bluuebunny/crossref_metadata_2025_split huggingface dataset:
Photocoagulation of Microvascular and Hemorrhagic Lesions of the Vocal Fold with the KTP Laser
Authors: Hirano Shigeru , Yamashita Masaru , Kitamura Morimasa , Takagita Shin-Ichi 
Published: October 2014

Objectives: Ectasias and varices of the vocal fold are microvascular lesions that are often due to chronic abuse of the voice, and are occasionally encountered in association with other disorders such as polyps, Reinke's edema, and hematoma. The KTP laser can be used for photocoagulation of small vascular lesions, because the laser beam is well absorbed by hemoglobin, and damage to the epithelium is minimal. The present pilot study examined how the KTP laser could be used for microvascular lesions and their associated lesions. Methods: Twelve patients who had undergone phonomicrosurgery were enrolled in the present study. The microvascular lesions were treated by photocoagulation with the laser set at a low power of 1.5 W in the continuous mode, while preserving the epithelium, and associated lesions were then treated by microdissection with cold instruments. The postoperative phonatory function was assessed by maximum phonation time, a perceptual test rating (GRBAS scale), and stroboscopy. Results: The procedures were completed successfully in all cases. An exceptional case of a small hemorrhagic polyp allowed treatment with the laser only. The postoperative stroboscopic findings, maximum phonation time, and perceptual test rating all showed significant improvement compared with the preoperative state. No adverse effects, such as scarring or reduction of the mucosal wave, were observed in the current series. Conclusions: KTP laser photocoagulation is a relatively simple and safe procedure for treating microvascular lesions of the vocal fold. It is not recommended for photocoagulation of hemorrhagic polyps or hematomas, because such lesions have little blood flow inside and thus photocoagulation is usually impossible or requires too much laser energy. However, photocoagulation of perimeter or feeding vessels of such disorders may facilitate the following procedure by avoiding unnecessary bleeding, as well as preventing recurrence of hemorrhagic lesions.
Allograft Tracheoplasty Technique for Management of Refractory Tracheal Stenosis
Authors: Genden Eric M. , Govindaraj Satish 
Published: October 2014

Objectives: Extensive tracheal airway defects represent a clinical dilemma. Although resection and reanastomosis and staged tracheoplasty may prove beneficial in some cases, recurrent or extensive circumferential stenosis remains a reconstructive challenge. We report the use of the allograft tracheoplasty technique for the reconstruction of recurrent, extensive defects of the trachea and cricoid. Methods: Nine consecutive patients with recurrent tracheal stenosis were treated with the two-stage allograft tracheoplasty technique. A retrospective review was performed to evaluate for prior surgery, length of stenosis, surgical technique, and outcome. All 9 patients underwent multiple surgical procedures for acquired tracheal stenosis (average, 3.4 procedures) before undergoing the allograft tracheoplasty technique. Before surgery, all patients were tracheotomy-dependent. Results: The patients were assessed 8 to 39 months after allograft tracheoplasty. The primary airway disorders included postintubation stenosis (n = 6), surgical resection for malignancy (n = 1), and idiopathic stenosis (n = 2). Three defects involved 30% to 60% of the cricoid cartilage, and 4 defects were complete circumferential tracheal defects. Five patients underwent an island deltopectoral flap for closure of the tracheoplasty site. One patient had a superficial wound infection at the cartilage recipient site, and 1 patient had a hematoma at the deltopectoral flap donor site. All 9 patients were successfully decannulated without shortness of breath, stridor, or recurrent stenosis at the time of follow-up. Conclusions: Allograft tracheoplasty is a new technique for the reconstruction of recurrent tracheal stenosis. It appears to be reliable for extensive airway defects that are refractory to conventional tracheoplasty techniques.
Expression Profile of Immune-Associated Genes in Nasal Polyps
Authors: Wang Xin , Dong Zhen , Zhu Dong-Dong , Guan Bing 
Published: October 2014

