bluuebunny/crossref_metadata_2025 huggingface dataset:
Lack of Association between Inherited Thrombophilic Risk Factors and Idiopathic Sudden Sensorineural Hearing Loss in Italian Patients
Authors: Cadoni Gabriella , Scipione Simona , Rocca Bianca , Agostino Stefania , La Greca Carmelo , Bonvissuto Davide , Paludetti Gaetano
Published: October 2014

Objectives:

We investigated the presence of congenital thrombophilic risk factors in a population of consecutive Italian patients affected by idiopathic sudden sensorineural hearing loss (SSNHL).

Methods:

We investigated 48 patients with idiopathic SSNHL for the presence of congenital thrombophilic risk factors. The factor V Leiden G1691A, the prothrombin G20210A allele, and methylenetetrahydrofolate reductase (MTHFR) C677T genotypes were investigated. Allele frequencies and genotype distribution of all factors found in patients were compared to those of 48 healthy subjects of the same ethnic background by χ2 and odds-ratio analysis. Odds ratios and 95% confidence intervals were calculated for allele and genotype frequencies of all thrombophilia variants. Statistical significance was accepted with a p value of less than .05. We also performed the following blood tests: hemacytometric analysis including platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, protein S, protein C, antithrombin III, and activated protein C resistance.

Results:

In our series, we did not find an association between SSNHL and abnormal levels of antithrombin III, protein C, protein S, D-dimer, or fibrinogen; activated protein C resistance; or factor V G1691 A, prothrombin G20210A, or MTHFR C677T mutations.

Conclusions:

At present, the few studies regarding genetic polymorphisms of congenital thrombophilic factors in SSNHL are not conclusive. According to our data, factor V G1691A, prothrombin G20210A, and MTHFR C677T variants should be not considered risk factors for SSNHL. Further large prospective studies are needed to provide currently lacking information and to improve our knowledge in the field before we recommend the determination of genetic polymorphism in SSNHL as routine practice.
Preoperative Administration of Rofecoxib versus Ketoprofen for Pain Relief after Tonsillectomy
Authors: Louizos Antonios A. , Pandazi Ageliki B. , Koraka Christina P. , Davilis Dimitrios I. , Georgiou Loucas G.
Published: October 2014

Objectives:

We evaluated the analgesic efficacy and the opioid-sparing effect of oral rofecoxib compared with intramuscular (IM) ketoprofen in tonsillectomy.

Methods:

Seventy-seven adult patients were randomized into 2 groups: group R (n = 39), which received a single oral preoperative dose of rofecoxib 50 mg, and group K (n = 38), which received 2 IM doses of ketoprofen 100 mg (before surgery and after 12 hours). In both groups, additional IM meperidine hydrochloride 1 mg/kg was given. All patients received general anesthesia. A pain score (visual analog scale, 0 to 100) was assessed both at rest and during swallowing at 30 minutes and at 4, 8, 12, 16, and 24 hours after operation. If the pain score exceeded 40, patients were given meperidine as rescue analgesia.

Results:

The pain scores during rest and swallowing in group R were significantly lower (p > .05) than those of group K at 4, 8, and 12 hours after operation. Meperidine was given as rescue medication in significantly more patients of group K (76%) than of group R (38%; p > .05).

Conclusions:

Oral premedication with rofecoxib seems to be more effective than use of ketoprofen in decreasing postoperative pain and the need for opioid rescue medication after elective tonsillectomy. Both drugs seem to be relatively safe as far as postoperative bleeding is concerned.
Cochlear Implantation in Children with Inner Ear Malformations
Authors: Kim Lee-Suk , Jeong Sung-Wook , Huh Min-Jung , Park Young-Deok
Published: October 2014

Objectives:

The aim of this study was to assess the outcomes of cochlear implantation in children with inner ear malformations (IEMs).

Methods:

A retrospective review of 212 children who received implants from September 1994 to May 2004 was performed. Forty-six of them had radiologic evidence of IEMs. The preoperative evaluations, intraoperative findings, postoperative complications, and performance outcomes were analyzed. For the comparative analysis of performance outcomes, the children with IEMs were matched and compared with children with a normal inner ear who had received implants. Statistical analysis was performed with a repeated-measures analysis of variance.

Results:

All of the children were studied with computed tomography and magnetic resonance imaging. Three-dimensional volume rendering of magnetic resonance images was performed in cases that were difficult to interpret because of structural complexity. The operative findings included aberrant facial nerves in 2 children and cerebrospinal fluid gushers in 22 children. Intraoperative fluoroscopic examination was performed to evaluate electrode placement. There were no serious postoperative complications. All children with IEMs achieved open-set speech perception abilities, except for the children with a narrow internal auditory canal (IAC), and showed progressive improvement of their speech perception abilities over time. There were no statistically significant differences in performance measured by the Common Phrases test between the 2 groups. Although the repeated-measures analysis of variance indicated that children with IEMs performed more poorly than those with a normal inner ear on the Phonetically Balanced Kindergarten test for phonemes, statistical significance was not found at 2 years after implantation. The children with a narrow IAC benefited from the implantation and used the device every day, although their speech perception abilities were limited.

