bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detecting Nasopharyngeal Reflux: A Novel pH Probe Technique
Authors: Brunworth Joseph D. , Garg Rohit , Mahboubi Hossein , Johnson Brandon , Djalilian Hamid R. 
Published: October 2014

Objectives: We sought to ascertain the normal pH values in the aerosolized environment of the nasopharynx in healthy subjects and utilize a novel pH probe that allows measuring acidity in a nonliquid environment. Methods: Between November 2009 and February 2011, healthy volunteers without a history of reflux or eustachian tube dysfunction were enrolled in the prospective study. A total of 20 subjects had a Dx–pH Measurement System Probe (Respiratory Technology Corp) placed near the torus tubarius. The pH probe records the pH throughout the 24-hour study. A pH below 5.5 while the subject was upright or below 5.0 while the subject was supine was used as a criterion to determine a reflux event. Recording was stopped during meals. Results: For normal individuals with no history of reflux or eustachian tube dysfunction, the pH values obtained from the nasopharynx ranged from 6.10 to 7.92. The average pH was 7.03 (SD, 0.67). Eight subjects (40%) had at least 1 reflux event during the 24-hour pH study. Conclusions: By utilizing a novel self-condensing pH probe, we were able to perform a 24-hour pH study in the nasopharynx of 20 healthy individuals. In our study, the average pH for individuals without symptomatic reflux or eustachian tube dysfunction was 7.03. Interestingly, 8 control subjects had at least 1 episode of pH below 5.5 while awake or below 5.0 while asleep, which was considered to be a reflux event in our study.
Aberrant Expression Levels of MTA1 and RECK in Nasopharyngeal Carcinoma: Association with Metastasis, Recurrence, and Prognosis
Authors: Deng Yan Fei , Zhou Dong Ni , Ye Chun Sheng , Zeng Liang , Yin Ping 
Published: October 2014

Objectives: We investigated the expression and clinical value of MTA1 and RECK genes in patients with nasopharyngeal carcinoma (NPC). Methods: We examined MTA1 and RECK expression in nasopharyngeal tissue from patients with chronic nasopharyngitis, lymph nodes with metastasis of NPC, and primary NPC tumor tissue by means of in situ hybridization and analyzed their correlation with the clinicopathologic features of NPC. Results: The positive expression of MTA1 in the NPC tissues and metastatic lymph nodes was significantly higher than that in the chronic nasopharyngitis tissues (p < 0.05). The positive expression of RECK in the NPC tissues and metastatic lymph nodes was significantly lower than that in the chronic nasopharyngitis tissues (p < 0.05). The RECK expression level was inversely correlated with the MTA1 expression level in the NPC tissues (p < 0.05). The increased MTA1 and decreased RECK expressions in the NPC tissues had no association with gender, age, T-stage, or clinical stage (p > 0.05). However, they had a positive correlation with cervical lymph node metastasis, tumor recurrence, and 5-year overall survival rate of the patients with NPC (p < 0.05). Moreover, multivariate analysis showed that MTA1 and RECK expressions were independent prognostic factors for survival (p < 0.05). Conclusions: The conversely abnormal expression levels of MTA1 and RECK may be collectively involved in progression of malignancies and may serve as molecular predictors for metastasis, recurrence, and prognosis of NPC.
Trade-off between Survival and Laryngeal Preservation in Advanced Laryngeal Cancer: The Otorhinolaryngology Patient's Perspective
Authors: Laccourreye Ollivier , Malinvaud David , Holsinger F. Christopher , Consoli Silla , Ménard Madeleine , Bonfils Pierre 
Published: October 2014

Objectives: We performed a prospective study to evaluate, from the patient's perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy. Methods: Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables. Results: We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of cure that patients agreed to trade to preserve their larynx. Conclusions: In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patient's attitude toward both laryngeal preservation and survival.
Impact of Endoscopic Stapling of Zenker's Diverticulum on Patient Health Status as Assessed by the Glasgow Benefit Inventory
Authors: Leong Samuel C. , Wilkie Mark D. , Webb Christopher J. 
Published: October 2014

