bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Compliance with Proton Pump Inhibitor Therapy in an Otolaryngology Practice
Authors: Chheda Neil N. , Postma Gregory N. 
Published: October 2014

Objectives: Proton pump inhibitors (PPIs) are used for the treatment of numerous otolaryngological disorders. It has been demonstrated that administration of the medication 15 to 45 minutes before a meal optimizes acid suppression. The rate of compliance with optimal PPI dosage patterns in an otolaryngology practice is not known. We sought to determine the rate of PPI compliance in patients seen in an otolaryngology practice. Methods: We conducted an interview at a tertiary voice and swallowing center of 200 consecutive patients who were taking PPIs. Results: Overall, 54% of patients took their PPI in an optimal manner. The rate of compliance was significantly higher for patients who had their PPI prescribed by an otolaryngologist (62%) than for patients whose PPI was prescribed by a non-otolaryngologist (40%). Conclusions: Nearly half of all patients seen at a voice and swallowing center were not compliant with optimal PPI usage. This percentage is similar to that found for other long-term medications. Patient education can lead to higher rates of compliance, improved acid control, and possibly improved treatment outcomes.
Clinical Application of in Situ Tissue Engineering Using a Scaffolding Technique for Reconstruction of the Larynx and Trachea
Authors: Omori Koichi , Tada Yasuhiro , Suzuki Teruhisa , Nomoto Yukio , Matsuzuka Takashi , Kobayashi Ken , Nakamura Tatsuo , Kanemaru Shinichi , Yamashita Masaru , Asato Ryo 
Published: October 2014

Objectives: The objective of the present study was to demonstrate the efficacy of the clinical application of in situ tissue engineering using a scaffolding technique for laryngeal and tracheal tissue. Methods: We have developed a tissue scaffold made from a Marlex mesh tube covered by collagen sponge. Based on successful animal experimental studies, in situ tissue engineering with a scaffold implant was applied to repair the larynx and trachea in 4 patients. Results: In 1 patient with subglottic stenosis, the thyroid cartilage, cricoid cartilage, and cervical trachea with scarring and granulation were resected and reconstructed by use of the scaffold. In 3 patients with thyroid cancer, the trachea and cricoid cartilage with tumor invasion were resected and the scaffold was implanted into the defect. Postoperative endoscopy during the observation period of 8 to 34 months showed a well-epithelialized airway lumen without any obstruction. Conclusions: Our current technique of in situ tissue engineering using a scaffold shows great potential for use in the regeneration of airway defects.
Lemierre's Syndrome: What are the Roles for Anticoagulation and Long-Term Antibiotic Therapy?
Authors: Bondy Peter , Grant Thomas 
Published: October 2014

Objectives: We wanted to describe what Lemierre's syndrome is and what risk factors may be involved, and to understand the roles, if any, of antibiotics and anticoagulants in the treatment of this syndrome. Methods: We performed a review of the pertinent literature regarding Lemierre's syndrome, as well as a review of otology, obstetrics and gynecology, and internal medicine literature looking at both anticoagulation and long-term antibiotic treatment for septic thrombosis. Results: The vast majority of patients with Lemierre's syndrome are successfully treated nonsurgically with antibiotics and, often, anticoagulation as well. Surgical intervention is reserved for those cases with persistent showering of septic emboli or continued propagation of the thrombosis. Although anticoagulation is commonly used in other specialties for similar septic thromboses, its role in Lemierre's syndrome is unclear at the present. Conclusions: Because Lemierre's syndrome is so rare, it is difficult to ascertain absolutely the need for either anticoagulation or long-term antibiotic therapy. At this time, the risks and benefits of providing either therapy must be weighed against the potential complications of incompletely treating septic thrombosis.
Canal Wall—Down Tympanoplasty with Soft-Wall Reconstruction Using the Pedicled Temporoparietal Fascial Flap: Technique and Preliminary Results
Authors: Haginomori Shin-Ichi , Nonaka Ryuzaburo , Takenaka Hiroshi , Ueda Koichi 
Published: October 2014

