimulation increased NBF on both sides and increased the mean arterial blood pressure. The increase in NBF was larger on the ipsilateral side than on the contralateral side. Hexamethonium bromide, a ganglion blocker, abolished the stimulation-induced pressure effect and the increase in NBF on the contralateral side, but did not abolish the increase in NBF on the ipsilateral side. The remaining increase in NBF was abolished by NG-nitro-L-arginine, a nitric oxide synthase inhibitor. Histochemical analysis with nicotinamide adenine dinucleotide phosphate-diaphorase showed neuronal nitric oxide synthase-containing nerves that innervate nasal mucosal arteries.

Conclusions

Nitric oxide released from parasympathetic nitrergic nerves may contribute to an increase in NBF in rats. The afferent impulses induced by sensory nerve stimulation may lead to an increase in mean arterial blood pressure that is partly responsible for the increase in NBF.
Hypopharyngeal Extrusion of 2.5 Feet (76 cm) of Polytetrafluoroethylene (Gore-Tex): Initial Laser-Assisted Office-Based Removal and Micropharyngeal Completion
Authors: Feinberg Steven , Lopez-Guerra Gerardo , Zeitels Steven M.
Published: May 2017

Extrusion of an implant after medialization laryngoplasty is unusual and warrants removal. Most commonly, it extrudes through the laryngeal introitus, but rarely, it extrudes through the pyriform sinus. A case report in which 2.5 feet (76 cm) of polytetrafluoroethylene (Gore-Tex) was removed from an 80-year-old female patient is presented to evaluate factors that led to this surgical complication and strategies that solved the problem. Because of the patient's multiple medical problems, initial removal of the foreign body was attempted in the office with topical anesthesia. When the Gore-Tex was noted to be lodged in the laryngeal parenchyma, it was severed at the edge of the pyriform sinus to stabilize the airway. Subsequently, microlaryngoscopic-controlled completion removal was done in the operating room with general anesthesia. The patient healed uneventfully with no further sequelae. Analysis of this case illustrates a number of factors leading to a rare iatrogenic foreign body complication. Office-based removal of the Gore-Tex implant evolved into a unique scenario in which the rapid use of a fiber-based laser to divide the foreign body facilitated stabilizing the airway to allow for elective completion removal in a controlled fashion.
Methicillin-Resistant Staphylococcus aureus Laryngitis
Authors: Liakos Tracey , Kaye Keith , Rubin Adam D.
Published: May 2017

Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have become more prevalent, in part because of the emergence and spread of community-acquired MRSA. This trend is particularly concerning because of the significant rates of morbidity and mortality associated with MRSA infections, and because MRSA strains are often resistant to many classes of antibiotics. Reports of infections of the head and neck, including wound infections, cellulitis, sinusitis, otitis media, and otitis externa, are well documented. However, to our knowledge, there have been no reports of bacterial laryngitis due to MRSA. We report the first published case of bacterial laryngitis caused by MRSA.
Neck Surface Electromyography as a Measure of Vocal Hyperfunction before and after Injection Laryngoplasty
Authors: Stepp Cara E. , Heaton James T. , Jetté Marie E. , Burns James A. , Hillman Robert E.
Published: May 2017

Objectives

The goal of this preliminary study was to determine whether neck surface electromyography (sEMG) is sensitive to possible changes in vocal hyperfunction associated with injection laryngoplasty, particularly with respect to alterations in the degree of vocal hyperfunction.

Methods

Thirteen individuals undergoing office-based injection laryngoplasty for glottal phonatory insufficiency were prospectively studied with a battery of acoustic, aerodynamic, endoscopic, and anterior neck sEMG assessments before the procedure and approximately 1 week afterward.

Results

Anterior neck sEMG values were not significantly reduced (p < 0.05) after the procedure; however, perceptual ratings of strain and false vocal fold compression were both significantly reduced, reflecting a decrease in vocal hyperfunction.

Conclusions

The results do not support the use of anterior neck sEMG measures to assess vocal hyperfunction, and place into question the use of some other measures (estimates of anterior-posterior supraglottic compression, quantitative measures of anterior-posterior and false vocal fold supraglottic compression, and acoustic vowel rise times) that have been considered reflective of vocal hyperfunction.
Elastic Fibers in Reinke's Edema
Authors: Sakae Flavio Akira , Imamura Rui , Sennes Luiz Ubirajara , Tsuji Domingos Hiroshi , Mauad Thais , Nascimento Saldiva Paulo Hilário
Published: May 2017

Objectives

We describe the distribution of elastic system fibers in the superficial layer of the lamina propria of Reinke's edema, as compared with normal vocal folds.

Methods

Weigert's resorcin-fuchsin stain after oxidation with 10% oxone was used to study the arrangement of elastic fibers. The findings were categorized and afterward compared with the severity of Reinke's edema.