Objectives: The aim of this study was to measure the effect of endoscopic stapling of Zenker's diverticulum on the health status of patients. Methods: We used the Glasgow Benefit Inventory (GBI) tool to ascertain patients' perceived experience. Results: The study demonstrated a positive health impact following endoscopic stapling of the Zenker's diverticulum. The mean total GBI score was +18.9 (95% confidence interval, ±11.2). The impact of endoscopic stapling was positive for all three subsets of the GBI. The GBI scores were comparable to those obtained after other common otorhinolaryngological procedures such as tonsillectomy, rhinoplasty, and middle ear surgery. Conclusions: These data should improve our ability to counsel patients regarding important therapeutic decisions and expectations of surgical outcome.
Etiology of Nasal Polyps in Cystic Fibrosis: Not a Unimodal Disease
Authors: Steinke John W. , Payne Spencer C. , Chen Philip G. , Negri Julie , Stelow Edward B. , Borish Larry 
Published: October 2014

Objectives: The objective was to determine whether the polyp subtypes observed in cystic fibrosis (CF)–related sinusitis were similar to those observed in non–CF-related sinusitis. Methods: Polyp and mucus samples were collected from CF patients who presented for sinus surgery. The polyps underwent histologic and cytochemical evaluation for the presence of lymphocyte cell populations and their respective cytokine markers. The mucus samples were evaluated for DNA content. Results: Of the polyps, 42% had an eosinophilic infiltrate, of which 80% had an additional mixed neutrophilic infiltrate. Of the remaining polyp samples, 42% did not have a granulocytic infiltrate, consistent with non-eosinophilic polyps. All samples had CD138-positive plasma cells. The mucus samples from the patients with CF showed higher extracellular DNA concentrations than did the mucus samples from patients with non-CF sinus disease. Conclusions: Cystic fibrosis–related polyps demonstrated an eosinophil-based dichotomy similar to that of idiopathic non–CF-related polyps. Many also demonstrated neutrophilic infiltrate, indicating that chronic mucus stasis and infection complicate the disease. Agents capable of reducing extracellular DNA may help manage sinusitis in CF patients.
Safety and Dosing of Bevacizumab (Avastin) for the Treatment of Recurrent Respiratory Papillomatosis
Authors: Best Simon R. , Friedman Aaron D. , Landau-Zemer Tali , Barbu Anca M. , Burns James A. , Freeman Mason W. , Halvorsen Yuan-Di , Hillman Robert E. , Zeitels Steven M. 
Published: October 2014

Objectives: Increasing evidence supports the use of laryngeal injections of the antiangiogenic agent bevacizumab (Avastin) for the adjuvant treatment of recurrent respiratory papillomatosis (RRP). A recent prospective open-label investigation, approved by the US Food and Drug Administration, employing 12.5 mg of sublesional bevacizumab demonstrated single-site efficacy without complications; however, the safety of multiple-site injections and higher dosing has not yet been reported. The primary objective of this study was to report on the safety of increased doses of bevacizumab for the treatment of RRP. Methods: Two cohorts of adult patients were evaluated. In the first group, a prospective analysis was performed on patients with a diagnosis of laryngeal RRP after their participation in the initial clinical trial with a single-site lower dose (7.5 to 12.5 mg). They received higher doses of sublesional laryngeal bevacizumab (15 to 50 mg total) with detailed physiologic, hematologic, and serum chemistry measurements performed before and after each bevacizumab injection. A second cohort of patients received sublesional laryngeal injections of bevacizumab (15 to 88 mg total) without physiologic measurements and underwent a retrospective analysis of reported complications. Results: One hundred consecutive laryngeal injection sessions (office, 87; operating room, 13) with bevacizumab were performed in 43 patients, with a mean dose of 30 mg total per treatment (range, 15 to 88 mg). Sixty-three of the 100 sessions were accompanied by KTP laser photoangiolysis of the papilloma prior to bevacizumab injections. Eighteen patients (cohort 1) underwent detailed physiologic assessment, and no dysfunction was observed. There were no local or systemic complications of bevacizumab administration. The second group of 25 patients (cohort 2) also reported no significant local or systemic complications. Neither patient group was observed to have a local wound problem in the larynx. Conclusions: This investigation provides evidence that higher doses of bevacizumab are relatively safe in adult patients with laryngeal RRP. Further refinements in pharmacologic concentration and drug delivery will determine the optimal treatment regimens in the future.
Relationship between the Branches of the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery
Authors: Kulekci Mehmet , Batıoglu-Karaaltın Aysegul , Saatci Ozlem , Uzun Ibrahim 
Published: October 2014

