bluuebunny/crossref_metadata_2025 huggingface dataset:
Cartilage Tympanoplasty in Smokers
Authors: Coelho Daniel H. , Peng Angela , Thompson Meghan , Sismanis Aristides
Published: October 2014

Objectives:

We compared the outcomes of cartilage tympanoplasty in nonsmokers and smokers.

Methods:

We performed a retrospective chart review of patients who underwent cartilage tympanoplasty in a tertiary academic medical center from 1991 to 2010. There were 129 operations in 118 patients; 84 operations were performed in nonsmokers and 45 operations were performed in smokers. The primary outcome measure was the tympanic membrane graft take rate at the interval and most recent follow-up visits. Secondary measures included recurrence, the need for revision surgery, and hearing outcomes.

Results:

Nonsmokers and smokers had comparable long-term rates of intact eardrums (90.6% versus 92.9%; p = 0.99). There was a trend toward a higher rate of recurrent or persistent disease requiring further operation for smokers (13.3% versus 4.7%; p = 0.09). Both groups had improvement in pure tone averages (12.1 dB in nonsmokers and 12.8 dB in smokers) and air-bone gaps (9.6 dB in nonsmokers and 5.1 dB in smokers), although the rates were not statistically significantly different from each other. The rates of success of cartilage tympanoplasty in smokers appear superior to previously published rates of noncartilage tympanoplasty.

Conclusions:

Cartilage tympanoplasty has success rates and postoperative audiological measures that are comparable between smokers and nonsmokers. In smokers, cartilage grafting is superior to noncartilage grafting and is recommended for any patient who smokes and is undergoing tympanoplasty.
Accuracy of Tinnitus Pitch Matching Using a Web-Based Protocol
Authors: Mahboubi Hossein , Ziai Kasra , Brunworth Joseph , Djalilian Hamid R.
Published: October 2014

Objectives:

We investigated the accuracy of a web-based protocol for tinnitus frequency matching compared to that of tinnitus pitch matching performed by an audiologist using an audiometer in an anechoic chamber.

Methods:

Twenty subjects underwent tinnitus frequency-matching in a random order using an audiometer in an anechoic chamber and using web-based software with a multiple-choice protocol in octave or half-octave steps from 250 Hz to 12,000 Hz and a slider in 25-Hz steps from 20 to 20,000 Hz. Octave challenge testing was performed. The participants were asked to indicate which protocol resulted in the closest match to their tinnitus frequency.

Results:

The median tinnitus frequency was 6,000 Hz (range, 2,000 to 12,000 Hz) with use of the audiometer and self-directed multiple-choice protocol. With the slider, the median frequency was 5,925 Hz (range, 1,850 to 16,000 Hz). The patients with a tinnitus frequency higher than 12,000 Hz experienced a greater level of satisfaction when using the computer-based slider system. Five patients experienced octave confusion with self-directed multiple-choice tinnitus matching that was corrected accurately after the octave challenge step.

Conclusions:

A web-based protocol for tinnitus frequency matching is as accurate as a standard audiometric protocol. An octave challenge test might be necessary for patient-directed tinnitus frequency matching.
New Animal Model for Assessment of Functional Laryngeal Motor Innervation
Authors: Björck Gunnar , Margolin Gregory , Måbäck Gudrun , Persson Jonas K. E. , Mattsson Per , Hydman Jonas
Published: October 2014

Objectives:

The functional motor innervation of the larynx is not fully understood because of the complexity of the peripheral neuroanatomy. Since the late 19th century, there has been controversy regarding the role of the superior laryngeal nerve, which may have wider motor projections than are currently acknowledged. The aim of this study was to develop a large animal model to characterize and quantify the functional motor input to the intrinsic laryngeal muscles.

Methods:

We performed invasive electrophysiology (evoked electromyography) in normal pigs.

Results:

The thyroarytenoid, lateral cricoarytenoid, and posterior cricoarytenoid muscles receive dual innervation from both the superior and recurrent laryngeal nerves, whereas the cricothyroid muscle is innervated only by the superior laryngeal nerve.

Conclusions:

The dual innervation pattern from both laryngeal nerves supports the concept of a laryngeal nerve plexus. The motor input through the external branch of the superior laryngeal nerve was surprisingly high. The animal model presented here may be used in future investigations of laryngeal reinnervation following nerve injury.
Lack of Adverse Events after Medialization Laryngoplasty with the Montgomery Thyroplasty Implant in Patients with Unilateral Laryngeal Nerve Paralysis
Authors: Laccourreye Ollivier , Benkhatar Hakim , Ménard Madeleine
Published: October 2014

Objectives:

We sought to document the incidence of and risk factors for adverse events after medialization laryngoplasty with Montgomery implant insertion in patients with unilateral laryngeal nerve paralysis.

Methods:

We studied a retrospective series of 191 patients consecutively managed at a university teaching hospital.

Results:

No adverse events were noted in 79.8% of the patients. Intraoperative, immediate, and late postoperative adverse events were noted in 8.3%, 8.9%, and 4.1% of the patients, respectively. The various adverse events noted were failure to insert the implant (3.6%), difficulties in stabilizing the implant (4.8%), misplacement of the implant (2.1%), dyspnea (2.7%), hematoma (4.8%), extrusion (1.6%), persistent morphological laryngeal alterations (1.6%), and keloid scars (1.1%). Tracheotomy, procedure-related death, and infection at the insertion site were not encountered. No significant statistical relationship was noted between the various adverse events encountered and the variables under analysis.