Conclusions:

The results of the present study show that cochlear implantation can be performed relatively safely in deaf children with IEMs and that they receive considerable benefit from their implants. Substantial benefit can be expected from implantation in children with most kinds of IEMs, except for a narrow IAC, which is often associated with limited results.
Varicella-Zoster Virus Load and Cochleovestibular Symptoms in Ramsay Hunt Syndrome
Authors: Ohtani Fumio , Furuta Yasushi , Aizawa Hiroshi , Fukuda Satoshi
Published: October 2014

Objectives:

The mechanism by which varicella-zoster virus (VZV) reactivation causes cochleovestibular symptoms (CVSs) in patients with Ramsay Hunt syndrome (RHS) remains to be elucidated. The present study analyzed the relationship between VZV load and the onset of CVSs in RHS.

Methods:

The subjects consisted of 56 patients with RHS; 29 exhibited CVSs and facial paralysis (FP; group 1), and 27 exhibited FP without CVSs (group 2). The VZV DNA copy number in the saliva was measured with a quantitative polymerase chain reaction. Anti-VZV antibodies were assayed by an enzyme-linked immunosorbent assay with paired sera.

Results:

There was no significant difference in maximum viral copy number between the Two groups. In group 1, CVSs occurred at various times between the early phase and the regression phase of VZV reactivation. In some patients, CVSs occurred in the early phase of VZV reactivation, before the onset of zoster lesions and FP.

Conclusions:

There are various different patterns in the development of eighth cranial nerve dysfunction, which is caused by progression of neuritis or labyrinthitis following VZV reactivation. Our data suggest that CVSs in RHS may also be caused by reactivation of VZV in the spiral and/or vestibular ganglia.
Imaging the Human Vocal Folds in Vivo with Optical Coherence Tomography: A Preliminary Experience
Authors: Klein Adam M. , Pierce Mark C. , Zeitels Steven M. , Anderson R. Rox , Kobler James B. , Shishkov Milen , de Boer Johannes F.
Published: October 2014

Objectives:

Optical coherence tomography (OCT) and polarization-sensitive OCT (PS-OCT) are promising noninvasive methods for in vivo, cross-sectional imaging of the microstructure of the vocal folds. Previous studies in other tissues have shown an axial resolution of less than 10 μm and a maximum imaging depth of about 2 mm. The objectives of this pilot study were to obtain images from the vocal folds of subjects who were being evaluated and/or treated for vocal fold disease and to evaluate how well normal and pathologic microstructure could be seen in these images.

Methods:

Twenty-six vocal folds in 13 subjects were imaged with a flexible OCT probe. The images were successfully collected from subjects who were either topically anesthetized or under general anesthesia for microlaryngoscopic procedures.

Results:

The thickness of the epithelium, the relative collagen content of the subepithelial connective tissue, and certain characteristic features of lesions (including cysts, scarring, and papilloma) were seen in the OCT and PS-OCT images.

Conclusions:

“Live microscopy” of the human vocal folds is very promising for improved diagnosis, mapping, and treatment planning. To our knowledge, this study is the first application of PS-OCT for in vivo imaging of the human vocal folds.
Detection of Herpes Simplex and Varicella-Zoster Viruses in Patients with Bell's Palsy by the Polymerase Chain Reaction Technique
Authors: Stjernquist-Desatnik Anna , Skoog Eva , Aurelius Elisabeth
Published: October 2014

Objectives:

Infectious causes of peripheral facial paralysis are well known. Bell's palsy, however, is an idiopathic facial paralysis, and the genesis is still unknown. Herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) have been suggested as etiologic agents.

Methods:

Twenty consecutive adult patients with Bell's palsy were included in the study. Ten adult patients operated on for chronic otitis served as controls. A biopsy specimen from the posterior auricular muscle was resected within 72 hours after the onset of Bell's palsy and was analyzed together with cerebrospinal fluid (CSF) by nested polymerase chain reaction for HSV-1 and VZV DNA. Serum samples were analyzed for antibodies to HSV-1 and VZV.

Results:

HSV-1 DNA was found in the muscle biopsy specimen from 1 of the 20 patients, but was not found in any of the CSF samples. VZV DNA was detected in the muscle biopsy as well as the CSF from 1 other patient. All controls were negative. Seventeen of 19 patients had stationary serum antibody concentrations to HSV-1, and none displayed an antibody titer rise. A significant antibody titer rise to VZV was found in 1 of 19 patients, whereas 17 of 19 had stationary antibody levels.

Conclusions:

HSV-1 or VZV DNA was detected in 10% of patients with Bell's palsy in the present study. Viral replication might already have declined in many cases at the onset of the palsy. Use of an HSV-1/VZV polymerase chain reaction on a muscle biopsy specimen or CSF does not seem to be the method of choice for rapid etiologic diagnosis in the acute phase of Bell's palsy.
Tympanoplasty for Chronic Otitis Media in Post-Irradiated Nasopharyngeal Carcinoma Patients
Authors: Hsu Yao-Chung , Su Chih-Ying
Published: October 2014

Objectives:

We evaluated the surgical outcome of tympanoplasty for chronic otitis media in post-irradiated patients with nasopharyngeal carcinoma.

Methods:

Nineteen ears were treated in 15 patients with nasopharyngeal carcinoma who had undergone radiotherapy in this retrospective clinical series. Only patients with simple perforations of the tympanic membrane and normal or near-normal eustachian tube function were enrolled in this study. All patients underwent type I tympanoplasty.

