bluuebunny/crossref_metadata_2025_split huggingface dataset:
Penetration and Aspiration in Healthy Older Adults as Assessed during Endoscopic Evaluation of Swallowing
Authors: Butler Susan G. , Stuart Andrew , Markley Lisa , Rees Catherine 
Published: October 2014

Objectives: A previous article from our group presented data on normal swallowing as assessed during simultaneous manometry and flexible endoscopic evaluation of swallowing (FEES). Because penetration and aspiration events were identified in healthy adults, the question arose, could the presence of the manometric catheter confound normal FEES findings? Thus, a follow-up study was designed to address the effects of catheter condition on healthy older adults as assessed during FEES. Methods: Twenty older adults (mean, 78.9 years of age) participated. The participants each contributed 28 swallows, affording a study total of 560 swallows for analyses. Results: The older adults demonstrated penetration on 82 (15%) and aspiration on 18 (3%) of 545 swallows. The numbers of participants who had penetration and aspiration during the study protocol were 75% and 30%, respectively. The older adults demonstrated both penetration and aspiration events irrespective of the presence of a catheter; whether they were drinking milk, water, or barium; whether the bolus was 5 or 10 mL; and whether they took the bolus via syringe or self-administered the bolus with a cup. However, significantly more aspiration was found on thin liquids than on puree or solids. Conclusions: Endoscopic data on normal swallowing physiology were generated. These may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.
Equine versus Bovine Pericardium in Transmeatal Underlay Myringoplasty
Authors: Albera Roberto , Dagna Federico , Lacilla Michelangelo , Canale Andrea 
Published: October 2014

Objectives: Many different grafting materials have been proposed in myringoplasty. The aim of this study was to evaluate the results obtained in transmeatal underlay myringoplasty using bovine and equine pericardium. The results were compared with those obtained by using autologous temporalis fascia. Methods: The study group consisted of 52 patients with tympanic perforation. Twenty-nine patients were randomly selected for treatment with bovine pericardium and 23 for equine pericardium. A group of 14 patients was treated with autologous temporalis fascia. Results: Closure of the perforation was achieved in 19 of 29 patients (66%) treated with bovine pericardium, in 19 of 23 (83%) treated with equine pericardium, and in 13 of 14 (93%) treated with autologous fascia. The best functional results in patients who gained closure of the perforation were obtained by means of equine pericardium. Conclusions: The overall long-term tympanic closure rate demonstrates that equine pericardium has a greater take rate than bovine pericardium. The results obtained are inferior to those obtained with autologous fascia, but this technique is less aggressive. The higher success rate with equine pericardium may be due to the fact that it is thinner and easier to handle and model than bovine pericardium.
Groningen Dilatation Tracheoscope in Treatment of Moderate Subglottic and Tracheal Stenosis
Authors: Halmos György B. , van der Laan Bernard F. A. M. , Dikkers Frederik G. 
Published: October 2014

Objectives: We describe our experience with the Groningen Dilatation Tracheoscope (Karl Storz GmbH & Co, Tuttlingen, Germany) in treating benign subglottic and tracheal stenosis. Methods: We performed a retrospective survey from a medical record analysis of 26 patients with different origins of benign, grade II (Myer-Cotton) subglottic or tracheal stenosis. All patients underwent dilatation tracheoscopy for a total of 64 times (average, 2.46 operations per patient). Five patients had to undergo subsequent operations. Patient data (sex, age at intervention, underlying and other systemic diseases) and operation data (course, intraoperative and postoperative adverse events) were recorded. Analysis of the measured preoperative and postoperative peak flow values was performed. Results: The average predilatation and postdilatation peak flow values were 225 L/min and 331 L/min, respectively Eighty percent of the patients (21 of 26) were successfully treated with 1 or more dilatation tracheoscopy interventions without supplementary treatment for the stenosis. There is only 1 tracheal cannula–dependent patient in the examined population, making the overall success rate of our treatment 96%. No major intraoperative or postoperative complications were recorded. Conclusions: Dilatation tracheoscopy is a simple, relatively safe, and effective method in the treatment of benign subglottic or tracheal stenosis of various origins. The intervention is minimally invasive and is easily repeatable in case of restenosis.
Laryngopharyngeal Reflux with Sore Throat: An Ultrastructural Study of Oropharyngeal Epithelium
Authors: Amin Sameh M. , Maged Khaled H. Abdel , Naser Ashraf Y. , Aly Balegh H. 
Published: October 2014