Results

Analysis of 20 specimens of vocal folds with Reinke's edema showed that the network of thin elastic fibers in Reinke's space lost their undulated appearance and had a tangled aspect. In addition, these fibers were no longer parallel to the epithelial basement membrane, but had a random distribution scattered throughout Reinke's space. The elastic fiber network immediately below the epithelial basement membrane also appeared more fragmented in Reinke's edema because of some alteration in organization combined with the 5-μm-thick histologic sectioning plane. No significant difference in the degree of elastic system fiber disarrangement was observed between severity grades II and III (p = 0.382). Large areas of disarrangement were predominant (80% of cases).

Conclusions

The disarrangement of elastic fibers in Reinke's edema may cause insufficient tissue resistance and resilience, contributing to the hypermobility observed in Reinke's edema.
Prevalence of Acoustic Neuroma Associated with Each Configuration of Pure Tone Audiogram in Patients with Asymmetric Sensorineural Hearing Loss
Authors: Suzuki Masaaki , Hashimoto Sho , Kano Shigeyuki , Okitsu Takuji
Published: May 2017

Objectives

The criteria have not yet been established for identifying the configuration of a pure tone audiogram constituting abnormal results that warrant further investigation. The purpose of this study was to determine the prevalence of acoustic neuroma associated with each configuration of the pure tone audiogram in patients with asymmetric sensorineural hearing loss (SNHL).

Methods

We performed a retrospective chart review of 500 patients 15 years of age or older who had asymmetric SNHL and had undergone magnetic resonance imaging.

Results

The prevalence of acoustic neuroma in these patients was 2.6% (13 of 500). The prevalence of acoustic neuroma in each audiometric configuration was as follows: 7.1% (3 of 42) for a basin-shaped loss (odds ratio [OR] versus overall prevalence, 2.88; p =0.23; 95% confidence interval [CI], 0.79 to 10.54),4.7% (5 of 107) for a flat loss, 3.4% (2 of 58) for total deafness, 2.9% (l of 34) for a high-frequency sloping audiogram, and 2.5% (2 of 81) for a high-frequency steep audiogram. The prevalence in patients with nonimproving idiopathic sudden deafness was 8.1% (OR, 3.29; p = 0.06; 95% CI, 1.13 to 9.55).

Conclusions

In conclusion, 2.9% to 8.1% of patients with a characteristic configuration of the pure tone audiogram and symptoms of nonimproving or progressive idiopathic sudden deafness may have acoustic neuroma.
Balloon Dilation for Recurrent Stenosis after Pediatric Laryngotracheoplasty
Authors: Bent John P. , Shah Maulik B. , Nord Ryan , Parikh Sanjay R.
Published: May 2017

Objectives

We assessed the safety and efficacy of balloon dilation as treatment for recurrent stenosis after pediatric laryngotracheoplasty.

Methods

We studied a retrospective case series at an academic tertiary care children's hospital. We included all patients under the age of 18 years with subglottic or tracheal stenosis treated at our institution with balloon dilation between June 2007 and April 2009. The records were analyzed for patient demographics, presenting symptoms, surgical technique, and airway description. The outcome measures were airway diameter, postoperative symptoms, tracheotomy status, and complications.

Results

Ten patients (9 with subglottic stenosis and 1 with tracheal stenosis) underwent 20 balloon dilation procedures without complication. The average age at the time of the procedure was 17 months (range, 3 months to 9 years). The patient presenting symptoms were stridor in 7 cases and tracheotomy in 3 cases. Vascular balloons (diameter range, 6 to 12 mm; length, 20 mm) were inflated to 10 to 12 cm H2O pressure for an average of 40 seconds (range, 10 to 120 seconds). Each procedure consisted of 1 to 3 dilation cycles. The immediate postdilation airway area increased by an average factor of 4.9 (range, 1.9 to 9). Six patients had repeat procedures with an average interval between dilations of 67 days (range, 6 to 337 days). Stridor was eliminated or greatly improved in all patients on the first postoperative day; 7 patients sustained this benefit, with an average follow-up time of 10 months (range, 4 to 23 months). Six of the 10 patients had undergone previous laryngeal reconstruction (age range, 3 months to 4 years). Of these 6, 3 have no tracheotomy, with a mean follow-up of 12.5 months. The 3 children who benefited the least from dilation were noted to have more diffuse and chronic inflammation of the larynx in comparison to the responders.