Conclusions:

Our data demonstrate that medialization laryngoplasty with Montgomery implant insertion in patients with unilateral laryngeal nerve paralysis from various causes is a relatively safe, reliable, and reproducible procedure with a short learning curve.
Morbidity and Patient Perception of Flexible Laryngoscopy
Authors: Paul Benjamin C. , Rafii Benjamin , Achlatis Stratos , Amin Milan R. , Branski Ryan C.
Published: October 2014

Objectives:

The recently published Clinical Practice Guideline: Hoarseness (Dysphonia) revealed major deficits in the literature regarding relatively routine clinical decision-making. One of the more controversial points in the Guideline regarded the utility and timing of laryngeal visualization via flexible laryngoscopy, potentially because of sparse literature regarding the risks and potential morbidity. We sought to prospectively address this issue in order to optimize evaluation protocols.

Methods:

Two-hundred fifty consecutive patients with a variety of complaints completed a survey after undergoing flexible laryngoscopy. The survey queried 1) demographics; 2) discomfort of pretreatment anesthesia and scope placement in the nose and pharynx; 3) fear of future examinations; and 4) patient perception and past experience. Concurrently, the laryngoscopist reported the complications and anatomic variations encountered.

Results:

The discomfort and pain ratings from both the anesthetic spray and the scope placement were low. No statistically significant differences were observed with regard to sex; however, women reported greater fear associated with examinations (p = 0.0001). Anatomic abnormalities were observed in 14.4% of patients, and these patients reported greater discomfort, pain, and fear regarding the examination. No adverse events were observed.

Conclusions:

Flexible laryngoscopy was well tolerated, with little to no risk. The presence of nasal anatomic abnormalities predicted increased discomfort.
Topical Gel Therapy for Sinonasal Polyposis in Samter's Triad: Preliminary Report
Authors: Shikani Alan H. , Kourelis Konstantinos , Rohayem Ziad , Basaraba Randall J. , Leid Jeff G.
Published: October 2014

Objectives:

Rhinosinusitis and polyposis are difficult to treat in patients with Samter's triad; they commonly recur despite sinus surgery, antibiotics, and/or nasal steroids. The present study assesses the efficacy of a multimodal regimen that includes topical corticosteroids and antibiotics delivered through a hydroxyethyl cellulose gel and by nebulization.

Methods:

Eleven patients with Samter's triad who had polyposis and rhinosinusitis that recurred despite endoscopic sinus surgery were treated with a 6-week course of multimodal topical therapy consisting of a hydroxyethyl cellulose gel that releases corticosteroids and antibiotics, topical nebulization of corticosteroids and antibiotics, saline solution rinses, and sinus debridement. Clinical outcomes were evaluated by Lund-Kennedy endoscopic and symptom scores. Histologic assessment was evaluated by hematoxylin and eosin staining before and after treatment.

Results:

Both Lund-Kennedy symptom and endoscopic scores showed a progressive and statistically significant decline throughout the course of treatment, reaching at 6 weeks 42% of the pretreatment values (p = 0.005) for the Lund-Kennedy symptom score and 34% (p = 0.002) for the endoscopic score, respectively; however, the significance of the improvement was lost with time.

Conclusions:

Topical gel therapy improves clinical symptoms, endoscopic findings, and sinus membrane histologic features in patients with refractory Samter's triad, but the improvement is transient, suggesting that a longer therapeutic period might be needed.
Oropharyngeal and Esophageal Swallowing Impairments: Their Association and the Predictive Value of the Modified Barium Swallow Impairment Profile and Combined Multichannel Intraluminal Impedance—Esophageal Manometry
Authors: Gullung Jessica L. , Hill Elizabeth G. , Castell Donald O. , Martin-Harris Bonnie
Published: October 2014

Objectives:

Deglutition is a highly integrated process of neural signaling and coordinated muscular contraction that begins with bolus preparation in the oral cavity and ends with closure of the lower esophageal sphincter after bolus passage. The goal of this study was to examine the relationship between measures of oropharyngeal and esophageal swallow function.

Methods:

A retrospective review was performed of patients who underwent modified barium swallow study (MBSS) and multichannel intraluminal impedance–esophageal manometry (MII-EM) over 7 years at an academic institution. The MBSS was scored with the Modified Barium Swallow Impairment Profile (MBSImP). Associations between impairments as measured by the MBSImP and MII-EM were assessed with a 2-sided Fisher's exact test.

Results:

One hundred sixty-four patients met the inclusion criteria for the study. Comparison of MBSImPcomponent and oral and pharyngeal total regional scores to MII-EM scores revealed a significant association between abnormal esophageal clearance on MBSS (MBSImP component 17) and abnormal findings on MII-EM (p < 0.001). Delay in initiation of pharyngeal swallow (MBSImPcomponent 6) was significantly associated with abnormal esophageal clearance on MBSS (p = 0.023).

Conclusions:

Abnormal esophageal clearance on MBSS (MBSImP component 17) indicates a need for further esophageal testing. A functional interrelationship between abnormalities of oropharyngeal and esophageal swallowing does exist, illuminating the importance of thorough pharyngoesophageal examination for dysphagia symptoms.
Quantitative Distinction of Unique Vocal Fold Subepithelial Architectures Using Optical Coherence Tomography
Authors: Maturo Stephen , Benboujja Fouzi , Boudoux Caroline , Hartnick Christopher
Published: October 2014

Objectives:

The primary objective of this study was to quantitatively analyze ex vivo porcine, fetal human, and adult human vocal folds by use of optical coherence tomography (OCT). A secondary objective was to quantitatively discriminate among 1-, 2-, and 3-layer lamina propria structures.