Results:

All patients had been treated with radiotherapy of 64.8 to 81.0 Gy. The intervals between radiotherapy and surgery ranged from 17 months to 20 years. The tympanic membranes in 10 of 19 ears were intact after surgery. Otorrhea had subsided in 11 ears (58%), and the incidence of otorrhea was decreased in 6 ears (32%). Thirteen of the 15 patients (86.7%) reported that their quality of life had improved.

Conclusions:

Surgical intervention benefits some patients with nasopharyngeal carcinoma with chronic otitis media resulting from radiotherapy.
Cost-Effectiveness of Tonsillectomy for Recurrent Acute Tonsillitis
Authors: Fujihara Keiji , Koltai Peter J. , Hayashi Masaki , Tamura Shinji , Yamanaka Noboru
Published: October 2014

Objectives:

We used a retrospective case series to perform a preliminary study to determine the clinical effectiveness and cost-effectiveness of tonsillectomy for recurrent acute tonsillitis.

Methods:

We studied 25 children and 16 adults who had tonsillectomy for recurrent acute tonsillitis. The adult patients and the children's caregivers were asked to respond to a questionnaire regarding the efficacy of their tonsillectomy. The cost of medical care and the work disability cost for tonsillitis and for tonsillectomy were calculated. We then applied the technique of break-even time analysis to assess when the total health care cost savings from surgery overtook the total cost of tonsillectomy.

Results:

In children, the overall economic costs (medical costs and work-related costs) were recovered at 1.6 years after tonsillectomy (break-even point). In adults, the overall economic costs (medical costs and work-related costs) were recovered at 2.5 years after tonsillectomy (break-even point).

Conclusions:

Tonsillectomy for recurrent acute tonsillitis is both clinically effective and cost-effective for children and adults in Japan.
Releasing Tension on a Tracheal Anastomosis: An Ex Vivo Study on a Sheep Model
Authors: Zaugg Yannick , Cuffel Cyril , Monnier Philippe
Published: October 2014

Objectives:

Tension is the limiting factor in long tracheal resection with end-to-end anastomosis. Complications such as dehiscence and restenosis are well correlated with the degree of anastomotic tension. The objective of our study was to investigate the effects of patches of auricular cartilage glued craniocaudally along a tracheal anastomosis.

Methods:

Rupture tests were performed on sheep tracheas collected from a slaughterhouse. In group A (n = 5), 3 patches of auricular cartilage of 0.5 × 5 cm were glued with albumin-glutaraldehyde tissue adhesive (BioGlue) craniocaudally along the left, right, and anterior borders of the transected tracheas. In group B (n = 10), the patches were fixed with 2 transparietal intercartilaginous stitches without adhesive. In group C (n = 10), adhesive and stitches were used.

Results:

Three patches of cartilage glued along the tracheal anastomosis held tension as high as 11.1 N. Adhesive maintained the tracheal extremities in closer contact than did stitches alone. It increased the anastomotic resistance strength (50.8 N in group C versus 29.6 N in group B). This increase was statistically significant.

Conclusions:

Gluing auricular cartilage patches along ex vivo tracheal anastomoses strengthened them and helped diminish tension on the suture line.
Fabry's Disease: Otoneurologic Findings in Twelve Members of One Family
Authors: Vibert Dominique , Blaser Beat , Ozdoba Christoph , Häusler Rudolf
Published: October 2014

Fabry's disease corresponds to an inherited disorder transmitted by an X-linked recessive gene. It generates a dysfunction of glycosphingolipid metabolism due to an enzymatic deficiency of α-galactosidase activity, resulting in glycosphingolipid deposits in all areas of the body. The clinical (heart, kidney, and central nervous system) manifestations are more severe in hemizygous boys than in heterozygous girls. They appear during childhood or adolescence: acroparesthesia, joint pain, angiokeratoma, corneal dystrophy, hypohydrosis or anhydrosis, and renal failure. The otoneurologic symptoms consist of hearing fluctuation, progressive unilateral or bilateral hearing loss, and episodes of vertigo or dizziness. Otoneurologic findings in 12 of 26 members of the same family are presented: the mother and 9 of her 12 children, as well as 2 of her 14 grandchildren: 4 healthy persons, 4 heterozygous female carriers, and 4 hemizygous male patients. Three of the male patients had fluctuation of hearing, sudden hearing loss, and episodes of vertigo and dizziness. The otoneurologic examinations showed a bilateral cochleovestibular deficit (n = 1), a right cochleovestibular deficit (n = 1), and a bilateral hearing loss combined with a right vestibular deficit (n = 1). Histopathologic evidence of glycosphingolipid accumulation in vascular endothelial and ganglion cells, as well as atrophy of the stria and spiral ligament, might explain the otoneurologic symptoms and findings.
Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy for Recurrent Laryngeal Cancer
Authors: Sewnaik Aniel , Hakkesteegt Marieke M. , Meeuwis Cees A. , de Gier Henriëtte H. W. , Kerrebijn Jeroen D. F.
Published: October 2014

Objectives:

Recurrent laryngeal cancer can be treated either with total laryngectomy or in selected cases with supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP). We performed a retrospective study to analyze the functional and oncological results of supracricoid laryngectomy with CHEP.

