bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Is Microvascular Compression of the Vestibulocochlear Nerve a Cause of Unilateral Hearing Loss?
Authors: van der Steenstraten Femke , de Ru J. Alexander , Witkamp Theo D. 
Published: October 2014

Objectives: We sought to confirm earlier findings in the literature that microvascular compression of the vestibulocochlear nerve might cause unilateral sensorineural hearing loss. We measured the length and width of the internal auditory canal (IAC) to investigate a possible association between a narrow porus, the presence of an anterior inferior cerebellar artery (AICA) loop, and the development of a microvascular compression syndrome. Methods: We performed a prospective blinded analysis of 167 magnetic resonance imaging scans of the cerebellopontine angle. The presence of an AICA loop was scored. We analyzed these 167 patients for unilateral sensorineural hearing loss, which was defined as an interaural difference of 20 dB at 1 frequency or 10 dB at 2 or more frequencies. Furthermore, the width and length of the IAC on magnetic resonance imaging were measured. Results: An AICA loop was identified in 94% of the 167 patients. There were 196 type I loops, 106 type II loops, and 14 type III loops. Sixty-six patients had unexplained unilateral hearing loss. There was no association between type II and III vascular loops, the width of the IAC, and unilateral hearing loss (p > .05). Conclusions: In this study we found no association between the depth of extension of the AICA loop into the IAC and the presence of unilateral hearing loss.
Bilabial Contact Pressure and Oral Air Pressure during Tracheoesophageal Speech
Authors: Searl Jeff 
Published: October 2014

Objectives: This study compared bilabial contact pressure (CPsp) and oral air pressure (Po) for /p/, /b/, and /m/ produced by tracheoesophageal (TE) versus laryngeal speakers. Nonspeech maximum bilabial contact pressures (CPmax) were measured to calculate the percentage of the range utilized for bilabial phonemes. Methods: Ten TE speakers and 10 laryngeal speakers produced syllables and sentences loaded with bilabial phonemes. The CPsp was measured with a miniature pressure transducer on the lower lip while the Po was simultaneously measured with a catheter in the corner of the mouth coupled to a differential pressure transducer. The speakers completed a non-speech lip-press task with the contact pressure transducer in place. Results: The TE speakers produced bilabial phonemes with significantly higher CPsp and Po than did laryngeal speakers. There was no difference in CPmax between the groups. The percentage of the contact pressure range utilized for bilabial phonemes was significantly higher for TE speakers. Conclusions: The increased CPsp and Po exhibited by TE speakers may reflect an attempt to overexaggerate articulation, although an alternate explanation related to neoglottal and oral aerodynamics must also be considered in future work. Subsequent studies evaluating the relationships between magnitude of articulatory contact pressure, phoneme intelligibility, and speaker's sense of effort should contribute to a better understanding of TE speech demands and may guide novel interventions to facilitate TE speech intelligibility.
Management of Aerodigestive Tract Foreign Bodies: Innovative Teaching Concepts
Authors: Deutsch Ellen S. , Dixit Divya , Curry Joseph , Malloy Kelly , Christenson Tom , Robinson Barbara , Cognetti David 
Published: October 2014

Objectives: We discuss a method to provide medical education in bronchoesophagology by using high-fidelity patient simulation manikins. Methods: A sophisticated, life-sized infant manikin with realistic anatomic, physiologic, and hemodynamic responses to interventions was programmed to simulate endobronchial foreign body lodgment by blocking ventilation of one lung and manifesting audible stridor, asymmetric chest wall motion, and decreased oxygen saturation. Results: Otolaryngology residents participated in simulation exercises incorporating the cognitive and technical skills necessary for successful airway endoscopy, including technical proficiency and teamwork, to learn to coordinate endoscopy and ventilation and manage laryngospasm. Rather than relying on instructor description, the participants responded directly to the manikin. This sense of realism stimulated participants to rehearse to improve provider performance and patient safety. Simulation provided an agenda determined by the needs of the learners, exploration without direct risk to patients, immediate feedback, and objective documentation. Conclusions: Rapidly evolving medical simulation technologies support activated, effective adult learning; they will play an increasing role in medical education.
True Vocal Fold Immobility in the Setting of Well-Differentiated Thyroid Carcinoma: Unusual Illustrative Cases and Recommendations for Operative Strategy
Authors: Amini Kamyar , Frank Douglas K. 
Published: October 2014