Methods:

We performed an analysis of the vocal folds of 10 adult pig, 3 adult human, and 2 fetal human vocal fold specimens using OCT and histologic techniques. We present a quantitative comparison of the OCT results and histologic findings.

Results:

We found that OCT allowed for the visualization of the subepithelial vocal fold architecture of all imaged tissue, and that it revealed distinct characteristic signal intensities for each type of specimen.

Conclusions:

Optical coherence tomography was developed for in vivo imaging of biological microstructures. This study demonstrates the ability of OCT to differentiate between the vocal fold architectures of 3 histologically distinct types of vocal folds. Future studies aim to develop a quantitative optical imaging algorithm that can be used to facilitate an in vivo longitudinal clinical investigation of the changes that occur in this layered structure over time and maturation.
Expression of Reactive Oxygen Species during Wound Healing of Vocal Folds in a Rat Model
Authors: Mizuta Masanobu , Hirano Shigeru , Ohno Satoshi , Tateya Ichiro , Kanemaru Shin-Ichi , Nakamura Tatsuo , Ito Juichi
Published: October 2014

Objectives:

Previous studies have indicated that although normal wound healing requires low levels of reactive oxygen species (ROS), excessive amounts of ROS impair wound healing. In injured vocal folds, this excess may result in dysphonia due to scarring that is difficult to treat. However, the expression of ROS during vocal fold wound healing has yet to be investigated. In this study, we assessed the expression and localization of ROS in injured vocal folds by immunohistochemical analysis.

Methods:

Vocal folds of Sprague-Dawley rats were unilaterally injured by stripping the mucosa under transoral endoscopy. The larynges were harvested at specific time points after injury and were immunohistochemically examined for 4-hydroxy-2-nonenal (4-HNE), an ROS marker, and for the presence of inflammatory cells.

Results:

We found that 4-HNE–immunopositive cells were significantly increased in the lamina propria of the injured vocal folds as compared to the normal vocal folds on postinjury days 1 and 3. More than half of the 4-HNE–immunopositive cells were also immunopositive for a macrophage- and granulocyte-specific antibody.

Conclusions:

This study suggests that a large amount of ROS is produced during early-phase wound healing, until postinjury day 3, and that this period may be crucial for regulating ROS levels. The results also suggest that inflammatory cells may contribute to ROS generation.
Single-Operator Flexible Nasolaryngoscopy-Guided Transthyrohyoid Vocal Fold Injections
Authors: Sung C. Kwang , Tsao Gabriel J.
Published: October 2014

Objectives:

A number of laryngeal injection techniques have been described for performing vocal fold medialization or delivery of medications, including peroral and percutaneous approaches. Although flexible nasolaryngoscopy-guided injection (FNGI) improves visualization and patient tolerance over rigid endoscopy, the technique requires an assistant to manipulate the laryngoscope. The efficacy and patient tolerance of a novel, single-operator technique for FNGI are evaluated.

Methods:

Patients who required laryngeal injection for vocal fold medialization or for administration of cidofovir or steroids were included in this study. Indications included vocal fold paresis or paralysis, sulcus deformities, recurrent respiratory papillomatosis, vocal fold polyps, and laryngeal granulomas. All procedures were performed in the office setting with topical and local anesthesia with the patient awake. The surgeon performed flexible nasolaryngoscopy with the nondominant hand while using the dominant hand to perform transthyrohyoid injection with a 25-gauge needle with proximal and distal bends.

Results:

Twenty-six patients underwent a total of 42 single-operator FNGI procedures; 19 unilateral and 23 bilateral injections were performed. All but 1 of the procedures were completed with adequate visualization and placement of injectant and good patient tolerance.

Conclusions:

Single-operator FNGI via a transthyrohyoid approach is a viable and versatile laryngeal injection technique for a variety of indications. It provides access to the anterior, middle, and posterior parts of the larynx. It eliminates the need for an assistant experienced in nasolaryngoscopy and allows the surgeon to adjust and optimize visualization in a fashion analogous to endoscopic sinus surgery.
Radiologically Predicting When a Sternotomy May Be Required in the Management of Retrosternal Goiters
Authors: Riffat Faruque , Del Pero Marcos Martinez , Fish Brian , Jani Piyush
Published: October 2014

Objectives:

Surgery remains the most effective treatment for retrosternal goiters. These commonly present as asymptomatic lesions in elderly patients, but may also cause airway and esophageal compression and, less commonly, may also be mali gnant. Although the majority of these goiters are amenable to transcervical thyroidectomy, in a minority of patients sternotomy is required. The ability to predict the need for sternotomy before operation would allow for safer surgery and operative counseling, as well as improved logistical efficiency if coordination with thoracic surgeons is required. In this report, we assess the radiologic factors that might be predictive of the need for sternotomy.

Methods:

We performed a retrospective review of 97 retrosternal goiters for which thyroidectomy was performed within the otolaryngology department at Addenbrooke's Hospital, Cambridge, between 2001 and 2011. There were a total of 80 cervical excisions and 17 cases in which sternotomy was required. A detailed computed tomographic analysis of these 17 cases was undertaken to assess the predictive factors for the requirement of sternotomy. The factors assessed included posterior mediastinal extension, presence of an ectopic nodule, extension below the carina, extension below the aortic arch, a “conical shape” of the goiter, and tracheal compression. These were compared to the same factors in the control group of 80 patients, and Fisher's exact test was used to determine statistical significance.

