bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Experiences of NBI Laryngoscope in Diagnosis of Laryngeal Lesions
Authors: Qi Xinmeng , Jin Chunshun , Yu Dan , Zhao Xue , Liu Xueshibojie , Cheng Jinzhang , Zhang Dejun 
Published: September 2014

Objectives:(1) Describe the use of narrowband imaging (NBI) to enhance diagnostic sensitivity and accuracy in an impressive number of patients. (2) Develop a complete description list of each laryngeal condition, which can serve as a criteria for further laryngoscopic examinations and diagnosis.Methods:This study was conducted between January 2012 and October 2013 at the Department of Otolaryngology, the second hospital attached to Jilin University (Changchun Jilin, China). A total of 3675 patients (2092 males, 1583 females; mean age 50.2 ± 19.5 years) were enrolled in this study. All 3675 patients underwent laryngoscopy equipped with conventional white light and NBI system. A total of 1153 lesions were classified into different groups according to their histopathological results.Results:On NBI view, mucosa of a normal vocal fold was light brown. Intraepithelial vessels displayed blue‐green, which were in striking contrast to the surrounding mucosa. Polyps demonstrated a color of light green. Cysts and mucocele appeared as light white. Leukoplakia was shown as a white color and hyperplastic epithelial lesions appeared as a slightly brownish color. Erythroplakia appeared as well‐distributed dark brown lesions. Pachydermia displayed light white with a quite different shape from that of cysts. Papilloma were shown as quite delicate green. Abnormal submucosal microvessel changes visualized in laryngeal carcinoma lesions were shown as typical scattered dark brownish spots. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view calculated from these results were 98.81 and 99.89%, respectively.Conclusions:The advent of NBI is a breakthrough in the field of assessing laryngeal diseases, especially malignant ones.
Detection and Characterization of Laryngeal Reflex Pathology in Mouse Models of Human Diseases
Authors: Farmer‐Shock Leslie , Gallemore Brandon , Oberto Richard , Hinkel Cameron , Lever Tersa 
Published: September 2014

Objectives:The laryngeal adductor reflex (LAR) is readily triggered in healthy, awake humans by delivering a puff of air to the laryngeal entrance via an endoscope passed through the nose into the throat. LAR impairment has been identified (but not well‐characterized) in people with amyotrophic lateral sclerosis (ALS) and is highly correlated with dysphagia. We propose to develop a nonsurgical approach for longitudinal investigation of the LAR in mice.Methods:We designed and constructed an elaborate prototype air pulse delivery system for use with mice. The system interfaces with a miniature endoscope that is small enough for oral insertion into the laryngeal entrance and contains a working channel through which calibrated puffs of air can be delivered, synchronized with rate and phase of the respiratory cycle.Results:We have successfully used this prototype system to evoke and video record (30 fps) the LAR in 10 healthy, C57BL/6 mice under light anesthesia, thus demonstrating proof of concept. Objective quantification of several LAR parameters is currently underway, including total LAR duration, duration of adduction versus abduction phases, and velocity of dorsal angle adduction and abduction.Conclusions:This study provides novel evidence that mice have an LAR similar to humans and that several parameters of the LAR can be objectively quantified in this small animal model. Additional research will include laryngeal brainstem response (LBR) recordings evoked by air pulse triggering of the LAR to elucidate pathological neural substrates in mouse models of ALS and other human diseases that cause dysphagia.
Evaluation of Airway and Voice following Posterior Transverse Cordotomy for Bilateral Vocal Fold Paralysis
Authors: O'Dell Karla D. , Allensworth Jordan J. , Schindler Joshua S. 
Published: September 2014

