bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amitriptyline for Symptomatic Treatment of Idiopathic Chronic Laryngeal Irritability
Authors: Stein Daniel J. , Noordzij J. Pieter 
Published: October 2014

Objectives: We evaluated the safety and efficacy of amitriptyline hydrochloride in treating idiopathic chronic laryngeal irritability. Methods: A retrospective chart review identified patients treated with amitriptyline for laryngeal irritability in an academic otolaryngology practice. Subjects who had documented medication compliance and a follow-up evaluation performed within 3 months after initiation of treatment were included. Symptoms, demographic information, and response to therapy were abstracted from the records. Results: Sixty-six subjects were identified, comprising 48 women and 18 men. The ethnicities were black, 42%; Hispanic, 27%; white, 20%; Asian, 6%; and other or unspecified, 5%. The response to treatment was judged complete in 32% of subjects, partial in 24%, and without improvement in 36%; the remaining 8% were unable to tolerate treatment. Overall, 56.1% of subjects improved (95% confidence limit, 43.3% to 68.3%). No significant differences in response rates were seen based on gender (p = 0.484), age (p = 0.590), or race (p = 0.846). Sedation was reported by 23% of individuals. Conclusions: We found that more than 50% of subjects who received amitriptyline for chronic laryngeal irritability experienced improvement, and most subjects tolerated this treatment. No differences in efficacy were seen among racial, age, and gender subgroups. A prospective randomized trial of this therapy appears warranted.
Potential for Respiratory Epithelium Regeneration from Induced Pluripotent Stem Cells
Authors: Otsuki Koshi , Imaizumi Mitsuyoshi , Nomoto Yukio , Wada Ikuo , Miyake Masao , Sugino Takashi , Omori Koichi 
Published: October 2014

Objectives: In cases of laryngeal inflammatory lesions and tracheal invasion of a malignant tumor, autologous tissue implantation techniques using skin or cartilage are often applied. However, these techniques are both invasive and unstable. The purpose of this study was to evaluate the potential use of induced pluripotent stem (iPS) cells in the regeneration of respiratory epithelium. Methods: We seeded iPS cells on low-attachment plates in serum-free media to generate embryoid bodies (EBs). After a 3-day culture, the EBs were transferred to a gelatin-coated dish supplemented with activin A alone or with basic fibroblast growth factor (induction groups). As a control, EBs were cultured without these growth factors (control group). Cultured tissues from all groups were histologically examined for 2 weeks. Results: In the induction groups, the presence of respiratory epithelium-like tissue was observed with hematoxylin and eosin staining after 14 days of culture. Conclusions: This study demonstrated the potential use of iPS cells in regeneration of the respiratory epithelium.
Recurrent Laryngeal Nerve Regeneration through a Silicone Tube Produces Reinnervation without Vocal Fold Mobility in Rats
Authors: Kumai Yoshihiko , Aoyama Takashi , Nishimoto Kohei , Sanuki Tetsuji , Minoda Ryosei , Yumoto Eiji 
Published: October 2014

Objectives: We established an animal model of recurrent laryngeal nerve reinnervation with persistent vocal fold immobility following recurrent laryngeal nerve injury. Methods: In 36 rats, the left recurrent laryngeal nerve was transected and the stumps were abutted in a silicone tube with a 1-mm interspace, facilitating regeneration. The mobility of the vocal folds was examined endoscopically 5, 10, and 15 weeks later. Electromyography of the thyroarytenoid muscle was performed. Reinnervation was assessed by means of a quantitative immunohistologic evaluation with anti-neurofilament antibody in the nerve both proximal and distal to the silicone tube. The atrophy of the thyroarytenoid muscle was assessed histologically. Results: We observed that all animals had a fixed left vocal fold throughout the study. The average neurofilament expression in the nerve both distal and proximal to the silicone tube, the muscle area, and the amplitude of the compound muscle action potential recorded from the thyroarytenoid muscle on the treated side increased significantly (p < 0.05) over time, demonstrating regeneration through the silicone tube. Conclusions: Recurrent laryngeal nerve regeneration through a silicone tube produced reinnervation without vocal fold mobility in rats. The efficacy of new laryngeal reinnervation treatments can be assessed with this model.
Salvage Transoral Laser Supraglottic Laryngectomy after Radiation Failure: A Report of Seven Cases
Authors: Hong Jong Chul , Kim Sung Won , Lee Hyoung Shin , Han Young Jin , Park Heon Soo , Lee Kang Dae 
Published: October 2014