Results:

The significant predictive factors for sternotomy were posterior mediastinal extension, extension below the carina, and a “conical” goiter in which the thoracic inlet becomes a ring of constriction (all p < 0.05).

Conclusions:

Our results suggest that it is possible to predict on the basis of computed tomographic imaging the need for sternotomy in retrosternal goiters.
Molecular and Cellular Mechanisms of Loss of Residual Hearing after Cochlear Implantation
Authors: Jia Huan , Wang Jing , François Florence , Uziel Alain , Puel Jean-Luc , Venail Frédéric
Published: October 2014

Objectives:

We describe the various molecular and cellular pathways that lead to early and delayed loss of residual hearing after cochlear implantation.

Methods:

We performed a systematic review using the Medline database with the key words cochlear implant, residual hearing, inflammation, apoptosis, and necrosis.

Results:

The mechanisms underlying the loss of residual hearing after cochlear implantation are multiple. Early hearing loss may be provoked by the surgical access to the inner ear spaces and by trauma caused by insertion of the electrode array. After the initial trauma, an acute inflammatory response promotes elevated levels of cytokines and reactive oxygen species, which in turn promote sensory cell loss by apoptosis, necrosis, and necrosis-like programmed cell death. Treatments that counteract such an inflammatory reaction, production of reactive oxygen species, and apoptosis are effective at preventing hair cell degeneration. However, delayed hearing loss appears to be a consequence of chronic inflammation with development of fibrotic tissue. The mechanisms that lead to fibrosis are poorly understood, and standard anti-inflammatory drugs are insufficient for preventing its development.

Conclusions:

Cochlear implantation is followed by an inflammatory response involving several pathways that lead to either short-term or long-term sensory hair cell degeneration. Future studies should focus on revealing the precise molecular mechanisms induced by cochlear implantation to allow the discovery of new targets for the effective prevention and treatment of loss of residual hearing.
Dexmedetomidine versus Morphine or Fentanyl in the Management of Children after Tonsillectomy and Adenoidectomy: A Meta-Analysis of Randomized Controlled Trials
Authors: He Xing-Ying , Cao Jian-Ping , Shi Xue-Yin , Zhang Hao
Published: October 2014

Objectives:

The primary objective of this review was to evaluate and compare the efficacy and safety of dexmedetomidine hydrochloride with the efficacy and safety of opioids for postoperative management of children after tonsillectomy and adenoidectomy.

Methods:

We searched the Cochrane Central Register of Controlled Trials (Central) in the Cochrane Library (most recent issue), Medline (1966 to date) through Ovid, Embase (1980 to date), and Web of Science (1945 to date). The number of patients who required rescue analgesics (morphine or fentanyl) in the postanesthesia care unit, the number of patients with emergence agitation, the number of patients with postoperative nausea and vomiting, the time to eye-opening in response to verbal stimuli, and the time to extubation were analyzed.

Results:

We included 5 trials, consisting of 482 patients in total. There were no significant differences in the number of patients who required rescue analgesics in the postanesthesia care unit, the number of patients with emergence agitation, the number of patients with postoperative nausea and vomiting, or the time to extubation between patients who received dexmedetomidine and those who received opioids. Compared with opioids, dexmedetomidine was associated with a significantly decreased time to eye-opening in response to verbal stimuli (mean difference, −2.11 minutes; 95% confidence interval, −3.32 to −0.91 minutes; p = 0.0006).

Conclusions:

Intraoperative use of dexmedetomidine was as effective as opioids in preventing postoperative pain and emergence agitation in children who had undergone tonsillectomy and adenoidectomy.
Bone Marrow-Derived Clonal Mesenchymal Stem Cells as a Source of Cell Therapy for Promoting Vocal Fold Wound Healing
Authors: Kim Young-Mo , Yi TacGhee , Choi Jeong-Seok , Lee Songyi , Jang Yun Ho , Kim Chul-Ho , Song Sun U. , Lim Jae-Yol
Published: October 2014

Objectives:

We investigated whether mouse bone marrow-derived clonal mesenchymal stem cells (BM-cMSCs) could promote vocal fold (VF) wound healing by using a xenograft animal model.

Methods:

Homogeneous BM-cMSCs isolated by a subfractionation culturing method from the bone marrow aspirates of green fluorescent protein transgenic mice were injected into the VFs of rabbits immediately after direct mechanical injury. Macroscopic, biomechanical (rheometric), histologic, immunohistochemical, and transcriptional evaluations were performed on the scarred VFs 1 to 3 months after injury. Engraftment of the implanted BM-cMSCs was determined by detection of green fluorescent protein cells in the recipient VF by confocal microscopy.

Results:

The BM-cMSC-treated VFs showed improved morphological properties and viscoelasticity as compared to control VFs injected with phosphate-buffered saline solution. Histologic and immunohistochemical evaluations showed less excessive collagen deposition and increased density of glycosaminoglycans in the BM-cMSC-treated VFs as compared to the control VFs at 3 months after injury (p = 0.003 and p = 0.037, respectively). BM-cMSC transplantation led to a significant attenuation of fibronectin (p = 0.036) and transforming growth factor β1 (p = 0.042) messenger RNA expression at 1 month after injury. Green fluorescent protein-expressing BM-cMSCs engrafted in recipient VFs were found at 1 month after implantation.