Conclusions

This case series suggests that balloon dilation is a relatively safe and effective procedure. It may be particularly well suited to recent stenosis after laryngotracheal reconstruction.
Dislocation of Stapes with Footplate Fracture Caused by Indirect Trauma
Authors: Kagoya Ryoji , Ito Ken , Kashio Akinori , Karino Shotaro , Yamasoba Tatsuya
Published: May 2017

We report the first case of isolated stapedial dislocation caused by indirect head trauma, and present imaging and surgical findings in the case of a 25-year-old woman who suffered hearing loss and dizziness after head trauma caused by a traffic accident. The pure tone average was 60 dB, with an air-bone gap of 50 dB. The stapedial reflex was positive with the probe on the affected ear. Computed tomography scans revealed a longitudinal fracture of the temporal bone and a dislocated stapedial superstructure in the tympanic cavity, adhering to the tympanic membrane. During surgery, it was found that the stapes was broken at the base of the posterior crus and at the anterior one third of the footplate and that the stapedial superstructure was dislocated outward and downward, with the anterior one third of the footplate adhering to the tympanic membrane. The stapedial tendon was connected to the superstructure. Ossicular chain reconstruction was performed with success. In the present case, two mechanisms may have acted together: 1) an increase in perilymphatic pressure that caused the footplate to fracture, and 2) a distorting force that broke the posterior crus, disconnecting the incudostapedial joint, and finally dislocating the stapedial superstructure together with the anterior part of the footplate.
Value of Barium Swallow Studies in Predicting the Response to Rabeprazole in Elderly Patients with Laryngopharyngeal Reflux Disease and Nonerosive Reflux Disease in Particular
Authors: Kimura Yurika , Sugiura Mutsumi , Kato Tomofumi , Makino Nao , Ohmae Yukio , Kishimoto Seiji
Published: May 2017

Objectives

Laryngopharyngeal reflux disease (LPRD) is an important cause of throat discomfort in the elderly. Our objective was to investigate the usefulness of barium swallow studies for the diagnosis of LPRD.

Methods

The subjects were 59 patients at least 60 years of age with LPRD suspected on laryngoscopy findings. We evaluated esophageal clearance using a barium swallow study and the upper gastrointestinal tract endoscopic findings of gastroesophageal reflux disease according to the revised Los Angeles classification, and correlated these findings with the effect of rabeprazole, a proton pump inhibitor.

Results

Among subjects with positive reflux findings in the esophageal phase of the barium swallow, rabeprazole was significantly effective (p = 0.0025). To identify nonerosive reflux disease, we analyzed the 50 cases with a negative Los Angeles classification of upper gastrointestinal tract endoscopic findings. Rabeprazole was again significantly effective in patients with positive findings for esophageal reflux (p = 0.0025).

Conclusions

Among elderly patients with suspected LPRD, there was a positive correlation between impaired esophageal clearance on the barium swallow study and the effectiveness of rabeprazole. The barium swallow study could be a screening test for LPRD in elderly patients with throat discomfort.
Sphenoid Sinus Pneumatization and Its Relation to Bulging of Surrounding Neurovascular Structures
Authors: Cho Jae Hoon , Kim Jin Kook , Lee Jeung-Gweon , Yoon Joo-Heon
Published: May 2017

Objectives

We investigated the bulging and dehiscence of neurovascular structures in the sphenoid sinus and their relationships to the pneumatization of the sphenoid sinus.

Methods

One hundred sagittally hemisected cadaveric heads were examined. The degree of pneumatization of the sphenoid sinus was determined. Bulging and dehiscence of the internal carotid artery (ICA), optic nerve, maxillary nerve, and vidian nerve were examined, and the distances between these structures and the anterior or superior wall of the sphenoid sinus were measured. Additionally, the degree of bony thickness over these structures was determined.

Results

The prevalences of bulging of the optic nerve, segments 1 and 3 of the ICA, and the maxillary and vidian nerves were 56%, 34%, 65%, 41%, and 52%, respectively. The greater the degree of pneumatization, the more frequently did the structures bulge into the sphenoid sinus. The optic nerve was found to be in close proximity to the anterior and superior walls of the sphenoid sinus. The bone over the surrounding structures was very thin, especially for the complete sellar type.

Conclusions

The prevalence of bulging of the optic nerve, the ICA, and the maxillary and vidian nerves increased in proportion to the degree of sphenoid sinus pneumatization.
Bilateral Peritonsillar Abscesses: Our Experience and Clinical Features
Authors: Watanabe Tetsuo , Suzuki Masashi
Published: May 2017

Objectives

This study analyzed the incidence and characteristics of bilateral peritonsillar abscesses (PTAs) that were treated with immediate tonsillectomy.

Methods

The study analyzed 409 patients with PTAs treated between 1984 and 2008. The patients included 304 male and 105 female patients between 2 and 85 years of age (median age, 30 years). Immediate tonsillectomy was performed in 371 of the PTA patients (90.7%). The incidence of bilateral PTAs and candidate predictive factors for bilateral PTAs were reviewed, including age, duration of PTA symptoms, history of recurrent tonsillitis, history of PTAs, deviation of the uvula, body temperature on admission, white blood cell count on admission, and C-reactive protein level on admission.