Objectives: We compared the use of the pedicled temporoparietal fascial flap (TPFF) with the use of free deep temporal fascia (DTF) in soft-wall reconstruction after canal wall–down tympanoplasty. Methods: In the TPFF group (6 ears), the pedicled TPFF that includes the superficial temporal artery and vein was raised ipsilaterally and rotated into the eradicated mastoid cavity. The tympanic membrane and external auditory canal (EAC) were reconstructed by gluing one side of the TPFF to the mucosal layer of the tympanic membrane and the reverse side of the posterior EAC skin. In the DTF group (21 ears), reconstruction was performed similarly with free DTF. The postoperative period for epithelialization of the tympanic membrane and EAC skin, postoperative complications, and reaeration in the middle ear revealed by computed tomography were reviewed in both groups. Results: In the TPFF group, the mean (±SD) period to epithelialization was 25.5 ± 2.8 days versus 38.4 ± 12.0 days in the DTF group; the two groups differed statistically (Welch's t-test, p = 0.0002). No postoperative complications occurred in the TPFF group, whereas 2 patients in the DTF group underwent graft necrosis with infection. Three of the 6 patients in the TPFF group showed reaeration not only in the tympanic cavity, but also in the mastoid cavity. However, no statistical differences between the two groups were observed in terms of postoperative complications or reaeration of the mastoid cavity. Conclusions: Our preliminary findings suggest that the pedicled TPFF has positive effects on quick epithelialization. Further prospective studies are needed to reveal the superiority of the pedicled TPFF over free DTF with regard to postoperative infection and recovery of mastoid aeration.
Reflex Vocal Fold Adduction in the Porcine Model: The Effects of Stimuli Delivered to Various Sensory Nerves
Authors: Woo Jeong-Soo , Hundal Jagdeep S. , Sasaki Clarence T. , Abdelmessih Mikhail W. , Kelleher Stephen P. 
Published: October 2014

Objectives: The aim of this study was to identify a panel of sensory nerves capable of eliciting an evoked glottic closure reflex (GCR) and to quantify the glottic closing force (GCF) of these responses in a porcine model. Methods: In 5 pigs, the internal branch of the superior laryngeal nerve (iSLN) and the trigeminal, pharyngeal plexus, glossopharyngeal, radial, and intercostal nerves were surgically isolated and electrically stimulated. During stimulation of each nerve, the GCR was detected by laryngeal electromyography and the GCF was measured with a pressure transducer. Results: The only nerve that elicited the GCR in the 5 pigs was the iSLN. The average GCF was 288.9 mm Hg. Conclusions: This study demonstrates that the only afferent nerve that elicits the GCR in pigs is the iSLN, and that it should remain the focus of research for the rehabilitation of patients with absent or defective reflex vocal fold adduction.
Nijmegen Results with Application of a Bone-Anchored Hearing Aid in Children: Simplified Surgical Technique
Authors: de Wolf Maarten J. F. , Hol Myrthe K. S. , Huygen Patrick L. M. , Mylanus Emmanuel A. M. , Cremers W. R. J. 
Published: October 2014

Objectives: A retrospective analysis was performed to evaluate the clinical outcome of percutaneous bone-anchored hearing aid (BAHA) application in children with the outcome measures of fixture loss and skin reactions. Methods: An analysis was done of 93 of the 101 children 16 years of age or younger who underwent the simplified Nijmegen surgical technique between January 1994 and July 2007. Results: Twenty-one of 129 fixtures (16.3%) were lost or removed. In 12 cases, osseointegration failed. The majority of the fixture losses (86%) occurred within 1 year after surgery. No differences were found between 3 age groups or between fixture lengths (seven 3-mm implants versus fourteen 4-mm implants). The BAHA fixtures were less stable in children than in adults. In 8 cases, Holgers grade 4 skin reactions were noted at an average (±SD) of 5.5 ± 4.7 months after surgery, ie, significantly sooner than the milder reactions (p = 0.001). In 28 cases (22%), skin reactions of Holgers grades 2 to 4 were observed. Revision surgery to reduce subcutaneous scar tissue was necessary in 22 implants (17%). Conclusions: Fixture loss was more frequent in children than in adults. The age of the child and the length of the fixture did not appear to influence fixture stability. Children should undergo frequent checkups at the outpatient clinic.
Cystic Lymphatic Malformation of the Middle Ear
Authors: Tanna Neil , Sidell Douglas , Schwartz Arnold M. , Schessel David A. 
Published: October 2014