Objectives: The relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) is an important and helpful landmark for isolating the RLN and its branches during surgery. In the present study, we aimed to define and classify in detail all of the possible relationships between the two anatomic structures and their branches. Methods: We examined 100 specimens (200 sides) from cadavers of 76 men and 24 women who were between 16 and 90 years of age at the time of death. After anatomic dissection was performed, the relationship between the RLN and the ITA was noted for each side and documented in the form of high-resolution photographs. Results: The relationships of both structures and their branches were classified into 6 types. Details were verified regarding the relationships between the main trunks, between the trunks and branches, and between the branches, as follows: Type A (ITA trunk to RLN trunk); type B (ITA branches to RLN trunk); type C (ITA trunk to RLN branches); type D (ITA branches to RLN trunk and RLN branches); type E (ITA branches to RLN branches); and type F (others). Conclusions: Despite the various anatomic and surgical studies already performed, in the present study we tried to demonstrate all types of relationships between the RLN and the ITA and their branches and devise a new, detailed classification of the possible relationships between the two structures.
Cartilage Tympanoplasty in Smokers
Authors: Coelho Daniel H. , Peng Angela , Thompson Meghan , Sismanis Aristides 
Published: October 2014

Objectives: We compared the outcomes of cartilage tympanoplasty in nonsmokers and smokers. Methods: We performed a retrospective chart review of patients who underwent cartilage tympanoplasty in a tertiary academic medical center from 1991 to 2010. There were 129 operations in 118 patients; 84 operations were performed in nonsmokers and 45 operations were performed in smokers. The primary outcome measure was the tympanic membrane graft take rate at the interval and most recent follow-up visits. Secondary measures included recurrence, the need for revision surgery, and hearing outcomes. Results: Nonsmokers and smokers had comparable long-term rates of intact eardrums (90.6% versus 92.9%; p = 0.99). There was a trend toward a higher rate of recurrent or persistent disease requiring further operation for smokers (13.3% versus 4.7%; p = 0.09). Both groups had improvement in pure tone averages (12.1 dB in nonsmokers and 12.8 dB in smokers) and air-bone gaps (9.6 dB in nonsmokers and 5.1 dB in smokers), although the rates were not statistically significantly different from each other. The rates of success of cartilage tympanoplasty in smokers appear superior to previously published rates of noncartilage tympanoplasty. Conclusions: Cartilage tympanoplasty has success rates and postoperative audiological measures that are comparable between smokers and nonsmokers. In smokers, cartilage grafting is superior to noncartilage grafting and is recommended for any patient who smokes and is undergoing tympanoplasty.
Accuracy of Tinnitus Pitch Matching Using a Web-Based Protocol
Authors: Mahboubi Hossein , Ziai Kasra , Brunworth Joseph , Djalilian Hamid R. 
Published: October 2014

