bluuebunny/crossref_metadata_2025_split huggingface dataset:
CO2 Laser versus Stapler‐Assisted Endoscopic Zenker's Diverticulotomy: A Systematic Review
Authors: Parker Noah P. , Misono Stephanie 
Published: August 2013

Objectives:To evaluate outcomes following endoscopic Zenker's diverticulotomy using a carbon dioxide (CO2) laser or stapler‐assisted technique.Methods:Systematic review and meta‐analysis of retrospective studies comparing CO2 laser and stapler‐assisted endoscopic Zenker's diverticulotomy were performed. PubMed, Scopus (Embase), and United States and United Kingdom clinical trial registries were searched. References were cross‐checked.Results:No randomized controlled trials were identified. Six studies were included: 2 retrospective reviews of consecutive patients, 3 retrospective reviews with unknown consecutive status, and 1 case series totaling 379 procedures (219 laser, 160 stapler). Individual study outcomes favoring the stapler technique included a shorter duration of nil per os (NPO) status and hospital stay (4 studies), as well as fewer postoperative fevers and abnormal chest x‐rays (1 study). Individual study outcomes favoring the laser technique included greater improvement in postoperative dysphagia and regurgitation scores and a lower revision rate (1 study). Random effects meta‐analysis of 2 appropriate studies demonstrated a greater duration of NPO status (weighted mean difference (WMD): 1.14, 95% confidence interval [0.46‐1.81]) and hospital stay (WMD: 2.84 [2.10‐3.58]) for the laser technique. Mantel‐Haenzel fixed effects meta‐analysis of all studies suggested a greater rate of non‐dental complications (odds ratio (OR): 2.32 [0.87‐6.20]) and revision surgery (OR: 1.27 [0.68‐2.36]) for the laser technique, but differences were not statistically significant.Conclusions:The stapler‐assisted technique may shorten duration of NPO status and hospital stay, while decreasing complication and revision rates compared to the laser technique for endoscopic Zenker's diverticulotomy; however, the best available evidence is Level 4.
Does Perception of Nasal Patency Correlate with Mucosal Cooling after Surgery for Nasal Obstruction?
Authors: Sullivan Corbin D. , Garcia Guilherme , Kimbell Julia S. , Frank Dennis O. , Rhee John S. 
Published: August 2013

Objectives:1) Quantify heat fluxes (ie, mucosal cooling) spatially in the nasal passages of nasal airway obstruction (NAO) patients before and after surgery using computational fluid dynamics (CFD). 2) Develop methods to correlate heat fluxes with patient‐reported symptoms, as measured by the nasal obstruction symptom evaluation (NOSE) and the visual analog score (VAS).Methods:Computed tomography (CT) scans of 10 patients were obtained before and after surgery to relieve NAO. Three‐dimensional models of each patient's nasal anatomy were used to run steady‐state CFD simulations of airflow and heat transfer during inspiration. The importance of anatomic location for perception of nasal patency was evaluated by comparing heat fluxes in the nasal vestibule vs. the entire nasal cavity, and by evaluating the percentage of nasal mucosa exposed to heat fluxes greater than 500 W/m2.Results:Post‐operatively, heat fluxes were statistically higher on the pre‐operative most obstructed side, for the nasal vestibule alone and the entire nasal cavity (p values < 0.01). A larger area of nasal mucosa was exposed to heat fluxes > 500 W/m2 after surgery than before. The best correlation between subjective and objective measures of nasal patency was obtained for NOSE against heat flux in the entire most obstructed nasal cavity (r = −0.81).Conclusions:A significant increase in heat fluxes (ie, mucosal cooling) correlates well with patients’ perception of better nasal patency after NAO surgery. CFD‐derived heat fluxes may prove to be a valuable predictor of success in NAO surgery.
Does Presence of Laryngotracheal Pepsin Increase Severity of Symptoms in Patients with Laryngotracheal Stenosis?
Authors: Khan Aayesha M. , Simpson C. Blake 
Published: August 2013