Objectives: We review the clinical, radiologic, and histopathologic features of cystic lymphangioma of the middle ear, and discuss the developmental etiology and management of such a lesion. Methods: We present an unusual location for the development of a cystic lymphangioma with emphasis on etiology, clinical implications, and current treatment. Results: A 10-year-old girl presented with a mass involving the medial surface of the right tympanic membrane. T2-weighted magnetic resonance imaging demonstrated a hyperintense lesion in the anterior-superior middle ear cavity without evidence of vascular abnormalities. Conclusions: To our knowledge, this is the only report of lymphangioma involving the middle ear represented in the English-language literature. Such a lesion has been demonstrated to arise from abnormalities in growth factors that contribute to the tightly regulated process of lymphangiogenesis. Lymphatic malformations can be diagnosed presumptively by virtue of magnetic resonance imaging in combination with a detailed physical examination. The treatment of choice for lymphangiomas located in the middle ear is surgical excision. Definitive diagnosis of the lesion is then made by identifying specific histopathologic characteristics. Although rare and histologically benign, middle ear lymphangiomas may produce significant patient discomfort and ultimately a conductive hearing loss. Therefore, these lesions warrant early recognition and treatment.
Performance of an Automated, Remote System to Detect Vocal Fold Paralysis
Authors: Wormald Robert N. , Moran Rosalyn J. , Reilly Richard B. , Lacy Peter D. 
Published: October 2014

Objectives: The aim of this project was to evaluate the diagnostic accuracy of an automated, remote system for correctly identifying vocal fold paralysis. Methods: Consecutive patients presenting for vocal analysis at the Beaumont Hospital Voice Clinic were enrolled in this prospective, blinded study. Control patients were enlisted from routine otolaryngology clinics. All patients were assessed by standard history, clinical examination, and flexible laryngoscopy or videostroboscopy. The subjects were blindly assessed by remote voice analysis. Sustained phonation was recorded over a standard telephone network. Each recording was subjected to automated, remote analysis of extracted features, including measures of pitch perturbation, amplitude perturbation, and harmonics-to-noise ratio. The presence or absence of a vocal fold paralysis as determined by the automated classifier was recorded and correlated with clinical findings. Results: Seventy-eight consecutive patients were enrolled in the study. The automated speech analysis system demonstrated 92% sensitivity and 75% specificity for detecting vocal fold paralysis. Conclusions: This pilot study, assessing an automated system that analyzes audiological data remotely over the standard telephone network, suggests that with further “training” it may become a reliable, simple, and convenient means for screening patients for voice disorders.
Contemporary Role of Endolymphatic Mastoid Shunt Surgery in the Era of Transtympanic Perfusion Strategies
Authors: Lee Lisa , Pensak Myles L. 
Published: October 2014

Objectives: Although there exist undisputed methods to permanently silence the aberrant end organ, controversy surrounds the durable efficacy of non-ablative interventions. This study provides a contemporary review of our institution's clinical experience in performing endolymphatic mastoid shunt surgery (EMSS) in patients with medically refractory endolymphatic hydrops, or Meniere's disease. Methods: Between 1984 and 2002, 1,612 patients were referred to our institution with a diagnosis of Meniere's disease. Of these referrals, 1,172 patients met the criteria for Meniere's disease. Although 553 patients responded to medical management, 486 patients underwent EMSS and 133 patients had refractory disease that required chemical or surgical obliterative interventions. The retrospective study utilizes data collected on 226 patients who were followed for a minimum of 5 years. Results: Overall, 78% patients responded favorably to EMSS, according to the functional level scale and class categories delineated by the American Academy of Otolaryngology-Head and Neck Surgery 1995 guidelines for control of vertigo. According to the Arenberg anatomic classification for endolymphatic sac location, EMSS achieved adequate control of vertigo in 86% of type I cases, 90% of type II cases, and 82% of type III cases. Conclusions: Endolymphatic mastoid shunt surgery is a relatively safe, effective procedure for the long-term control of vertigo in patients with medically refractory Meniere's disease.
Damage to Ciliated Epithelium in Chronic Rhinosinusitis: What is the Role of Bacterial Biofilms?
Authors: Galli Jacopo , Calò Lea , Ardito Fausta , Imperiali Micaela , Bassotti Ezio , Passali Giulio Cesare , La Torre Giuseppe , Paludetti Gaetano , Fadda Giovanni 
Published: October 2014