Objectives:Objectively describe the change in glottic airflow following unilateral transverse posterior cordotomy for bilateral true vocal fold paralysis based on peak inspiratory flow rate and pulmonary function tests. Evaluate the impact of unilateral posterior cordotomy on voice related quality of life.Methods:Retrospective chart review of 17 patients with bilateral vocal fold paralysis undergoing CO2 laser posterior transverse cordotomy from January 2008 through December 2013 in an academic medical center. Preoperative and postoperative pulmonary function tests were reviewed including the peak inspiratory flow rate (PIF) and maximal inspiratory flow at 50% of forced vital capacity (PIF50). The results of the 30‐item voice handicap index (Voice Handicap Index), an externally validated survey, were recorded pre‐ and postprocedure.Results:There was a statistically significant (P <. 0014) improvement in mean peak inspiratory flow rates postprocedure (2.89 L/s) compared with preprocedure (1.57 L/s). There was a 44% improvement in peak inspiratory flow rate following unilateral posterior transverse cordotomy. Expiratory flow loops did not reflect changes in airway following the procedure. There was no statistically significant change (P <. 475) in the voice handicap index scale preoperative and postoperative (55 and 41, scale 0‐100).Conclusions:Unilateral posterior transverse cordotomy for bilateral true vocal fold paralysis results in a 44% improvement in peak inspiratory flow rates. Preoperative pulmonary function tests can be used to evaluate the potential success of cordotomy alone for glottis stenosis. This procedure does not result in any statistically significant change in voice related quality of life.
Functional Electrical Stimulation of the Larynx with a Flexible Ribbon Electrode Array
Authors: Bliss Morgan R. , Wark Heather , McDonnall Daniel , Smith Marshall E. 
Published: September 2014

Objectives:This study explored the selectivity of epimysial stimulation of the larynx using multi‐channel electrode arrays. Recruitment curves from electrode channels within the array were compared, focusing on differences between location of the electrode and specific muscle activation.Methods:This was a prospective, nonrandomized acute animal study. Four cats underwent surgical implantation of electrode arrays into the posterior cricoarytenoid muscle. The airway was secured with a tracheostomy, and the glottis was visualized with a 0° 4‐mm telescope while individual and combinations of electrodes within the array were stimulated with varying current. Digitized recordings of stimulated vocal folds were analyzed using imageJ and the degree of vocal fold abduction was measured to create recruitment curves.Results:Electrodes implanted along the medial aspect of the posterior cricoarytenoid stimulated graded physiologic degrees of abduction depending on the amplitude of stimulation current. Electrodes implanted laterally along the posterior cricoarytenoid stimulated greater degrees of simultaneous adduction with abduction. The electrode array allowed mapping of most useful electrode position, so that only one implantation procedure was required to yield good results, thus limiting trauma to the larynx. Electrode arrays with more electrodes were more likely to contain electrodes that were appropriately positioned for optimal abduction.Conclusions:Acute studies of implanted electrode arrays into the posterior cricoarytenoid produce graded physiologic degrees of abduction necessary for respiration. Further chronic studies are warranted to investigate long term feasibility and durability of this electrode design.
Increased Macrophages and T‐Lymphocytes Precede Fibrosis in a Mouse Model of Laryngotracheal Stenosis
Authors: Hillel Alexander T. , Ding Dacheng , Namba Daryan 
Published: September 2014

Objectives:Identifying the inflammatory cells mediating laryngotracheal stenosis (LTS) could allow for identification and modulation of specific immune mechanisms to reduce the development of airway fibrosis. The objective of this study is to (1) introduce a novel mouse model of LTS and 92) define the inflammatory cell infiltrate preceding fibrosis.Methods:The experimental design was a 21‐day prospective controlled in‐vivo in‐situ animal study. The mouse laryngotracheal complex was chemomechanically injured with a bleomycin‐coated wire brush. Mice were sacrificed at 7, 14, and 21 days. Specimens were examined using histology to assess mucosal inflammation and fibrosis. Immunohistochemistry (IHC) and gene expression analysis were performed to delineate inflammatory cells. Results were compared with 2 control groups: (1) mice with no tracheal injury; and (2) mice that underwent tracheal injury with a saline‐coated wire brush.Results:Histology demonstrated progressive thickening of the subepithelial lamina propria with an increased inflammatory infiltrate including lymphocytes, neutrophils, and macrophages that peaked at Day 7. This transitioned to resolving inflammation and initial fibrosis by Day 14 with progression of fibrosis to day 21. Gene expression and IHC confirmed increased T‐cells and macrophages compared to controls. IHC staining was positive for CD4+ T‐lymphocytes.Conclusions:Chemomechanical injury of the mouse trachea in situ was successful and may be used as a model to study LTS. Bleomycin accelerates fibrosis as compared to controls with saline‐coated wire brush injury. Macrophages and CD4+ T‐lymphocytes precede the development of fibrosis in this mouse model and should be further investigated as mediators of LTS.
Microsurgical Release of the Cover and Fibrin Glue Implantation for Treatment of Sulcus and Scars
Authors: Campos Guillermo , Mantilla Natalia , Ospina Javier A. 
Published: September 2014