Objectives: We evaluated the oncological and functional outcomes of salvage transoral laser supraglottic laryngectomy after radiation failure. In addition, we demonstrated the usefulness of laser surgery in patients with recurrent supraglottic cancer. Methods: Between December 1999 and May 2011, 7 patients (6 men and 1 woman) underwent transoral laser supraglottic laryngectomy after radiation failure. We conducted 4 different types of endoscopic supraglottic laryngectomy. In the cases with lymph node metastasis, we performed neck dissection at the time of laser surgery. Results: All patients had recurrent squamous cell carcinoma confirmed on the surgical specimen. Two patients were classified as having T1 disease, 2 as having T2 disease, and 3 as having T3 disease with preepiglottic space involvement. The 2- and 5-year overall survival rates were 85.7% and 68.6%, respectively. There was a recurrence at 8 months of follow-up after laser surgery in 1 patient; he underwent successful salvage total laryngectomy. The ultimate local control rate was 100%, and the laryngeal preservation rate was 85.7%. The hospitalization times ranged from 2 to 32 days (mean, 15.6 days). The mean decannulation time was 10.7 days (range, 5 to 30 days). All patients started oral feeding within 1 to 3 days after surgery. Conclusions: Salvage transoral laser supraglottic laryngectomy following radiation failure seems a feasible and oncologically safe procedure in recurrent supraglottic cancers ranging from T1 to selected T3 with minimal preepiglottic space involvement. It can be an option for minimally invasive organ preservation surgery with lesser morbidity for recurrent supraglottic cancer.
Optimal Level of Continuous Positive Airway Pressure: Auto-Adjusting Titration versus Titration with a Predictive Equation
Authors: Choi Ji Ho , Jun Young Joon , Oh Jeong In , Jung Jong Yoon , Hwang Gyu Ho , Kwon Soon Young , Lee Heung Man , Kim Tae Hoon , Lee Sang Hag , Lee Seung Hoon 
Published: October 2014

Objectives: The aims of the present study were twofold. We sought to compare two methods of titrating the level of continuous positive airway pressure (CPAP) — Auto-adjusting titration and titration using a predictive equation — With full-night manual titration used as the benchmark. We also investigated the reliability of the two methods in patients with obstructive sleep apnea syndrome (OSAS). Methods: Twenty consecutive adult patients with OSAS who had successful, full-night manual and auto-adjusting CPAP titration participated in this study. The titration pressure level was calculated with a previously developed predictive equation based on body mass index and apnea-hypopnea index. Results: The mean titration pressure levels obtained with the manual, auto-adjusting, and predictive equation methods were 9.0 ± 3.6, 9.4 ± 3.0, and 8.1 ± 1.6 cm H2O, respectively. There was a significant difference in the concordance within the range of ±2 cm H2O (p = 0.019) between both the auto-adjusting titration and the titration using the predictive equation compared to the full-night manual titration. However, there was no significant difference in the concordance within the range of ±1 cm H2O (p > 0.999). Conclusions: When compared to full-night manual titration as the standard method, auto-adjusting titration appears to be more reliable than using a predictive equation for determining the optimal CPAP level in patients with OSAS.
Bioluminescent Imaging of Pneumococcal Otitis Media in Chinchillas
Authors: Johnson Alan W. , Sidman James D. , Lin Jizhen 
Published: October 2014

Objectives: Bioluminescent imaging has emerged as a powerful tool for monitoring the pathological process of infections in animals. The purpose of this study was to harness this new tool for objective assessment of acute otitis media (AOM) in animals with and without antibiotic interventions. Methods: Thirty-six healthy chinchillas, free of middle ear infections, were randomly divided into a control group and a group that received amoxicillin treatment. Bioluminescent Streptococcus pneumoniae (Xen 10) was injected into the epitympanic bullae of chinchillas (50 colony-forming units each) for induction of AOM. The infectious process of Xen 10 in the bullae of living animals with and without antibiotic interventions was monitored in real time with bioluminescence equipment. Results: A dynamic change of bioluminescent signals in the bullae of chinchillas from days 1 to 14 was observed after Xen 10 injection. Amoxicillin treatment reduced the bioluminescent signals in the bullae of chinchillas compared with controls. The AOM persisted for 14 days, and middle ear effusion for 6 weeks, in the control animals, whereas AOM lasted for 2 days, and effusion for 6 to 12 days, in the antibiotic-treated animals. Conclusions: Bioluminescent imaging provides an innovative method for assessment of the bacterial loads in the middle ear of chinchillas in a real-time manner and is very useful for objective evaluation of the efficacy of therapeutic interventions.
Balloon Dilation Complication during the Treatment of Subglottic Stenosis: Background of the FDA Class 1 Recall for the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System
Authors: Achkar Jihad , Dowdal Jayme , Fink Daniel , Franco Ramon , Song Phillip 
Published: October 2014