Objectives: We assess the association between the presence of biofilms and cilial damage in patients with chronic rhinosinusitis (CRS), describe the microorganisms associated with samples that exhibited cilial loss and biofilms, and demonstrate the absence of ciliary injury and biofilms in similarly prepared “normal” controls. Methods: We examined samples of ethmoid mucosa obtained from 24 patients who underwent functional endoscopic sinus surgery for CRS. Samples from a control group (20 healthy subjects) were also examined. The specimens were divided into 2 fragments; the first was processed for bacterial cultures, and the second was subjected to scanning electron microscopy. Statistical analysis was performed. Results: All CRS samples had positive bacterial cultures. The scanning electron microscopy analysis showed bacterial biofilms in 10 of the 24 specimens. A marked destruction of the epithelium was observed in samples positive for biofilms (p < 0.001), and the presence of Haemophilus influenzae was associated with ciliary abnormalities (partial damage in 55.6% and absence of cilia in 50%; p = 0.041). Conclusions: The high percentage of biofilms in our specimens confirms the association between biofilms and CRS. Our data support the hypothesis that biofilm formation represents the latter phase of an inflammatory process that leads to complete epithelial destruction.
Comparison of an Oropharyngeal pH Probe and a Standard Dual pH Probe for Diagnosis of Laryngopharyngeal Reflux
Authors: Golub Justin S. , Johns Michael M. , Lim Jae H. , DelGaudio John M. , Klein Adam M. 
Published: October 2014

Objectives: We compared the ability of an oropharyngeal (OP) aerosol-detecting pH probe and a standard dual pH probe in measuring laryngopharyngeal reflux (LPR). Methods: Fifteen subjects with LPR symptoms had 24-hour simultaneous placement of the OP probe and a standard dual pH probe. Acid exposure was defined as a 10% pH decrease below baseline for the OP probe or a pH of less than 4 at the upper esophageal sphincter (UES) probe of the dual pH probe. Results: The mean duration of acid exposure was 650 seconds (SD, 619) or 0.75% of the total time for the OP probe and 438 seconds (SD, 511) or 0.51% of the total time for the UES probe. When we excluded meals and sleep, the mean duration of acid exposure was 271 seconds (SD, 356) or 0.31% of the total time for the OP probe and 271 seconds (SD, 359) or 0.31% of the total time for the UES probe. The correlation coefficient (R) between the two probes for measurement of the duration of acid exposure was 0.50 (p < 0.05). When we excluded meals and the supine position, the R was notably higher, at 0.95 (p < 0.0001). Conclusions: The OP probe reliably documented LPR events when meals and sleep were eliminated and was better tolerated than the standard dual probe.
Advanced Oral Tongue Cancer in a 22-Year-Old Pregnant Woman
Authors: Cheung Esther J. , Wagner Henry , Botti John J. , Fedok Fred , Goldenberg David 
Published: October 2014

Objectives: Oral squamous cell carcinoma generally occurs in older men and is associated mostly with tobacco and alcohol as the primary risk factors. The incidence of oral squamous cell carcinoma in younger patients has increased. We report a case of a young woman, 25 weeks pregnant, who presented with stage IV carcinoma of the oral tongue. Methods: The following is a case presentation and literature review. Results: The patient presented with T4 N3 M0 oral tongue cancer. A team consisting of a head and neck surgeon, a radiation oncologist, a medical oncologist, and a maternal-fetal medicine specialist was assembled. The patient initially refused surgery. Chemotherapy was initiated until 32 weeks' gestation. After an infant boy was delivered via cesarean section, the patient began concurrent irradiation and chemotherapy, which induced complete regression of the primary tongue neoplasm with a partial response of the neck nodes. The patient underwent bilateral neck dissection followed by hemiglossectomy for recurrence. Conclusions: Management of advanced oral carcinoma in pregnancy presents a unique set of challenges. Few studies have described chemotherapy and radiotherapy during pregnancy, and long-term results are needed. Care must be taken to balance appropriate and adequate treatment of disease and to ensure the safety of the patient and the fetus.
Secondary Airway Lesions in Infants with Laryngomalacia
Authors: Dickson J. Matthew , Richter Gresham T. , Meinzen-Derr Jareen , Rutter Michael J. , Thompson Dana M. 
Published: October 2014

