bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comprehensive Dynamic Airway Assessment: Audit of a Novel Technique to Improve Rates of Tracheostomy Decannulation
Authors: Oakley Richard J. , Ashfield Tom , Clarke Lynne , Chaterjee Debamoy , Shephard Buzz , Ahmad Imran 
Published: August 2013

Objectives:Prolonged tracheostomy is associated with morbidity, mortality, and length of stay. Otolaryngologists are called upon to diagnose and manage patients who have failed to achieve decannulation through conventional protocols. Flexible nasendoscopy (FNE) is commonly used but examines only the supraglottic airway. The comprehensive dynamic airway assessment (CDAA) extrapolates the principles of awake fiber‐optic intubation, allowing a complete upper airway assessment, including the subglottis with decannulation under direct vision, if appropriate.Methods:A two‐cycle audit was performed on patients discharged from the intensive care unit with tracheostomy in situ. A retrospective 25 month audit of decannulation rates was performed to assess conventional management with ear, nose, and throat (ENT) review and standard FNE in cases that failed to achieve decannulation due to airflow problems. A prospective 8 month audit was then undertaken after the inception of CDAA.Results:Using conventional management, the number of patients discharged from intensive care unit (ICU) with tracheostomy in situ was 137, of which 17 failed to decannulate through protocol management alone. Five (31%) patients were eventually decannulated using a standard approach. After inception of CDAA, 76 were discharged from ICU. Eight underwent CDAA, of whom 6 (75%) were decannulated; a diagnosis for decannulation failure was made in the remaining 2 patients.Conclusions:CDAA is an essential diagnostic tool that can improve outcomes for complex patients with tracheostomies. It requires minimal resource, is versatile, and is a natural extension of the expert nasendoscopic skills of the otolaryngologist. CDAA should form an integral part of all decannulation protocols.
Does PPI Therapy Normalize pH in Laryngopharyngeal Reflux Patients?
Authors: Friedman Michael , Pott Thomas R. , Waxman Jonathan 
Published: August 2013

Objectives:Laryngopharyngeal reflux (LPR) is commonly treated with twice‐daily proton pump inhibitor (PPI) therapy. However, a significant number of patients do not achieve complete resolution of symptoms. In this study, we aimed to assess the effect of twice‐daily PPI treatment on the oropharyngeal pH environment in patients with pH‐probe confirmed LPR.Methods:LPR was identified in 56 symptomatic patients using 24 hour Dx‐pH probe monitoring at a single center. Following a period of treatment with twice‐daily PPI, a second 24 hour pH monitoring study was performed. Compliance was determined by self‐report. Outcomes included supine and upright Ryan scores, number of patients with normal Ryan scores post‐treatment, and reflux severity index. Reflux severity index (RSI) was assessed pre‐ and post‐treatment.Results:34 women and 22 men were assessed pre‐ and post‐treatment, with age of 51.9 ± 16.8 years and BMI of 30.8 ± 7.0 kg/m2 (mean ± SD). Pre‐treatment upright and supine Ryan scores were 142.3±161.9 and 14.21 ± 17.14, respectively (mean ±SD). Patients were treated with twice‐daily PPIs for a duration of 105.7 ± 88.2 days (mean ± SD). Post‐treatment upright and supine Ryan scores were 72.66±140.5 and 12.27 ± 21.1, respectively (mean ±S D). Paired T‐tests showed a significant decrease in mean post‐treatment upright Ryan scores (P = 0.0003). However, post‐treatment Ryan scores normalized in only 26 subjects (46.4%). RSI scores were higher in non‐responders.Conclusions:While PPI therapy resulted in a significant decrease in mean upright Ryan score, the Ryan score was normalized in only 46.4% of patients. This suggests that twice‐daily PPIs may be insufficient to completely eliminate reflux and symptoms of LPR.
The Incidence of Premalignant and Malignant Disease in Reinke's Edema
Authors: Lim Shueh Y. , Sau Phoebe C.Y. , Cooper Lorna , McPhaden Allan , Mackenzie Kenneth 
Published: August 2013