Objectives: We present cases of transient true vocal fold (TVF) immobility caused by well-differentiated thyroid carcinoma (WDTC), and review the literature concerning management of WDTC invading the recurrent laryngeal nerve (RLN). Methods: A description of the clinical course of 2 patients with WDTC and transient TVF immobility is presented in the context of a review of the literature concerning locally advanced WDTC with extrathyroidal extension and RLN involvement. Results: Both patients had papillary thyroid carcinoma with ipsilateral TVF paralysis that resolved completely before operation. During the operation, the RLN was found to be grossly involved with disease and inseparable from the tumor, necessitating resection. Review of the literature revealed the following points that should be considered when confronting an RLN invaded by WDTC. 1) Benign disease can mimic invasive WDTC and must be ruled out. 2) RLN invasion does not carry the same prognostic implications as other categories of extrathyroidal extension of WDTC. 3) RLN sacrifice does not increase the overall survival rate. 4) There is no evidence that a paralyzed RLN will regain function when preserved. 5) The majority of RLNs that function before operation can be expected to function after the operation if preserved. Conclusions: Resolution of TVF paralysis should not reduce suspicion of RLN involvement by WDTC. When RLN involvement is discovered during operation, every attempt should be made to preserve a functioning RLN.
Optical Recording of the Intrinsic Signal from the Human Olfactory Cleft
Authors: Ishimaru Tadashi 
Published: October 2014

Objectives: Endoscopy of the human olfactory cleft is important for both research in human olfaction and clinical examination with regard to olfactory disorders. However, endoscopy only provides information on the morphology and functional status of the epithelium, and it does not allow discrimination between respiratory and olfactory mucosa. To obtain information on the functional status of the olfactory mucosa, I used endoscopy to investigate the optical intrinsic signal recording from the human olfactory cleft. Methods: A light-emitting diode (617 nm) light source and a cooled charge-coupled device camera were prepared for endoscopy of the olfactory cleft. Subjects were exposed to various odors presented in front of their nostrils. In addition, blanks were used for control. Results: When normosmic subjects sniffed the odors, the intensity of the signal from the olfactory mucosa changed, which was not the case when blank stimuli were presented. Different odors activated different response patterns. A decrease of the oxyhemoglobin level in the activated olfactory epithelium is suspected to be responsible for this observation. Conclusions: The optical intrinsic signals were recorded from the human olfactory cleft with an endoscope. This technique may be applicable to basic research in olfaction and to a clinical test for the assessment of olfactory disorders.
Localization and Expression of MUC5B and MUC7 Mucins in Pediatric Sinus Mucosa
Authors: Peña Maria T. , Aujla Pawandeep K. , Zudaire Enrique , Watson Alan M. , Przygodzki Ronald , Zalzal George H. , Rose Mary C. 
Published: October 2014

Objectives: The purpose of this study was to analyze the secretory cell population and distribution of MUC5B and MUC7 mucins in the sinus mucosa of pediatric patients with and without chronic rhinosinusitis (CRS). Methods: Sinus mucosal specimens were collected at surgery in a pediatric tertiary care facility. Histologic, immunohistochemical, and morphometric analyses were performed on sinus mucosa of 20 children with CRS and 7 children without CRS. Results: A significant increase in the area of submucosal glands was evident in the sinus mucosa of children with CRS as compared to controls. MUC5B and MUC7 mucins were expressed in the submucosal glands, as well as in goblet cells, in the sinus mucosa of both populations. No differences in MUC5B or MUC7 expression were observed when mucin expression was normalized to glandular area. Conclusions: Children with CRS have an increased number of submucosal glands, indicating that glandular mucins contribute to mucus overproduction in CRS. MUC5B and MUC7 mucins, which have previously been considered only glandular mucins, are also expressed in goblet cells in the sinus mucosa.
Reflux Symptom Index versus Reflux Finding Score
Authors: Mesallam Tamer A. , Stemple Joseph C. , Sobeih Tarek M. , Elluru Ravindhra G. 
Published: October 2014

Objectives: We examined the correlation between the Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS) to determine the laryngeal signs and symptoms that were most significantly correlated. Methods: Forty randomly selected patients were included in the study. A retrospective chart review was performed for patients who fit the inclusion criteria. Videostroboscopic samples for the study group were reviewed and RFS-rated by 6 experienced raters on 2 different occasions to evaluate the interrater and intrarater reliability. The RSI and the RFS were statistically compared regarding both the total scores and the individual parameters. Results: The RFS ranged from 0 to 20, and the RSI varied from 14 to 38. There was a high agreement between the raters' scores, demonstrating high interrater and intrarater reliability for RFS. Additionally, the RSI and RFS were highly correlated (p < .0001). Hoarseness was highly correlated with vocal fold edema and thick laryngeal mucus (p < .01), and excessive throat clearing correlated significantly with thick endolaryngeal mucus (p < .01). Conclusions: The study demonstrates a highly significant correlation between the RFS and the RSI.