Objectives: We sought to determine the incidence of secondary airway lesions in infants with laryngomalacia and to compare the incidences of these concomitant airway lesions in infants with severe, moderate, and mild laryngomalacia; to determine whether infants with mild or moderate laryngomalacia have a higher incidence of surgical intervention when a secondary airway lesion is present; and to determine whether the incidence of gastroesophageal reflux disease (GERD) is affected by the presence of a secondary airway lesion. Methods: We performed a retrospective review of a database consisting of 201 infants with a diagnosis of laryngomalacia treated at a pediatric tertiary referral center between June 1998 and June 2003. Data pertaining to demographic information, severity of laryngomalacia, presence of secondary airway lesions, and diagnosis of GERD were collected and analyzed. Results: Of the 201 infants, 104 (51.7%) were found to have a secondary airway lesion. Subglottic stenosis was found in 38.8%, and tracheomalacia in 37.8%. Of the infants with severe laryngomalacia, 30 (79%) had a diagnosis of a secondary lesion, compared with 51 (61.5%) of those with moderate and 23 (28.8%) of those with mild disease. Among infants with mild or moderate disease, those with secondary airway lesions were more likely to require surgical intervention than were infants without secondary airway lesions (27% versus 5.6%; p = 0.0002). There was no difference in the rates of secondary airway lesions in infants managed with supraglottoplasty versus tracheotomy. The incidence of GERD in this patient population was 65.6%. Infants with a secondary airway lesion were more likely to have GERD than were those without a secondary airway lesion (84.6% versus 45.4%; p < 0.0001). Conclusions: The incidence of secondary airway lesions in our population of infants with laryngomalacia was higher than those previously reported. The severity of disease correlated with the diagnosis of a secondary airway lesion. Secondary airway lesions lead to an increased incidence of surgical intervention and GERD in infants with laryngomalacia.
Preserved Regeneration and Functional Recovery of the Injured Recurrent Laryngeal Nerve after Secondary Surgical Repair in Adult Rats
Authors: Hydman Jonas , Mattsson Per 
Published: October 2014

Objectives: Transection of the recurrent laryngeal nerve (RLN) is accompanied by poor functional recovery, despite primary repair, because of regeneration difficulties. Nimodipine can promote regeneration, but it is not yet clear whether preoperative treatment is necessary. It is also not clear whether surgical repair following RLN injury may be performed in a second procedure, with preserved regeneration. This study investigated the time window for secondary surgical repair of the transected RLN and the need for preoperative administration of nimodipine. Methods: In adult rats, the left RLN was transected and repaired at time intervals up to 3 weeks after transection, in combination with nimodipine treatment starting either before or after the operation. Regeneration and neuromuscular recovery were assessed by electrophysiology, retrograde tracing, and immunohistochemistry. Results: Similar (whether 0, 2, or 7 days) regenerative results were obtained when the RLN was repaired up to 1 week after injury, given nimodipine administration, whereas fewer motor neurons managed to regenerate after nerve repair at 3 weeks after the initial transection. No beneficial effect was detected from preoperative nimodipine administration. Conclusions: Provided that nimodipine is administered, surgical reconstruction of the RLN can be performed within 1 week after the initial nerve trauma, with preserved neuromuscular function. Nimodipine may be administered at the time of RLN transection injury.
Indirect Estimation of Laryngeal Resistance via Airflow Redirection
Authors: Rieves Adam L. , Hoffman Matthew R. , Jiang Jack J. 
Published: October 2014

Objectives: Our aim was to estimate aerodynamic parameters of laryngeal resistance (Rl) and aerodynamic power indirectly from a subglottal pressure (Ps) data trace obtained with the airflow redirection system. Methods: During airflow interruption, the airflow redirection tank fills capacitively with pressure until it reaches the subject's Ps. Therefore, a time constant, τ, can be extracted from the data trace and used to calculate Rl. The validity of applying this method to the estimation of RL was demonstrated with a computer model. Estimations were made for values of 10, 20, 30, 40, and 50 cm H2O per liter per second (L/s). Twenty subjects performed 10 trials on the experimental system designed to measure Ps. The values of RL and aerodynamic power were then calculated. Results: The computer model simulation yielded a maximum measurement error of 3.00% and a mean error of 1.78%. In human subject testing, the mean ± SD laryngeal resistance was 22.61 ± 8.65 cm H2O per L/s, the mean Ps was 6.91 ± 1.94 cm H2O, and the mean aerodynamic power was 0.247 ± 0.170 kPa × (L/s). Conclusions: The proposed method of data analysis enables a clinician to estimate Rl and aerodynamic power from a single experimental trial designed to measure Ps. This technique provides the clinician with an aerodynamic function report that can be used to analyze patient health and treatment efficacy.