bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticholinergic Use Is a Major Risk Factor for Chronic Laryngitis
Authors: Haft Sunny , Mirza Natasha , Thompson Nikki 
Published: August 2013

Objectives:Dysphonia in the setting of chronic laryngitis is a common complaint within an otolaryngology practice. Often, the exact causes are poorly understood. We hypothesize that much of the laryngitis is a form of sicca caused by anticholinergic medication use and aimed to determine their association.Methods:A case‐control study evaluating 185 patients presenting to a laryngology practice was conducted over an 8 week period. Patients with a chief complaint of hoarseness secondary to chronic laryngitis rated a variety of symptoms (hoarseness, throat clearing, cough, post‐nasal drip, globus sensation) on a scale of 1‐5. Controls had few to no symptoms of laryngitis. After controlling for subjects with known causes of laryngitis, laryngitis scores were compared with subjects’ medication lists, age, and gender, and then evaluated using logistic regression via odds ratios (OR), with confidence intervals set at 95%.Results:Any patient taking at least one anticholinergic medication had a 3.86 increased odds (confidence interval [CI] 1.18‐12.60) of experiencing chronic laryngitis. If the patient was taking 2 or more anticholinergic medications, those odds rose to 7.94 (CI 1.88‐33.50). Polypharmacy was also an independent risk factor for chronic laryngitis (OR 4.46, CI 1.49‐13.07), while increasing age potentiated this risk.Conclusions:This is the first study to our knowledge that implicates medication use as a major risk factor, and possible cause, of chronic laryngitis. The striking association with anticholinergic use suggests that much laryngitis is due to sicca, or a drying effect. An awareness of this important association is invaluable when attributing cause to chronic laryngitis and considering treatment options.
Displacement of Residual Gore‐Tex Thyroplasty Implant Presenting as a True Vocal Fold Mass
Authors: Lalich Ian J. , Ekbom Dale C. 
Published: August 2013

Objectives:Describe the unique presentation and management of a patient with an ipsilateral true vocal fold mass following revision thyroplasty that was identified to have migration of residual Gore‐Tex thyroplasty implant into the superficial lamina propria of the anterior true vocal fold.Methods:A single case of a patient who underwent revision type I thyroplasty after an unsuccessful attempt elsewhere using a Gore‐Tex implant is reported. At the time of revision surgery, it was thought that all prior implant material was extricated, and the patient underwent revision type I thyroplasty using a carved silastic Netterville Implant with arytenoid adduction.Results:After initial improvement following the revision type I thyroplasty, the patient experienced deterioration of her voice. Indirect laryngeal examination revealed fullness on the superior surface of the right true vocal fold affecting mucosal wave and glottic closure. Microdirect laryngoscopy with endoscopic evaluation revealed migration of residual implant material into the superficial lamina propria. Using microflap technique, excision of the residual Gore‐Tex thyroplasty implant was successfully performed with a combination of carbon dioxide laser and cold‐dissection techniques.Conclusions:This case report describes the unique presentation of a displaced, non‐extruded residual Gore‐Tex thyroplasty implant, which presented as new onset dysphonia and mass involving the superior surface of the true vocal fold. This case demonstrates that displaced or migrated Gore‐Tex thyroplasty implant material can be successfully removed endoscopically using a modified microflap technique.
Severe Glotto‐Subglottic Stenosis in Children: Surgical Treatment with Extended Cricotracheal Reconstruction Technique
Authors: Hernandez Enrique G. O. , Grub Jaime P. , Neri Hiram A. , Morales Gustavo T. , Rodriguez Gerardo B. 
Published: August 2013