Objectives:Extraesophageal reflux has been implicated in the development of laryngotracheal stenosis, and presence of pepsin has been reported in up to 59% of patients with idiopathic subglottic stenosis. The objective of this study was to determine 1) the incidence of a positive pepsin biopsy in patients with laryngotracheal stenosis (LTS) and 2) if presence of laryngotracheal pepsin increases the severity of symptoms as perceived by the patients.Methods:A retrospective cohort was conducted on 24 patients with LTS who underwent pepsin biopsy. Severity of symptoms was determined by using Reflux Symptom Index (RSI), Voice Handicap Index‐10 (VHI‐10), and Glottal Function Index (GFI) scores on initial presentation. Student T‐test was used for statistical analysis.Results:The incidence of positive pepsin biopsy was 37.5% (9/24). Three patients were tracheostomy tube dependent and were excluded from further analysis, which resulted in 8 pepsin positive and 13 pepsin negative patients. The mean RSI, VHI‐10, and GFI scores were higher in the pepsin positive group; only the GFI scores were statistically significant (P = 0.034) between the two groups.Conclusions:In this cohort only 37.5% of patients with laryngotracheal stenosis tested positive for pepsin. Our study did not show a correlation of presence of pepsin with RSI or VHI‐10 scores but was statistically significant for GFI scores. This suggests that higher GFI scores may predict presence of pepsin at the site of stenosis. Larger studies are needed to determine if presence of pepsin plays a role in the severity of laryngotracheal stenosis.
Etiology and Presentation Time of Unilateral Vocal Fold Paralysis
Authors: Paniello Randal C. , Grindler David J. 
Published: August 2013

Objectives:1) Determine the etiology of unilateral vocal fold paralysis (UVFP) at a tertiary care institution over 10 years. 2) Determine the length of time between onset of symptoms and presentation/diagnosis of UVFP by an otolaryngologist at a tertiary medical center.Methods:Retrospective review of medical records of patients with UVFP between 2002 and 2012 in a tertiary care institution. Patients were seen and evaluated over 10 years by the Department of Otolaryngology at the Washington University School of Medicine. Medical records were reviewed for information relating to diagnosis, initial presentation date, date of onset of symptoms, and etiology of UVFP.Results:938 patients were included in the study. 621 (66.2%) patients had left sided UVFP. 581 (61.9%) patients had UVFP due to iatrogenic effects related to surgery. 158 (27.2%) of these were related to thyroid/parathyroid surgery. 357 patients had UVFP due to reasons not related to surgery. 124 (34.7%) patients had idiopathic UVFP. The median time to presentation from symptom onset until presentation to any otolaryngologist was 2 months. There was a significant delay of 3.33 months between mean time to presentation to a community otolaryngologist and subsequent referral and evaluation at a tertiary medical center, P < 0.01.Conclusions:Iatrogenic injury related to surgery is the most common cause of UVFP. Thyroidectomy remains the leading cause of surgically related UVFP. Patients are typically seen within 4 months; however, a significant delay exists between diagnosis and referral to a specialist.
Management of Chronic Laryngeal Neuropathy in the United States versus Europe
Authors: Noordzij J. Pieter , Jang Minyoung , Depietro Joseph 
Published: August 2013

Objectives:Analyze differences in the evaluation of laryngeal neuropathy by laryngologists in the United States versus other countries.Methods:Members of the American Laryngology Society (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were emailed to 137 members of the ALA and 324 members of the ELS. As laryngology fellowships are less available outside the U.S., ELS members who devoted more than 50% of their practice to laryngology were identified as laryngologists for this study.Results:Of the ELS members surveyed, 72 (22.2%) responded, compared to 43 (24.5%) for ALA members. 56.9% of ELS respondents identified as devoting more than 50% of their practice to laryngology. Fellowship‐level training in laryngology was completed by 74.1% of ELS respondents and 79.5% of ALA respondents. 11% of ELS respondents commented on completing fellowships in phoniatry or phonosurgery, or the absence of formal fellowships in their country. When comparing comfort with the diagnosis of laryngeal neuropathy, ELS laryngologists’ average comfort level was 4.33 on the Leikert scale versus 6.1 for ALA laryngologists (P <.000002). When asked if they were concerned about over‐diagnosing gastroesophageal reflux disease (GERD)‐related laryngitis, 73% of ELS respondents vs. 40.9% of ALA respondents said yes (P = 0.0109).Conclusions:Laryngologists in the United States vs. Europe vary significantly in their familiarity with laryngeal neuropathy. This could lead to differences in the workup of patients with laryngopharyngeal symptoms, possibly resulting in ineffective treatments. These differences are likely amenable to further education.
The Mayo Clinic Arizona Spasmodic Dysphonia Experience: 24 Years and 686 Patients
Authors: Pollei Taylor R. , Bansberg Stephen F. , Adler Charles , Lott David G. , Patel Alpen B. 
Published: August 2013