Results

Bilateral PTAs were found in 24 of 371 patients (6.5%). Younger age, absence of a deviated uvula, and a higher C-reactive protein value were the clinical features associated with bilateral PTAs in multivariate analysis.

Conclusions

The occurrence of bilateral PTAs was not rare; this fact has to be taken into consideration in discussing therapeutic concepts. The clinical features of bilateral PTAs suggested that bilateral PTAs might be a part of the natural history of PTAs, and that they occur in cases in which there is a delay in diagnosis and treatment. Further study is necessary to confirm the causation of bilateral PTAs.
Atypical and Disparate Presentations of Laryngeal Sarcoidosis
Authors: Mayerhoff Ross M. , Pitman Michael J.
Published: May 2017

Sarcoidosis is a multisystem chronic granulomatous disease of unknown cause that typically affects patients between 20 and 40 years of age. Laryngeal involvement most frequently involves the supraglottis and presents with dyspnea. We present a retrospective review of 4 patients with previously undiagnosed sarcoidosis who presented with atypical signs and symptoms of sarcoidosis: dysphonia with isolated vocal fold involvement; cough and globus pharyngeus; pediatric sarcoidosis; and severe bilateral vocal fold paresis and dysphagia. Our aim is to highlight disparate presentations of laryngeal sarcoidosis, as well as the treatment options. Laryngeal sarcoidosis may present with atypical signs and symptoms and occasionally presents in pediatric patients. A high degree of suspicion is necessary for a correct diagnosis in these patients. Early diagnosis and proper management of laryngeal sarcoidosis is important, as the symptoms are debilitating and possibly life-threatening. Treatment may consist of local and systemic chemotherapy, and adjunctive procedures.
Childhood Hearing and its Relationship with Tinnitus at Thirty-Two Years of Age
Authors: Dawes Patrick J. D. , Welch David
Published: May 2017

Objectives

Tinnitus is associated with hearing loss in adulthood, often resulting from noise or age, but it is not known whether children's hearing and/or middle ear health predispose them to tinnitus in adulthood.

Methods

The participants were members of the Dunedin Multidisciplinary Health and Development Study, born in Dunedin, New Zealand, between April 1972 and March 1973. The base sample consisted of 1,037 children. Otitis media was assessed at 5, 7, and 9 years of age; audiometry and tympanometry findings were recorded at 11 years of age, and a detailed description of the tympanic membrane was made at 15 years of age. At 32 years of age, 970 of the 1,015 living study members (96%) answered questions about tinnitus.

Results

Children who had otitis media and a raised audiometric threshold went on to experience more tinnitus in adulthood than did those without middle ear disease or those who had otitis media without a raised threshold. In those who had recovered from otitis media, audiometric threshold elevation at lower and higher frequencies was associated with experiencing tinnitus in adulthood. Neither childhood otitis media alone nor elevated thresholds alone predicted adult tinnitus.

Conclusions

Childhood otitis media with an associated hearing loss in the low and high frequencies was associated with a greater probability of experiencing tinnitus in adulthood.
Ki-67 Proliferation Rate as a Prognostic Marker in Major Salivary Gland Carcinomas
Authors: Vacchi-Suzzi Martino , Bocciolini Corso , Bertarelli Claudia , Dall'olio Danilo
Published: May 2017

Objectives

The study was performed to evaluate the prognostic relevance of cell proliferation associated with Ki-67/Mib-1 immunostaining in malignant tumors of the major salivary glands.

Methods

Cell proliferation was evaluated by Mib-1 antibody against Ki-67 antigen in 41 patients with cancer of the parotid or submandibular glands, including 14 acinic cell carcinomas, 12 ductal carcinomas, 7 mucoepidermoid carcinomas, 5 carcinomas ex pleomorphic adenoma, 1 adenoid cystic carcinoma, 1 undifferentiated carcinoma, and 1 polymorphous low-grade adenocarcinoma.

Results

Patients with Ki-67 values of more than 15% and those with Ki-67 values of 15% or less differed both in disease-free survival (p < 0.001) and in overall survival (p < 0.001). We evaluated the association between Ki-67 and time to recurrence in correlation to age, sex, ductal histotype, and N stage; the Cox regression model was significant (p = 0.013). In the group of patients with T1 and T2 cancers, those with Ki-67 values of 15% or less had better survival rates than did those with Ki-67 values of more than 15% (p = 0.004). In the group of patients with NO cancers, those with Ki-67 values of 15% or less had a better survival than did those with Ki-67 values of more than 15% (p < 0.001).