Objectives:Sulcus vocalis and scars of the vocal folds reduce pliability of the cover impairing vibration. Severity of dysphonia is directly related to magnitude of structural damage. The purpose of surgical treatment is to restore anatomy in order to re‐establish function. The aim of the study was to evaluate the effectiveness of microsurgical liberation of scars and placement of fibrin glue implants into the subepithelial space of the vocal folds to improve pliability.Methods:Fifteen patients (age range, 13‐69 years) with diagnosis of sulcus and/or scars were classified into 3 groups, according to severity of structural damage: Group 1: Unilateral, localized lesions with minimal subepithelial compromise. Group 2: Sulcus and/or scars with subepithelial fibrosis. Group 3: Severe scarring. Microsurgical liberation of scar tissue and placing of fibrin glue implants were performed. Fibrin glue components are mixed until solidified. An implant is tailored and it is placed into the subepithelial space. All patients were evaluated preoperatively and postoperatively with stroboscopy. Voice quality changes were assessed by means of the Voice Handicap Index 30 questionnaire.Results:The technique offered significant vibratory pattern and voice quality improvement in group one and better vibratory pattern and moderate voice quality improvement in group 2. In group 3, although some vibratory improvement was achieved, voice quality results were not satisfactory in 4 out of 5 patients.Conclusions:The technique described is useful for treatment of vibratory impairment caused by sulcus and/or scarring of the vocal folds in which structural damage is limited. In extensive lesions results show little improvement.
Narrow Band Imaging: Demonstration of Laryngeal Micro‐vascularization in Normal and Pathological Conditions
Authors: Shoffel‐Havakuk Hagit , Halperin Doron , Yosef Liron , Lahav Yonatan 
Published: September 2014

Objectives:With blue and green light only, narrow band imaging (NBI) allows better visualization of mucosal micro‐vascular architecture. Intra‐epithelial papillary capillary loops (IPCL) is a classification of vascular patterns based on previous esophageal NBI studies. The aims of the study were to: (1) Study the normal micro‐vascular anatomy of the larynx by means of NBI. (2) Better understand the clinical applications of NBI in laryngeal lesions. (3) Assess the relative advantages and disadvantages of NBI versus white light imaging in the larynx. (4) Assess the relevance of previously described IPCL classification in laryngeal pathologies.Methods:A prospective comparative study including patients who arrived for laryngeal examination at an ENT referral center in 2013. White light images and NBI were compared in each patient to assess relative advantages of each modality. Micro‐vascular architecture was described by IPCL classification.Results:A total of 110 patients were included and underwent video‐stroboscopy, flexible distal‐chip endoscopy, and NBI of the larynx. Thirty‐two patients had a normal larynx, 54 had benign conditions, and 24 had malignant lesions. Distinct characteristics of vascular patterns were visualized by NBI in normal tissues, as well as a wide spectrum of benign and malignant conditions. In several patients with malignant and premalignant conditions, NBI revealed more extended disease than what was observed by white light imaging.Conclusions:Using NBI along with white light imaging, while understanding the unique microvascular fingerprint of each laryngeal pathologic condition, can assist the physician in differential diagnosis. In specific conditions, including malignant and premalignant lesions, NBI can bring better assessment of lesions’ size and extension.
A New Coupling Device to Record Fiber‐Optic Laryngoscopies onto a Smartphone: A Pilot Study
Authors: Brant Jason A. , Leahy Kevin , Mirza Natasha 
Published: September 2014

