bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aerodynamic Phonatory Pattern as a New Sign of Superior Laryngeal Nerve Injury
Authors: Fernandez Secundino , Alcalde Juan M. , Baptista Peter M. , Barona Luz 
Published: September 2014

Objectives:Reduced quality of life after thyroid surgery is multifactorial and may include the need of lifelong different treatments. About 1 in 20 patients experience voice changes, and it is very frequent that these changes may not be caused by neural lesions. The purpose of this study is to describe aerodynamic phonatory features in thyroidectomized patients in order to determine what mechanisms are involved in voice changes in these patients and what are the best rehabilitative options.Methods:We studied 58 thyroidectomized patients with neither apparent neural cause of thyroidectomy‐related dysphonia nor recurrent laryngeal nerve injury nor external branch of the superior laryngeal nerve (EBSLN) injury. The patients were asked to produce sustained vowels, syllables, and sentences. Three items were recorded in upright and sitting positions. Afterward, acoustic and aerodynamic measurements were made: fundamental frequency, jitter, shimmer, intensity, harmonic/noise ratio, spectrographic analysis, subglottic pressure, mean transglottic flow, and laryngeal resistance. All measurements were made using Voice Plus from Alamed Corporation software. STATA software was used to analyze variables.Results:We describe 2 different groups of patients with different aerodynamic pattern in voice production that correlate with voice quality. In 66% of patients there was no change and in 34% the glottal pressure and laryngeal resistance decreased as a result of lower tension in the vocal fold as a consequence of an injury of the EBSLN.Conclusions:This aerodynamic phonatory pattern that may be understood by objective aerodynamic measurements could be another new sign of EBSLN injury.
Anterior‐Commissure Laryngoscope Extraction of Esophageal Coins in Children Using an Apnea Technique
Authors: Tarrats Luis A. , Rivera Marinell , Vargas‐Pinto Susana , Garraton Miguel , March Antonio Riera , Quintero Elisa 
Published: September 2014

Objectives:(1) To evaluate the efficacy and safety of coin extraction with the anterior‐commissure laryngoscope during apnea in children less than 10 years old. (2) To present the sociodemographic characteristics of this population and analyze the differences in foreign body features. (3) To describe heart rates (HR), minimal O2 saturation, and end‐tidal CO2 (ETCO2) during the procedure.Methods:In this retrospective chart review study, consecutive patients with a diagnosis of cervical esophageal coin who underwent this procedure between May 2011 and December 2013 at our institution (n = 59) were evaluated and data analyzed. Age (independent variable) was categorized as ≤1, >1 and <5, ≥5 and ≤10 years old.Results:The mean and standard deviation (SD) of age was 3.1 ± 2.4 years. The majority were Medicaid participants (87.5%). We successfully removed the coin in 94.9% (n = 59) of our cases with this technique. Among children completing the technique, children ≤1 year of age were more likely to ingest pennies (100%), whereas children ≥5 years old more likely ingested quarters (50%; P =. 01) Younger children showed higher HR than older groups and baseline values were similar to intraoperative ones (P <. 001). The length of apnea was 57.7 ± 25.2 seconds. The median minimum O2 saturation was 99.5% (min 93, max 100), and the media and SD of the ETCO2 at the end of the procedure was 35.7 ± 4.8 mm Hg.Conclusions:In properly selected patients the anterior‐commissure apnea technique represents an efficient and secure modality for treatment. If successful, the patient can be safely discharged home after clearance from anesthesia and a PO trial.
Complete Laryngotracheal Separation from Blunt Trauma: A Case Series and Discussion of Surgical Techniques
Authors: Spinner Alycia G. , Wang Robert C. 
Published: September 2014