Objectives: We performed an electron microscopic ultrastructural study of oropharyngeal epithelium in patients with laryngopharyngeal reflux (LPR) and sore throat to evaluate whether dilatation of intercellular spaces could be traced at this level. Methods: The study included 20 patients with LPR and sore throat and 5 control subjects. The patients were subjected to upper gastrointestinal tract endoscopy and flexible pharyngolaryngoscopy. Oropharyngeal biopsy specimens were taken from the patients and controls for ultrastructural study by transmission electron microscopy. Results: The entire group of patients with LPR showed dilatation of intercellular spaces essentially at the squamous basal and suprabasal levels in their oropharyngeal biopsy specimens, whereas none of the control subjects showed such a morphological marker. Conclusions: Dilatation of intercellular spaces as a morphological marker can be traced in patients with LPR and sore throat at the level of the oropharynx. This contributes to a better understanding of the pathophysiology of LPR. If this finding is confirmed in a large series, it will represent a cost-effective, relatively noninvasive method for diagnosis of LPR.
Bacteremia during Adenoidectomy: A Comparison of Suction Diathermy Adenoid Ablation and Adenoid Curettage
Authors: Casserly Paula , Kieran Stephen , Phelan Eimear , Smyth Edmond , Lacy Peter 
Published: October 2014

Objectives: Transient bacteremia is induced by adenoidectomy when the integrity of the nasopharyngeal membrane is broken. The aim of this study was to determine the incidence of bacteremia in patients undergoing adenoidectomy, to identify the causative organisms, and to compare the incidences of bacteremia between the two techniques suction diathermy and curettage. Methods: A prospective single-blind randomized trial was performed. Sixty-four patients between the ages of 2 and 13 years who were undergoing adenoidectomy were included in the study. Exclusion criteria included antimicrobial therapy in the immediate preoperative period and concurrent respiratory tract infection or pyrexia. Patients were randomized in the anesthetic room to either suction diathermy or curettage. Venous blood samples for culture were obtained 30 seconds after the procedure began (intraoperative sample) and 2 minutes after removal of the adenoid tissue (postoperative sample). Postoperative complications were recorded, and all patients were followed in the outpatient department. Results: Twenty-six patients underwent adenoidectomy by suction diathermy, and 38 underwent adenoidectomy by curettage. In the suction diathermy group, 38.5% of intraoperative and 19.2% of postoperative blood cultures had a positive result for bacteremia. In the curettage group, 31.6% of intraoperative and 23.6% of postoperative blood cultures had a positive result for bacteremia. There was no significant difference between the two groups. The techniques were equivalent in terms of postoperative complications. Gram-positive cocci were the most commonly isolated organisms. Conclusions: A transient bacteremia exists after pediatric adenoidectomy, but does not correlate with symptoms or signs. Neither suction diathermy adenoidectomy nor curettage adenoidectomy offers a particular advantage in terms of decreasing the incidence of bacteremia.
Cochlear Implantation in Children with Congenital X-Linked Deafness Due to Novel Mutations in POU3F4 Gene
Authors: Stankovic Konstantina M. , Hennessey Ann Marie , Herrmann Barbara , Mankarious Leila A. 
Published: October 2014

Objectives: We report novel mutations in the POU3F4 gene resulting in congenital X-linked deafness DFN3, and describe the results of cochlear implantation in 4 boys (3 siblings) followed for an average of 3.5 years. Methods: The diagnosis of DFN3 was made in infant boys on the basis of the radiologic criteria of an underdeveloped modiolus, a wide cochlear fossette, and the presence of all cochlear turns. The POU3F4 gene was sequenced. A standard, transmastoid, facial recess approach was used for cochlear implantation. A lumbar drain was placed before the operation. Results: The identified mutations in the POU3F4 gene were novel (p.R167X in the 3 siblings) or recently reported (p.S310del). A high-flow cerebrospinal fluid leak through the cochleostomy was encountered in each patient and was ultimately controlled. Although the implants functioned properly, the auditory perceptual abilities did not progress past sound detection in the 3 siblings, or past closed-set word identification in the non-sibling, who achieved better speech perception with contralateral amplification. Three boys (2 siblings) show signs of other learning disorders; 1 boy was too young for a complete assessment. Conclusions: Preoperative gene mutation analysis in DFN3 patients who are considering cochlear implantation may help in long-term counseling and in avoidance of postoperative complications. Limited auditory perception and language acquisition may result. Amplification may sometimes be a better alternative than cochlear implantation, despite the severity of the hearing loss.
Effect of Successful Surgical Treatment on Changes of Position during Sleep in Adults with Obstructive Sleep Apnea Syndrome
Authors: Choi Ji Ho , Kim Eun Joong , Choi June , Kwon Soon Young , Lee Heung Man , Kim Tae Hoon , Lee Sang Hag , Shin Chol , Lee Seung Hoon 
Published: October 2014