Objectives:Evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded directly onto smartphones using a novel coupling device.Methods:Prospective, blinded study at a tertiary referral hospital. Inpatients requiring laryngoscopy underwent bedside flexible fiberoptic endoscopy. A smartphone was then attached to the endoscope using a novel coupling device and the same examination was recorded. The laryngologist performing the live examination documented their findings on a standardized scoring sheet. A second laryngologist, blinded to the findings of the first, evaluated the recorded examination using an identical scoring sheet.Results:Eighteen patients were evaluated from July 2013 to January 2014. Evaluation of airway patency was identical (Kappa 1.0, P <. 001). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa 0.687, P <. 001). There was no disagreement on the sidedness of the vocal fold involved (3 left, 1 right, 1 bilateral). There was 1 paretic‐paralytic and 2 normal‐paretic discrepancies. Subjective evaluation of the mucosa over each subsite showed moderate reliability (Kappa 0.515, P <. 001).Conclusions:There is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings of those examinations using a coupling device to transfer the recordings on to smart phones. Critical findings such as airway patency and vocal fold motion showed the highest correlation, subjective evaluation of the quality of the mucosa showed more variability.
Noninvasive versus Rigid Endoscopic Evaluation of Upper Aerodigestive Tract in Penetrating Neck Trauma
Authors: Jalisi Scharukh , Jumaily Jeffrey S. , Winter Leslie , Burke Peter 
Published: September 2014

Objectives:(1) Describe the effectiveness of current diagnostic modalities in diagnosing upper aerodigestive tract injuries. (2) Recognize the potential complications of rigid endoscopy in trauma patients.Methods:This is a retrospective chart review of patients admitted between January 1998 to May 2008 with penetrating neck trauma in all zones who underwent assessment with physical examination, barium swallow, computed tomography, and/or endoscopy. The sensitivity and specificity of these modalities were calculated and compared.Results:Physical examination appears to be unreliable due to poor sensitivity in this study. Direct laryngoscopy appears to be more sensitive than flexible laryngoscopy. Bronchoscopy was not frequently performed and 1 patient (2%) had tracheal repair diagnosed with rigid bronchoscopy. Rigid esophagoscopy was performed more commonly than flexible esophagoscopy. Both types of esophagoscopies detected the 2 (4%) esophageal injuries. Computed tomography scan was nonspecific due to presence of subcutaneous air in most patients. Barium swallow had a 100% negative predictive value in our study and did not miss any injuries. There were 5 patients (10%) who had postprocedure symptoms that can be potentially attributed to rigid endoscopy including teeth injury, and upper and lower extremity weakness and paresthesias.Conclusions:Barium swallow appears to be a reliable study which did not miss any significant injuries. Endoscopic studies, especially rigid ones, carry a risk of C‐spine complications that should be recognized in trauma patients.
Office‐Based Photoangiolytic Laser Treatment of Reinke's Edema: Safety and Voice Outcomes
Authors: Koszewski Ian J. , Hoffman Matthew R. , Young William G. , Dailey Seth H. 
Published: September 2014

Objectives:The office‐based use of photoangiolytic lasers may be a viable option in the treatment of Reinke's edema. We aimed to determine the safety and efficacy of this technique.Methods:We performed a retrospective analysis of patients undergoing office‐based laser treatment of endoscopy‐proven Reinke's edema between January 2007 and November 2013. Safety was evaluated by reviewing complications. Efficacy was analyzed by comparing pre‐ and postprocedural aerodynamic, acoustic, and voice handicap index (VHI) measurements, and by quantifying procedure tolerance. Data were analyzed using paired t tests, if parametric, or signed rank tests, if not parametric. Complete datasets were not available for all subjects; sample size for each parameter is reported with the corresponding result.Results:Nineteen patients met inclusion criteria. There were no major complications. Phonation threshold pressure decreased after treatment (n = 4; 8.21 ± 2.10 vs 6.69 ± 2.59 cmH2O; P =. 049). Phonatory frequency range increased (n = 12, 180 ± 67 vs 363 ± 295 Hz; P =. 003) while percentage jitter decreased (n = 12; 4.05 ± 2.83 vs 1.65 ± 1.10%; P =. 004). VHI also decreased (n = 14; 56 ± 26 vs 37 ± 27; P <. 001). Five procedures were truncated due to benign patient intolerance.Conclusions:This study represents the largest series of patients undergoing office‐based photoangiolytic laser treatment specifically for Reinke's edema. Our data suggest that this is a safe and effective modality to treat Reinke's edema, though patient intolerance of the procedure may represent a barrier.
Outcomes and Resource Utilization of Endoscopic Mass‐Closure Technique for Laryngeal Clefts
Authors: Balakrishnan Karthik , Cheng Esther , de Alarcon Alessandro , Sidell Douglas R. , Hart Catherine K. , Rutter Michael J. 
Published: September 2014