Objectives:1) Outline onabotulinumtoxinA (onaBTX‐A) injection dose and frequency trends in adductor spasmodic dysphonia (AdSD) patients. 2) Assess correlations between onaBTX‐A injection dose, duration of breathiness, time to therapeutic onset, percent maximal benefit obtained, and duration of benefit.Methods:Retrospective chart review. Setting: Tertiary academic care center. Subjects and Methods: 686 patients with spasmodic dysphonia (SD) were treated with 6345 BTX injections between 1989 and 2013. This included 630 AdSD and 56 AbSD patients further subdivided into subgroups based on presence of vocal tremor (VT) and injection laterality. Injection frequency, dosing, laterality, and background demographic data were recorded in addition to subjective onaBTX‐A injection responses.Results:AdSD patients’ symptom onset and injections began at an older age than AbSD patients (52.5; 60.6 years vs. 43.7; 50.0 years respectively; P = 0.0008) and had VT more frequently (P= 0.0012). For the 380 AdSD patients (+/‐ VT) receiving over six injections, the average total onaBTX‐A dose was 5.0 units, which remained stable up to 15 years (year 15 dose mean= 5.29, std dev= 5.07). Using Pearson's correlation coefficients, there was no significant positive or negative correlation between onaBTX‐A dose and percent maximal benefit (p=0.760), duration of breathiness (P = 0.618), dysphagia duration (P = 0.142), benefit duration (P = 3622), or time to therapeutic onset (P = 0.618).Conclusions:Spasmodic dysphonia is effectively treated according to patient subjective response; however, more refined longitudinal analysis is needed to show if any objective correlation between injection dose and outcomes are present. Treatment methods and outcomes as described should aid others in developing best practice patterns.
A Novel Distending Laryngoscope: Implications in Transoral Surgery
Authors: Patel Alpen B. , Howard Brittany E. , Nagel Thomas H. , Hinni Michael L. 
Published: August 2013

Objectives:1) Describe an innovative laryngoscope developed to improve visualization, provide greater exposure, and enhance precision during transoral procedures. 2) Demonstrate improved proficiency and success with transoral surgery within the oropharynx, hypopharynx, and larynx. 3) Analyze and compare specific mechanical dimensions and exposure with that of currently available instrumentation. 4) Identify the advantages of use with minimally invasive surgical techniques and approaches, including transoral laser microsurgery and transoral robotic surgery.Methods:A retrospective review of 170 patients who underwent transoral surgery with a new distending laryngoscope was conducted. We compared and contrasted our exposure within the oropharynx, hypopharynx, and larynx using the new laryngoscope with that of currently available instrumentation. Specific mechanical dimensions of the laryngoscope along with the provided working field were calculated.Results:Experience with the new distending laryngoscope afforded better exposure than currently available instrumentation. This new prototype was manufactured using design elements from the Steiner, Weerda, and Lindholm laryngoscopes, including an anteriorly curved distal tip, distending capability, and lateral wings to protect against tongue herniation. The panoramic of view was increased when engaged. This design provided enhanced transoral visibility and working room, allowing for improved bimanual instrumentation.Conclusions:Direct laryngoscopic technique and instrumentation has continued to evolve. Over the last two decades, there has been a significant movement towards minimally invasive transoral surgical techniques fueling innovative concepts and advancement in laryngoscopic design and application. We present our experience with an innovative laryngoscope allowing for improved visualization, greater exposure, and enhanced precision with transoral technique.
PPI versus Placebo in the Treatment of LPR: A Meta‐analysis of Nine RCTs
Authors: Wineland Andre M. , Piccirillo Jay F. 
Published: August 2013