Methods:

Fourteen patients were treated with supracricoid laryngectomy with CHEP. In 8 patients, flexible endoscopic evaluation of swallowing was performed. Preoperative and postoperative voice evaluation was performed in 5 patients. Oncological and functional follow-up, postoperative complications, and data concerning rehabilitation were recorded on standard forms.

Results:

After the supracricoid laryngectomy with CHEP, 11 of the 14 patients were alive and disease-free. No local recurrences were found, but 2 patients had regional recurrences. The voice was worse after the operation; however, most patients were satisfied. Swallowing was uncompromised.

Conclusions:

Supracricoid laryngectomy with CHEP for recurrent glottic laryngeal cancer after radiotherapy appears to be oncologically safe and functional.
Effects of Converting Bilateral Cochlear Implant Subjects to a Strategy with Increased Rate and Number of Channels
Authors: Dunn Camille C. , Tyler Richard S. , Witt Shelley A. , Gantz Bruce J.
Published: October 2014

Objectives:

Three different Advanced Bionics processing strategies were evaluated: 1) 8-channel, 813 pulses per second (pps), Continuous Interleaved Sampling (CIS); 2) 16-channel, 5,100 pps, HiResolution Paired (HiRes P); and 3) 16-channel, 2,900 pps, HiResolution Sequential (HiRes S).

Methods:

Seven adult bilateral Clarion CII cochlear implant recipients who had been using a CIS processing strategy for at least 18 months participated in this study. Sentence recognition in multitalker babble from the front was collected on subjects using their CIS strategy and after subjects were programmed for the first time with HiRes P and HiRes S strategies. An ABAB design was implemented for 1 month whereby subjects used each HiResolution strategy every other day. Sentence recognition testing was repeated at the 1- and 3-month post-HiResolution test intervals.

Results:

Comparisons between the CIS and HiResolution strategies showed immediate improvements for 5 subjects in favor of the HiResolution strategies. After 1 month of alternating between the HiRes P and HiRes S strategies, remarkably, 2 subjects showed improvements of 60%, 2 subjects showed improvements of 40%, and 2 subjects showed improvements of 30% over the CIS strategy that they had previously used for at least 18 months. The results after 3 months of use were consistent with those obtained at 1 month.

Conclusions:

The HiRes S and HiRes P strategies resulted in dramatic improvements in speech perception in noise for a subset of subjects who had been using the CIS strategy bilaterally. This finding demonstrates that these subjects were able to tolerate a more difficult signal-to-noise ratio. Further work is needed to determine the independent effects of rate versus number of channels.
Laryngoscopy in Bilateral Vocal Fold Immobility: Can You Make a Diagnosis?
Authors: Cohen Seth M. , Garrett C. Gaelyn , Netterville James L. , Courey Mark S.
Published: October 2014

Objectives:

This study explores whether videoendoscopic findings and patient history help make the diagnosis in bilateral vocal fold immobility (BVFI).

Methods:

Medical records from 1995 to 2003 were searched to identify patients with posterior glottic stenosis (PGS) and bilateral vocal fold paralysis (BVFP) who also had videoendoscopic examinations. Videoendoscopic examination findings that could help differentiate PGS from BVFP were identified a priori. A weighted scoring index, based on the adjusted odds ratios of significant examination findings on multiple logistic regression, was derived. Associations between the weighted scoring index, patient history, and diagnosis were then evaluated.

Results:

Twenty-six patients with BVFP and 28 patients with PGS were identified. Posterior glottic scar (weight = 2), medial arytenoid erosion with a widened posterior glottis (weight =1), and appropriate vocal fold motion (weight = 1) were significant variables (p ≤ .05, multiple logistic regression) and constituted the weighted scoring index. A weighted scoring index of ≥ 2 and a history of prolonged intubation predicted PGS in 95.2% of cases. A weighted scoring index of ≤ 1 and a history of neck surgery predicted BVFP in 95.0% of cases.

Conclusions:

The weighted scoring index with the patient history provides an objective tool for diagnosing BVFI.
Multichannel Intraluminal Impedance in the Evaluation of Patients with Persistent Globus on Proton Pump Inhibitor Therapy
Authors: Anandasabapathy Sharmila , Jaffin Barry W.
Published: October 2014

Objectives:

Studies suggest an association between globus sensation (“globus”) and gastroesophageal reflux. Although globus often persists despite proton pump inhibitor (PPI) therapy, the role of nonacid reflux has never been determined. Our goal was to use 24-hour multichannel intraluminal impedance (pH/MII) to determine 1) reflux characteristics in patients with globus despite PPI therapy; 2) whether there are differences in reflux patterns between patients with globus and patients with heartburn alone; and 3) whether there are differences in the number of positive symptom indices when standard pH testing is compared to pH/MII.

Methods:

Twenty-one adult patients with globus and 12 with heartburn symptoms alone underwent 24-hour pH/MII on PPI therapy. Reflux frequencies and characteristics were compared in both groups. For patients with globus, the symptom index and symptom sensitivity index were calculated. Logistic regression was performed to determine which reflux characteristics correlated with symptoms.

Results:

With pH/MII, we detected 1,160 reflux episodes; 64.7% were nonacid, and 55% reached the proximal sensor. In identifying patients with positive symptom indices, pH/MII increased the yield of standard pH testing by 27.8%. Proximal reflux was a significant predictor of globus symptoms (p = .04). Nonacid reflux approached significance in predicting globus (p = .08). Compared to patients with heartburn alone, those with globus had a higher mean frequency of proximal reflux (27.76% versus 15.63%; p = .04).