Objectives:Evaluate the efficacy of an extended variant to the CTR technique in patients diagnosed with severe glottic‐subglottic stenosis (GGS), which consists of expanding the glottis stenosis by placing a costal graft over the posterior cricoid plate and then performing a tyrotracheal anastomosis.Methods:Between 2004 to 2011 at the Hospital Infantil de Mexico “Federico Gomez,” patients with severe GSS based on laryngeal endoscopic evaluation, underwent an extended double‐stage CTR. They had a silastic stent for 3‐4 weeks and a temporal tracheotomy, which was removed when an appropriate size of the glottis and subglottis was confirmed. Results were analyzed, basing the success of the treatment on the patient's decannulation.Results:A total of 19 patients were identified, 8 male and 11 female, within an age range from 1 year 7 months to 13 years old, with a mean age of 6.2 years. All patients depended on tracheotomy and were sent to surgery. Fourteen had a favorable outcome and were decannulated (74%); the remaining 5 patients presented restenosis. From these 5, 1 patient has improved and is now waiting for decannulation. Only 1 patient presented anastomosis dehiscence and was successfully reoperated upon. There were no fatalities, and the 14 patients have good respiratory function.Conclusions:The combination of an extended technique to amplify the posterior glottis, where the scar is located, and the tirotracheal anastomosis, which eliminates the subglottic damage, is the only effective procedure to solve a severe glottis subglottic stenosis, as shown in our series.
Silastic Septal Buttons: A Safe, Effective Method to Close Tracheoesophageal Fistulas
Authors: Nicolli Elizabeth A. , Farquhar Douglas , Thompson Nikki , Mirza Natasha 
Published: August 2013

Objectives:Tracheo‐esophageal fistulas (TEFs) are significant source of morbidity, leaving many patients feeding‐tube dependent. Surgical closure may be unsuccessful, especially if the fistula is large or the patient has been irradiated.Methods:The first patient is a 64‐year‐old male with a history of total laryngectomy and postoperative radiation therapy and secondary tracheosophageal puncture. The second patient is a 74‐year‐old male with a history of radiation therapy for non‐Hodgkins lymphoma with subsequent iatrogenic TEF during a dilation procedure.Results:Both patients failed multiple attempts to close the fistula. A silastic septal button was placed via endoscopy in the operating room, and both patients were able to resume eating without signs of leakage around the button.Conclusions:Silastic septal buttons are a safe, effective way to close tracheoesophageal fistulas in patients who have failed other attempts at closure.
Transoral Robotic Resection of a Massive Laryngeal Lipoma
Authors: Adkins Lacey K. , Kalejaiye Adedoyin , Steehler Matthew K. , Pierce Matthew L. , Chia Stanley H. 
Published: August 2013

Objectives:Describe the clinical and radiographic features of a massive laryngeal lipoma and discuss the management through a transoral robotic approach.Methods:Retrospective case report. An otherwise healthy 66 year old male presented with 6 months of progressive dysphagia, dyspnea, and muffled voice. On flexible endoscopy a massive, smooth mass was seen filling the oropharynx and obstructing visualization of the vocal folds and hypopharynx. Computed tomography imaging revealed an 8.5x4.9 cm low‐attenuation mass extending from the right paraglottic space posteriorly into the hypopharynx and oropharynx. On magnetic resonance imaging, the mass was T1 hyperintense with slight rim enhancement and complete suppression on T2 weighted fat saturation. The patient underwent tracheotomy under local anesthesia and excision of the mass through a transoral robotic approach.Results:Final pathology was consistent with lipoma. The patient began tolerating oral intake on postoperative day 1 and was decannulated on postoperative day 8. At 2 months follow‐up, he had right vocal cord paresis but had significant improvement in both his vocal quality and dysphagia and no recurrent mass in the oropharynx or hypopharynx.Conclusions:Lipomas of the larynx are rare, accounting for 0.6% of benign laryngeal lesions. Despite their benign nature, removal is indicated to manage airway obstruction and dysphagia. To our knowledge, this is the first report of transoral robotic resection of a laryngeal lipoma. We propose the use of transoral robotic surgery for large benign lesions of the larynx in order to avoid the morbidity of an open cervical approach.
Analyzing ECoG Distortions in Cochlear Implant Patients and Gerbils
Authors: Forgues Mathieu , Adunka Oliver F. , Choudhury Baishakhi , Campbell Adam P. , Buchman Craig A. , Fitzpatrick Douglas 
Published: August 2013

