bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) Curative Therapy for Severe Dysphagia: Myth or Reality?
Authors: Shaw Gary Y. , Sechtem Phillip R. , Searl Jeff , Keller Kristina , Rawi Taib A. , Dowdy Emily 
Published: October 2014

Objectives: VitalStim therapy was approved by the US Food and Drug Administration in 2001 for the treatment of dysphagia through the application of neuromuscular electrical stimulation to cervical swallowing muscles. This approval was based upon submission of data on more than 800 patients who received this therapy collected by the principal developer and patent-holder of the device. The therapy is marketed as successful in restoring long-term swallowing function in 97.5% of dysphagic patients past the point of requiring a feeding tube and as significantly better than existing therapies. More than 2,500 speech-language pathologists have taken the certification course, and thousands of devices have been sold. To date, however, aside from the developer's own studies, there are no peer-reviewed publications supporting these claims. We sought to evaluate the effectiveness of VitalStim therapy in a heterogeneous group of dysphagic patients. Methods: We performed a retrospective analysis of 18 patients who received this therapy at an urban tertiary referral center. All patients underwent pretherapy evaluation by speech-language pathologists, including modified barium swallow and/or functional endoscopic evaluation of swallowing and clinical evaluation of swallowing that included assessment of laryngeal elevation, diet tolerance, and swallowing delay, and were then assigned an overall dysphagia severity score. After therapy, all patients underwent the same assessments. Twelve of the 18 also underwent a functional swallowing telephone survey months (range, 1 to 21 months) after their therapy to assess whether the improvement was worthwhile and sustained. Results: Eleven of the 18 patients (61%) demonstrated some improvement in their swallowing. Six of the 18 patients (33%) were improved enough to no longer require a feeding tube. However, of the 5 patients categorized as having “severe dysphagia” before therapy, only 2 showed any improvement, and these patients still required a feeding tube for adequate nutrition. Telephone surveys did confirm that those who improved with their therapy seemed to maintain their progress and that most patients were satisfied with their therapy. Conclusions: VitalStim therapy seems to help those with mild to moderate dysphagia. However, the patients with the most severe dysphagia in our study did not gain independence from their feeding tubes. The authors conclude that VitalStim therapy clearly has a place in the management of dysphagia, but that the most severely afflicted are unlikely to gain dramatic improvement.
Height and Shape of the Skull Base as Risk Factors for Skull Base Penetration during Endoscopic Sinus Surgery
Authors: Lee Jong Cheol , Song Yong Jin , Chung Yoo-Sam , Lee Bong-Jae , Jang Yong Ju 
Published: October 2014

Objectives: Computed tomography (CT) and magnetic resonance imaging have identified several risk factors for life-threatening complications of skull base penetration during endoscopic sinus surgery (ESS). We compared these risk factors between groups of patients with and without penetration. Methods: We performed a retrospective review of direct coronal paranasal sinus CT scans. Using preoperative CT scans of 100 patients without and 7 patients with penetration, we classified height into 4 groups and contour into 2 groups. The frequencies of shape and height differences of the right and left halves of the skull base were calculated in each group. Results: In 6 of the 7 patients who had skull base penetration, ESS was performed by a resident or junior staff member who had less than 3 years of experience with this technique. Shape asymmetry was seen in 4 of the 7 patients (57%) with penetration, which was a significantly higher rate than in patients without penetration (18 of 100; p = 032). The frequencies of a low skull base and a height difference were 15% and 28%, respectively. Conclusions: The most important risk factor for skull base penetration was the surgeon's inexperience. An asymmetry of shape of the right and left halves of the skull base was significantly related to inadvertent skull base penetration during ESS.
Differential Expression of Human Beta Defensin 2 and Human Beta Defensin 3 in Human Middle Ear Cholesteatoma
Authors: Song Jae-Jun , Chae Sung-Won , Woo Jeong-Su , Lee Heung-Man , Jung Hak-Hyun , Hwang Soon-Jae 
Published: October 2014