Conclusions

To our knowledge, this is the first study to stratify different risk classes in early T1–T2 or NO malignant tumors of the major salivary glands that identified aggressive lesions with elevated Ki-67 expression at an initial stage.
Histologic Study of Perifascial Areolar Tissue Implanted in Rabbit Vocal Folds: An Experimental Study
Authors: Hachiya Adriana , Imamura Rui , Parra Edwin Roger , Sennes Luiz Ubirajara , Tsuji Domingos Hiroshi
Published: May 2017

Objectives

Perifascial areolar tissue (PAT) consists of loose areolar tissue with viscoelastic properties that are similar to those found in tissues in the superficial layer of the vocal fold. The aim of this study was to quantify the inflammatory process and the collagen content of the graft, as well as that of the host tissue, after placement of a strip of PAT into the rabbit vocal fold.

Methods

Surgeries were performed on 30 rabbits. The grafts were implanted in pockets that were surgically created in the right vocal fold. The left vocal fold (control group) was subjected only to surgical manipulation. The animals were divided into 3 groups for evaluations at 15 days, 3 months, and 6 months, and their larynx tissues were subsequently reviewed by histology.

Results

The grafts were characterized by disorganized and thick collagen bundles and were identified in all study groups. The collagen density stayed constant over time. There was an acute inflammatory response induced by the graft at 15 days that did not exist in the specimens taken at 3 and 6 months. Deposition of collagen fibers in the lamina propria was observed starting at 15 days after the operation and was more intense in the experimental vocal fold than in the control vocal fold.

Conclusions

Our findings indicated that PAT has a low tendency for promoting an inflammatory response. However, there was a loss of the original architecture of the graft tissue and a greater deposition of collagen in the implanted vocal folds than in the control group.
Endoscopic Treatment of Adversely Located Osteomas of the Frontal Sinus
Authors: Sieśkiewicz Andrzej , Lyson Tomasz , Piszczatowski Bartosz , Rogowski Marek
Published: May 2017

Objectives

We assess the utility and limitations of an endoscopic technique in the treatment of osteomas that are considered difficult to manage endoscopically, ie, those located superiorly or laterally in the frontal sinus, extending beyond a virtual plane through the lamina papyracea, and we describe the principles of a surgical technique that facilitates removal of such tumors.

Methods

We performed a retrospective study on 8 patients with symptomatic frontal sinus osteomas, including tumors extending past the commonly recognized limits of endoscopic resection because of their size or site of attachment.

Results

All tumors were removed by a purely transnasal endoscopic approach. No major complications were observed during or after the operation. All patients experienced improvement or total regression of their symptoms.

Conclusions

With appropriate instruments and specific endoscopic techniques, it is possible to resect osteomas that not long ago were deemed inaccessible to endoscopic surgeons. The commonly recognized limits of endoscopic treatment of such tumors may be exceeded in some cases; however, favorable anatomic conditions are decisive for a successful operation.
The Ram Sign: Detecting Previously Undiagnosed Congenital Laryngeal Clefts in Adults
Authors: Weissbrod Philip A. , Inglis Andrew , Merati Albert L.
Published: May 2017

Objectives

We present the clinical characteristics of a case series of adult patients with type III laryngeal clefts according to the classification of Benjamin and Inglis, in an attempt to make practitioners aware of the “ram sign,” a clinical finding associated with laryngeal clefts in adults. Laryngeal clefts are uncommon defects that are nearly universally identified during infancy as a result of persistent aspiration and pneumonia. Undiagnosed laryngeal clefts in adults are extremely rare.

Methods

Three type III laryngeal clefts were identified in adults (29, 48, and 60 years of age) from one clinic over an 18-month period. The existing literature features only one type III cleft, to our knowledge. The 60-year-old patient represents the oldest person in the English-language literature to have a newly diagnosed laryngeal cleft. All three cases presented with various degrees of aspiration over an extended period.

Results

The computed tomographic imaging and endoscopic findings from these three patients were reviewed. The videolaryngoscopic images demonstrated that the “ram sign” — an endoscopic finding associated with redundant soft tissue overlying the arytenoid cartilages that prolapses into the cleft, creating the appearance of ram's horns — was a consistent and striking feature in all three patients.

Conclusions

Although rare, laryngeal clefts may represent an underdiagnosed entity in the adult population. With increased awareness, they may be identified more frequently as a treatable cause of aspiration and recurrent pneumonia.
Spectral- and Cepstral-Based Acoustic Features of Dysphonic, Strained Voice Quality
Authors: Lowell Soren Y. , Kelley Richard T. , Awan Shaheen N. , Colton Raymond H. , Chan Natalie H.
Published: May 2017

Objectives

We sought to determine whether spectral- and cepstral-based acoustic measures were effective in distinguishing dysphonic-strained voice quality from normal voice quality and whether these measures were related to auditory-perceptual ratings of strain severity.

Methods

Voice samples from 23 speakers with dysphonia characterized predominantly by strained voice quality and 23 speakers with normal voice were acoustically analyzed. Measures related to the prominence of the cepstral peak and the ratio of low- to high-frequency spectral energies, as well as the variation of each, were computed from continuous speech and a sustained vowel. Correlations to perceptually rated strain severity were determined.