Objectives: We investigated the accuracy of a web-based protocol for tinnitus frequency matching compared to that of tinnitus pitch matching performed by an audiologist using an audiometer in an anechoic chamber. Methods: Twenty subjects underwent tinnitus frequency-matching in a random order using an audiometer in an anechoic chamber and using web-based software with a multiple-choice protocol in octave or half-octave steps from 250 Hz to 12,000 Hz and a slider in 25-Hz steps from 20 to 20,000 Hz. Octave challenge testing was performed. The participants were asked to indicate which protocol resulted in the closest match to their tinnitus frequency. Results: The median tinnitus frequency was 6,000 Hz (range, 2,000 to 12,000 Hz) with use of the audiometer and self-directed multiple-choice protocol. With the slider, the median frequency was 5,925 Hz (range, 1,850 to 16,000 Hz). The patients with a tinnitus frequency higher than 12,000 Hz experienced a greater level of satisfaction when using the computer-based slider system. Five patients experienced octave confusion with self-directed multiple-choice tinnitus matching that was corrected accurately after the octave challenge step. Conclusions: A web-based protocol for tinnitus frequency matching is as accurate as a standard audiometric protocol. An octave challenge test might be necessary for patient-directed tinnitus frequency matching.
New Animal Model for Assessment of Functional Laryngeal Motor Innervation
Authors: Björck Gunnar , Margolin Gregory , Måbäck Gudrun , Persson Jonas K. E. , Mattsson Per , Hydman Jonas 
Published: October 2014

Objectives: The functional motor innervation of the larynx is not fully understood because of the complexity of the peripheral neuroanatomy. Since the late 19th century, there has been controversy regarding the role of the superior laryngeal nerve, which may have wider motor projections than are currently acknowledged. The aim of this study was to develop a large animal model to characterize and quantify the functional motor input to the intrinsic laryngeal muscles. Methods: We performed invasive electrophysiology (evoked electromyography) in normal pigs. Results: The thyroarytenoid, lateral cricoarytenoid, and posterior cricoarytenoid muscles receive dual innervation from both the superior and recurrent laryngeal nerves, whereas the cricothyroid muscle is innervated only by the superior laryngeal nerve. Conclusions: The dual innervation pattern from both laryngeal nerves supports the concept of a laryngeal nerve plexus. The motor input through the external branch of the superior laryngeal nerve was surprisingly high. The animal model presented here may be used in future investigations of laryngeal reinnervation following nerve injury.
Lack of Adverse Events after Medialization Laryngoplasty with the Montgomery Thyroplasty Implant in Patients with Unilateral Laryngeal Nerve Paralysis
Authors: Laccourreye Ollivier , Benkhatar Hakim , Ménard Madeleine 
Published: October 2014

Objectives: We sought to document the incidence of and risk factors for adverse events after medialization laryngoplasty with Montgomery implant insertion in patients with unilateral laryngeal nerve paralysis. Methods: We studied a retrospective series of 191 patients consecutively managed at a university teaching hospital. Results: No adverse events were noted in 79.8% of the patients. Intraoperative, immediate, and late postoperative adverse events were noted in 8.3%, 8.9%, and 4.1% of the patients, respectively. The various adverse events noted were failure to insert the implant (3.6%), difficulties in stabilizing the implant (4.8%), misplacement of the implant (2.1%), dyspnea (2.7%), hematoma (4.8%), extrusion (1.6%), persistent morphological laryngeal alterations (1.6%), and keloid scars (1.1%). Tracheotomy, procedure-related death, and infection at the insertion site were not encountered. No significant statistical relationship was noted between the various adverse events encountered and the variables under analysis. Conclusions: Our data demonstrate that medialization laryngoplasty with Montgomery implant insertion in patients with unilateral laryngeal nerve paralysis from various causes is a relatively safe, reliable, and reproducible procedure with a short learning curve.
Morbidity and Patient Perception of Flexible Laryngoscopy
Authors: Paul Benjamin C. , Rafii Benjamin , Achlatis Stratos , Amin Milan R. , Branski Ryan C. 
Published: October 2014