Objectives: The purpose of this study was to investigate the differential expressions of human beta defensin ( hBD) 2 and hBD-3 in human middle ear cholesteatoma epithelium. Methods: The expressions of hBD-2 and hBD-3 were analyzed by quantitative real-time reverse transcription-poly-merase chain reaction (RT-PCR), Western blotting, and immunohistochemical staining. Samples were obtained from 10 patients who underwent middle ear surgery for middle ear cholesteatoma. Results: Real-time RT-PCR and Western blot analysis showed that the messenger RNAs and proteins of hBD-2 and hBD-3 were higher in the cholesteatoma epithelium than in normal external auditory canal skin. In cholesteatoma epithelium, hBD-2 and hBD-3 activities were present in the upper granular layer and in the prickle cell layer, but in the normal skin they were poorly expressed in all layers. Conclusions: Increased expressions of hBD-2 and hBD-3 in cholesteatoma epithelium suggest that cholesteatoma, a chronic inflammatory state of middle ear keratinocytes, may induce an innate immune response. That the induction of hBD-2 was found to be more intense than that of hBD-3 in cholesteatoma epithelium implies that hBD-2 is the major effector in terms of chronic epithelial inflammatory responses.
In Vivo Estimates of the Position of Advanced Bionics Electrode Arrays in the Human Cochlea
Authors: Skinner Margaret W. , Holden Timothy A. , Whiting Bruce R. , Voie Arne H. , Brunsden Barry , Neely J. Gail , Saxon Eugene A. , Hullar Timothy E. , Finley Charles C. 
Published: October 2014

Objectives: A new technique for determining the position of each electrode in the cochlea is described and applied to spiral computed tomography data from 15 patients implanted with Advanced Bionics HiFocus I, Ij, or Helix arrays. Methods: ANALYZE imaging software was used to register 3-dimensional image volumes from patients' preoperative and postoperative scans and from a single body donor whose unimplanted ears were scanned clinically, with micro computed tomography and with orthogonal-plane fluorescence optical sectioning (OPFOS) microscopy. By use of this registration, we compared the atlas of OPFOS images of soft tissue within the body donor's cochlea with the bone and fluid/ tissue boundary available in patient scan data to choose the midmodiolar axis position and judge the electrode position in the scala tympani or scala vestibuli, including the distance to the medial and lateral scalar walls. The angular rotation 0° start point is a line joining the midmodiolar axis and the middle of the cochlear canal entry from the vestibule. Results: The group mean array insertion depth was 477° (range, 286° to 655°). The word scores were negatively correlated (r = −0.59; p = .028) with the number of electrodes in the scala vestibuli. Conclusions: Although the individual variability in all measures was large, repeated patterns of suboptimal electrode placement were observed across subjects, underscoring the applicability of this technique.
Voice Handicap Evaluation of Patients with Pathologic Sulcus Vocalis
Authors: Welham Nathan V. , Dailey Seth H. , Ford Charles N. , Bless Diane M. 
Published: October 2014

Objectives: The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI). Methods: The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar. Results: The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone. Conclusions: These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.
Mass Psychogenic Illness Presenting as Acute Stridor in an Adolescent Female Cohort
Authors: Powell Scott A. , Nguyen Chau T. , Gaziano Joy , Lewis Vicki , Lockey Richard F. , Padhya Tapan A. 
Published: October 2014