Objectives: We performed this study to investigate the expression profile of immune-associated genes and to probe the role of related genes in the immune pathogenesis of nasal polyps. Methods: Microarray analysis was used to find the expression profile of 491 immune-associated genes in nasal polyps. In validation studies, immunohistochemical staining and Western blot analysis were used to detect interleukin (IL)–17 and IL-17 receptor (IL-17R) in nasal polyps and controls. Results: Eighty-seven genes were differentially expressed in the immune-associated gene profile of nasal polyps, and 15 genes showed differential expression in both chips. In nasal polyp tissues, IL-17 was expressed mainly in the cytoplasm of plasma cells and to a lesser degree in the prickle cell layer of the epithelium and the acinus of the serous gland. In turbinates, IL-17 was also expressed in the same location, but the expression of IL-17 in nasal polyps and that in turbinates differed significantly (p > .05). Both IL-17 and IL-17R displayed specific bands in nasal polyps and turbinates, but the bands of IL-17 and IL-17R in nasal polyps were stronger than those in turbinates. Conclusions: The differentially expressed genes in immune-associated gene chips will provide clues about, and a theoretical foundation for, the pathogenesis of nasal polyps. Furthermore, IL-17 may play an important role in the occurrence of nasal polyps by overexpression.
New Method of Identifying the Internal Auditory Canal as Seen from the Middle Cranial Fossa Approach
Authors: Lee Ho-Ki , Kim In Sup , Lee Won-Sang 
Published: October 2014

Objectives: The middle cranial fossa approach allows one to remove acoustic tumors and preserve the facial nerve and hearing. However, there are no consistent landmarks on the surface of the temporal bone to identify the internal auditory canal. This study was designed to identify the internal auditory canal by use of external and internal references as seen during the middle cranial fossa approach. Methods: We dissected 32 temporal bones using the middle cranial fossa approach and measured the distances from the posterior origin of the zygomatic arch to an imaginary coronal line between the foramen spinosum and the foramen ovale. We measured the angle between the lines drawn from the posterior origin of the zygomatic root to the foramen spinosum and from the foramen spinosum to the porus of the internal auditory canal. Results: The distances were 14.7 mm and 22.9 mm, respectively, and the angle was roughly 90°. Conclusions: In this study, we found external and internal landmarks that help to locate the internal auditory canal.
Fibrin Sealant Reduces Pain after Tonsillectomy: Prospective Randomized Study
Authors: Vaiman Michael , Krakovski Daniel , Gavriel Haim 
Published: October 2014

Objectives: Postsurgical pain in adults following tonsillectomy with fibrin sealant or electrocoagulation was assessed by surface electromyography (sEMG), a dysphagia severity rating scale (DSRS), and a visual analog scale (VAS) pain score. Methods: For group 1 (n = 40), hemostasis was achieved by fibrin sealant spraying to the tonsillar fossae. For group 2 (n = 40), hemostasis was achieved by bipolar or needle point electrocautery. The timing of single swallowing and continuous drinking and the mean electrical activity of the masseter, infrahyoid, and submental-submandibular muscles were compared with a normative database during 30 days and with DSRS and VAS scores. Results: Electrical activity of the masseter and infrahyoid muscles was significantly higher in both groups in comparison with the normative database (p > .05 to p > .005), whereas timing was less affected. The combined sEMG, DSRS, and VAS assessment showed that tonsillectomy ended with sealant causes less pain than electrocoagulation (p > .05). The DSRS score data were in strong positive correlation with the sEMG records, whereas the VAS pain score was less informative. Conclusions: The combined sEMG and pain score data indicate that the electrocautery hemostatic technique is more painful and traumatic than the sealant technique. Surface electromyography of swallowing is a simple, reliable evaluation method for postsurgical odynophagia complaints and might be used as an objective tool for pain assessment.
Effects of Tumor Necrosis Factor Alpha Antagonist, Platelet Activating Factor Antagonist, and Nitric Oxide Synthase Inhibitor on Experimental Otitis Media with Effusion
Authors: Kim Dong-Hyun , Park Yong-Soo , Jeon Eun-Ju , Yeo Sang-Won , Chang Ki-Hong , Lee Seung Kyun 
Published: October 2014