Objectives:(1) Describe operative time and materials for a mass‐closure endoscopic laryngeal cleft repair technique. (2) Determine swallowing and endoscopic outcomes of this technique.Methods:Case series of children with confirmed diagnosis of type 1, 2, and 3 laryngeal clefts from 2008 to 2013 in a tertiary pediatric aerodigestive program. Interventions: Endoscopic mass cleft closure; pre‐ and postoperative swallow evaluations. Outcomes: Operative time, number of sutures, laser use, endoscopic findings, aspiration or penetration on postoperative swallow evaluation.Results:Eighteen patients were studied. Mean age 5.8 ± 4.9 years (range, 0.3‐7 years). Sixteen had type I cleft, 1 had type II, and 1 had type III. Four had unilateral or bilateral vocal fold immobility preoperatively. Fifteen underwent functional endoscopic evaluation of swallow (FEES) and/or videofluoroscopic swallow study (VSS) preoperatively; 14 showed laryngeal penetration and/or aspiration. Mean operating time was 76.6 ± 40.9 minutes (range, 43‐181 minutes) with a fellow or resident participating in all cases. Operating time was unchanged by laser use (P =. 15) or presence of tracheostomy (P =. 34). Mean 2.5 ± 0.6 sutures were required for each repair (range, 2‐4). Twelve patients spent 1 postoperative night in hospital. Mean follow‐up was 87.7 ± 15.8 months (range, 1 week‐61.2 months). Sixteen patients have had postoperative endoscopy to date; intact repair was noted in all 16. Postoperative VSS was available for 8 patients and demonstrated persistent aspiration in 2 patients, with further improvement expected in 1 as sensation returned. No operative complications occurred.Conclusions:The endoscopic mass‐closure technique is safe, fast, technically straightforward, and produces swallowing outcomes similar to traditional techniques. Postoperative hospital stay is brief, and repairs remain intact over long‐term follow‐up.
Type 1 Thyroplasty as an Outpatient Surgery: Safety and Cost Effectiveness
Authors: Gross Brian C. , Patel Neil S. , Ekbom Dale C. 
Published: September 2014

Objectives:Determine the safety and cost effectiveness of type 1 thyroplasty as outpatient surgery without a surgical drain or post‐anesthesia care unit (PACU) observation. Study Design: Prospective cohort study.Methods:Patients with vocal cord immobility (n = 25) were surgically managed with an outpatient type 1 thyroplasty under conscious sedation without a surgical site drain from April 1, 2013, through October 1, 2013. Eighteen of 25 patients were transported directly from the operating room to the nursing unit, completely avoiding the PACU. Historical inpatient controls (n = 25) were included for comparison. Postoperative complications were recorded. A cost analysis was conducted to compare inpatient versus outpatient surgery.Results:In our series of patients undergoing outpatient type 1 thyroplasty, only 1 of 25 (4.0%) postoperative hematoma was documented. No postoperative complications occurred in the inpatient control group. Outpatient type 1 thyroplasty cost $922 less than overnight surgery. Avoiding the PACU resulted in an additional $550 savings.Conclusions:Our prospective study demonstrated that outpatient type 1 thyroplasty without a surgical drain is a safe and cost‐effective surgery in appropriately selected patients. Furthermore, doing the surgery under light sedation allows the patient to be transported directly to the nursing unit, avoiding the additional cost of the post‐anesthesia care unit.