Objectives:(1) Recognize the often subtle clinical presentation of complete laryngotracheal separation. (2) Address immediate course of action in the event of a total separation. (3) Describe components of a successful surgical repair.Methods:Over 3 years at a tertiary care center in Las Vegas, Nevada, 3 cases of complete laryngotracheal separation secondary to blunt trauma were successfully treated with prompt surgical intervention. Various surgical techniques were employed, given the complexity and different characteristics of each patient's presentation, with cartilaginous reduction and fixation favored over soft tissue apposition, along with fenestration tracheostomy procedures to prevent infection of the repair sites. Successful long‐term outcome was defined by tracheostomy tube decannulation and lack of multiple tracheal dilations or other tracheoplasty procedures to maintain a patent airway.Results:All 3 patients initially required a tracheostomy due to airway edema, but each made an uneventful recovery with early capping and tracheostomy tube decannulation. None of the patients necessitated further tracheal procedures, and all had serviceable voice and good swallowing function.Conclusions:Because of the relative rarity of complete laryngotracheal separations due to blunt trauma, surgical methods for repair are not widely published. We present our experience with the hope that it will assist other surgeons when faced with the challenge of diagnosing and repairing this life‐threatening injury.
Correlation of Reflux Finding Scores on Laryngoscopy to Clinical Outcomes
Authors: Patton Samuel R. , Underbrink Michael P. 
Published: September 2014

Objectives:Evaluate the reflux finding score as a clinical tool to diagnose laryngopharyngeal reflux disease by testing its reliability and reproducibility.Methods:Two scorers independently and blindly reviewed 330 videostrobes of patients that were performed from 2005‐2009. Scorers gave each videostrobe a reflux finding score. A chart review was then performed to determine the diagnosis given at the time of the videostrobe, smoking status, whether the patient was treated with anti‐reflux medication, and any abnormalities noted on recent esophagoscopy. The reflux finding scores of the 2 scorers were statistically compared for agreement with each other and to the findings of the chart review.Results:A total of 168 out of 330 patients met final criteria for inclusion in the study. The interrater agreement between the 2 scorers had a weighted kappa of 0.30. The c‐statistic scores for correlation of the scorers’ reflux finding scores (RFSs) to the chart diagnosis were 0.554 and 0.609 for scorer 1 and scorer 2, respectively.Conclusions:The reflux finding score has a fair inter‐relater reliability in our study. Blinded rater use of RFS in our study did not correlate well with clinical diagnosis of laryngopharyngeal reflux disease. No statistically significant differences in RFS validity were found based on gender, age, or treatment status.
New Experimental Model of Facial Nerve Function and Integrity to Evaluate Regeneration
Authors: Bento Ricardo F. , Costa Heloisa J. Z. R. , Nascimento Silvia B. , Ferreira Ricardo J. R. , Salomone Raquel 
Published: September 2014

Objectives:The ideal animal model for nerve regeneration studies is an object of controversy because all models described by the literature have advantages and disadvantages. Small animals such as rats have been repeatedly used in experimental procedures because of their easy caretaking and handling, resistance to manipulation and infections, and low cost. In this case, rats have the additional benefit of tolerating bilateral facial paralysis. This study aimed to describe the histologic and functional (electroneuromyographic) patterns of the mandibular branch of the facial nerve of Wistar rats in order to create a new experimental model of facial nerve regeneration.Methods:Forty‐two male Wistar rats were submitted to neurophysiologic evaluation by a nerve conduction test of the mandibular branch of the facial nerve to obtain the compound muscle action potential. Twelve of these rats had the mandibular branch of the facial nerve surgically removed and submitted to histologic analysis (total axon number, partial axonal density, and axonal diameter) of the proximal and distal nerve segments.Results:There was no statistical difference in the functional and histologic variables studied.Conclusion:These new histologic and functional standards of the mandibular branch of the facial nerve of rats establish an objective, easy, and greatly reproducible model for future facial nerve regeneration studies.
Hand Manometry to Assess Overall Muscle Strength (Frailty) in Dysphagic Patients
Authors: Kim Luke Y. , Farquar Douglas , Mirza Natasha 
Published: September 2014