Conclusions:

BM-cMSCs appeared to survive in the injured xenogeneic VFs after transplantation for up to 1 month and favorably enhanced the wound healing of VFs after injury. We conclude that BM-cMSCs are a possible source of cell therapy for vocal fold regeneration.
Surgical Management of Airway Dysfunction in Parkinson's Disease Compared with Parkinson-Plus Syndromes
Authors: Sinclair Catherine F. , Gurey Lowell E. , Brin Mitchell F. , Stewart Celia , Blitzer Andrew
Published: October 2014

Objectives:

We sought to compare the laryngeal symptoms of Parkinson's disease (PD) with those of multiple system atrophy (MSA), a Parkinson-plus syndrome; to review the differences in surgical management of upper airway dysfunction between patients with PD and those with MSA; and to present a treatment algorithm for management of upper airway disorders in patients with PD and MSA.

Methods:

We analyzed the airway manifestations of each disease, including clinical and physiological test results and management outcomes, in a case series of 30 patients (24 with PD and 6 with MSA).

Results:

Vocal fold atrophy causing bowing with a midfold glottic gap was common in patients with PD. One third of patients with PD underwent vocal fold augmentation with noticeable improvement in vocal volume and phonation time. Tracheostomy was required for life-threatening sleep apnea in 50% of the patients with MSA. Systemic medications and speech therapy were integral components of the management regimen.

Conclusions:

Surgical management of laryngeal disorders in patients with PD should focus on restoring bulk to atrophic vocal folds to minimize glottic gaps, thus improving vocalization efficiency even in the presence of impaired respiratory effort. Conversely, the autonomic dysfunction that characterizes MSA results in upper airway obstruction, and thus surgical management focuses primarily on maintaining an adequate airway, which frequently necessitates tracheostomy.
Impairment of Habituation of the Auditory Brain Stem Response in Migrainous Vertigo
Authors: Brodsky Jacob R. , Mejico Luis J. , Giraud Andrew , Woods Charles I.
Published: October 2014

Objectives:

We evaluated the auditory brain stem response (ABR) in migrainous vertigo (MV).

Methods:

Four subjects who met clinical criteria for definite MV and 4 subjects with non-vertiginous migraine (NVM) underwent ABR testing while asymptomatic and within 16 hours of a symptomatic episode. Four control subjects were also tested. A set of 4 consecutive 750-click series was administered at 50-, 60-, and 70-dB intensities. We compared the groups in terms of habituation of the amplitude of wave IV-V (habituation of IV-V) from the first through fourth series for each set.

Results:

The habituation of IV-V amplitude to 50-dB stimuli was significantly less (p = 0.047) in the symptomatic MV group (5.08% ± 22.32%) than in the symptomatic NVM group (–21.44% ± 13.50%) or the control group (–26.06% ± 9.76%). The habituation of IV-V amplitude to 70-dB stimuli in the MV group was significantly less (p = 0.031) during symptomatic testing (–3.43% ± 8.89%) than during asymptomatic testing (–21.23% ± 6.41%).

Conclusions:

The habituation of IV-V amplitude is reduced during MV attacks. This finding suggests impaired brain stem inhibition at the level of the inferior colliculus, which shares serotonergic connections with the dorsal raphe nucleus, an area hyperactive in migraine.
Use of Coblation in Resection of Juvenile Nasopharyngeal Angiofibroma
Authors: Cannon Daniel E. , Poetker David M. , Loehrl Todd A. , Chun Robert H.
Published: October 2014

We present a series of 4 patients with juvenile nasopharyngeal angiofibroma (JNA) who underwent Coblation-assisted endoscopic resection after preoperative embolization, and discuss the use and advantages of endoscopic Coblation-assisted resection of JNA. Our limited case series suggests that Coblation may be used in the resection of JNA after embolization in a relatively safe, efficient, and effective manner. Coblation allows for decreased bleeding, less need for instrumentation, and improved visualization. There are limited published data in the literature to date on the use of Coblation in endoscopic JNA resection. We describe its use in a more extensive tumor than those previously reported. Further studies are needed to fully define the safety and utility of Coblation technology for this application.
Long-Term Use of Heat and Moisture Exchangers among Laryngectomees: Medical, Social, and Psychological Patterns
Authors: Brook Itzhak , Bogaardt Hans , van As-Brooks Corina
Published: October 2014

Objectives:

After laryngectomy, pulmonary protection is mostly acquired by means of a heat and moisture exchanger (HME) that is placed on an airtight seal around the stoma. The effects of HMEs on the tracheal climate have been well described, and the filtration effect of an HME with an electrostatic filter has been described in vitro. The effects of HME use in patients have been documented in several trials in different countries. The follow-up time of the patients in these trials, however, is limited. Less is known about long-term use of HMEs, and studies describing long-term compliance with HME use are scarce. This study investigated the long-term use of HMEs in laryngectomees.

Methods:

Questionnaires were sent to 195 laryngectomees, and 75 questionnaires were returned.

Results:

More than 85% of the respondents used an HME, of whom 77% were compliant users (ie, use for more than 20 hours per day). The incidence of pulmonary illnesses (either before or after surgery) was about 25%. More than 90% of the respondents were heavy smokers before laryngectomy. One third of the respondents are regularly exposed to dusty environments. Compliant HME users tend to make less use of external humidifiers and vaporizers, and have better pulmonary status and lower health-care costs. Regarding quality of life, patients who use a FreeHands device tended to have more frequent social contacts (r = 0.251; p = 0.030). The prevalence of depression is high, pointing to an urgent need to recognize and treat psychiatric problems such as depression and suicidal ideation in this patient group.

