bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Corticosteroid Oral Therapy and Intraoperative Bleeding during Functional Endoscopic Sinus Surgery in Patients with Severe Nasal Polyposis: A Preliminary Investigation
Authors: Sieskiewicz Andrzej , Olszewska Ewa , Rogowski Marek , Grycz Ewa 
Published: October 2014

Objectives: The aim of the study was to investigate whether orally administered steroids might improve surgical field conditions during functional endoscopic sinus surgery. Methods: Total blood loss and visualization of the surgical field during the surgical procedure were compared in 2 groups of 18 patients each with severe nasal polyposis. The groups were similar in respect to age, body mass index, general health status, incidence of allergy, bronchial asthma, aspirin triad, and stage of disease. One group received 30 mg of prednisone daily for 5 consecutive days before the operation. The second group served as a control. Results: Although the total blood loss was only slightly less in the steroid group, the visual conditions of the surgical field improved significantly. Conclusions: Better surgical field conditions were the results of the powerful anti-inflammatory and antiedematous activity of the drug, which facilitated blood and secretion evacuation from the operated area and prevented the optic system from staining.
Prognostic Factors in Sudden Sensorineural Hearing Loss: Our Experience and a Review of the Literature
Authors: Narozny Waldemar , Kuczkowski Jerzy , Kot Jacek , Stankiewicz Czeslaw , Sicko Zdzislaw , Mikaszewski Boguslaw 
Published: October 2014

Objectives: We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL). Methods: Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant. Results: Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring. Conclusions: A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.
Voice-Related Quality of Life in T1 Glottic Cancer: Irradiation versus Endoscopic Excision
Authors: Cohen Seth M. , Garrett C. Gaelyn , Dupont William D. , Ossoff Robert H. , Courey Mark S. 
Published: October 2014

Objectives: Several studies have explored posttreatment voice outcomes for early glottic cancer with varying results. To further clarify the voice-related quality of life (QOL) of T1 glottic cancer patients treated by external beam radiotherapy (EBRT) compared to endoscopic carbon dioxide laser excision (CLE), we performed a meta-analysis. Methods: We performed a meta-analysis review for the years 1966 to 2005 for the Voice Handicap Index (VHI), laryngeal cancer, voice outcome, voice quality, and quality of life. Studies in which the VHI was assessed at least 3 months after treatment for T1 glottic cancer were identified and analyzed by meta-analysis techniques. Results: Six studies with 208 patients (6 T1b and 202 T1a) treated with CLE and 91 patients (6 T1b and 85 T1a) treated with EBRT were identified. The posttreatment VHI scores were similar for the EBRT- and CLE-treated patients (p = .1, Wilcoxon rank sum test). Conclusions: We conclude that CLE and EBRT provide comparable levels of voice handicap for patients with T1 glottic cancer.
Thyrohyoid Approach for Vocal Fold Augmentation
Authors: Amin Milan R. 
Published: October 2014

Objectives: I performed a retrospective chart review to evaluate the patient tolerance and clinical results of a new technique for office-based vocal fold augmentation. Methods: Ten patients undergoing the thyrohyoid approach for vocal fold augmentation were asked to rate their tolerance of the procedure using a 10-point rating scale (1 = “no problem” and 10 = “very uncomfortable”). The patients also filled out a quality-of-life survey (Voice Handicap Index-10) immediately before and 1 month after the procedure. I reviewed the preprocedure and postprocedure stroboscopic findings. The findings analyzed included changes in wave symmetry and glottal closure, and evidence of implant migration. Results: All patients successfully underwent the procedure. The mean patient tolerance score was found to be 2.1. The average score on the Voice Handicap Index-10 improved from 21.3 before the procedure (SD, 9.23) to 7.5 after the procedure (SD, 5.77). These values were compared by use of a paired t-test, and the difference was found to be significant, with a p value of .01. The analysis of stroboscopic results revealed “improvement” or “no change” in the wave symmetry, “improvement” in glottal closure, and “no evidence of migration” after the procedure in all cases. Conclusions: The study findings demonstrate that the thyrohyoid approach can be used successfully in patients who need vocal fold augmentation, and that it is generally well tolerated.
Does Obstructive Sleep Apnea Affect Aerobic Fitness?
Authors: Guillermo Louis Q. , Gal Thomas J. , Mair Eric A. 
Published: October 2014