Objectives:(1) Evaluate whether patients with symptoms of aspiration as assessed by fiberoptic endoscopic evaluation of swallowing (FEES) demonstrate reduced overall muscle weakness, or frailty, as seen by handgrip strength. (2) Determine whether tools such as the Eating Assessment Tool (EAT‐20) and Penetration‐Aspiration Scale (PAS) correlate with muscle strength as seen by handgrip strength.Methods:Prospective, single‐blind study on patients with chief complaints of dysphagia who presented to a tertiary referral center over a 4‐month period. Participants completed the EAT‐20 dysphagia questionnaire. FEES was performed by administering standardized boluses of 4 different consistencies (thin liquid, nectar, puree, mechanical soft food) and assessing for spillage, penetration, pharyngeal residue, aspiration, and reflux. Patients were additionally scored using the Penetration‐Aspiration Scale. Aspirators had a score >5. Overall muscle strength was assessed using handgrip strength measured by hand dynamometry.Results:Twenty‐seven patients with chief complaints of dysphagia were eligible for enrollment. Average grip strength was 25.9 kg, average EAT‐20 score was 35, and average PAS score was 3. Six out of 27 patients (22%) were found to be aspirators with PAS >5. Average grip strength for nonaspirators and aspirators was 25.9 kg and 25.6 kg, respectively (P >. 05). Controlling for weight, age, and sex, EAT‐20 showed no correlation with grip strength (P >. 05). EAT‐20 demonstrated significance with PAS score (P <. 01).Conclusions:Grip strength does not demonstrate association with dysphagia and risk of aspiration. Frailty may not be strongly predicted by grip strength. Other measures of frailty should be investigated with risk of aspiration.
Identifying Occupations at Risk of Laryngeal Disorders in an Academic Laryngology Clinic
Authors: Mori Matthew C. , Song Phillip 
Published: September 2014

Objectives:Identify occupations of new laryngology patients found in high prevalence compared with the occupations of the surrounding general population. Laryngeal disorders have been associated with several occupations, including teachers, singers, and telemarketers. Our study may help identify new groups of patients at risk for laryngeal pathology.Methods:Using our laryngology clinic database, we determined prevalence of occupations in employed new patients from 1993 to 2012 and compared this with data from the Bureau of Labor Statistics for the greater Boston area over the same time period. Proportions with confidence intervals were used to establish statistical significance.Results:The occupations of 10,119 patients were analyzed. Occupations with statistically significant higher prevalence in laryngology clinic than in the general population included singers, teachers, lawyers, scientists, and clergy. Occupations with lower prevalence included maintenance workers, cleaners, bus drivers, repairmen, and computer programmers.Conclusions:This study identified several new occupational groups that may be at higher risk of laryngeal pathology because of their relatively higher prevalence in laryngology clinic.
Management of Tracheo‐esophageal Fistulae with Montgomery T‐Tube
Authors: Tran Christopher M. , Fink Daniel S. , Kunduk Melda , McWhorter Andrew J. 
Published: September 2014

Objectives:(1) Describe a minimally‐invasive technique for management of trachea‐esophageal fistulae. (2) Analyze outcomes of management of trachea‐esophageal fistulae with t‐tube placement.Methods:A retrospective case series with chart review was conducted at an academic practice in a regional referral center. Two patients with tracheo‐esophageal fistulae who either were not candidates for open surgical repair or refused open surgical repair were successfully managed with a Montgomery T‐tube to stent the fistula. Outcome measures included resumption of oral diet, need for further procedures, and fistula size.Results:Both patients had t‐tubes that were sized to stent the fistula and maintain an airway without esophageal stent or tracheostomy. There were no cases of migration or enlargement of fistula. No patients required revision procedures. Fistulae were successfully controlled in all patients, with full resumption of oral intake and maintenance of voice. No patients had closure of fistula.Conclusions:Montgomery T‐tube stenting is a safe and minimally invasive way to manage trachea‐esophageal fistulae in patients who are not candidates for open surgical repair. This technique minimizes soilage of the airway with maintenance of voice that is often difficult in management with cuffed tracheotomy tubes. Neither migration nor enlargement of fistula was noted.
Metastatic Calcification of the True Vocal Folds in the Setting of Renal Failure
Authors: Hardison Scott A. , Schuman Theodore A. , Jakowski Joseph 
Published: September 2014