Objectives: We describe a cohort of patients with an unusual presentation of stridor, their evaluation and management, and their outcome. We review the pertinent English-language literature. Methods: We performed a retrospective review of the records of 12 adolescent patients treated for acute-onset inspiratory stridor at the Departments of Otolaryngology-Head and Neck Surgery and Allergy and Immunology at the University of South Florida and the Department of Speech Pathology at the H. Lee Moffitt Cancer Center and Research Institute. Two additional patients received treatment elsewhere. Demographic, historical, and laboratory data, physical examination findings, and follow-up information were extracted. A review of both the Hillsborough County Department of Health epidemiological report and the English-language literature was performed. Results: Fourteen female patients who attended a local high school developed audible inspiratory noise. Twelve of the 14 were seen at the University of South Florida Ear, Nose and Throat Center. The remaining 2 patients were evaluated by outside otolaryngologists but were included in all reports from the Department of Health. Environmental studies did not find noxious chemical or biological agents in the students' environments to explain the development of the symptoms. Physical and videostroboscopic examination identified two distinct laryngeal findings causing the audible stridor. One involved paradoxical vocal fold movement, and the other, supraglottic mucosal collapse into the airway. All patients underwent rigorous speech pathology intervention and structured treatment with either complete resolution or significant improvement, seen both clinically and on videostroboscopic evaluation. Conclusions: Audible stridor can arise from numerous disease processes. In the vast majority of presentations it occurs sporadically and on an individual basis. Our cohort is especially unusual because of the sheer number of patients. Our presentation of a case of mass psychogenic illness as the cause of vocal cord dysfunction with additional findings of laryngomalacia within a group of adolescent girls is the first in the English-language literature. The key to the diagnosis is recognition of the disorder and susceptible individuals by using a thorough physical examination with emphasis on the laryngoscopic and videostroboscopic findings. The systematic approach, undertaken by a team including an otolaryngologist, an allergist, a speech pathologist, and an epidemiologist, proved to be effective in the management of this complex disorder and highly unusual situation.
Myosin Heavy Chain Composition and Fiber Size of the Cricopharyngeus Muscle in Patients with Achalasia and Normal Subjects
Authors: Davis Melinda V. , Merati Albert L. , Jaradeh Safwan S. , Blumin Joel H. 
Published: October 2014

Objectives: Cricopharyngeal achalasia (CA) can be defined as inadequate opening of the cricopharyngeus muscle (CPM) resulting in dysphagia. Myosin heavy chain (MHC) isoform fiber type composition and size are key determinants of muscle function. These parameters have not been described in CA. It is hypothesized that there is a difference between the MHC isoform composition of the CPM in patients with the clinical diagnosis of CA and that in normal subjects. Methods: Patients who had received prior botulinum were excluded. The MHC fiber type composition and size in patients and cadaveric controls were determined by adenosine triphosphatase staining and image analysis. Results: The CPMs of 12 CA patients (6 male, 6 female; mean age, 61 years) and 5 control cadaveric subjects (3 male, 2 female; mean age, 67 years) were analyzed. There were relatively fewer type I fibers (67%) in patients with CA than in controls (81%), but the difference was not significant (p = 18). Type I fibers were slightly smaller in CA patients (38.7 μm) than in controls (47.2 μm), but this was not significantly different (p > 05). Of the 12 CA patients, 3 had type II predominance, a feature not seen in normal subjects. Conclusions: Patients with CA had relatively fewer type I fibers, although the difference was not statistically significant. The MHC isoform composition and fiber size were not different between CA patients and normal subjects. This is the first report to characterize the CPM in patients with CA.
Thermal Damage during Thulium Laser Dissection of Laryngeal Soft Tissue is Reduced with Air Cooling: Ex vivo Calf Model Study
Authors: Burns James A. , Kobler James B. , Heaton James T. , Lopez-Guerra Gerardo , Anderson R. Rox , Zeitels Steven M. 
Published: October 2014

Objectives: The 2-μm-wavelength thulium laser has recently been shown to be an effective cutting instrument in endolaryngeal surgery, although there is increased thermal trauma as compared with the carbon dioxide laser. This study investigated temperature changes and thermal trauma during thulium laser dissection of laryngeal tissue, with and without air cooling, in an ex vivo model. Methods: A continuous-wave thulium laser (400-μm fiber, 4-W continuous power, 4-second duration) was used to incise 10 calf vocal folds. Paired cooled and uncooled cuts were made in each fold with a dermatologic cooling device. A thermistor inserted into the glottic subepithelium was used to measure tissue temperatures. Thermal damage was analyzed histologically by measuring the depth of the zone of lactate dehydrogenase inactivation surrounding the mucosal incision. Results: The initial vocal fold temperature averaged 24.3°C without cooling and 4.4°C with cooling. The peak temperature during cutting averaged 59.1°C without cooling and 28.0°C with cooling. The thermal damage zone surrounding the cooled incisions was approximately 27% less than that surrounding the uncooled incisions. Conclusions: Air cooling can reduce the extent of thermal trauma associated with thulium laser surgery of the vocal folds, and the high-temperature plume generated during laser cutting is effectively cleared.
Adjunctive Neuromuscular Electrical Stimulation for Treatment-Refractory Dysphagia
Authors: Carnaby-Mann Giselle D. , Crary Michael A. 
Published: October 2014