Objectives: We sought to determine whether patients with obstructive sleep apnea (OSA) had an objective change in aerobic fitness during cycle ergometry compared to a normal population. The most accurate test of aerobic fitness is measurement of maximum oxygen consumption (V̇O2max) with cycle ergometry. Methods: We performed a retrospective cohort analysis (247 patients with OSA) of V̇O2max from annual cycle ergometry tests compared to a large control group (normative data from 1.4 million US Air Force tests) in a tertiary care setting. Results: Overall, individuals with OSA had increased V̇O2max when compared to the normalized US Air Force data (p > .001). Patients with an apnea-hypopnea index of greater than 20 demonstrated a decreased V̇O2max as compared to normalized values (p > .001). No differences in V̇O2max were observed after either medical or surgical therapy for OSA. Conclusions: Overall, in a US Air Force population, OSA does not predict a decrease in aerobic fitness as measured by cycle ergometry. However, patients with an apnea-hypopnea index of greater than 20 have a statistically significant decrease in aerobic fitness compared to the normal population. This study demonstrates the effects of OSA on aerobic fitness. Further correlation of fitness testing results with OSA severity and treatment is needed.
Advantage of Accelerated Fractionation Regimens in Definitive Radiotherapy for Stage II Glottic Carcinoma
Authors: Nomiya Takuma , Nemoto Kenji , Wada Hitoshi , Takai Yoshihiro , Yamada Shogo 
Published: October 2014

Objectives: We evaluated the prognostic factors for local control of T2 glottic cancer and verified the efficacy of accelerated fractionation regimens such as hyperfractionation and accelerated hyperfractionation. Methods: A total of 86 patients with T2 NO MO glottic squamous cell carcinoma, who were treated with definitive radiotherapy, were analyzed retrospectively by multivariate analysis. Results: Overall treatment time of radiotherapy (p = .0003) and total dose (p = .0036) were the significant prognostic factors for local control on multivariate analysis. The group with a higher total dose (>67 Gy versus <67 Gy) showed a favorable prognosis (5-year local control rate of 91% versus 60%, respectively; p = .0013, log-rank test). Likewise, the group with a shorter overall treatment time of radiotherapy (<54 days versus >54 days) showed a favorable prognosis (5- year local control rate of 87% versus 71%, respectively; p = .023). Conclusions: A radiotherapy total dose of >67 Gy delivered for a shorter period is required for T2 glottic cancer. The fractionation regimens of hyperfractionation and accelerated hyperfractionation are more effective than conventional fractionation in terms of shortening overall treatment time and delivering a high total dose with acceptable toxicity.
Expression and Distribution of CD44 and Hyaluronic Acid in Human Vocal Fold Mucosa
Authors: Sato Kiminori , Sakamoto Kikuo , Nakashima Tadashi 
Published: October 2014

Objectives: Expression of CD44 (a cell surface receptor for hyaluronic acid) and the distribution of hyaluronic acid were examined in the human vocal fold mucosa. Methods: Light microscopic investigation was carried out on 10 normal larynges of newborn, infant, younger adult, and older adults with Alcian blue staining, a hyaluronidase digestion study, and immunohistochemistry for CD44. Results: Before the appearance of hyaluronic acid in the newborn vocal fold mucosa, CD44 was expressed on the stellate cells in the macula flava and on the fibroblasts in Reinke's space. During infancy, hyaluronic acid appeared and was distributed in the vocal fold mucosa. Many more stellate cells in the macula flava showed CD44 expression, and a large amount of hyaluronic acid was present around the infant stellate cells; however, the fibroblasts in Reinke's space expressed little CD44. During adulthood, hyaluronic acid was distributed in the vocal fold mucosa. Almost all of the stellate cells in the macula flava showed CD44 expression, and much hyaluronic acid existed around the stellate cells in the adult macula flava. However, fibroblasts in the adult Reinke's space expressed little CD44, and hyaluronic acid density in that space was lower than that in the macula flava. Conclusions: Stellate cells in the macula flava and CD44 cooperatively play important roles in maintaining hyaluronic acid in the human vocal fold mucosa as a vibrating tissue.
Outcome of Endoscopic Management of Extensive Laryngotracheal Stenosis
Authors: Kim Young-Ho , Baek Seung Jae 
Published: October 2014

Objectives: When performing endotracheal intubation or tracheotomy in unconscious patients in emergent situations, one should consider the possibility of the later complication of laryngotracheal stenosis, which can result in difficulties with decannulation. We analyzed the clinical features of laryngotracheal stenosis to search for its possible etiologic factors and its proper preventive methods. Methods: The medical records of 249 cases of laryngotracheal stenosis out of 2,208 patients who underwent tracheotomy in our hospital during the past 12 years were retrospectively reviewed regarding several parameters, such as the duration of endotracheal intubation, site of tracheostoma, site of stenosis, treatment method, and so forth. Results: Non-otolaryngologists had a tendency to place the tracheostoma at a higher level of the trachea. We identified technical precautions that should be taken into consideration in performing an emergency tracheotomy. Bronchoscopic evaluation and tracheal stent insertion was the most commonly used treatment method. Successful decannulation was achieved in about 70%, and was especially frequent in patients whose endotracheal intubation was less than 20 days. Conclusions: It is desirable that the duration of endotracheal intubation be limited to less than 20 days. A database of patients who undergo tracheotomy should be submitted to careful follow-up to diagnose early development of laryngotracheal stenosis and to prevent long-term complications.
Leaving a Lasting Impression: Ear Mold Impressions as Middle Ear Foreign Bodies
Authors: Jacob Abraham , Morris Targhee J. , Welling D. Bradley 
Published: October 2014