Objectives:(1) Present a case of metastatic calcinosis of the true vocal cords. (2) Discuss the pathogenesis, diagnosis, and treatment strategies for this condition.Methods:This is a case report of a 52‐year‐old male with a history of end‐stage renal disease and tobacco abuse who presented to clinic with complaints of dysphagia, cough, and subtle voice changes. Transnasal fiberoptic laryngoscopy revealed bilateral patches of leukoplakia on the anterior third of the vocal cords. After a 3‐month period of conservative management with a proton pump inhibitor and serial scope examinations, the lesions were noted to be slowly enlarging. It was determined that an excisional biopsy should be performed to rule out malignancy. The patient underwent micro‐suspension direct laryngoscopy with microflap excision of the bilateral vocal cord lesions.Results:Surgical pathology revealed benign squamous mucosa with calcinosis, parakeratosis, and submucosal hyalinization. These findings were characteristic of metastatic calcification. Review of the patient's medical records confirmed ongoing phosphorous dysregulation. Metastatic calcinosis of the true vocal fold is a very rare finding, with only 2 other reported cases in the literature.Conclusions:In patients suffering from end‐stage renal disease, dysregulation of calcium and phosphate levels may lead to deposition of calcium in many types of soft tissue, including the true vocal cords. Examination findings may mimic dysplastic lesions, and this diagnosis should be considered in patients with chronic kidney disease.
Objective Assessment of Postoperative Outcomes in Endonasal Spreader Grafts
Authors: Jeffery Caroline C. , Ansari Khalid , Cote David 
Published: September 2014

Objectives:Use acoustic rhinometry to objectively measure the functional outcomes of endonasal spreader grafts in patients undergoing surgical correction of internal nasal valve collapse.Methods:Eighteen adult patients undergoing open septoplasty with unilateral or bilateral endonasal spreader graft placement were recruited. Patients were asked to undergo preoperative and postoperative acoustic rhinometry to measure changes in cross‐sectional area of the internal nasal valve. Postoperative subjective nasal symptoms as measured by SNOT‐22 and NOSE scores were also compared to preoperative values.Results:Patients undergoing septoplasty with endonasal spreader graft placement had a statistically significant increase in the cross‐sectional area of the internal nasal valve (P <. 05). This was concomitant with mild improvement in SNOT‐22 and NOSE scores postoperatively (P <. 05).Conclusions:This study provides objective evidence of an increase in internal nasal valve area after placement of endonasal cartilage spreader grafts in combination with septoplasty.
Outcomes of Arytenoid Adduction under Laryngeal Mask Mechanical Ventilation for Unilateral Vocal Fold Paralysis
Authors: Kawamoto Ai , Honkura Yohei , Watanabe Kenichi , Katori Yukio 
Published: September 2014

Objectives:Arytenoid adduction surgery for the unilateral vocal fold paralysis is usually carried out under intravenous sedation because improvement of the voice evaluable during surgery. In patients preferred for surgery under general anesthesia due to their physical or mental condition, we selected general anesthesia using laryngeal mask mechanical ventilation, and we confirmed the location of the vocal fold during surgery using a flexible fiberscope. To evaluate this procedure of anesthesia, we compared outcomes of the adduction surgeries between intravenous sedation and general anesthesia.Methods:From September 2012 to August 2013, adduction surgeries were performed in 17 cases under intravenous sedation with spontaneous breathing, and in 5 cases under general anesthesia using laryngeal mask. Pre‐ and postoperative maximum phonation time (MPT), mean flow ratio (MFR), and voice handicap index‐10 (VHI‐10) were evaluated.Results:MPT, MFR, and VHI‐10 were remarkably improved in all adduction surgery with intravenous sedation cases. In the general anesthesia group, improvement of the factors was also recognized in most cases, but not in all.Conclusions:Adduction surgery under general anesthesia with laryngeal mechanical mask ventilation is a useful tool for the unilateral vocal fold palsy patient. However, even though we checked the position of the vocal fold in surgery, the efficacy of the surgery is not guaranteed in a few cases because the actual voice cannot be evaluated in general anesthesia.
Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross‐Sectional Controlled Study
Authors: Turfe Zaahir , Kasti Maher M. , Beydoun Nour , Hamdan Abdul Latif 
Published: September 2014