Objectives: We studied the inflammatory responses in otitis media with effusion induced by lipopolysaccharide (LPS) in rats, and compared the preventive effects of tumor necrosis factor (TNF) soluble receptor type I (sTNFRI, a TNF-α antagonist), platelet activating factor antagonist, and the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME). Methods: We used 2 control groups of Sprague Dawley rats (untreated and saline-treated) and 4 experimental groups, which all received an intratympanic injection of LPS, followed in 3 groups by experimental treatment of the same ear. The LPS group had no additional treatment. The l-NAME group received intraperitoneal injection of L-NAME and was reinjected after 12 hours. The A-85783 group was first given an intraperitoneal injection of A-85783. The sTNFRI group was first given an intratympanic injection of sTNFRI. Twenty-four hours after the initial intratympanic injection of LPS, temporal bones from each group were examined histopathologically and the vascular permeability of the middle ear mucosa was measured by Evans blue vital dye staining. Results: The l-NAME, A-85783, and sTNFRI groups showed significantly reduced capillary permeability, subepithelial edema, and infiltration of inflammatory cells in comparison with the LPS group. There were no differences in capillary permeability, subepithelial edema, or infiltration of inflammatory cells between the A-85783 and sTNFRI groups. The l-NAME group showed no difference in vascular permeability or subepithelial edema in comparison with the A-85783 and sTNFRI groups, but showed more infiltration of inflammatory cells. Conclusions: We conclude that sTNFRI, A-85783, and l-NAME can be proposed as alternative future treatments for otitis media with effusion. However, l-NAME may be the least effective of these agents.
Evaluation of Recovery from Transient Facial Palsy following Canalplasty and Tympanoplasty for the Treatment of Congenital Aural Atresia
Authors: Ushio Munetaka , Takeuchi Naonobu , Kaga Kimitaka 
Published: October 2014

Objectives: Canalplasty is a surgical procedure of the external auditory canal. In this study we examined anatomic risk factors for facial nerve injury in aural atresia surgery, in addition to facial nerve outcomes and the time course of recovery in patients with facial nerve palsy following atresia surgery. Methods: Transient facial palsy was observed immediately after surgery in 6 of 99 ears (6 of 87 patients) after canalplasty and tympanoplasty for the treatment of congenital aural atresia. We assessed the course of recovery and mean scores using Jahrsdoerfer's grading system. Results: The rate of absence of the stapes and the rate of presence of positional anomalies of the facial nerve were significantly higher among cases with facial palsy, and Jahrsdoerfer total scores were significantly lower among cases with facial palsy. The mean recovery time in 5 cases with a minimum electroneurography value of 0% was 16.2 weeks (range, 14 to 18 weeks). No trends during recovery were detected for the nerve excitability test and R1 components of the blink reflex. Conclusions: The anatomic conditions that cause a predisposition to transient facial palsy include absence of the stapes and the presence of positional anomalies of the facial nerve. Although some patients displayed transient facial palsy after surgery, all patients fully recovered. Mechanisms of facial nerve injury are proposed.
Respiratory Retraining Therapy and Management of Laryngopharyngeal Reflux in the Treatment of Patients with Cough and Paradoxical Vocal Fold Movement Disorder
Authors: Murry Thomas , Tabaee Abtin , Owczarzak Vicki , Aviv Jonathan E. 
Published: October 2014

Objectives: We describe the outcome of patients with cough and paradoxical vocal fold movement disorder (PVFMD) treated with respiratory retraining therapy and management of laryngopharyngeal reflux (LPR). Methods: Twenty patients with the complaint of cough were given a diagnosis of PVFMD and treated with proton pump inhibitors for a minimum of 6 months followed by 3 to 5 sessions of respiratory retraining therapy. Pulmonary function testing (PFT) and subjective rating of cough and reflux (reflux symptom index; RSI) were performed. Also, PFT and rating of cough were performed on a group of 10 healthy volunteers with no complaint of cough. Results: The study group comprised 13 women and 7 men. The baseline cough rating and ratio of forced inspiratory volume at 0.5 second to forced inspiratory vital capacity (FIV0.5/FIVC) on PFT were significantly worse in the treatment group than in the control group. After therapy, 20 patients (100%) experienced improvement in cough, 19 patients (95%) experienced improvement on PFT, and 17 patients (85%) experienced improvement in the RSI score. The differences were statistically significant. Conclusions: Respiratory retraining therapy combined with management of LPR is an effective treatment for patients with cough and PVFMD when a single-modality treatment is not sufficient.
Development of the Human True Vocal Fold: Depth of Cell Layers and Quantifying Cell Types within the Lamina Propria
Authors: Boseley Mark E. , Hartnick Christopher J. 
Published: October 2014