Objectives: We describe a series of otologic complications from impression material used to make hearing aid molds. Methods: We examined a retrospective case series of patients presenting to a tertiary care academic medical center. Results: The presentation, clinical course, and treatment outcomes of 6 patients with complications related to ear molds are discussed. These patients had preexisting abnormalities in their aural anatomy, including tympanic membrane perforations, retraction pockets, and mastoidectomy cavities. Conclusions: Although the majority of patients who have ear canal impressions taken experience no adverse outcomes, hearing aid dispensers should perform a thorough history-taking and physical examination to discern those with abnormal anatomy at risk for complications. These patients may benefit from evaluation in conjunction with an otolaryngologist.
Hands-on Training Methods for Vocal Fold Injection Education
Authors: Amin Milan , Rosen Clark A. , Simpson C. Blake , Postma Gregory N. 
Published: October 2014

Objectives: Vocal fold injection (VFI) in the office setting and in the operating room is becoming increasingly popular. Most training programs fail to educate residents in performing these injections. In this report, we describe novel and effective teaching tools that provide real-life simulation of VFI for the education of residents and otolaryngologists in practice. Methods: Equipment was developed to allow the use of excised fresh cadaver larynges to simulate peroral VFI in a life-sized model of the human head and neck. A separate setup was also developed for use of a laryngoscope holder and cadaver larynges to simulate microlaryngoscopy VFI. Each of these VFI training setups allows the student to perform and practice VFI in a simulated setting with physical and anatomic constraints and laryngeal anatomy similar to those of real-life VFI. The use of fresh cadaver larynges allows the user to have a realistic feel of actual injection. A visual analog scale was used to measure the participants' comfort levels with the peroral and microlaryngoscopic injection techniques before and after the workshop. Results: Pre-workshop and post-workshop surveys were collected from 22 of the VFI course participants. The mean comfort levels for VFI prior to the workshop were 22 for peroral VFI and 69 for microlaryngoscopy VFI (0 = not comfortable at all and 100 = very comfortable). The post-workshop comfort levels were 52 for peroral VFI and 85 for microlaryngoscopy VFI. The differences in the pre- and post-workshop comfort level scores for each VFI technique were significant (microlaryngoscopy, p = .001; peroral, p <0001). Conclusions: The use of VFI simulations appears to improve surgeon comfort level with injection techniques. The described training simulations may be useful for allowing residents and practicing otolaryngologists to learn VFI before attempting these techniques on actual patients.
Directional Asymmetry in the Measured Nitrous Oxide Time Constant for Middle Ear Transmucosal Gas Exchange
Authors: Doyle William J. , Yuksel Sancak , Banks Juliane , Alper Cuneyt M. 
Published: October 2014

Objectives: Simple, 2-compartment mathematical models of middle ear (ME) transmucosal gas exchange reproduce observed ME pressure behavior. These models require input of an experimentally determined, lumped-parameter exchange constant for each represented gas species. Previous model applications assumed directional asymmetry for those parameters, which has not been experimentally validated. Methods: As a surrogate for the inert gas nitrogen (N2), for which exchange is too slow to be measurable, the nitrous oxide (N2O) transmucosal exchange constant for 16 ears of 8 monkeys was measured for positive and negative ME blood N2O gradients. Results: The paired exchange constants for each ear were highly correlated, but the ME-blood/blood-ME exchange constant ratio was approximately 13. Modeling shows this asymmetry to depend on the value of the arterial-venous/arterial-ME ratio, a variable in the exchange constant for perfusion-limited gases. Conclusions: These results support an asymmetric rate of transmucosal N2O and, by extension, N2 exchange for the ME. Because the primary controlling parameter for ME pressure behavior in the absence of eustachian tube opening is the rate of transmucosal N2 exchange, this effect needs to be incorporated into the simple 2-compartment exchange models for predictive accuracy. The gradient ratio dependence suggests that parameter-free modeling may require treating the ME mucosa as having a distributed gradient for certain gas species.
Effects of Corticosteroids on Expression of Interleukin-18 in the Airway Mucosa of a Mouse Model of Allergic Rhinitis
Authors: Kim Si Whan , Jeon Yoon Kyung , Won Tae Bin , Dhong Hun-Jong , Min Jin-Young , Shim Woo Sub , Min Yang-Gi 
Published: October 2014