Objectives:Investigate the prevalence of phonatory symptoms, perceptual, acoustic, and aerodynamic findings in patients with asthma compared to a control group.Methods:A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and sex, were enrolled in this study. All subjects were asked about the presence or absence of cough, dyspnea, respiratory failure, dysphonia, degree of vocal fatigue, and phonatory effort. Perceptual evaluation, acoustic analysis, and aerodynamic measurements were also performed. Patient self‐assessment using the Voice Handicap Index 10 was reported.Results:The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the 2 groups (32.3% vs 5.3%, P =. 025) with a significant difference in the mean score of respiratory effort and vocal fatigue (P =. 019,. 041, respectively). The overall grade of dysphonia was significantly higher in asthmatics compared to controls (P =. 002). Patients with asthma also had significantly higher degree of asthenia and straining with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for jitter. There was also no significant difference in the maximum phonation time between the 2 groups.Conclusions:Phonatory symptoms are significantly more prevalent in patients with asthma compared to controls.
Postoperative Glottal Function and Voice‐Related QOL after Type1 and Type2 Cordectomy against Laryngeal Leukoplakia
Authors: Kono Takeyuki , Saito Koichiro , Yabe Haruna , Uno Kosuke , Ogawa Kaoru 
Published: September 2014

Objectives:Recent progress in phonomicrosurgical technique and equipment enabled one to precisely differentiate the subepithelial (type1) and subligamental (type2) cordectomy concept as needed. The purpose of this study was to compare postoperative glottal function and voice‐related quality of life (QOL) between these 2 surgical concepts against laryngeal leukoplakia.Methods:From January 2007 to August 2013, 42 consecutive laryngeal leukoplakia patients had excisional biopsies using type1 procedures. Of these, cancer patients (n = 10) had additional type2 laser surgeries. Furthermore, some severe dysplasia/carcinoma in situ patients (n = 11) preferred additional type2 surgery aiming at relatively safe surgical margins. Sequential pre‐ and postoperative measurements of Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale and evaluations of laryngeal videostroboscopic images were performed. Acoustic measurements and voice‐related QOLs (VHI and V‐RQOL) were examined at the patients’ last visits. All data were compared between type1 and type2 groups.Results:Vocal quality was well‐preserved in type1 group after surgery. Although immediate postoperative deterioration of GRBAS score was observed in type2 group, vocal recovery was obtained in 6 months to present no significant difference compared with type1 group. Impaired glottal closure and pliability were observed in both groups after surgery. While videostroboscopic findings of type1 group recovered to normal in 3 months, impaired glottal findings remained for 1 year in half of the type2 patients. Moreover, voice‐related QOLs were significantly better in type1 group.Conclusions:Our study proved that advanced phonomicrosurgical technique and equipment could offer a well‐preserved vocal quality even in the type2 group. However, subjective voice‐related QOLs were better in the type1 group with superior videostroboscopic findings.
Prevalence of Phonatory Symptoms and Acoustic Findings in Patients with Chronic Obstructive Lung Disease
Authors: Turfe Zaahir , Kanj Nadim , Jaffal Hussein , Attallah Jane , Hamdan Abdul Latif 
Published: September 2014

Objectives:Investigate phonatory symptoms and acoustic and aerodynamic findings in patients with chronic obstructive lung disease (COPD) compared to a control group.Methods:A total of 40 subjects, 27 COPD and 13 control subjects matched according to age and sex, were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, degree of vocal fatigue, and phonatory effort. Perceptual evaluation, acoustic analysis, and aerodynamic measurements were also performed. Patient self‐assessment using the Voice Handicap Index 10 was reported.Results:There was a statistically significant difference in the prevalence of dysphonia between the 2 groups (12% vs 0%, P <. 05) with a significant difference in the mean score of respiratory effort and vocal fatigue (P =. 011,. 012, respectively). There was no significant difference in any of the perceptual parameters between the 2 groups except for roughness (P =. 009). There was no significant difference in the means of any of the acoustic parameters between patients and controls. There was also no significant difference in the maximum phonation time between the 2 groups (P =. 916).Conclusions:Dysphonia is significantly more prevalent in patients with COPD compared to controls.