Objectives: Balloon dilation for subglottic stenosis allows for a controlled radial expansion of the airway and is considered superior to older techniques of airway dilation. We report the case of a 39-year-old woman with idiopathic subglottic stenosis who had entrapment of an inflated balloon in her subglottis due to device failure while undergoing balloon dilation of the stenotic area. Methods: We present a case report and a review of the literature. Results: As a result of this and other reported incidents, on March 13, 2012, the US Food and Drug Administration issued a class 1 recall of the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System (Acclarent Inc, Menlo Park, California). Conclusions: This is the first report describing a dislodged inflated balloon in the subglottis as a complication of dilation for idiopathic subglottic stenosis. Awareness of this possibility, as well as preparedness with the proper instruments, is vital for prevention of a catastrophic emergency during an otherwise low-risk procedure.
Preoperative Computed Tomography Scan May Fail to Predict Perilymphatic Gusher
Authors: Krouchi Lydia , Callonnec Françoise , Bouchetemblé Pierre , Tollard Eleonore , Dehesdin Danièle , Marie Jean-Paul 
Published: October 2014

Objectives: A stapes gusher is a very rare event in ear surgery, but the consequences for hearing can be dramatic. It can usually be predicted by characteristic radiologic abnormalities. We report 2 cases of gusher without any abnormalities seen on the preoperative computed tomography scans. Methods: The first case was in a 30-year-old man with a bilateral mixed hearing loss. The gusher occurred after a stapedotomy performed with a microdrill. The oval window was plugged with a vein graft, and a fluoroplastic piston was inserted. The second case was in a 39-year-old woman with a family history of hearing loss who presented with a bilateral mixed hearing loss. The footplate was fractured during the stapedotomy drilling and was covered with a temporalis fascia graft that was fixed with a fluoroplastic piston. Results: The first patient had no cerebrospinal fluid leakage and no vertigo or tinnitus. He did have a sensorineural hearing loss. The second patient had dizziness and tinnitus. Postoperative magnetic resonance imaging scans were performed, but again no features were identified that might have predicted these cases. Conclusions: Surgeons should be reminded that a preoperative computed tomography scan may fail to detect the risk of a perilymphatic gusher.
Topical Bethanechol for the Improvement of Esophageal Dysmotility: A Pilot Study
Authors: O'Rourke Ashli , Weinberger Paul , Morrison Michele , Conklin Jeffrey , Postma Gregory 
Published: October 2014

Objectives: We studied a case series to evaluate the effect of topical bethanechol chloride on esophageal function in individuals with ineffective esophageal motility. Methods: Five subjects with ineffective esophageal motility underwent high resolution esophageal manometry. Ten 5 mL liquid swallows were performed to establish a baseline. Five milligrams of topical bethanechol was then administered. After 10 minutes, the subjects completed 10 additional liquid swallows. This procedure was repeated with 10 mg of bethanechol in 4 subjects. Results: After administration of 5 mg of topical bethanechol, the mean (±SD) distal contractile integral, an index of esophageal contractility, increased from 178.3 ± 83.1 mm Hg·s·cm to 272.3 ± 216.9 mm Hg·s·cm (p = 0.69). The percentage of failed swallows decreased from 52.8% ± 33.2% to 29.4% ± 18.3% (p = 0.14). The percentage of peristaltic swallows increased from 28.0% ± 26.8% to 67.2% ± 15.3% (p = 0.04). The contractile front velocity was essentially unchanged. After administration of 10 mg of bethanechol, the distal contractile integral decreased from 349.3 ± 371.0 mm Hg·s·cm to 261.8 ± 293.5 mm Hg·s·cm (p = 0.72). The percentage of failed swallows increased from 57.5% ± 37.7% to 66.8% ± 24.9% (p = 0.46). The percentage of peristaltic swallows increased from 17.5% ± 23.6% to 28.3% ± 19.1% (p = 0.29). The contractile front velocity decreased from 11.6 ± 5.2 cm/s to 4.9 ± 3.0 cm/s (p = 0.32). No adverse side effects occurred. Conclusions: The results of this pilot study support the need for further investigation with larger sample sizes and dose escalation.
Otologic Iontophoresis: A No-Papoose Technique
Authors: Syms Charles A. , Grantham Mary Lou 
Published: October 2014