Results

Measures related to the cepstrum were the strongest discriminators between dysphonic-strained voice and normal voice. Variation in the ratio of low- to high-frequency spectral energies also significantly differentiated the two speaker groups. All measures were significantly correlated with perceptually rated strain severity, including an acoustic severity index that incorporated both cepstral- and spectral-based measures.

Conclusions

Cepstral- and spectral-based measures that have been previously studied in dysphonia characterized by breathiness and roughness are effective in distinguishing strained dysphonia from normal voice quality. The utility of these acoustic measures is supported by their moderate-to-high relationship with perceptually rated strain severity.
Ethnic Disparity in Skin Complications following Bone-Anchored Hearing Aid Implantation
Authors: Zeitler Daniel M. , Herman Bjorn S. , Snapp Hillary A. , Telischi Fred F. , Angeli Simon I.
Published: May 2017

Objectives

Sound processor loading after implantation of a bone-anchored hearing aid is often delayed by skin-site complications. This study examined the frequency of skin-site complications in various ethnic groups and determined factors that may lead to higher rates of skin-site complications resulting in delayed processor loading.

Methods

Adult, English-speaking patients who underwent implantation of a bone-anchored hearing aid between 2007 and 2010 were reviewed. Demographic data including ethnicity, tobacco use, diabetes mellitus, immunosuppression, and long-term steroid use were determined. Major and minor skin-site complications and the time to processor loading were recorded.

Results

The mean time to processor loading was 9.5 weeks, and the mean follow-up time was 23 months. There were no cases of osseointegration failure. African American patients had a significantly higher rate of major skin-site complications (p < 0.005) and a longer time to processor loading (mean, 17.6 weeks; p < 0.05) than the other ethnic groups. There was no significant difference in minor skin complication rates. There was no correlation between diabetes mellitus, long-term immunosuppression, or tobacco use and skin-site complications.

Conclusions

Skin complications can delay processor loading following implantation of a bone-anchored hearing aid. There is a higher rate of major skin-site complications in African American patients, and these often delay processor loading. The risk of skin-site complications is not correlated with smoking, diabetes mellitus, or immunosuppression. An increased risk of skin-site complications is an important consideration for preoperative counseling.
Sensory Integration and Chronic Schizophrenia: Past, Present and Future
Authors: Hixson Virginia J. , Mathews Arthur W.
Published: May 2017

This paper briefly outlines the therapy of sensory integration as developed by Dr. A. Jean Ayres, including a breakdown of the most prevalent types of dysfunction. In an extensive literature review which includes writings from 1811 through to the present day, the symptoms of schizophrenia which may be related to sensory integrative deficit are then examined. Finally, current research and treatment programs which utilize sensory integrative treatment with schizophrenics are reviewed, with emphasis on a program review conducted at Whitby Psychiatric Hospital in Ontario, 1981. Implications for future treatment and research are explored.
Adjusting Beginning Reading Intervention Based on Student Performance: An Experimental Evaluation
Authors: Coyne Michael D. , Simmons Deborah C. , Hagan-Burke Shanna , Simmons Leslie E. , Kwok Oi-Man , Kim Minjung , Fogarty Melissa , Oslund Eric L. , Taylor Aaron B. , Capozzoli-Oldham Ashley , Ware Sharon , Little Mary E. , Rawlinson D'Ann M.
Published: May 2017

This experimental study evaluated a model in which the delivery of a supplemental beginning reading intervention was adjusted based on student performance. Kindergarten students identified as at risk for reading difficulties were assigned to one of two versions of the Early Reading Intervention (ERI; Pearson/Scott Foresman, 2004). Students assigned to the experimental condition received the intervention with systematic adjustments based on student performance. Students in the comparison condition received the same intervention without instructional modifications. The experimental group outperformed the comparison group on all posttest measures at the end of kindergarten. Follow-up analyses at the end of first grade revealed a continued advantage for the experimental group. Findings suggest that systematically adjusting intervention support in response to student performance may be feasible and efficacious.
Patterns of Referral Recommendations for Ethnically Diverse Children in Subsidized Child Care
Authors: Crane Jennifer , Winsler Adam , Sands Bethany
Published: May 2017

It is important for researchers and practitioners to understand how early referral decisions are made in communities because the long-term consequences of an at-risk child being referred (or not) to an agency for evaluation and intervention are profound. This study explored one referral/intervention program for ethnically diverse, low-income children receiving subsidies to attend center-based child care, and examined correlates of referral recommendations made by teachers and clinicians. In 67 child-care centers, 899 children ages 3 to 4 (67% Hispanic/Latino, 25% African American, and 8% Caucasian/other) were assessed at the beginning of the academic year on cognitive, language, and social-emotional skills, and 588 of these children scored at a level suggesting follow-up. Clinicians and teachers generally agreed on the group of children recommended for further evaluation/referral and interventions. The referred group of children consisted of the children with the lowest scores on the child assessments and those whose parents and teachers showed the most disagreement on self-control.
Impact of Non-Tariff Measures on Trade in Mauritius
Authors: Jordaan André C
Published: May 2017