Objectives: The purpose of this study was to evaluate the changes of position during sleep as determined by polysomnography before and after upper airway surgery for obstructive sleep apnea syndrome in patients with no response to surgery (“nonresponse group”) and in those who did have a response to surgery (“response group”). Methods: We analyzed a total of 106 polysomnograms from 53 subjects and compared the preoperative-postoperative differences in the frequency of positional changes during sleep and the distribution of sleep positions between the nonresponse group (n = 25) and the response group (n = 28). Surgical response was defined as a greater than 50% decrease in the postoperative apnea-hypopnea index. Results: The positional change index in the response group was significantly reduced (from 4.2 ± 3.8 to 2.6 ± 1.6; p = 0.038), whereas the positional change index in the nonresponse group did not significantly change (from 3.4 ± 2.0 to 3.4 ± 2.1; p = 0.861). The proportion of sleep time spent in the supine position did not significantly change in the nonresponse group (from 62.4% ± 18.1% to 60.5% ± 21.3%; p = 0.904) or the response group (from 55.5% ± 23.9% to 60.1% ± 23.1%; p = 0.412). Conclusions: The frequency of positional changes during sleep was significantly decreased with the improvement of respiratory disturbances and arousals in the response group after upper airway surgery.
Analysis of Functional and Anatomic Success following Endonasal Dacryocystorhinostomy
Authors: Zuercher Barbara , Tritten Jean-Jacques , Friedrich Jean Paul , Monnier Philippe 
Published: October 2014

Objectives: The aim of this study was to assess the concomitant perioperative procedures, the causes of nasolacrimal duct obstruction, the success rate, and the complications associated with endonasal dacryocystorhinostomy (ENDCR). Methods: In this single-center retrospective study, 98 patients underwent 104 ENDCRs between January 1994 and February 2006. There were 78 patients with 84 nasolacrimal duct obstructions who were included in this study. Results: The overall functional success rate with improvement in symptoms was 94.9% for primary surgery (59 of 84 obstructions) and 63.6% for salvage surgery after failure of primary surgery performed in another hospital (25 of 84 obstructions). The mean follow-up time was 36.8 ± 17.11 months. Primary surgery showed better results, with a complete success rate of 93.2%, than did salvage surgery, with a success rate of only 68%. Persistent symptoms, despite an open rhinostomy, were found in 1.7% of patients with primary surgery and in 12% of those with salvage surgery. Failure of ENDCR was observed in 3.4% of patients after primary surgery and in 20% after salvage surgery. We encountered only minimal perioperative complications, and these were essentially related to lacrimal intubation. Conclusions: Because of the possibility of treating concomitant sinonasal disorders, the cosmetic advantages, and the excellent results, ENDCR represents the procedure of choice for treating nasolacrimal duct obstructions. The main challenge lies in the exact preoperative assessment, as well as postoperative evaluation in case of failure.
Low-Acid Diet for Recalcitrant Laryngopharyngeal Reflux: Therapeutic Benefits and Their Implications
Authors: Koufman Jamie A. 
Published: October 2014