Objectives: We sought to further describe the development of the 3-layered human vocal fold in children and to quantify macrophage and myofibroblast concentrations in each layer. Methods: We used an optical analysis software package to examine 8 longitudinally sectioned human vocal folds that had been fixed in formalin (ages 2 days to 14 years). Results: The 2-day-old vocal fold contained only a monolayer of cells. This became a bilayer by 5 months, and a trilayer began to become evident by 7 years. The percent of total depth represented by the superficial layer of the lamina propria (SLP) gradually decreased with age. The SLP made up 22% of the total lamina propria by age 7 years; this percentage approximates that in the adult vocal fold. Macrophages and myofibroblasts were predominately found in the SLP, and began to be apparent by 11 months of age. Conclusions: These results help describe the development of human voice and may have implications as to when phonosurgical therapy can be considered for children.
Airway Resistance and Airflow Dynamics after Fat Injection into Vocal Folds
Authors: Cantarella Giovanna , Fasano Valter , Maraschi Barbara , Mazzola Riccardo F. , Sambataro Giuseppe 
Published: October 2014

Objectives: The aim of this prospective study was to verify whether vocal fold fat augmentation (VFFA) modifies upper airway patency. To the best of our knowledge, this is the first study analyzing the impact of VFFA on laryngeal resistance to airflow. Methods: Twenty-one consecutive patients 16 to 74 years of age underwent 24 VFFA operations because of glottic incompetence due to laryngeal hemiplegia (13 patients) or vocal fold tissue defects (8 patients). Flow-volume loop spirometry and body plethysmography were performed before and 1 to 6 months after surgery. Results: There were no significant differences between preoperative and postoperative pulmonary volumes (FVC and FEV1), expiratory flows (PEF, FEF50), or inspiratory flows (PIF, FIF50), although a slight increase in inspiratory flows meant that FEF50/FIF50 slightly decreased. Specific airway resistance (sRaw) increased after VFFA, but not in a statistically significant manner (p = .078). None of the patients experienced postoperative stridor. One obese woman with laryngeal hemiplegia had postoperative effort dyspnea; her respiratory studies showed a reduction in inspiratory flows and an increase in sRaw, and demonstrated progressive improvement. Conclusions: Flow-volume loop spirometry showed that VFFA does not significantly modify respiratory airflows, although a slight increase of inspiratory airflows suggested an improvement in variable extrathoracic obstruction. Body plethysmography proved to be a sensitive procedure that highlighted the subtle increase in upper airway resistance. Hence, VFFA can be considered a relatively safe procedure for achieving vocal fold medialization, and spirometry and plethysmography can be useful for preoperative assessment and postoperative follow-up.
Histopathologic Changes in Laryngeal Mucosa of Extremely Low-Birth Weight Infants after Endotracheal Intubation
Authors: Sato Kiminori , Nakashima Tadashi 
Published: October 2014

Objectives: Advances in medicine have improved the survival of infants with increasingly lower birth weights. The histopathologic changes of intubation-related laryngeal injury in extremely low-birth weight infants (less than 1,000 g) have not been well known. We examined histopathologic changes in infant larynges, including extremely low-birth weight infants, after endotracheal intubation. Methods: Forty-four infants, including 21 extremely low-birth weight infants, who had been intubated for periods ranging from 10 minutes to 138 days, were examined in a whole organ serial section study. Results: As the duration of intubation increased, the ulceration was found to be larger and deeper. The injury at the subglottis and posterior glottis was greater than that at other portions. The perichondrium of the cartilage was exposed in many cases intubated longer than 8 days. Repaired epithelium that was composed of squamous epithelium was present in 6 of 7 larynges that had been intubated more than 20 days, indicating that not only injury but also the healing process occurred during long intubation. There were no obvious relationships between the degree of intubation injury and the birth weight of the infants. Conclusions: Prolonged intubation is better tolerated by infants than adults. The intubation-related laryngeal injuries of extremely low-birth weight infants were histopathologically the same as those of infants of other birth weights.
Radiofrequency Ablation in the Treatment of Idiopathic Bilateral Palatal Myoclonus: A New Indication
Authors: Aydin Omer , Iseri Mete , Ozturk Murat 
Published: October 2014