Objectives:1) Describe how rectification and saturation in hair cell and neural responses contribute to electrocorticography (ECoG) recordings in an animal model. 2) Analyze distortions in intraoperative recordings of cochlear implant patients.Methods:ECoG potentials from the round window (RW) of humans and gerbils were measured to tones of different frequencies and intensities. Human subjects receiving cochlear implants had a variable degree of hearing loss. The gerbils had normal hearing or a pattern of high frequency, noise‐induced hearing loss similar to many cochlear implant recipients. In our animal model, forward masking, simultaneous masking, and application of a neurotoxin to the RW were used to isolate hair cell and neural responses.Results:In both humans and gerbils, discrete patterns of distortions in the ECoG waveform were present that had either a hair cell or neural origin. Distortions due to phase locking of nerve fibers (the ANN) were the main cause of distortion at low frequencies and up to moderate intensities, while distortions seen at high intensities across all frequencies suggested saturation of stereociliary movement in the CM.Conclusions:Distortions originating from phase locking in nerve fibers can be diminished with forward masking or a neurotoxin, helping to isolate the relative contribution of nerve fibers and hair cells. Distortions in the animal model are also present in ECoG recordings in cochlear implant patients, and can have hair cell or neural origins.
Audio‐Visual Vowel Perception of Cochlear Implant Users
Authors: Ogata Erika , Yamasoba Tatsuya , Akamatsu Yusuke 
Published: August 2013

Objectives:We created a vowel perception test to analyze the contribution of visual and auditory inputs during vowel processing in cochlear implant (CI) users.Methods:We enrolled 30 adults and 40 children who received cochlear implants (CI). Ten adults and 11 children with normal hearing (NH) also participated as controls. The auditory stimuli were 5 Japanese vowels and the visual stimuli were apparent motions that were succeeded by pictures of faces. The following three test conditions were used: 1) AV, the matched pairs of visual and auditory stimuli, 2) AV‐mismatch, the inconsistent pairs of stimuli, and 3) A‐only. During the session, the subjects were instructed to judge which vowel was said and to press the correct button. Correct rate and reaction time were measured.Results:Correct rate in AV‐mismatch and A‐only condition was significantly higher in NH compared to CI. Correct rate of AV‐mismatch condition was significantly lower than that of AV and A‐only conditions in CI. Moreover, CI took longer reaction time in AV‐mismatch condition compared to other conditions. We found that the degree of visual dependence of adult CI users was correlated with speech discrimination score, but not age, duration of deafness, or duration of CI use. Among pediatric CI users, mode of communication during preschool period affected the results.Conclusions:The aural group showed results similar to those of adult CI users, which imply that their processing of visual and auditory inputs is close to those who learned speech and language through the auditory modality.
Balance Rehabilitation with Virtual Games in Elderly with Vestibular Disorders
Authors: Dorigueto Ricardo S. , Silva Rodrigo M. , Doná Flavia , Biabock Arlete , Krauser Solange P. , Kasse Cristiane A. 
Published: August 2013

Objectives:Evaluate the effectiveness of balance rehabilitation protocol with virtual games in elderly with vestibular disorders.Method:Pilot prospective clinical trial at a university center for balance disorders. Nine older patients of both genders diagnosed with vestibular disorder were elected. Their symptoms, static posturography parameters (functional reserve and velocity of oscillation (VOS) in ten visual‐vestibular interaction and somatosensory conflicts) and the Dynamic Gait Index were evaluated before and after vestibular rehabilitation. The virtual games rehabilitation program used the Wii Balance Board. Patients were put in situations causing dizziness and postural instability, such as walking with eyes open and closed on a stable and unstable surface, beyond optokinetic stimuli, saccadic, and pursuit eye visuovestibular interaction. Sessions lasted 60 minutes, two times per week for eight weeks.Results:After treatment, there was significant reduction of the following symptoms: dizziness (P < 0.01), motion sickness (P < 0.05), postural instability (P < 0.01), and fear of falling (P < 0.05). The Dynamic Gait Index increased in all subjects and was above the cutoff score for high risk of falling. Mean values of functional reserve and VOS improved in all conditions after vestibular rehabilitation (P < 0.05), exception in conditions 2,4,9, and 10 of VOS.Conclusions:Preliminary results suggest that balance rehabilitation program using virtual games is effective in improving symptoms and clinical parameters related to static and dynamic balance in older patients with balance disorders.
Benign Paroxysmal Positional Vertigo Is More Commonly Associated with Orthostatic Dizziness than Orthostatic Hypotension
Authors: Jeon Eun‐Ju , Park Yong‐Soo , Chang Ki‐Hong 
Published: August 2013