Conclusions:

These findings have implications for any postlaryngectomy research that uses pulmonary parameters.
External Auditory Canal Mass as the First Manifestation of a Bronchogenic Carcinoma: Report of a Rare Case
Authors: Vasileiadis Ioannis , Kapetanakis Stylianos , Vasileiadis Dimitrios , Petousis Aristotelis , Karatzas Theodore
Published: October 2014

Objectives:

Metastatic tumors in the external auditory canal (EAC) are exceptionally rare. These metastases almost always occur in the latter stages of the disease process. Ten cases of metastatic tumors of the EAC have been reported in the literature. We report the first case of a metastatic bronchogenic adenocarcinoma that presented initially as an EAC mass.

Methods:

We present a case report and a literature review.

Results:

Although bronchogenic adenocarcinoma not uncommonly metastasizes to the temporal bone, metastasis to the EAC is extremely rare. We report the case of a 62-year-old woman who presented with a 6-week history of swelling in her right EAC and sudden onset of hearing loss. Physical examination revealed a small, polypoid, friable mass originating from the superior-posterior wall of the right EAC. Incision biopsy was performed, and the histopathologic examination of specimens revealed a moderately to poorly differentiated adenocarcinoma compatible with a bronchogenic origin.

Conclusions:

A patient with an aural mass presents a diagnostic dilemma. Metastatic tumors in the EAC are extremely rare, but they should be included in the differential diagnosis of a mass in this location.
Hot or Cold? Is Monothermal Caloric Testing Useful and Cost-Effective?
Authors: Bush Matthew L. , Bingcang Christopher M. , Chang Edward T. , Fornwalt Brandon , Rayle Christopher , Gal Thomas J. , Jones Raleigh O. , Shinn Jennifer B.
Published: October 2014

Objectives:

Videonystagmography (VNG) is used widely in the assessment of balance dysfunction. The full test battery can be time-consuming and can induce patient discomfort. The purpose of this study was to examine the value of monothermal caloric testing in predicting unilateral caloric weakness, as well as abnormal VNG vestibular and nonvestibular eye movement, while considering the time and reimbursement associated with these tests.

Methods:

In a retrospective review of 645 patients who completed a comprehensive VNG test battery with bithermal caloric testing, we calculated the specificity, sensitivity, and predictive values of monothermal caloric testing in relation to bithermal caloric results and noncaloric VNG results.

Results:

With unilateral vestibular weakness (UVW) defined as a 25% interear difference, warm-air monothermal caloric testing yielded a sensitivity of 87% and a negative predictive value of 90% for predicting UVW. With a 10% UVW definition, the warm-air caloric testing sensitivity increased to 95% and the negative predictive value to 92%. Warm-air monothermal caloric testing had a positive predictive value of 85% and a negative predictive value of 18% for predicting noncaloric VNG findings; cold-air monothermal and bithermal testing displayed similar results.

Conclusions:

Isolated monothermal testing is a sensitive screening tool for detecting UVW, but is not adequate for predicting noncaloric VNG results.
Analysis of Long-Term Hearing Gains after Stapes Surgery with Piston Reconstruction for Otosclerosis
Authors: Gristwood Ronald Edward , Venables William Norman
Published: October 2014

Objectives:

We sought to assess the postoperative hearing gains at individual frequencies after stapes surgery with piston reconstruction for clinical otosclerosis.

Methods:

We analyzed the air conduction (AC) hearing gains at various audiometric frequencies in a sample of 1,168 stapes procedures with piston reconstruction performed on 911 strictly consecutive patients by one surgeon between 1963 and 1979. Assiduous follow-up of patients was attempted for at least 10 years. The audiometric results over time were stored for computer analysis.

Results:

The mean AC gain over the speech frequencies (0.5, 1, 2, and 3 kHz) was 35.5 dB at 1 year after operation, and the rate of deterioration over the next 19 years was 0.58 dB/y.

Conclusions:

The picture to emerge from the analysis is clear. The mean AC gain is maximal at nearly 40 dB for the audiometric frequencies of 0.25, 0.5, and 1 kHz. The mean AC gain at any given time after operation decreases with increasing frequency, at least for frequencies of ≥1 kHz. For any frequency there is, with few exceptions, a significant decrease in the AC gain from one time period to the next.
Voice Symptoms and Voice-Related Quality of Life in College Students
Authors: Merrill Ray M. , Tanner Kristine , Merrill Joseph G. , McCord Matthew D. , Beardsley Melissa M. , Steele Brittanie A.
Published: October 2014

Objectives:

The purpose of this study was to examine the prevalence of voice disorders in college students and their effect on the students as shown by quality-of-life indicators.

Methods:

A cross-sectional survey was completed by 545 college students in 2012. The survey included 10 questions from the Voice-Related Quality of Life (V-RQOL), selected voice symptoms, and quality-of-life indicators of functional health and well-being based on the Short Form 36-item Health Survey (SF-36).

Results:

Twenty-nine percent of the college students (mean age, 22.7 years) reported a history of a voice disorder. Hoarseness was the most prevalent voice symptom, but was not correlated with V-RQOL scores. A wobbly or shaky voice, throat dryness, vocal fatigue, and vocal effort explained a significant amount of variance on the social-emotional and physical domains of the V-RQOL index (p < 0.05). Voice symptoms limited emotional and physical functioning as indicated by SF-36 scores.