Conclusions:

In adults on PPI therapy with refractory globus, acid reflux does not predict globus symptoms. Through detection of nonacid reflux, pH/MII increased the yield of standard pH testing in identifying positive symptom indices. Additionally, pH/MII provided important information regarding reflux-symptom correlation. Proximal reflux may be predictive of globus symptoms.
Computerized Dynamic Visual Acuity with Volitional Head Movement in Patients with Vestibular Dysfunction
Authors: Roberts Richard A. , Gans Richard E. , Johnson Erika L. , Chisolm Theresa Hnath
Published: October 2014

Objectives:

Patients with uncompensated vestibular dysfunction frequently report blurred vision during head movement, a symptom termed oscillopsia. One way to measure the functional deficit associated with an impaired vestibulo-ocular reflex is by comparing visual acuity from a baseline condition in which there is no head movement to visual acuity obtained during a dynamic condition with head movement. A previously described test incorporated a treadmill upon which patients walked during assessment of visual acuity. The objective of the current investigation was to evaluate an alternative method of assessing dynamic visual acuity that uses volitional head movement instead of walking on a treadmill.

Methods:

Fifteen participants with normal vestibular function and 16 participants with impaired vestibular function were enrolled. All participants performed the visual acuity task under baseline conditions with no movement and also under dynamic conditions that included 1) walking on a treadmill and 2) volitionally moving their head in the vertical plane.

Results:

No difference in performance was observed between the treadmill task and the volitional head movement task. Participants with impaired vestibular function performed more poorly under the dynamic conditions than did participants with normal vestibular function.

Conclusions:

The results suggest that the volitional head movement paradigm may be useful in identification of patients with functional deficits of the vestibulo-ocular reflex.
Office-Based 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis and Dysplasia
Authors: Zeitels Steven M. , Akst Lee M. , Burns James A. , Hillman Robert E. , Broadhurst Matthew S. , Anderson R. Rox
Published: October 2014

Objectives:

Treatment of glottal papillomatosis and dysplasia was mirror-guided and done in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. The primary treatment goals, which are disease regression and voice restoration and/or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. To obviate general anesthesia, office-based laser laryngeal surgery was first done in 2001 with the 585-nm pulsed dye laser (PDL), because it employs a fiber delivery system and its energy is selectively absorbed by oxyhemoglobin. Since then, this new angiolytic laser treatment paradigm has become a mainstay of management for many surgeons; however, there are a number of shortcomings of the PDL. To further develop this concept and address the limitations of the PDL, we used a 532-nm pulsed potassium titanyl phosphate (KTP) laser.

Methods:

A prospective assessment was performed on 48 patients in 72 cases of recurrent glottal dysplasia (36) or papillomatosis (36). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation.

Results:

Two dysplasia patients did not tolerate the procedure. Of the treatable dysplasia cases, there was follow-up in 29 of 34. Disease regression was at least 75% in 18 of 29 cases (62%), 50% to 75% in 7 of 29 (24%), and 25% to 50% in the remaining 4 of 29 (14%). Papilloma patients returned for treatment when symptoms recurred, so disease regression could not be assessed accurately. Similar to data obtained with the PDL, these data confirmed that dysplastic mucosa could normalize without resection.

Conclusions:

Our observations revealed that the 532-nm pulsed KTP laser provided enhanced performance over the PDL laser in a number of ways. The ability to use smaller glass fibers precluded mechanical trauma to the channels of the flexible laryngoscopes and allowed for improved suctioning of secretions. Oxyhemoglobin absorbs energy better at 532 nm than at 585 nm, and the KTP laser can be delivered through a longer pulse width. These factors provide enhanced hemostasis and improved intralesional energy absorbance. Finally, unlike the PDL, the KTP laser is a solid-state laser and is not prone to mechanical failure.
Headache with Unilateral Pulsatile Tinnitus in Women Can Signal Dural Sinus Thrombosis
Authors: Sigari Farhad , Blair Elizabeth , Redleaf Miriam
Published: October 2014

Objectives:

Dural sinus thrombosis commonly presents with headache, and rarely with tinnitus. These thromboses can progress to neurologic impairment and death. We are sharing recent clinical experiences with these thromboses as they present to the otologist.

Methods:

We report the presentation, physical examination, and imaging studies of 4 patients.

Results:

Four women had thrombotic occlusion of the sigmoid sinus. Their only symptoms were focal headache in all 4 patients, and unilateral pulsatile tinnitus in 2 of them. Imaging studies had to be repeated or alternative testing performed in order to conclusively identify the problem.

Conclusions:

It is important to be vigilant for the possibility of sigmoid sinus thrombosis in women who complain of unilateral head pain or unilateral pulsatile tinnitus. Appropriate imaging must be performed.
Impact of Facial Dysfunction on Quality of Life after Vestibular Schwannoma Surgery
Authors: Lassaletta Luis , Alfonso Carolina , Del Rio Laura , Roda Jose Maria , Gavilan Javier
Published: October 2014

Objectives:

This study was performed to evaluate the impact of facial dysfunction on quality of life in patients who underwent surgery for vestibular schwannoma. Other factors with a possible impact on quality of life were also assessed.