Objectives: Neuromuscular electrical stimulation (NMES) has been proposed as an adjunctive modality for the treatment of swallowing disorders. We present data from a prospective case series to define and measure effects of a systematic therapy for chronic pharyngeal dysphagia using adjunctive NMES. Methods: Six adult patients with pharyngeal dysphagia received 15 sessions of a standardized protocol of swallowing exercises with adjunctive NMES. The patients completed clinical and instrumental baseline, posttreatment, and 6-month follow-up evaluations. Outcome measures included the proportion of patients who improved in clinical swallowing ability, functional oral intake, and change in body weight; patient perception of swallowing ability; and changes in kinematic aspects of swallowing. Results: Significant change was demonstrated for clinical swallowing ability (p < .042), functional oral intake (p < .02), weight gain (p < .026), and patient perception of swallowing ability (p < .043). Hyoid and laryngeal elevation during swallowing demonstrated bolus-specific patterns of change. No patient experienced a treatment-related or swallowing-related complication. Patients (4 of 5) who were followed out to 6 months after treatment maintained functional gains. Conclusions: A systematic therapy for chronic pharyngeal dysphagia using adjunctive NMES produced improvement in clinical swallowing ability and functional oral intake without significant weight loss or complications.
Endoscopic Management of Zenker's Diverticulum: Factors Predictive of Success or Failure
Authors: Visosky Ann Marie B. , Parke Robert B. , Donovan Donald T. 
Published: October 2014

Objectives: We review our experience with endoscopic management of Zenker's diverticulum. We sought to analyze and determine risk factors for success or failure of endoscopic diverticulum treatment. Methods: We performed a retrospective review of 72 consecutive patients who underwent attempted endoscopic management of a Zenker's diverticulum between January 2000 and April 2006. The procedures were performed by either of 2 otolaryngologists. There were 50 men and 22 women ranging in age from 44 to 93 years. A total of 85 procedures were performed. The medical records were reviewed for preoperative diverticulum size (small, 1 to 2 cm; moderate, 2.1 to 3.0 cm; and large, more than 3.0 cm), intraoperative diverticulum characteristics, patient anatomic limitations that prevented adequate endoscopic visualization, surgical complications, and management of recurrences. Results: Of our 72 patients, 61 (85%) were able to undergo endoscopic cricopharyngeal myotomy with diverticulum elimination. Of the 61 endoscopic procedures, 47 (77%) resulted in complete symptom resolution. The most common risk factors for recurrence were diverticulum size (more than 3 cm) and amount of redundant mucosa. Of the 14 patients with a recurrence, 10 (71%) underwent a repeat procedure. Six of the 14 (43%) had a successful excision via a cervical approach, and 4 of the 14 (29%) underwent a repeat endoscopic myotomy. There was 1 major complication (esophageal tear), and there were 3 minor complications (mucosal abrasions). Conclusions: Most patients with a Zenker's diverticulum are good candidates for endoscopic management. In our series, 84% of those who underwent endoscopic treatment ultimately achieved relief of symptoms. The patient morbidity is minimal. A large diverticulum with redundant mucosa is a risk factor for recurrence after endoscopic treatment.
Phonation Threshold Flow in Elongated Excised Larynges
Authors: Jiang Jack J. , Regner Michael F. , Tao Chao , Pauls Steven 
Published: October 2014