Conclusions:

Voice disorders significantly influence psychosocial and physical functioning in college students. These findings have important implications for voice-care services in this population.
End-to-Side Interposed Donor Grafting as a Facial Nerve Reinforcement Technique after Vestibular Schwannoma Surgery
Authors: Celis-Aguilar Erika , Lassaletta Luis , Roda José M. , Gavilán Javier
Published: October 2014

Objectives:

This retrospective case review was performed to determine the facial function outcome of an end-to-side interposed donor grafting technique in patients who had a nonresponsive and partially injured facial nerve during a translabyrinthine approach for vestibular schwannoma resection.

Methods:

The study included patients with silent electrophysiological tests after partial injury of the facial nerve during translabyrinthine schwannoma resection surgery in a tertiary referral hospital. The patients underwent end-to-side interposed donor grafting as a facial nerve reinforcement technique, and we evaluated their facial function after 1 year of follow-up.

Results:

Four cases with intact preoperative facial function were included (3 men and 1 woman). All patients had a lack of electrical response from the facial nerve and partial anatomic injury after a translabyrinthine approach. An end-to-side interposed donor grafting technique was performed. The donor grafts used were the sural nerve (2 patients), superior vestibular nerve (1 patient), and greater auricular nerve (1 patient). All patients achieved a good House-Brackmann grade. Ocular adjuvant procedures were performed in all patients.

Conclusions:

Immediate repair of the facial nerve with an interposed donor graft may provide better facial function in patients who have no electrical response from a partially injured facial nerve after vestibular schwannoma surgery.
Carbon Dioxide Laser Fiber for the Excision of Oral Leukoplakia
Authors: Chee Michael , Sasaki Clarence
Published: October 2014

Objectives:

We compared the efficacies of cold knife excision and carbon dioxide (CO2) laser fiber excision of oral cavity leukoplakia.

Methods:

Between August 2009 and June 2011, 45 patients who underwent excision of oral cavity leukoplakia were assessed for operative time, use of bipolar cautery, blood loss, and number of intraoperative margins needed. Patients were assigned randomly to either a cold knife group (23 procedures) or a CO2 laser fiber group (24 procedures) at the time of the procedure.

Results:

The times of excision were similar in the CO2 laser fiber group (1.64 min/cm2) and the cold knife group (1.70 min/cm2). There were large differences between the CO2 laser fiber group and the cold knife group in the categories of bipolar cautery uses per square centimeter (0.34 uses versus 3.32 uses) and blood loss (0.19 g/cm2 versus 2.55 g/cm2). The average number of margins needed to clear a specimen by frozen section was 1.21 for the CO2 laser fiber group and 1.83 for the cold knife group.

Conclusions:

The CO2 laser fiber did not show an advantage in operative time. The CO2 laser fiber did show better outcomes in the areas of blood loss, bipolar cautery use, and intraoperative margins needed.
Muscular Anatomy of the Human Ventricular Folds
Authors: Moon Jerald , Alipour Fariborz
Published: October 2014

Objectives:

Our purpose in this study was to better understand the muscular anatomy of the ventricular folds in order to help improve biomechanical modeling of phonation and to better understand the role of these muscles during phonatory and nonphonatory tasks.

Methods:

Four human larynges were decalcified, sectioned coronally from posterior to anterior by a CryoJane tape transfer system, and stained with Masson's trichrome. The total and relative areas of muscles observed in each section were calculated and used for characterizing the muscle distribution within the ventricular folds.

Results:

The ventricular folds contained anteriorly coursing thyroarytenoid and ventricularis muscle fibers that were in the lower half of the ventricular fold posteriorly, and some ventricularis muscle was evident in the upper and lateral portions of the fold more anteriorly. Very little muscle tissue was observed in the medial half of the fold, and the anterior half of the ventricular fold was largely devoid of any muscle tissue. All 4 larynges contained muscle bundles that coursed superiorly and medially through the upper half of the fold, toward the lateral margin of the epiglottis.

Conclusions:

Although variability of expression was evident, a well-defined thyroarytenoid muscle was readily apparent lateral to the arytenoid cartilage in all specimens.
Endoscopic Keel Placement to Treat and Prevent Anterior Glottic Webs
Authors: Paniello Randal C. , Desai Shaun C. , Allen Clint T. , Khosla Siddarth M.
Published: October 2014

We performed a retrospective chart review to examine and describe our clinical experience of use of the Lichtenberger technique to place silicone elastomer keels after lysis of existing webs or for prevention of webs following anterior commissure surgery in adults. Twenty-two patients were identified for inclusion, ranging in age from 24 to 80 years. For 18 patients with existing glottic webs, the surgical procedure involved laryngoscopy with complete lysis of the anterior glottic web by laser or sharp technique, followed by placement of a square of silicone elastomer that is sutured in place with the Lichtenberger needle holder and left in place for 3 to 5 weeks. The procedure was well tolerated, and successfully corrected the web in all but 2 cases. For 4 patients, the procedure was performed prophylactically at the time of anterior commissure surgery considered high-risk for web formation. The procedure does not require a tracheotomy, and patients can maintain a normal diet and have functional phonation while the keel is in place. This approach to treating anterior glottic webs offers several advantages over traditional open thyrotomy with keel placement and should be considered to treat or prevent anterior glottic webs.
Long-Term Outcomes of Facial Nerve Function in Irradiated and Nonirradiated Nerve Grafts
Authors: Leong Samuel C. , Lesser Tristram H.
Published: October 2014

Objectives:

We reviewed the long-term results of facial nerve repair in a tertiary head and neck institution in the north of England.