Objectives: We describe a new iontophoresis solution, used in conjunction with a new iontophoresis system for achieving anesthesia of the tympanic membrane before myringotomy and insertion of pressure equalization tubes in an office setting. Methods: We selected 50 patients (86 ears) who met standard indications for myringotomy only or myringotomy and pressure equalization tube insertion for a single-site consecutive series trial (Institutional Review Board-approved; informed consent and assent) in the authors' clinical practice. Topical anesthesia was obtained with a new US Food and Drug Administration–cleared iontophoresis system (Acclarent, Inc, Menlo Park, California) and a novel iontophoresis solution mixture. The Wong-Baker FACES Pain Rating Scale was used to assess the tolerability of the iontophoresis system with the new solution and of the otologic procedure after topical anesthesia was obtained. Results: Iontophoresis success was obtained in 78 of 86 ears (90.7%). The average pain score for patients after iontophoresis was 1.07 on a 0-to-5 scale of increasing pain. The ear treatment was successful in 70 of 78 ears (89.7%). The average pain score for the surgical procedure was 1.19. Conclusions: This study demonstrates the safety and clinical effectiveness of the Acclarent iontophoresis system in conjunction with a new iontophoresis solution for anesthesia of the tympanic membrane in an office setting. This solution and device enable otologic procedures in children as young as 12 months of age without the use of a papoose, premedication, or general anesthesia.
Effect on Auditory Threshold of Air and Water Pockets Bordering the Pathway between Soft Tissue Stimulation Sites and the Cochlea
Authors: Adelman Cahtia , Perez Ronen , Sohmer Haim 
Published: October 2014

Objectives: Auditory sensation can be elicited by applying a bone conduction vibrator to skin sites on the head, neck, and thorax over soft tissues. This is called soft tissue conduction (STC). We hypothesized that introducing substances with acoustic impedances that sharply deviate from those of soft tissues, such as air pockets, into the soft tissues beneath soft tissue stimulation sites would have an effect on the auditory threshold to stimulation at skin sites over soft tissue. Methods: In human subjects, we assessed the auditory threshold with a bone vibrator applied to several STC sites, especially the cheek, and to several bone conduction sites on the skull. The subjects were equipped with bilateral earplugs. The subject then filled his or her cheek with either air or water, and the auditory threshold was again determined. We also recorded the auditory brain stem response to STC stimulation under the chin in fat sand rats in the absence and presence of subcutaneous air or saline solution pockets (0.4 mL) under the chin. Results: In humans, the threshold to stimulation on the cheek was elevated (13 to 18 dB) in the presence of an air-inflated cheek, but not with a water-filled cheek. In animals, in the presence of an air pocket, the auditory brain stem response threshold was elevated by 10 to 20 dB; no threshold change occurred with a saline solution pocket. Conclusions: The introduction of air (but not water) into the soft tissues beneath the soft tissue stimulation sites led to a threshold elevation in both humans and animals. This was not the case when an identical volume of water was introduced, which would also have interrupted a possible parallel bone conduction pathway. These results provide evidence that soft tissue stimulation at low intensities induces tissue vibrations that are transmitted to the cochlea along a series of soft tissues with similar acoustic impedances.
Prospective Evaluation of Office-Based Injection Laryngoplasty with Hyaluronic Acid Gel
Authors: Upton David C. , Johnson Matthew , Zelazny Sherri K. , Dailey Seth H. 
Published: October 2014