Objectives:Orthostatic dizziness (OD) and positional dizziness (PD) are very common conditions in dizziness clinics, but those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI).Methods:Patients presenting with OD (n = 102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI.Results:The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for all patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). A total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n = 10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n = 2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P = 0.039).Conclusions:It is suggested that orthostatic testing such as OVSM or HUTT should be performed as an initial work‐up for patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD.
Er:YAG Laser Ablation of Bone versus Conventional Burrs in Otologic Surgery
Authors: Dalchow Carsten V. , Reimer Rudolph , Böttcher Arne , Kucher Stan , Jowett Nathan 
Published: August 2013

Objectives:The Er:YAG laser (EYL) provides an efficient means of precise and predictable bone ablation, without intense thermal injury associated with CO2 laser use. Use of the EYL in otology is possible, but must be undertaken with caution as ablation is associated with brief intense acoustic transients up to 120 dB. This study details the use of the EYL in otologic and neuro‐otologic surgery and compares ablation using a commercially available EYL with customizable glass fiber tips versus diamond and cutting burrs by means of infrared thermal imaging (IRT) and environmental scanning electron microscopy (ESEM).Methods:Five 0.6 mm diameter cylindrical cuts to a depth of 0.6 mm were made in formalin fixed human squamous temporal bone using a 300 µs EYL with pulse energies of 250 and 400 mJ (corresponding fluence levels of 175 and 280 mJ/cm2) and 0.6 mm diameter cutting and diamond burrs. Copious irrigation was used for all cuts. IRT was used to determine temperature rise. Ablation regions were inspected with ESEM.Results:Peak temperature rises were similar for all methods of ablation, none exceeding the 12 °C threshold required for irreversible bone injury. ESEM revealed rough margins for cuts made using the cutting burr and smooth edges with no sign of microfracture for those made with EYL and diamond burr.Conclusions:EYL ablates bone efficiently and predictably with smooth margins without microfractures or clinically significant temperature rise. When used appropriately, EYL may be a valuable tool for the otologic surgeon.
Gait Speed Seems to Predict Body Balance in Elderly Women
Authors: Dorigueto Ricardo S. , Kasse Cristiane A. , Raso Vagner 
Published: August 2013

Objectives:Determine the influence of body fat distribution, functional capacity, gait speed, and peak oxygen uptake on body balance of elderly women.Methods:Prospective clinical trial: at a university medical center. The sample consisted of 41 healthy elderly women aged from 61 to 77 years‐old (68.1 ± 0.7 years). Body fat distribution was assessed by subcutaneous central body adiposity and waist girth. Functional capacity was determined by time taken to move from seated to standing position (TSSP) and time to tie sneakers. Gait speed was assessed by the time to walk 3.33 m. Peak oxygen uptake (VO2peak) was measured during cardiopulmonary exercise testing. Body balance was assessed by the time to maintain an unipodal position during 30 seconds.Results:There were no significant prediction power for subcutaneous central body adiposity (adjusted R2=.01; P =.471), waist girth (adjusted R2=.01; P =.355), TSSP (adjusted R2=.04; P=.107), time to tie sneakers (adjusted R2 =.01; P =. 413) or VO2peak (adjusted R2=.03; P =. 747) with body balance. Nevertheless, it was observed that the time to walk 3.33 m significantly predicted the body balance (adjusted R2 =.08; P =. 047).Conclusions:Our results suggest that gait speed seems to be an important variable to predict body balance in elderly women. The prediction power of this association was very low, but appears to be a biological phenomenon because their impact was significant even in this small sample size.
Malignant Otitis Externa: An Evolving Disease
Authors: Hobson Candace E. , Moy Jennifer , Byers Karin , Raz Yael , Hirsch Barry E. , McCall Andrew A. 
Published: August 2013