Objectives: Laryngopharyngeal reflux (LPR) is an expensive, high-prevalence disease with a high rate of medical treatment failure. In the past, it was mistakenly believed that pepsin was inactive above pH 4; however, human pepsin has been reported to be active up to pH 6.5. In addition, it has been shown by Western blot analysis that laryngeal biopsy samples from patients with symptomatic LPR have tissue-bound pepsin. The clinical impact of a low-acid diet on the therapeutic outcome in LPR has not been previously reported. To provide data on the therapeutic benefit of a strict, virtually acid-free diet on patients with recalcitrant, proton pump inhibitor (PPI)–resistant LPR, I performed a prospective study of 20 patients who had persistent LPR symptoms despite use of twice-daily PPIs and an H2-receptor antagonist at bedtime. Methods: The reflux symptom index (RSI) score and the reflux finding score (RFS) were determined before and after implementation of the low-acid diet, in which all foods and beverages at less than pH 5 were eliminated for a minimum 2-week period. The subjects were individually counseled, and a printed list of acceptable foods and beverages was provided. Results: There were 12 male and 8 female study subjects with a mean age of 54.3 years (range, 24 to 72 years). The symptoms in 19 of the 20 subjects (95%) improved, and 3 subjects became completely asymptomatic. The mean pre-diet RSI score was 14.9, and the mean post-diet RSI score was 8.6 (p = 0.020). The mean pre-diet RFS was 12.0, and the mean post-diet RFS was 8.3 (p < 0.001). Conclusions: A strict low-acid diet appears to have beneficial effects on the symptoms and findings of recalcitrant (PPI-resistant) LPR. Further study is needed to assess the optimal duration of dietary acid restriction and to assess the potential role of a low-acid diet as a primary treatment for LPR. This study has implications for understanding the pathogenesis, cell biology, and epidemiology of reflux disease.
Quantity and Three-Dimensional Position of the Recurrent and Superior Laryngeal Nerve Lower Motor Neurons in a Rat Model
Authors: Weissbrod Philip , Pitman Michael J. , Sharma Sansar , Bender Aaron , Schaefer Steven D. 
Published: October 2014

Objectives: We sought to elucidate the 3-dimensional position and quantify the lower motor neurons (LMNs) of the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) in a rat model. Quantification and mapping of these neurons will enhance the usefulness of the rat model in the study of reinnervation following trauma to these nerves. Methods: Female Sprague-Dawley rats underwent microsurgical transection of the RLN, the SLN, or both the RLN and SLN or sham surgery. After transection, either Fluoro-Ruby (FR) or Fluoro-Gold (FG) was applied to the proximal nerve stumps. The brain stems were harvested, sectioned, and examined for fluorolabeling. The LMNs were quantified, and their 3-dimensional position within the nucleus ambiguus was mapped. Results: Labeling of the RLN was consistent regardless of the labeling agent used. A mean of 243 LMNs was documented for the RLN. The SLN labeling with FR was consistent and showed a mean of 117 LMNs; however, FG proved to be highly variable in labeling the SLN. The SLN LMNs lie rostral and ventral to those of the RLN. In the sham surgical condition, FG was noted to contaminate adjacent tissues — In particular, in the region of the SLN. Conclusions: Fluorolabeling is an effective tool to locate and quantify the LMNs of the RLN and SLN. The LMN positions and counts were consistent when FR was used in labeling of either the RLN or the SLN. Fluoro-Gold, however, because of its tendency to contaminate surrounding structures, can only be used to label the RLN. Also, as previously reported, the SLN LMNs lie rostral and ventral to those of the RLN. This information results in further clarification of a rat model of RLN injury that may be used to investigate the effects of neurotrophic factors on RLN reinnervation.
Surgery or Botulinum Toxin for Adductor Spasmodic Dysphonia: A Comparative Study
Authors: Mendelsohn Abie H. , Berke Gerald S. 
Published: October 2014