Objectives: The role of Juvederm Ultra Plus hyaluronic acid gel for use in injection laryngoplasty has not been well examined. The aim of this study was to prospectively assess the safety and clinical effectiveness of office-based injection laryngoplasty of Juvederm Ultra Plus gel in patients with glottic insufficiency. Methods: Thirty patients met the criteria for study inclusion and were treated with unsedated office-based injection laryngoplasty of Juvederm Ultra Plus gel over a 20-month period. The preinjection acoustic and aerodynamic measures, Voice Handicap Index, Glottal Function Index, and Dysphonia Severity Index were compared with values recorded at 1 and 4 months after injection. Results: Data for 27 patients were available for follow-up analysis at 1 month, and 12 patients' data were available at 4 months. Significant improvements, compared to preinjection levels (p < 0.02), were shown in all outcome measures at 1 and 4 months. One patient required intravenous steroid therapy for delayed glottic inflammation that resolved without permanent sequelae. Conclusions: The injection of Juvederm Ultra Plus gel is a relatively safe procedure that allows for short-term improvements in objective and subjective outcome measures of vocal function in patients with glottic insufficiency, provided the surgeon remains alert to the possibility of postprocedural injection site inflammation.
Cardiovascular and Blood Glucose Parameters in Infants during Propranolol Initiation for Treatment of Symptomatic Infantile Hemangiomas
Authors: Puttgen Katherine B. , Summerer Barbara , Schneider Jeremy , Cohen Bernard A. , Boss Emily F. , Bauman Nancy M. 
Published: October 2014

Objectives: We sought to determine the effect of propranolol on cardiovascular and blood glucose parameters in infants with symptomatic infantile hemangiomas who were hospitalized for initiation of treatment, and to analyze adverse effects of propranolol throughout the course of inpatient and outpatient treatment. Methods: A retrospective cohort analysis was performed on 50 infants (age less than 12 months) with symptomatic infantile hemangiomas who were hospitalized for propranolol initiation between 2008 and 2012. Demographic data and disease characteristics were recorded. Systolic and diastolic blood pressures, heart rate, blood glucose values, and adverse events recorded during hospitalization were analyzed. An additional cohort of 200 consecutively treated children was also assessed for adverse events associated with outpatient propranolol use. Results: The median age among the inpatient cohort was 3.4 months (range, 0.8 to 12.0 months). Infants older than 6 months were more likely to exhibit bradycardia than were younger infants (p < 0.001). Hypotensive and/or bradycardic periods were infrequent and were not associated with observable clinical symptoms. The mean systolic and diastolic blood pressures and the mean heart rate decreased significantly from day 1 of hospitalization to day 2 (p = 0.004; p = 0.008; p < 0.001), but not from day 2 to day 3, when the propranolol dose was increased to target. Hypoglycemia was rare (0.3% incidence.) Among the 250 outpatients, 2 infants developed lethargy and hypoglycemia during a viral illness and recovered without sequelae. One infant experienced recurrent bronchospasm with viral illnesses and required concomitant bronchodilator therapy. Conclusions: Frequent deviations from normal ranges of blood pressure and heart rate occur upon initiation of propranolol, but are clinically asymptomatic. These findings support that outpatient initiation of propranolol in healthy, normotensive infants appears to be a relatively safe alternative to inpatient initiation. Hypoglycemia is rare, but can occur throughout the treatment period; parent counseling is of paramount importance.
Laryngeal Obstruction by Cervical and Endolaryngeal Lymphatic Malformations in Children: Proposed Staging System and Review of Treatment
Authors: Berg Eric E. , Sobol Steven E. , Jacobs Ian 
Published: October 2014

Objectives: We review and stage a series of congenital lymphatic malformations (LMs) that caused laryngeal obstruction according to a proposed staging system, review the treatment modalities utilized, and correlate the stage of disease with clinical outcomes and tracheotomy statuses. Methods: We present a detailed description of the clinical presentation, management approach, and clinical outcome and tracheotomy status of a series of patients with laryngeal obstruction by LMs. A 4-part staging system (stages I to IV) for congenital LMs obstructing the larynx, based upon our clinical experience, is proposed. The patients were retrospectively reviewed and staged according to the proposed system, and clinical management and outcomes were correlated with the stage of disease. Results: We identified 16 patients with laryngeal obstruction by LMs. Eighty-one percent (13 of 16) received sclerotherapy, and 50% (8 of 16) underwent operative excision or debridement. Forty percent (2 of 5) of stage I lesions, 75% (3 of 4) of stage II lesions, 100% (4 of 4) of stage III lesions, and 100% (3 of 3) of stage IV lesions were in patients who required tracheotomy. All patients who had stage I and II lesions and required tracheotomy have been decannulated, whereas only 2 of the 4 patients with stage III lesions and no patients with stage IV lesions have been successfully decannulated. Conclusions: Lymphatic malformations obstructing the larynx require a careful and often staged management approach. A proposed staging system helps to predict the need for tracheotomy and the likelihood of long-term tracheotomy dependence.