Objectives:Reinke's Edema is a benign lesion of the vocal folds affecting the subepithelial space. This condition occurs almost exclusively in moderate to heavy smokers. As part of a study of the management of Reinke's Edema, we aimed to determine the prevalence of dysplasia and malignancy in histologically proven Reinke's Edema.Methods:A retrospective analysis of all laryngeal biopsies performed in North Glasgow, United Kingdom, between 2001 and 2010 was carried out through the North Glasgow Pathology Database. Clinical and pathological data from all patients with histologically confirmed Reinke's Oedema were recorded with specific respect to the reporting of dysplasia and malignancy.Results:From the 10 year cohort, a total of 3902 laryngeal biopsies were performed. 190 patients (19 males and 171 females) had histologically proven Reinke's Edema. Of this cohort, the pathologist commented on dysplasia in 172 (91%) of patients. The remaining 18 (9%) patients subsequently had their pathology reviewed. In the 190 patients who had Reinke's Edema, 13 (8%) patients had mild dysplasia, 2 (1%) had moderate dysplasia, and 1 (0.5%) had severe dysplasia. There was no malignancy reported in the cohort.Conclusions:In our predominantly female smoking population, the epithelium appears to differentiate to benign Reinke's Edema rather than malignancy. Patients can be reassured with regard to the very low risk of malignancy in classical Reinke's Edema. The principle indication for surgical intervention should be the patient's desire to improve their voice.
Laryngeal Muscle Activity in Unilateral Vocal Fold Paralysis Patients Using Electromyography and Coronal Reconstructed Images
Authors: Sanuki Tetsuji , Yumoto Eiji , Kumai Yoshihiko , Nishimoto Kohei 
Published: August 2013

Objectives:Assess laryngeal muscle activity in patients with unilateral vocal fold paralysis (UVFP) using laryngeal electromyography (LEMG) and coronal multi‐planar reconstructed images (coronal images).Methods:Twenty‐one patients suffering from paralytic dysphonia, who had had onset of UVFP more than 6 months previously, underwent LEMG, phonatory function, and coronal images. For LEMG analysis, a four‐point scale was employed to grade motor unit (MU) recruitment; 4+: absent, 3+: greatly decreased, 2+: moderately decreased, and 1+: mildly decreased (less than full interference). Maximum phonation time (MPT) and mean airflow rate (MFR) were employed. Coronal images during phonation and inhalation were assessed focusing on differences in thickness and vertical position between the vocal folds during phonation.Results:MU recruitment results were three patients for 1+, five for 2+, six for 3+, and seven for 4+. MPT was positively correlated with the MU recruitments (P = 0.011). The thinning of the affected fold was evident during phonation in 20 of the 21 subjects. All 8 subjects with MU recruitments 1+ and 2+ showed the affected fold located at an equal level to the healthy fold. Twelve of 13 subjects with MU recruitments 3+ and 4+ showed the affected fold located at a higher level than the healthy fold. There was a significant difference between MU recruitment and vertical position of the affected fold (P = 0.001).Conclusions:MU recruitments in patients with UVFP may be related to phonatory function and the vertical position of the affected fold. Synkinetic reinnervation may occur in some cases with UVFP.
Laryngopharyngeal Reflux: Paradigms for Evaluation, Diagnosis, and Treatment
Authors: Gooi Zhen , Ishman Stacey L. , Bock Jonathan M. , Blumin Joel H. , Akst Lee M. 
Published: August 2013

Objectives:Describe current otolaryngologic paradigms for diagnosis and treatment of laryngopharyngeal reflux (LPR) and analyze differences between laryngologists and non‐laryngologists.Methods:American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) and American Bronchoesophageal Association (ABEA) members were invited to complete a 23‐question online survey regarding evaluation, diagnosis, and treatment of LPR in 2012. Subgroup analysis was performed to identify differences between respondents who completed laryngology fellowships (LL) and those who did not (NL).Results:Of 159 respondents, 40 completed laryngology fellowships. NL respondents had been practicing longer than LL (19.6 vs. 11.4 years, P = 0.0001). Video‐documentation of laryngopharyngeal exams was almost universal in the LL group (97% vs 38%, P < 0.0001); similarly, use of rigid (100%, P = 0.002) and flexible distal‐chip technologies (94%, P = 0.004) were far more common in the LL group. Diagnostic criteria were otherwise similar between the groups, with symptoms of heartburn, globus, and throat clearing thought most suggestive of LPR. Adjunctive tests most commonly used were barium esophagram, dual‐probe pH testing with impedance, and esophagoscopy, although most ordered no initial testing. NL used dual pH probe with impedance more often than LL (P = 0.004). LL were significantly more likely to perform transnasal esophagoscopy in their office (P < 0.0001), to prescribe twice‐daily proton pump inhibitors with concurrent H2‐blocker medication initially (P = 0.004), and to treat for longer than 4 weeks (P = 0.0003).Conclusions:Otolaryngologists are in broad agreement on symptoms and physical features of LPR; however, significant differences exist between laryngologists and non‐laryngologists on the use of adjunctive testing and treatment strategy.
Lessons Learned from Endoscopic Treatment of Early Glottic Carcinomas: A Primer for the General Otolaryngologist
Authors: Sofer Elazar , Jamal Nausheen , Chhetri Dinesh 
Published: August 2013