Objectives: This study proposes the use of a new parameter of vocal aerodynamics, phonation threshold flow (PTF). The sensitivities of the PTF and the phonation threshold pressure (PTP) were quantitatively compared to the percent of vocal fold elongation from physiologic length. Methods: Ten excised canine larynges were mounted on a bench apparatus capable of controlling vocal fold elongation. Subglottal airflow was gradually increased until the onset of phonation. Elongation of the vocal folds was varied from +0% (physiologic length) to +15%, and the PTF and PTP were measured. Results: The mean PTFs at physiologic vocal fold length ranged from 101 to 217 mL/s. No statistically significant relationship was found to exist between the size of the larynx and the measured PTF values (p = .404). The average percent change of PTF compared to the magnitude of elongation was found to be statistically significant (p < .001). The data indicated that the PTF was proportional to the percent of vocal fold elongation. Conclusions: The PTF was positively correlated with vocal fold elongation and the PTP for small magnitudes of elongation. The results suggest that the PTF may be indicative of the biomechanical properties of the vocal folds, thus providing a possibly valuable tool in the clinical evaluation of laryngeal function.
Study of Wound Healing in Rats Treated with Topical and Injected Mitomycin C
Authors: Ribeiro Fernando de Andrade Quintanilha , Guaraldo Lusiele , de Pádua Borges Janaina , Vianna Maria Regina , Eckley Claudia A. 
Published: October 2014

Objectives: Mitomycin C, a widely used chemotherapeutic drug, has been proposed as a potential adjuvant for the control of scar tissue in surgical wounds because of its capacity to inhibit fibroblast proliferation. The current study used a combination of topical and injected mitomycin C to slow the healing process of surgical wounds in rats. Methods: An experimental model of surgical wounding at the dorsum of rats was used. A total of 43 animals were subdivided into 3 groups: Control, topical mitomycin C, and a combination of topical treatment and intradermal injections of the drug at 30 and 60 days after the initial topical treatment. After 3 months, the animals were painlessly sacrificed and the surgical scars were removed for microscopic analysis. Results: The group that received only topical mitomycin C presented milder inflammatory signs and consequently had a less intense healing process than the control group. The group treated with a combination of both topical and injected mitomycin C presented results comparable to those of the control group. Conclusions: The toxic characteristics of mitomycin C were most likely responsible for the greater tissue damage that occurred when it was used in the injected form, causing increased scar tissue formation. Mitomycin C slows the healing process of surgical wounds when used topically, but causes enhanced scar tissue formation when injected.
Benign Paroxysmal Positional Vertigo: Concomitant Involvement of Different Semicircular Canals
Authors: Tomaz Andreza , Ganança Maurício Malavasi , Ganança Cristina Freitas , Ganança Fernando Freitas , Caovilla Heloisa Helena , Harker Lee 
Published: October 2014

Objectives: We evaluated the simultaneous ipsilateral or contralateral involvement of the posterior and lateral, anterior and lateral, or posterior and anterior semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). Methods: The files of 2,345 patients with BPPV were analyzed. Results: Single-canal BPPV occurred in 2,310 cases (98.5%) — Unilaterally in 2,058 (89.1%) and bilaterally in 252 (10.9%). Multiple-canal BPPV occurred in 35 cases (1.5%). Of these 35 cases, there was simultaneous involvement of the posterior and lateral canals on the same side (23) or on opposite sides (9) in 32 cases (91.4%). Simultaneous involvement of the anterior canal on one side and the posterior canal on the opposite side occurred in 2 cases (5.7%), and that of the anterior canal on one side and the lateral canal on the opposite side occurred in 1 case (2.9%). All cases represented canalithiasis. Conclusions: Multiple-canal BPPV was rare, and usually involved canals on the same side; simultaneous involvement of the posterior and lateral canals was much more common than involvement of the anterior and posterior canals or the anterior and lateral canals. Trauma increased the risk for multiple-canal BPPV, but not the risk for bilateral single-canal BPPV. Cupulolithiasis was not a factor in multiple-canal BPPV.