Methods:

We performed a retrospective review of 95 patients who underwent removal of a unilateral vestibular schwannoma. The Glasgow Benefit Inventory, an open-ended questionnaire, and a pain scale were sent to each patient. The questions were answered by 70 respondents (74%). After a minimum 1-year follow-up, the overall House-Brackmann postoperative facial function was grade I-II in 61% of patients, grade III-IV in 36%, and grade V-VI in 3%.

Results:

The open-ended questionnaire showed that 33% of patients stated a complaint related to facial dysfunction; it was the main complaint for 13% of patients. No significant difference was found in terms of Glasgow Benefit Inventory scores between patients with and without facial dysfunction, nor between those with different House-Brackmann grades. The most frequent complaint after surgery was hearing loss (46%). Postoperative pain was significantly associated with a worse postoperative quality of life.

Conclusions:

An overestimation of the effect of facial paralysis after vestibular schwannoma resection may exist on the surgeon's part. Detailed information about the possibility of hearing loss, vestibular problems, and pain must be given to all patients.
Relationship between Time of Exposure of Laryngopharyngeal Reflux and Gene Expression in Laryngeal Fibroblasts
Authors: Ylitalo Riitta , Thibeault Susan L.
Published: October 2014

Objectives:

Acid reflux is damaging to the laryngeal mucosa; however, the significance of the duration of reflux episodes has not been evaluated. The purpose of this study was to determine whether varying the exposure times at low pH with or without pepsin alters gene expression in laryngeal fibroblasts.

Methods:

Human false vocal fold and postcricoidal cultures were exposed to pH 4 or pH 5 media with and without pepsin for 10, 30, 60, and 240 seconds. Using a real-time polymerase chain reaction, we determined the messenger RNA expression of TGFβ-1, VEGF, FGF-2, EGR-1, ATF-3, CTGF, MMP-1, MMP-2, and decorin.

Results:

Molecular responses were initiated at pH 5. Postcricoidal fibroblasts were more sensitive than false vocal fold fibroblasts to the presence of pepsin. Changes in transcript levels were dependent on acid exposure time, and the most significant changes were measured during the first 60 seconds after exposure.

Conclusions:

Time of exposure to acid and pepsin needs to be taken into consideration when determining limit of pathology in pharyngeal reflux. Genes are identified that are induced by low pH and that may be of potential importance in the pathogenesis of reflux laryngitis.
Partial Neurolysis of the Hypoglossal Nerve for Selective Lingual Atrophy in a Porcine Model
Authors: Licup Ana Teresa , Arkia Homan , Mabel Anita , Cohen-Kerem Raanan , Forte Vito
Published: October 2014

Objectives:

Obstructive sleep apnea in children is most commonly treated with adenotonsillectomy; however, in cases of significant tongue base prolapse, this may prove inadequate. Surgical procedures used to increase the retroglossal airway have significant morbidities and low patient acceptability. We theorized that effective reduction of the tongue base can be achieved through partial denervation of the hypoglossal nerve, which is easily accessed in the submandibular space with minimal morbidity.

Methods:

We performed a prospective, experimental study in which topographic innervation maps of porcine tongue were generated by stimulating the hypoglossal main trunk and peripheral branches. The effects of complete unilateral nerve sectioning on tongue base volume and linear dimensions were measured and compared to the contralateral control side. In the final stage, only the peripheral nerve that was determined as the main supply to the tongue base was sectioned, and the results were compared to those in the matched controls.

Results:

A medial branch of the hypoglossal nerve was consistently identified as the main motor supply to the tongue base. Complete denervation resulted in a measurable decrease in the volume of the tongue base as compared to that of controls. Partial neurolysis produced inconsistent changes in 2 subjects, with decreases in linear dimensions that were not proportional to the decrease in volume. Histologically, complete denervation was followed by a significantly greater replacement of muscle with fat and connective tissue as compared with partial neurolysis.

Conclusions:

There were inconsistent changes in volume and linear dimensions of the tongue base following partial neurolysis of the hypoglossal nerve over the 3-month experimental period.
Tympanic Reperforation in Myringoplasty: Evaluation of Prognostic Factors
Authors: Albera Roberto , Ferrero Vittorio , Lacilla Michelangelo , Canale Andrea
Published: October 2014

Objectives:

The most frequent failure in myringoplasty is reperforation. This complication appears at a rate of 7% to 27%. The aim of this study was to evaluate the importance of the principal prognostic factors to the risk of reperforation.

Methods:

This is a study of prognosis based on an inception cohort. The prognostic factors considered in the study refer to clinical and surgical aspects; follow-up ranged from 5 to 7 years (mean, 68 months). The study was performed on 212 patients with or without otorrhea who underwent operation for tympanic perforation. All subjects underwent myringoplasty by means of an underlay or overlay technique depending on the size and site of the perforation.

Results:

Healing of the tympanic perforation was obtained in 182 cases (86%). Age, otorrhea, status of the contralateral ear, and conductive hearing loss did not significantly affect the outcome of surgery. On the other hand, time from surgery, the site of perforation, the type of anesthesia, the approach, the surgical technique, and the type of graft were significantly related to the outcome.