Gains of international trade are largely based on the absence of trade restrictions among trading countries. The perceived advantage of a steady decrease in tariffs worldwide was unfortunately progressively replaced by non-tariff measures (NTMs) globally. The impact of these NTMs is, however, not exactly clear as it appears in sometimes a much disguised manner. NTMs seem to be very important in limiting the flow of imports to trading countries, although accurately measuring the effects of it is fairly difficult. The purpose of this article is to estimate the impact of NTMs on the volume of trade in Mauritius. The 20 major export destinations of Mauritius are analyzed to determine the impact of tariffs and NTMs on the exports from Mauritius. Using the trade freedom scores as proxy for trade restrictions, it has been established that Mauritius’ volume of export flows are much lower due to the NTMs applied by its importing trading partners.
Proxy Means Tests to Identify the Income Poor: Application for the Case of Vietnam
Authors: Viet Nguyen Cuong , Tho Tran Dat
Published: May 2017

Poverty targeting plays an important role in ensuring the success of support programs for the poor. We assess the governmental poverty targeting in Vietnam, which identifies poor households by collecting income data using a simple two-page questionnaire. We propose a proxy means tests (PMT) method to predict income and poverty status of households using data on basic household characteristics. Compared with the poverty targeting using the simple income questionnaire, the PMT method has higher coverage and lower leakage rates. In addition, the proposed approach also allows for more transparent and comparable poverty estimation across small areas in Vietnam.
Lowered or Increased Cutaneous Sensitivity during Movement Depends on Stimulus Intensity
Authors: Helminen Riina , Mansikka Heikki , Pertovaara Antti
Published: May 2017

The effect of active and passive finger movement on cutaneous sensitivity to nonpainful electric stimulation was studied in 7 healthy human subjects. Active and passive finger movement produced a suppression of threshold stimuli, whereas the amplitude discrimination of suprathreshold stimuli was enhanced during passive but not active movement.
Sensation of Resistor-Induced Warmth in Blind Persons
Authors: Vandierendonck André , Van Der Goten Koen
Published: May 2017

It is commonly believed that the human sense of warmth is inferior in spatiotemporal acuity to the tactile senses. However, little or no evidence is available about the active feeling of warmth. We investigated the ability of people to detect in an active way small changes of warmth on very small areas (2-mm × 2-mm resistors). To that end, a new procedure was developed to measure perception of warmth. The results indicate that people who are able to detect the warmth stimuli perceive small incremental changes and that detection performance improves as stimulus intensity increases. Male subjects seem to be less sensitive than female subjects at lower levels of stimulation, but this relationship is reversed at higher levels of stimulation.
Effects of Temporal Speed Instruction on Temporal Length Judgment
Authors: Dawson Kim A.
Published: May 2017

Given the flexible use of an inverse rule relating temporal speed and temporal length in some psychological studies, an hypothesized effect of an instruction regarding temporal speed on temporal length judgment was tested. By subjects asked to compare the speeds (rates of passage) and then to estimate the two temporal lengths (durations) of two successive intervals, there was greater use of the inverse rule and increased accuracy in estimating the first of the two intervals. The results have important implications for effortful processing of temporal information.
Effects of Various Walking Speeds on Probe Reaction Time during Treadmill Walking
Authors: Kurosawa Kazuo
Published: May 2017

The relative attention demanded by standing and walking at five velocities on a treadmill were examined by the measurement of probe reaction time (probe-RT). Subjects were 13 healthy men, who were from 21 to 42 years of age (M = 28.3 yr., SD = 7.4). The mean RT value was shortest at the velocity of 4 km/hr. and became longer at treadmill walking speeds above and below 4 km/hr. The mean preferred velocity of subjects obtained from 10-m free walking was 4.85 km/hr. (3.1 to 6.2 km/hr.), which is reasonably close to the optimal velocity of 4.0 km/hr. during treadmill walking. Walking at the optimum velocity calls for extremely low demands for attention, and walking at velocities higher or lower than this requires more attention.
Cross-Cultural Effects on Hemispheric Specialization Reflected on a Task Requiring Spatial Discrimination of the Thumb by Japanese and American Students
Authors: Nishizawa Sho
Published: May 2017