Objectives:1) Identify technical considerations involved in performing oncologic resection while maintaining laryngeal function. 2) Analyze on a case‐by‐case basis what type of treatment protocol to implement and when lesions persist or recur.Methods:A retrospective review was performed to identify all endoscopic laser resections of glottic carcinomas performed over a 4‐year period. Records were reviewed to identify technical factors that led to cure vs. recurrent disease; disadvantages of extensive resection vs. adjuvant radiation; when and how often patients returned to the operating room for further resection; how to push surgical limits while maintaining good functional results; and what to expect on examination in the post‐operative healing process.Results:Twelve patients were treated during the study period. Difficult exposure was not a contraindication to endoscopic resection, if the lesion did not extend to the anterior commissure. For patients with deeply invasive disease who cannot afford lengthy vocal downtime, radiation therapy is the answer. However, radiation leads to dysphagia and contralateral vocal fold injury that is avoided with surgery. Additionally, good voice can be achieved in patients undergoing intramuscular cordectomy, but it does cause longer vocal downtime compared to radiation. The key to optimal vocal results is achieving glottal closure. Patients should be counseled pre‐operatively regarding the possibility of additional surgery.Conclusions:Endoscopic resection can be tailored on an individual basis based on both cancer stage and the patient's personal needs. Patients should be counseled pre‐operatively regarding the advantages and disadvantages of surgery vs. radiation, including side effects and voice results.
Management of Voice Prosthesis Leakage with Blom‐Singer Large Esophageal and Tracheal Flange Voice Prostheses
Authors: Choussy Olivier , Paviot Alexandre , Beulque Emilie , Hibon Renaud , Dehesdin Daniele 
Published: August 2013

Objectives:Voice rehabilitation after total laryngectomy is a major socio‐economic challenge. Voice rehabilitation can be achieved by voice prostheses, which provide rapid patient satisfaction. Enlarged tracheo‐esophageal puncture is a frequent complication and can be difficult to manage.Methods:A prospective study was conducted from November 2010 to October 2011 on 28 Blom‐Singer large esophageal and tracheal flange voice prostheses placed in 18 patients with enlarged tracheo‐esophageal puncture, causing leakage around the voice prosthesis.Results:Leakage around the voice prosthesis resolved in all patients with a mean prosthesis lifespan of 95 days. The patients considered voice quality to be similar to that obtained with the initial voice prosthesis.Conclusions:The Blom‐Singer large esophageal and tracheal flange voice prosthesis is a useful solution for the management of periprosthetic leakage, ensuring similar voice quality and an identical lifespan to that of other voice prostheses.
Effects of Aging on Rat Pedicled Fasciocutaneous Flap Survival
Authors: Roy Sudeep , Heffelfinger Ryan , Hota Salini , Duddy Beth , Pribitkin Edmund A. 
Published: August 2013