Conclusions:

In the analysis of our results, the surgical approach proved to be the principal prognostic factor in the anatomic outcome of myringoplasty. The results obtained suggest that the principal factors influencing the outcome of myringoplasty are technical and not clinical.
Transoral Robotic Surgery: Supraglottic Partial Laryngectomy
Authors: Weinstein Gregory S. , O'Malley Bert W. , Snyder Wendy , Hockstein Neil G.
Published: October 2014

Objectives:

We assessed the feasibility of performing transoral supraglottic partial laryngectomy with robotic instrumentation.

Methods:

Transoral robotic surgery (TORS) was performed on 3 human patients with supraglottic carcinoma in a prospective human trial. The study was approved by our institutional review board and involved the da Vinci Surgical Robot (Intuitive Surgical, Inc, Sunnyvale, California).

Results:

All procedures were completed robotically. The median overall operation time to perform the robotic procedure was 120 minutes (range, 1:32:48 to 2:58:18), including 18 minutes (range, 00:6:07 to 00:30:39) for exposure and robotic positioning. There were no intraoperative or postoperative complications or surgical mortality.

Conclusions:

The preliminary results of our series suggest that application of the da Vinci robotic surgical system for TORS to supraglottic partial laryngectomy is technically feasible and relatively safe. Furthermore, TORS provides excellent surgical exposure that allows complete tumor resection. Most importantly, TORS provides an alternative to open approaches and “conventional” transoral supraglottic partial laryngectomy.
Spontaneous Laryngeal Reinnervation after Recurrent Laryngeal or Vagus Nerve Injury
Authors: Woodson Gayle E.
Published: October 2014

Objectives:

The status of innervation in patients with laryngeal paralysis is somewhat controversial. Electromyographic activity has been frequently documented in the laryngeal muscles of patients with laryngeal paralysis, and animal experiments report a strong propensity for reinnervation after laryngeal nerve injury. However, a study of intraoperative electromyography performed in patients during reinnervation surgery failed to document activity with stimulation of the recurrent laryngeal nerve (RLN). Noting the long-observed differences in the symptoms of patients with vagus nerve injury and those with RLN injury, I hypothesized that reinnervation is influenced by the site of nerve injury.

Methods:

Cats were sacrificed at various intervals after resection of 1 cm of either the RLN or the vagus nerve, without any attempt to repair the nerve.

Results:

Four months after RLN resection, distal nerve biopsy revealed unmyelinated axons scattered through fibrous tissue. By 6 months, myelinated axons were organized, and electromyographic and histologic examination showed preferential reinnervation of the thyroarytenoid muscle. After vagotomy, the RLN was fibrotic and no axons were present. Both the thyroarytenoid and posterior cricoarytenoid muscles were fibrotic and had no electromyographic activity.

Conclusions:

The results confirm the strong propensity for laryngeal reinnervation after RLN injury, but not after vagus nerve injury. Preferential reinnervation of adductor muscles may account for a medial position of the paralyzed vocal fold.
Glottal Function Index: A Predictor of Glottal Disorders in Children
Authors: Cohen Jacob T. , Oestreicher-Kedem Yael , Fliss Dan M. , DeRowe Ari
Published: October 2014

Objectives:

Hyperkinetic laryngeal behaviors may be used to achieve glottal closure in the presence of vocal cord disorders. In adults, the Glottal Function Index (GFI) is a validated self-administered survey used to evaluate glottal insufficiency. In children, the relationships between glottal closure and vocal cord lesions have not been examined. We undertook to evaluate the efficacy of the GFI in detecting disorders of the vocal cords in children.

Methods:

We evaluated 100 consecutive children who underwent flexible fiberoptic laryngoscopy. A 4-item GFI questionnaire was administered to the parents of each study subject on study entry. The videotapes of the examinations were evaluated and scored by 3 investigators in a blinded manner. The GFI scores were compared in subjects with and without vocal cord findings.

Results:

The final analysis included 100 children 2 to 16 years of age. The mean age of the study group was 7.3 years (±3.9 years). Of the 100 patients, 54 had vocal cord disorders. The most common was vocal cord nodules, in most cases combined with bowing of the vocal cords; the two variables were highly correlated (p << .01). We performed a receiver operating characteristics test between the presence of vocal cord disorders and the GFI score. We found that the “optimal” score, on which the sensitivity and specificity curves cross, was 3. Of the 54 patients who had vocal cord disorders, the index identified 38 patients (70%), whereas the patients' complaints identified only 30 patients (55.6%). This difference was statistically significant (p < .05).

Conclusions:

The GFI is a reliable 4-item symptom index with excellent correlation to the presence of vocal cord lesions in children.
Numerical Analysis of Effects of Transglottal Pressure Change on Fundamental Frequency of Phonation
Authors: Deguchi Shinji , Matsuzaki Yuji , Ikeda Tadashige
Published: October 2014

Objectives:

In humans, a decrease in transglottal pressure ( Pt) causes an increase in the fundamental frequency of phonation ( F0) only at a specific voice pitch within the modal register, the mechanism of which remains unclear.

Methods:

In the present study, numerical analyses were performed to investigate the mechanism of the voice pitch-dependent positive change of F0 due to Pt decrease. The airflow and the airway, including the vocal folds, were modeled in terms of mechanics of fluid and structure.