Objectives: In this study, we aimed to investigate the release and response of interleukin (IL)-18 to steroid treatment in a mouse model of allergic rhinitis. Methods: BALB/c mice were sensitized systemically by intraperitoneal injection of ovalbumin and locally by ovalbumin inhalation. Dexamethasone sodium phosphate was given by intraperitoneal injection in the steroid treatment group. Symptom scores, eosinophil counts, and IL-18 concentrations in the nasal and lung lavage fluids were analyzed. Results: The symptom scores and eosinophil counts of the negative control and steroid treatment groups were significantly lower than those of the positive control group (p < .01). The mean IL-18 concentrations in the nasal lavage fluid were not significantly different among the three groups (56.68 ± 9.57, 63.39 ± 8.93, and 64.47 ± 6.83 pg/mL, respectively). The IL-18 concentrations in the lung lavage fluid were significantly different between the positive control group and the steroid treatment group (430.75 ± 154.54 and 69.94 ± 14.26 pg/mL, respectively, p = .028). Conclusions: The IL-18 concentration was found to be increased in the lung lavage fluid, but not in the nasal lavage fluid, in a mouse model of allergic rhinitis. Increased IL-18 concentrations returned toward the previous concentrations after steroid treatment. These results suggest that the roles of IL-18 may be different in the pathogenesis of allergic rhinitis and the pathogenesis of asthma.
Gene Therapy for Laryngeal Paralysis
Authors: Shiotani Akihiro , Saito Koichiro , Araki Koji , Moro Kazuhisa , Watabe Kazuhiko 
Published: October 2014

Objectives: The surgical options for laryngeal paralysis only achieve static changes of vocal fold position. Laryngeal reinnervation procedures have had little impact on the return of dynamic laryngeal function. The development of a new treatment for laryngeal paralysis, aimed at the return of dynamic function and neurologic restoration and regeneration, is necessary. Methods: To assess the possibility of gene therapy for laryngeal paralysis aiming for the return of dynamic laryngeal function, we investigated the therapeutic effects of gene therapy using rat laryngeal paralysis models. Results: In a rat vagal nerve avulsion model, we transferred glial cell line-derived neurotrophic factor (GDNF) gene into the nucleus ambiguus using an adenovirus vector. Two and 4 weeks after the GDNF gene transfer, a significantly larger number of surviving motoneurons was observed. These neuroprotective effects of GDNF gene transfer were enhanced by simultaneous brain-derived neurotrophic factor gene transfer. In a rat recurrent laryngeal nerve crush model, we transferred GDNF gene into recurrent laryngeal nerve fibers after crush injury. Two and 4 weeks after GDNF gene transfer, we observed significantly faster nerve conduction velocity and better vocal fold motion recovery. Conclusions: These results indicate that gene therapy could be a future treatment strategy for laryngeal paralysis. Further studies will be necessary to demonstrate the safety of the vector before clinical application.
Aerodynamic and Acoustic Effects of False Vocal Folds and Epiglottis in Excised Larynx Models
Authors: Alipour Fariborz , Jaiswal Sanyukta , Finnegan Eileen 
Published: October 2014

Objectives: The purpose of this study was to examine the aerodynamic and acoustic effects of the false vocal folds and the epiglottis on excised larynx phonation. Methods: Several canine larynges were prepared and mounted over a tapered tube that supplied pressurized, heated, and humidified air. Glottal adduction was accomplished either by using two-pronged probes to press the arytenoids together or by passing a suture to simulate lateral cricoarytenoid muscle activation. First, the excised larynx with false vocal folds and epiglottis intact was subjected to a series of pressure-flow experiments with longitudinal tension and adduction as major control parameters. Then, the epiglottis and finally the false vocal folds were removed and the experiment was repeated. The subglottal pressure and the electroglottographic, flow rate, audio, and sound pressure signals were recorded during each experiment. Glottal flow resistance was calculated from the pressure and flow signals. The electroglottographic signal was used to extract the fundamental frequency. Results: It was found that the false vocal folds and the epiglottis offer a positive contribution to the glottal resistance and sound intensity of the larynx. Also, vocal fold elongation and glottal medial compression caused an increase in glottal resistance. The pressure-flow relationships were approximately linear regardless of the structure. Conclusions: The addition of the supraglottic laryngeal structures has a significant impact on both aerodynamic and acoustic characteristics of excised larynges.