Objectives:Characterize the effects of aging on rat pedicled fasciocutaneous flap survival and associated ischemia‐induced vascular proliferation and inflammation.Methods:After approval from the Institutional Animal Care and Use Committees, three cohorts containing six young rats, six intermediate‐aged rats, and six old rats were created. A fasciocutaneous flap based axially on the inferior epigastric vessel was raised on each rat and rotated 60 degrees into a contralateral defect. Animals were sacrificed seven days postoperatively and flaps harvested. Each flap was evaluated for degree of gross necrosis, and samples were sent for both histopathological evaluation of vessel density as well as protein analysis for levels of vascular endothelial growth factor (VEGF), heme‐oxygenase 1 (HO‐1), and pyruvate dehydrogenase kinase (PDH‐K) to assess angiogenesis and cellular response to ischemic injury.Results:There was a clear and scaled distinction between the three groups (0% of the young rats, 33% of the intermediate rats, and 100% of the old rats) in terms of observable necrosis of the distal flap on gross examination. Histology showed decreased vascular density as well as increased fibrosis, apoptosis, and inflammation in specimens collected from the old rats compared to the younger groups, and this correlated with expected variations in VEGF, HO‐1, and PDH‐K levels.Conclusions:Age correlates inversely with flap survival, angiogenesis, and resistance to ischemic injury in this rat pedicled fasciocutaneous flap model. Accordingly, this flap model can be used to explore the effects of interventions designed to ameliorate the effects of aging on these variables.
The Quantified‐Self: Mobile Analysis to Facilitate Research and Empower Patients with Voice Problems
Authors: Hughes Owain R. , Forth Oscar , Alexander Anil 
Published: August 2013

Objectives:1) Build into a commonly available mobile device the ability to accurately measure the acoustic characteristics of normal and abnormal voices. 2) Build a user interface that allows untrained patients to reproducibly measure the quality of their voice and track changes over time.Methods:Apple mobile devices (iPhones, iPads, iPod Touches) were chosen as the platform since they are equipped with microphones of consistent good quality for reliable acoustic voice analysis. Novel implementations of state of the art acoustic analysis algorithms best suited for these devices were developed. The algorithms and user interface were refined following usability tests on patients at University College London Hospitals from June 2012 to December 2012.Results:We have built into these devices the capability for performing analysis of (a) fundamental frequency (F0), formant frequencies (F1‐F4), jitter and shimmer (b) maximum phonation time (c) reading and singing pitch ranges. Obtaining standardized recordings was hindered initially by excessive ambient noise. To minimize ambient noise, a volume level sensor that prevented the patient from completing an analysis outside of a quiet environment was implemented. Furthermore, visual and auditory feedback with spectrograms and playback was provided to the patient to check recording quality. Initial testing shows moderate to strong correlation and agreement to existing clinical voice quality measurement equipment.Conclusions:We have demonstrated that standardized acoustic analyses can be obtained on mobile devices without additional hardware or patient training. In this way, patients can be empowered to monitor their voice quality and engage with researchers and clinicians.
Role of Human Papillomavirus (HPV) in the Pathogenesis of Laryngeal Dysplasia
Authors: Pagliuca Giulio , Martellucci Salvatore , De Vincentiis Marco , Greco Antonio , Fusconi Massimo , Gallipoli Camilla , Gallo Andrea 
Published: August 2013

Objectives:A synergistic effect between smoking and alcohol intake is the major cause of premalignant and malignant lesions of the larynx, but the risk factors and pathogenesis of the neoplastic transformation in non‐smokers remain poorly‐defined. The aim of this retrospective study is to establish the relationship between smoking habits and HPV infection in laryngeal dysplasia.Methods:HPV DNA was amplified from 30 paraffin‐embedded laryngeal dysplasia tissue specimens by the polymerase chain reaction (PCR) using 2 groups of different consensus primers (MYO9/MY11 AND LCRF1, LCRF2, LCRF3, LCRF4, E7R1, E7R2, E7R3, E7R4). 15 samples were taken from smokers and 15 from non‐smokers. To select these tissue samples, we reviewed the medical charts of 164 patients who underwent suspension microlaryngoscopy between 1992 and 2012.Results:The present investigation failed to demonstrate HPV genome in all samples of laryngeal precancerous lesions, whereas HPV was detected in 4 laryngeal papilloma samples used as control to confirm the reliability of our method on paraffin‐embedded samples.Conclusions:The absence of viral genomes in laryngeal dysplasia specimens of smokers as well as non‐smokers suggests that other factors play a more important role than HPV infection in the carcinogenesis of these lesions.
Stem‐Cell Tracheal Reconstruction in a Canine Model
Authors: Wood Megan W. , Wright Stephen C. , Feng Xin 
Published: August 2013