Objectives: Currently, botulinum toxin (Botox) injection is the standard of treatment for adductor spasmodic dysphonia (ADSD). We sought to compare the outcome of selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery for ADSD to that of Botox injections. Methods: Patient-oriented measures (VHI-10) and objective single-blinded gradings of digital voice recordings were utilized as outcome measures. The surgical cohort, recruited by retrospective patient selection, consisted of 77 patients with a mean follow-up time of 7.54 ± 2.55 years (range, 2.2 to 14.2 years). The injection cohort, recruited prospectively, included 28 patients with a mean follow-up time of 46.37 ± 5.51 days (range, 36 to 54 days). Results: As measured by the VHI-10, the surgical patients had significantly improved voice handicap outcome scores (mean, 14.4 ± 13.6) as compared to the patients who had Botox injection (mean, 26.5 ± 12.1; p = 0.001). Aside from VHI-10 item 2, the surgical group demonstrated significantly improved voice-related function on each VHI-10 component (p = 0.01). Within the injection subgroup, 88% agreed that Botox successfully treats their ADSD, yet only 63% agreed that Botox improves their speech consistently. Within the surgical subgroup, 82% would recommend this surgery to others, and 78% agreed that their voice was actually better after surgery than after Botox. Objective voice ratings demonstrated similar levels of breathiness and overall voice quality in the treatment subgroups. Conclusions: When indicated, the SLAD-R surgery for ADSD demonstrates outcomes equal to or superior to those of the current standard of Botox injections.
Application of Natural Orifice Transluminal Endoscopic Surgery (NOTES) Instrumentation to the Endolarynx
Authors: Tan Melin , Prufer Neil , Chinosornvatana Nina , Park Chan , Woo Peak 
Published: October 2014

Objectives: RealHand instruments are high-dexterity instruments that have been designed for natural orifice transluminal endoscopic surgery applications. They provide dexterity by offering a full range of motion to endoscopic instruments. We hypothesize that RealHand instruments will resolve some of the limitations encountered in traditional endolaryngeal surgery. They have the potential to do so in the following ways: 1) they negate the limitation of mobility of traditional laryngoscopy instrumentation, which is rigid and fixed; 2) they maintain the ability of direct visualization through a telescope while precluding the need for an operating microscope; 3) they provide the dexterity to perform tasks that are otherwise not possible with traditional instrumentation; and 4) they provide flexibility that can be advantageous in difficult foreign body retrieval from distal airways. Methods: To test this hypothesis, we developed and optimized a cadaveric lamb larynx model for endolaryngeal microsurgery. To evaluate the feasibility of the RealHand instruments in their application to laryngeal surgery, we had 2 otolaryngology senior residents and 2 laryngology fellows-in-training perform 5 different endoscopic tasks: 1) foreign body removal; 2) arytenoidectomy; 3) microflap elevation; 4) cricopharyngeal myotomy; and 5) endoknot suture tying. Results: Experience with RealHand instruments demonstrated that although they are limited in application to phonosurgery, they have the potential for more facile tissue manipulation in the supraglottic and hypopharyngeal structures. Endoscopic suturing ability is enhanced. Conclusions: RealHand high-dexterity instrumentation allows for full range-of-motion instrumentation and, with modification, has potential for wider application in endoscopic laryngeal surgery.
In-Office Stand-Alone Balloon Dilation of Maxillary Sinus Ostia and Ethmoid Infundibula in Adults with Chronic or Recurrent Acute Rhinosinusitis: A Prospective, Multi-Institutional Study with 1-Year Follow-up
Authors: Levine Steven B. , Truitt Theodore , Schwartz Michael , Atkins James 
Published: October 2014

Objectives: This study evaluated in-office balloon dilation of maxillary sinus ostia and ethmoid infundibula to treat chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS). Methods: Seventy-four patients with disease in the maxillary and anterior ethmoid sinuses on computed tomography were prospectively enrolled across 12 study centers. All procedures were performed in the office. The primary outcomes were clinical effectiveness and health-care utilization at 1 year, measured by the validated surveys Sino-Nasal Outcome Test (SNOT-20) and Rhinosinusitis Symptom Inventory (RSI). Results: Dilation was successful in 69 patients (93.2%), and the average periprocedural pain level was 3.2 (scale of 0 to 10). The mean improvement on the SNOT-20 at 1 year was clinically and statistically significant (p < 0.0001), with no significant difference between the CRS and RARS patient outcomes. The treatment effect was the same in the CRS and RARS subgroups and was either “moderate” or “large” for 10 of 12 symptoms. The mean numbers of antibiotic courses (p ≤ 0.001), sinus-related physician visits (p < 0.0001), and number of acute sinus infections (p < 0.001) decreased significantly in both subgroups. There were no serious device-related adverse events, and the rate of revision surgery was 5.8%. Conclusions: Stand-alone balloon dilation of the maxillary sinus ostia and ethmoid infundibula performed in the office is well tolerated and effectively treats both CRS and RARS.