Difference limens and constant errors were obtained by the method of constant stimuli on a task requiring discrimination of the thumb's spatial position for 26 Japanese (13 male and 13 female) and 26 American (13 male and 13 female) college students. The left thumbs of Japanese and American subjects exhibited smaller difference limens, suggesting that both groups show the same hemispheric specialization of spatial perception. Japanese subjects showed smaller difference limens, but no sex difference was observed.
Exploration of the Neuropsychological Spectrum in Clients of Heterogeneous Disabilities
Authors: Siscoe Karen L. , Segel Martin D. , Lagrange Michele R. , Templer Donald I. , Richardson Robert L.
Published: May 2017

The concept of the neurological spectrum extending from neurological functioning to academic skills was explored and confirmed with 242 clients seeking social service disability benefits. Correlations within segments of the spectrum were higher than those between adjacent segments which were higher than the correlations between distal segments.
Visual-Motor Coordination and Intelligence as Predictors of Reading, Mathematics, and Written Language Ability
Authors: Goldstein Donald J. , Britt Thomas W.,
Published: May 2017

Previous research on the relationship between visual-motor coordination and academic achievement has been equivocal and has frequently not included controls for the effect of intelligence on achievement. In the present study, scores on three tests of children's visual-motor coordination correlated moderately to highly with scores on a test of reading, mathematics, and written language for a sample of 44 elementary school children referred for learning difficulties. Multiple regression analyses indicated that visual-motor coordination scores accounted for little unique achievement test score variance when IQs were included in the equations.
Evidence Limiting the Subtended-Angle Hypothesis of Response-Programming Delays
Authors: Fischman Mark G. , Yao Wan-Xiang
Published: May 2017

In 1991 Sidaway proposed an alternative explanation to account for the traditional effect of response complexity on programming time. He suggested that rather than number of movement parts per se, it is the directional accuracy demand of a response, as quantified by the “subtended angle,” that constrains the movement initiation and produces programming delays. In Sidaway's experiments targets were positioned so that the first target was always closest to the starting position, with subsequent targets positioned further away from the start. This study tested the subtended-angle hypothesis by placing the first target furthest from the starting position, with subsequent targets struck by reversing direction and coming back toward the start. 30 subjects performed two aiming responses, a discrete 1-TAP condition and a serial 3-REVERSE condition. Because the subtended angle was identical in both conditions, there should be no differences in programming time. Our analyses, however, showed a significant effect for number of targets. Mean reaction time was longer for 3-REVERSE than for 1-TAP. These results argue against a strict constraint interpretation based on subtended angle and suggest that, under certain conditions, number of movement parts can still affect delays in response programming.
Visuospatial Imagery in Alzheimer Disease
Authors: Grossi Dario , Becker James T. , Trojano Luigi
Published: May 2017

The purpose of the present study was to investigate the imagery ability of 8 “probable” Alzheimer disease patients using a standard task sensitive to the disruption of the imagery system. These patients were selected based on their good performance on a prerequisite clock-setting task, and with 8 matched control subjects were then required to compare the angles made by the hands on clock faces using only imagined stimuli. There were no significant differences between patients and controls in performance on the clock-imagery task. These data are consistent with models of information processing which postulate the relationships between visual imagery and a short-term memory store and include a central executive system for allocation of cognitive resources.
Maximized Split-Half Reliabilities for Harris-Lingoes Subscales: A Follow-up with Larger Ns
Authors: Davis R. D. , Wagner Edwin E. , Patty Charles C.
Published: May 2017

Max r reliability estimates were significantly and consistently greater than corresponding alpha estimates for Harris-Lingoes subscales of the MMPI-2 containing 13 to 21 items. As previously reported with subscales of fewer items, Max r distributions were negatively skewed. Implications of these findings were discussed.
Alphanumeric Sequencing: A Report on a Brief Measure of Information Processing Used among Persons with Multiple Sclerosis
Authors: Grigsby Jim , Kaye Kathryn , Busenbark David
Published: May 2017

Alphanumeric Sequencing involves the alternating recitation of counting and the alphabet. We report data on the use of this measure with two clinical samples of persons with multiple sclerosis, having either the chronic progressive (n = 23) or relapsing-remitting form (n = 52) of the disease. Patients were administered Alphanumeric Sequencing and several other tests of information-processing speed/capacity and short-term memory. Chronic progressive MS patients performed worse than 23 healthy controls on both the speed and error components of the test, while relapsing-remitting patients were worse than 35 controls only on the total time to complete the task. The time score was correlated with several measures of information processing and short-term memory.
Correlations among Measures of Performance on Sternberg's Item-Recognition Task
Authors: Diener Don
Published: May 2017

Examination of the correlations among measures of performance on Sternberg's item-recognition task by 136 students showed a low correlation of. 38 between the slopes of the functions relating response latency to set size for positive and negative responses. The correlation between the mean latency of positive and negative responses was substantially higher (r =. 91) than that of the slopes. The low correlation between the slopes suggests a mechanism such as an adjustable response criterion that results in a tradeoff between response latency on positive and negative trials.