Objectives:Advance the science of stem‐cell based tracheal reconstruction.Methods:Tracheal reconstruction is an evolving field with recent success using a stem‐cell based ex‐vivo engineered trachea. Taking this idea a step further, an in‐vivo method requiring less time and fewer procedures would be optimal. We performed a pilot study using 18 rabbits in 2012 at Wake Forest Institute of Regenerative Medicine. The tracheal replacements in the adipose study arm exhibited superior survival when compared to the bone marrow derived stem cell group. In this follow‐up study, we performed tracheal replacement in a canine model using 4 experimental animals. We used a segment of fixed, cell‐free donor trachea, and stem cells harvested from adipose tissue in the recipient animals. Acellular conduits were seeded with stem cells and implanted.Results:The live‐animal procedures were successful, with stable oxygenation and vital signs at extubation. The animals were able to demonstrate comfortable and spontaneous respiration and were bright and active for the first post‐operative week. They were then euthanized to evaluate the early phase of stem cell survival and differentiation. The complete histologic categorization is ongoing and will be reported.Conclusions:We will report the early findings of a single stage stem cell based tracheal replacement—the next evolution of this exciting potential reconstructive option.
Evaluation of Autogenous Engineered Septal Cartilage Grafts in Rabbits: A Minimally Invasive Preclinical Model
Authors: Kushnaryov Anton , Yamaguchi Tomonori , Briggs Kris , Reuther Marsha S. , Watson Deborah , Masuda Koichi , Sah Robert L. 
Published: August 2013

Objectives:1) Evaluate safety of autogenous engineered septal neocartilage grafts. 2) Compare properties of implanted grafts versus in vitro controls.Methods:Constructs were fabricated from septal cartilage and serum harvested from adult rabbits. Constructs were cultured in vitro or implanted on the nasal dorsum as autogenous grafts for 30 or 60 days. Rabbits were monitored for local and systemic complications. Histological, biochemical, and biomechanical properties of implanted and in vitro constructs were evaluated and compared.Results:No systemic or serious local complications were observed. Implanted constructs contained more DNA (p=0.00, p=0.003) and a higher ratio of total collagen to GAG (p=0.015, p=0.091) when compared with in vitro controls. Confined compressive moduli were also higher in implanted constructs when compared with in vitro controls (p=0.092, p=0.122). No significant differences were detected between the 30 and 60 day cohorts. Implanted constructs displayed resorption rates of 20‐45 percent. Calcium deposition in implanted constructs was observed using alizarin red histochemistry and microCT analyses.Conclusions:Autogenous engineered septal cartilage grafts were well tolerated. As seen in experiments with athymic mice, implanted constructs accumulated more DNA and had a higher ratio of total collagen to GAG when compared with in vitro controls. Confined compressive moduli were also higher in implanted constructs. Implanted constructs displayed resorption rates similar to previously published studies using autogenous implants of native cartilage. The basis for observed calcification in implanted constructs and its effect on long‐term graft efficacy is unknown at this time and will be a focus of future studies.
Tracheocutaneous Fistula Closure in the Pediatric Population: Should Secondary Closure Be the Standard of Care?
Authors: Osborn Alexander J. , Rutter Michael J. , Hart Catherine K. , de Alarcon Alessandro , Cotton Robin T. 
Published: August 2013

Objectives:Tracheocutaneous fistula (TCF) closure is achieved by excision followed either by primary closure or healing by secondary intention. Although primary closure provides immediate resolution of the fistula, it is associated with more severe potential complications. Healing by secondary intention minimizes these potential complications; however, it is inconvenient for the patient and may be more likely to require revision surgery. We have had two life‐threatening complications after primary closure, and this has raised the question of whether we should change our practice pattern. We wish to compare complication and success rates of the two methods in order to guide this decision.Methods:We conducted a retrospective study of 216 patients who underwent TCF closure in our academic tertiary care pediatric otolaryngology practice between 2004 and 2012.Results:Seventy percent of all fistulas closed by secondary intention. The complication and revision rates were not significantly different between the two methods (9% vs 11% and 9% vs 14%, respectively).Conclusions:TCF closure is accomplished by more than one method. In our study, we did not see any statistical differences between the two methods studied. We have only experienced life‐threatening complicaitons when performing primary closure. Even though these complications are very rare, they are potentially disastrous. Given that both methods are equally efficacious, we recommend secondary closure as the standard of care for management of pediatric TCF.