Results:

Simulations of phonation using the numerical model indicated that Pt affects both the average position and the average amplitude magnitude of vocal fold self-excited oscillation in a non-monotonous manner. This effect results in voice pitch-dependent responses of F0 to Ft decreases, including the positive response of F0 as actually observed in humans.

Conclusions:

The findings of the present study highlight the importance of considering self-excited oscillation of the vocal folds in elucidation of the phonation mechanism.
Immuno-Scanning Electron Microscopy of Collagen Types I and III in Human Vocal Fold Lamina Propria
Authors: Tateya Tomoko , Tateya Ichiro , Bless Diane M.
Published: October 2014

Objectives:

This study was undertaken to identify the types of collagen fibrils in the extracellular matrix of the human vocal fold lamina propria.

Methods:

Human vocal folds were obtained from 3 autopsy cases less than 65 years of age. The vocal fold specimens were labeled by primary antibodies of anti-type I and anti-type III collagens, and then by secondary antibody conjugated with 15 nm colloidal gold. The specimens were observed with a scanning electron microscope. Secondary electron imaging and backscatter electron imaging of high-resolution field emission scanning electron microscopy were used to detect gold particles indicating immunolabeling.

Results:

Type III collagen-labeling gold particles were abundant on the fibrils constructing collagenous fibers, whereas type I collagen-labeling gold particles were sparsely present on fibrils in collagenous fibers. A few reticular fibers were labeled by both collagen type I and collagen type III.

Conclusions:

The results suggest that collagen type I coexists with collagen type III in fibrils of both collagenous fibers and reticular fibers.
Videokymography in Voice Disorders: What to Look For?
Authors: Švec Jan G. , Šram František , Schutte Harm K.
Published: October 2014

Objectives:

Kymographic imaging through videokymography has been recognized as a convenient, novel way to display laryngeal behavior, yet little systematic research has been done to map the relevant features displayed in such images. Here we have aimed at specification of these features to enable systematic visual characterization and categorization of vocal fold vibratory patterns in voice disorders.

Methods:

A cross-sectional, descriptive design was used. We selected 45 subjects and extracted 100 videokymographic images from the archive of more than 7,000 videokymographic examinations of subjects with a wide range of voice disorders. The images showed a large variety of vocal fold vibratory behaviors during sustained phonations. We visually identified the prominent features that distinguished the vibration patterns across the images.

Results:

We divided the findings into 10 feature categories. They included refined traditional features (eg, mucosal waves), as well as additional features that are obscured in strobolaryngoscopy (eg, different types of irregularities, left-right frequency differences, shapes of lateral and medial peaks, cycle aberrations).

Conclusions:

The variations in the identified features reveal different behavioral origins of voice disorders. The findings open new possibilities for objective documentation and for monitoring vocal fold behavior in clinical practice through kymographic imaging.
Vortical Flow Field during Phonation in an Excised Canine Larynx Model
Authors: Khosla Sid , Muruguppan Shanmugam , Gutmark Ephraim , Scherer Ronald
Published: October 2014

Objectives:

To more fully understand the mechanisms of vocal fold vibration and sound production, we studied the velocity flow fields above the folds. Such velocity fields during phonation have not been reported in the literature.

Methods:

Using the particle image velocimetry method for 3 excised canine larynges, we obtained the velocity fields in the mid-membranous coronal plane during different phases of phonation. The velocity field was determined synchronously with the vocal fold motion recorded by high-speed videography.

Results:

The results show that vortices occur immediately above the vocal folds and that the location and shape of the vortices depend on the phase of the phonation cycle. Consistent vortical structures found included starting vortices, Kel-vin-Helmholtz vortices, entrainment vortices, and vortices directly above the folds during the divergent glottal stage.

Conclusions:

These vortical structures were consistently found during specific phases of the glottal cycle for 3 canine larynges that significantly varied in size. This consistent behavior suggests that the vortices may be important for both vibration and sound production; however, further study is needed to prove this. The clinical significance of these vortices is discussed.
Transoral “Adenoidectomy” Excision of Juvenile Nasopharyngeal Angiofibromas
Authors: Solomon Don , Isaacson Glenn
Published: October 2014

Objectives:

We describe a minimally invasive technique for excision of selected juvenile nasopharyngeal angiofibromas (JNAs) using indirect visualization of the nasopharynx.

Methods:

An observational case series with follow-up of 9 months to 3 years was performed. The subjects included 4 teenage boys with early-stage nasopharyngeal angiofibromas. The intervention included computed tomography, magnetic resonance imaging, angiography and embolization, tumor excision, pathologic examination, and follow-up. The outcome measures included blood loss, perioperative morbidity, and surgical cure.

Results:

Four teenage boys underwent excision of early stage JNAs — 3 with preoperative embolization. The JNAs were excised under indirect mirror guidance with an adenoid curette and the nasopharynx packed. Residual tumor was removed endoscopically. The operative time was less than 1 hour in each case, and blood loss was less than 100 mL. All 4 boys are free of disease.

Conclusions:

With the advent of refined imaging techniques and relatively safe preoperative embolization, minimally invasive approaches to JNA excision have been advocated. Endoscopic transnasal piecemeal excision is feasible but time-consuming. Transoral avulsion of the tumor mass by adenoidectomy techniques combined with endoscopic removal of tumor remnants from the pterygopalatine fossa allows complete, controlled surgical excision with minimal blood loss.