Objectives: We tested the effect of radiofrequency ablation in the treatment of palatal myoclonus refractory to other therapeutic regimens. Methods: A 20-year-old patient who presented with palatal myoclonus and annoying rhythmic objective clicking noise was treated with a radiofrequency generator with topical and local anesthesia in an outpatient setting. Results: The clicking noise was abolished within 3 to 4 days of the radiofrequency ablation. The rhythmic, jerky movements of the soft palate were confirmed to be absent 2 weeks later with electromyographic studies. The patient has been symptom-free for 6 months, and no side effects have occurred. Conclusions: As a new indication, radiofrequency ablation may effectively abolish abnormal movements of the soft palate and relieve associated tinnitus.
Relationship between Fluoroscopic and Manometric Measures of Pharyngeal Constriction: The Pharyngeal Constriction Ratio
Authors: Leonard Rebecca , Belafsky Peter C. , Rees Catherine J. 
Published: October 2014

Objectives: The gold standard objective measure of pharyngeal strength is pharyngeal manometry. We have developed an objective fluoroscopic measure of pharyngeal strength, the pharyngeal constriction ratio (PCR). A high PCR indicates poor pharyngeal constriction. The objective of the current study was to evaluate the correlation between the PCR and peak pressures on pharyngeal manometry. Methods: The charts of 20 consecutive individuals who underwent a dynamic fluoroscopic swallow evaluation and pharyngeal manometry at the Center for Voice and Swallowing of the University of California, Davis, were retrospectively reviewed. Information regarding patient demographics, diagnoses, PCR, and manometric pharyngeal peak pressures was abstracted. The correlation between the PCR and pharyngeal pressure was determined with the Pearson correlation coefficient. Results: The mean (±SD) age of the cohort was 63 ± 11 years. Fourteen of the 20 patients (70%) were male. The most common diagnoses were reflux (7 of 20) and cerebrovascular accident (4 of 20). The mean PCR was 0.26 ± 0.31. The mean pharyngeal pressure was 83 ± 43 mm Hg. The correlation between the PCR and pharyngeal pressure was −0.70 (p <.01). Conclusions: There was a high inverse correlation between the PCR and the peak pharyngeal pressure on manometry (-0.70). The PCR appears to be a valid objective surrogate measure of pharyngeal strength.
Transoral Approach to Laser Thyroarytenoid Myoneurectomy for Treatment of Adductor Spasmodic Dysphonia: Short-Term Results
Authors: Su Chih-Ying , Chuang Hui-Ching , Tsai Shang-Shyue , Chiu Jeng-Fen 
Published: October 2014

Objectives: The surgical technique for the resection of the recurrent laryngeal nerve for adductor spasmodic dysphonia (ASD) has high late failure rates. During the past decade, botulinum toxin has emerged as the treatment of choice for ASD. Although effective, it also has significant disadvantages, including a temporary effect and an unpredictable dose-response relationship. In this study we investigated the effectiveness of a new transoral approach to laser thyroarytenoid myoneurectomy for treatment of ASD. Methods: Fourteen patients with ASD underwent transoral laser myoneurectomy of bilateral thyroarytenoid muscles. Under general anesthesia, an operating microscope and a carbon dioxide laser were used to perform myectomy of the mid-posterior belly of bilateral thyroarytenoid muscles together with neurectomy of the terminal nerve fibers among the deep muscle bundles. Care was taken not to damage the vocalis ligaments, arytenoid cartilages, and lateral cricoarytenoid muscles. Preoperative and postoperative videolaryngostroboscopy and vocal assessments were studied. Results: The 13 patients who completed more than 6 months follow-up were enrolled in this study. Moderate and marked vocal improvement was achieved in 92% of the patients (12 of 13) after laser surgery during an average follow-up period of 17 months (range, 6 to 31 months). No vocal fold atrophy or paralysis was observed in any patient. None of the patients had a recurrence during the follow-up period. Conclusions: Transoral laser myoneurectomy of bilateral thyroarytenoid muscles is a relatively simple, effective, and valuable technique for the treatment of ASD. The durability of outcome achieved with this procedure is encouraging.