Methods:

We performed a case notes review of patients who had facial nerve repair over a 10-year period and had completed 24 months of follow-up.

Results:

The study population comprised 18 female patients and 24 male patients, with an overall mean age of 53.2 years (range, 16 to 80 years). Of the 24 patients who had a cable nerve graft, the greater auricular nerve was used in 15 cases. The sural nerve was used as the donor in a cross-facial nerve graft in 9 patients. Sixteen patients had transposition nerve repair: Hypoglossal and ansa cervicalis in 7 and 9 cases, respectively. Two patients had primary anastomosis after surgery for extensive malignant tumors. In this series, no patients achieved a House-Brackmann (HB) grade of II. Overall, the HB grades III, IV, and V were the best postoperative facial nerve functions achieved in 11.9%, 33.3%, and 26.2% of patients, respectively. Failure (HB grade VI) was observed in 28.6% of patients. More than half of patients (62.5%) who had either a sural nerve cable graft or a faciohypoglossal transposition had a good outcome (HB grade III or IV).

Conclusions:

In the present series, 45% of patients had an HB grade of III or IV at long-term follow-up. The best outcome (HB grade III) was observed after cross-facial grafting with the sural nerve.
Temporal Measurements of Deglutition in Dynamic Magnetic Resonance Imaging versus Videofluoroscopy
Authors: Lafer Marissa , Achlatis Stratos , Lazarus Cathy , Fang Yixin , Branski Ryan C. , Amin Milan R.
Published: October 2014

Objectives:

We undertook to provide data regarding temporal measurements of swallow function obtained by dynamic magnetic resonance imaging in a midsagittal plane and to compare these values to normative fluoroscopy data.

Methods:

Seventeen healthy female volunteers with no swallowing complaints underwent turbo-fast low-angle-shot magnetic resonance imaging with a 3-T scanner while swallowing liquid and pudding boluses delivered via syringe. Ninety sequential images were acquired with a temporal resolution of 113 ms per frame for each swallow. The imaging was performed in the midsagittal plane. The analyses focused on oral and pharyngeal transit times.

Results:

All subjects tolerated the protocol without complaints or adverse events. The mean (±SD) oral transit times for liquids and pudding were measured as 0.25 ± 0.09 second and 0.25 ± 0.13 second, respectively. This difference was not statistically significant (p = 0.74). The mean pharyngeal transit times for liquids and pudding were measured as 0.84 ± 0.16 second and 1.11 ± 0.21 seconds, respectively. This difference achieved statistical significance (p < 0.0001). The intrarater and inter-rater reliabilities for the measurements were excellent.

Conclusions:

This sequence provided a high degree of temporal resolution of deglutition in the midsagittal plane. Furthermore, the temporal measurements acquired with dynamic magnetic resonance imaging were reliable and were relatively consistent with those of previous studies done with videofluoroscopy.
Acoustic Analysis of Changes in Articulation Proficiency in Patients with Advanced Head and Neck Cancer Treated with Chemoradiotherapy
Authors: Jacobi Irene , van Rossum Maya A. , van der Molen Lisette , Hilgers Frans J. M. , van den Brekel Michiel W. M.
Published: October 2014

Objectives:

Our aim was to characterize articulation proficiency and differences between tumor sites before and after chemoradiotherapy for advanced head and neck cancer with the help of acoustic measures. Our further goal was to improve objective speech measures and gain insight into muscle functioning before and after treatment.

Methods:

In 34 patients with laryngeal or hypopharyngeal, nasal or nasopharyngeal, or oral or oropharyngeal cancer, we acoustically analyzed nasality, vowel space, precision, and strength of articulation in 12 speech sounds (/α/, /i/, /u/, /p/, /s/, /z/, /l/, /t/, /tj/, /k/, /x/, /r/) before treatment and 10 weeks and 1 year after treatment. Outcomes were compared between assessment points and between tumor sites.

Results:

Nasality in nonlaryngeal sites was significantly reduced by treatment. Most affected in articulation were the oral or oropharyngeal cancer sites, followed by the nasal or nasopharyngeal sites. One year after treatment, vowel space had not recovered and consonant articulation had weakened. Laryngeal sites were less affected in articulation by tumor or treatment.

Conclusions:

Analyses of articulatory-acoustic features are a useful instrument for assessing articulation and speech quality objectively. Assessment of a number of sounds representing various articulation manners, places, and tongue shapes revealed patterns of speech deterioration after chemoradiotherapy. The results suggest that patients' speech could benefit from articulation exercises to address changes in muscle coordination and/or sensitivity and to counteract side effects and “underexercise” atrophy.
XCIII. the Importance of Radical Ethmoidectomy and Sphenoidectomy in the Relief of General and Ocular Diseases.
Authors: Wilkinson Oscar
Published: October 2014

It is becoming more generally recognized that a certain number of chronic, serious, general and ocular diseases are due to chronic sinus infection.

The older so-called radical intranasal and extranasal operations have been in disrepute chiefly because they were too destructive, on the one hand, and not sufficiently complete on the other. With this operative method one can eliminate sinus infection in practically every case.

This operation can be done with a minimum of sacrifice of the tissues and with a minimum of danger and discomfort to the patient.