Objectives: The recently published Clinical Practice Guideline: Hoarseness (Dysphonia) revealed major deficits in the literature regarding relatively routine clinical decision-making. One of the more controversial points in the Guideline regarded the utility and timing of laryngeal visualization via flexible laryngoscopy, potentially because of sparse literature regarding the risks and potential morbidity. We sought to prospectively address this issue in order to optimize evaluation protocols. Methods: Two-hundred fifty consecutive patients with a variety of complaints completed a survey after undergoing flexible laryngoscopy. The survey queried 1) demographics; 2) discomfort of pretreatment anesthesia and scope placement in the nose and pharynx; 3) fear of future examinations; and 4) patient perception and past experience. Concurrently, the laryngoscopist reported the complications and anatomic variations encountered. Results: The discomfort and pain ratings from both the anesthetic spray and the scope placement were low. No statistically significant differences were observed with regard to sex; however, women reported greater fear associated with examinations (p = 0.0001). Anatomic abnormalities were observed in 14.4% of patients, and these patients reported greater discomfort, pain, and fear regarding the examination. No adverse events were observed. Conclusions: Flexible laryngoscopy was well tolerated, with little to no risk. The presence of nasal anatomic abnormalities predicted increased discomfort.
Topical Gel Therapy for Sinonasal Polyposis in Samter's Triad: Preliminary Report
Authors: Shikani Alan H. , Kourelis Konstantinos , Rohayem Ziad , Basaraba Randall J. , Leid Jeff G. 
Published: October 2014

Objectives: Rhinosinusitis and polyposis are difficult to treat in patients with Samter's triad; they commonly recur despite sinus surgery, antibiotics, and/or nasal steroids. The present study assesses the efficacy of a multimodal regimen that includes topical corticosteroids and antibiotics delivered through a hydroxyethyl cellulose gel and by nebulization. Methods: Eleven patients with Samter's triad who had polyposis and rhinosinusitis that recurred despite endoscopic sinus surgery were treated with a 6-week course of multimodal topical therapy consisting of a hydroxyethyl cellulose gel that releases corticosteroids and antibiotics, topical nebulization of corticosteroids and antibiotics, saline solution rinses, and sinus debridement. Clinical outcomes were evaluated by Lund-Kennedy endoscopic and symptom scores. Histologic assessment was evaluated by hematoxylin and eosin staining before and after treatment. Results: Both Lund-Kennedy symptom and endoscopic scores showed a progressive and statistically significant decline throughout the course of treatment, reaching at 6 weeks 42% of the pretreatment values (p = 0.005) for the Lund-Kennedy symptom score and 34% (p = 0.002) for the endoscopic score, respectively; however, the significance of the improvement was lost with time. Conclusions: Topical gel therapy improves clinical symptoms, endoscopic findings, and sinus membrane histologic features in patients with refractory Samter's triad, but the improvement is transient, suggesting that a longer therapeutic period might be needed.
Oropharyngeal and Esophageal Swallowing Impairments: Their Association and the Predictive Value of the Modified Barium Swallow Impairment Profile and Combined Multichannel Intraluminal Impedance—Esophageal Manometry
Authors: Gullung Jessica L. , Hill Elizabeth G. , Castell Donald O. , Martin-Harris Bonnie 
Published: October 2014

Objectives: Deglutition is a highly integrated process of neural signaling and coordinated muscular contraction that begins with bolus preparation in the oral cavity and ends with closure of the lower esophageal sphincter after bolus passage. The goal of this study was to examine the relationship between measures of oropharyngeal and esophageal swallow function. Methods: A retrospective review was performed of patients who underwent modified barium swallow study (MBSS) and multichannel intraluminal impedance–esophageal manometry (MII-EM) over 7 years at an academic institution. The MBSS was scored with the Modified Barium Swallow Impairment Profile (MBSImP). Associations between impairments as measured by the MBSImP and MII-EM were assessed with a 2-sided Fisher's exact test. Results: One hundred sixty-four patients met the inclusion criteria for the study. Comparison of MBSImPcomponent and oral and pharyngeal total regional scores to MII-EM scores revealed a significant association between abnormal esophageal clearance on MBSS (MBSImP component 17) and abnormal findings on MII-EM (p < 0.001). Delay in initiation of pharyngeal swallow (MBSImPcomponent 6) was significantly associated with abnormal esophageal clearance on MBSS (p = 0.023). Conclusions: Abnormal esophageal clearance on MBSS (MBSImP component 17) indicates a need for further esophageal testing. A functional interrelationship between abnormalities of oropharyngeal and esophageal swallowing does exist, illuminating the importance of thorough pharyngoesophageal examination for dysphagia symptoms.