Objectives:1) Compare the clinical presentations and outcomes of patients with MOE caused by Pseudomonas aeruginosa and methicillin‐resistant Staphylococcus aureus (MRSA). 2) Recognize the evolving trend of atypical and drug‐resistant organisms causing malignant otitis externa (MOE).Methods:A retrospective review of disease course and outcome was performed of patients diagnosed with MOE at a tertiary referral center between 1995 and 2012.Results:Forty‐four patients with a diagnosis of MOE were identified. Eighteen patients were excluded due to insufficient or inconsistent clinical data, leaving 26 patients for analysis. Forty‐six percent of patient cultures grew Pseudomonas and 12% grew MRSA. All patients infected with Pseudomonas had diabetes mellitus, compared to 33% of MRSA‐infected patients (P < 0.05). Twenty‐five percent of Pseudomonas‐infected patients presented with at least one cranial nerve palsy, as compared to none of the MRSA‐infected patients (ns). Duration of therapy for Pseudomonas‐infected patients lasted an average of 7.2 weeks, while MRSA‐infected patients lasted 10 weeks (ns). Excluding failed initial treatment courses, the average treatment durations were 5.0 and 7.7 weeks for Pseudomonas and MRSA infections, respectively. Other atypical pathogenic organisms isolated in culture include Candida, Aspergillus, and Enterococcus species.Conclusions:Increasingly, MOE is being caused by organisms other than Pseudomonas, including MRSA. Empiric treatment, without culture, can lead to delays in definitive therapy. A high index of suspicion for atypical or drug resistant organisms should be maintained in MOE patients who are not diabetic. Culture directed therapy for treatment of MOE is paramount.
A Novel Interactive 3‐Dimensional Model for Teaching and Learning the Anatomy of the Epitympanum
Authors: Ng Chew Lip , Liu Xuandao 
Published: August 2013

Objectives:The epitympanum is a challenging area for teachers and learners of its anatomy. Its complex 3‐dimensional relations are difficult to appreciate using texts or 2‐dimensional diagrams. We developed an interactive 3‐dimensional computer‐based model of the epitympanum that can be viewed from all angles for teaching and learning.Methods:The model was evaluated by 21 fourth‐year medical students in 2013. Students were given textbooks, journal articles, and 2‐dimensional diagrams of the epitympanum to study, followed by a demonstration of spatial relations using the model in one session. A questionnaire was used to assess the usefulness of the model.Results:81% of students found the epitympanic anatomy difficult to understand. 14.3% found the texts easy to understand. 33.3% found the texts easy to understand with 2‐dimensional diagrams. More males (50.0%; 6/12) than females (11.1%; 1/9) found it easy with 2‐dimensional diagrams (P = 0.07). 100% agreed that the model helps in understanding and remembering the anatomy (38.1% strongly agreed). 100% agreed that the model made understanding spatial relations easier than 2‐dimensional diagrams (33.3% strongly agreed). 90.5% agreed that the model helps in understanding the texts (28.6% strongly agreed). 100% agreed that the model is useful to residents/students (38.1% strongly agreed). One hundred percent agreed the model will be useful to teachers and would want this resource available if they were ear, nose, and throat (ENT) residents, with 47.6% and 38.1% strongly agreeing, respectively.Conclusions:Our model can be a useful tool in demonstrating epitympanic anatomy. It complements textbooks and 2‐dimensional diagrams to facilitate understanding.
Steroid‐Antiviral Treatment Improves the Recovery Rate in Patients with Severe Bell's Palsy
Authors: Kim Tae‐Hyun , Lee Ho‐Yun , Kang Ho‐Min , Byun Jae‐Yong , Park Moon‐Suh , Yeo Seung‐Geun 
Published: August 2013

Objectives:The extent of facial nerve damage is expected to be more severe in higher grades of facial palsy, and the outcome after applying different treatment methods may reveal obvious differences between severe Bell's palsy and mild to moderate palsy. This study aimed to systematically evaluate the effects of different treatment methods and related prognostic factors in severe to complete Bell's palsy.Methods:This randomized, prospective study was performed in patients with severe to complete Bell's palsy. Patients were assigned randomly to treatment with a steroid or a combination of a steroid and an antiviral agent. We collected data about recovery and other prognostic factors.Results:The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There were no significant intergroup differences in age, sex, accompanying disease, period from onset to treatment, or results of an electrophysiology test (P > 0.05). There was a significant difference in complete recovery between the 2 groups. The recovery (grades I and II) of the S group was 66.4% and that of the S+A group was 82.8% (P = 0.010). The S+A group showed a 2.6‐times higher possibility of complete recovery than the S group, and patients with favorable electromyography showed a 2.2‐times higher possibility of complete recovery.Conclusions:Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell's palsy than steroid treatment alone.