Objectives:Identify if proton pump inhibitors (PPIs) in the treatment of laryngopharyngeal Reflux (LPR) are superior to placebos. Study Design: Meta‐analysis of double‐blind randomized controlled trials (RCTs) of PPIs vs. placebo in adult participants with laryngeal symptoms and endoscopic findings of LPR.Methods:Articles were identified by searching MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov without date limits. Relative risks were reported with 95% confidence intervals using a random‐effects model. Publication bias, heterogeneity, and sensitivity analysis were also conducted. Modified PRISMA guidelines were used to assess data quality. The primary outcome measure was defined as the proportion of patients with 50% reduction in self‐reported laryngeal symptoms.Results:Nine RCTs examining PPI vs. placebo (n = 402; 226 PPI/176 placebo) suggest PPI therapy is superior to placebo (relative risk [RR] 1.36; 95% confidence interval [CI] 1.02, 1.81; P = 0.036). Additional sensitivity analysis suggests PPIs provide a greater benefit for those < 50 years old or to those who receive therapy for > 8 weeks. Moderate heterogeneity was found (I2 = 41.1%, X2 = 13.57, d.f. = 8, P = 0.094) among the studies. Significant publication bias was detected through Egger's test (coefficient 2.06; 95% CI ‐0.41, 4.54; P = 0.09).Conclusions:PPI therapy appears to provide superior symptomatic relief for LPR when compared to placebo. Significant publication bias and pharmaceutical association was found among included studies. Future research should focus on identifying those patients who would benefit most from medical therapy.
Total Laryngeal Transplant Explanted in 2012: 14 Years of Lessons Learned
Authors: Lorenz Robert R. , Strome Marshall 
Published: August 2013

Objectives:In 1998, the first successful total laryngeal transplant was performed at the Cleveland Clinic. The patient was a 40 year‐old‐man who had suffered an MVA, which left him aphonic. Not only was his larynx completely replaced with a vascularized graft, but also his pharynx, thyroid, parathyroids, and a portion of his trachea. Over the subsequent 14 years, much was learned about tolerance of a transplanted laryngeal complex, marking this surgery as the longest surviving maiden transplanted organ system when immunosuppression was applied.Methods:Outstanding voice quality and swallowing function were achieved, although volitional vocal cord movement was not attempted, and therefore the patient remained stoma dependent for breathing. The scientific advancement of understanding around laryngeal transplantation was concurrently conducted in the laboratory via animal models, which translated into gradual reduction in the level of immunosuppression for the patient without acute rejection.Results:After approximately a decade, a slowly progressive, chronic rejection process gradually rendered the organ non‐functional, and the patient and his providers deemed him appropriate for explantation with free‐flap reconstruction and tracheoesophageal puncture voice restoration. Pre‐operative functional studies showed a reversion back to his original thyroidal tissue as the source of his circulating thyroid hormone. Post‐explantation histologic studies demonstrated loss of tissue cellularity and organ architecture.Conclusions:On routine explantation follow‐up, the patient was found to have an asymptomatic early stage, human papillomavirus‐related oropharyngeal neoplasm that was successfully treated with surgical resection alone. Voice results will be demonstrated over the patient's 14 year experience, as well as his own perspective on this landmark experience.
Trends of Total Laryngectomy: Analysis of California Patient Discharge Data 1996‐2010
Authors: Verma Sunil P. , Mahboubi Hossein 
Published: August 2013

Objectives:Determine if the number of total laryngectomies (TL) performed in California has changed over the last fifteen years. We also sought to investigate if the location of surgery, length of stay, and use of rotational/free flaps changed over this time period.Methods:All patient records enlisting ICD‐9‐CM procedural codes for laryngectomy were extracted from the California Patient Discharge Data sets of 1996‐2010. Patients’ demographics were evaluated. Teaching otolaryngology hospitals were coded as academic. Population‐adjusted surgery rates, percentage of surgeries with rotational/free flap and/or percutaneous endoscopic gastrostomy (PEG), length of stay, total charges, and disposition status were then analyzed and compared between academic and non‐academic centers.Results:A total of 4,145 TLs were performed from 1996‐2010. The overall number of surgeries declined from 1.3 surgeries per 100,000 California residents to 0.6 per 100,000 California residents. The number of surgeries performed in non‐academic medical centers dropped by 70% during this time period (P <. 01). The median length of stay increased from 10 to 12 days, and the median total charges increased from $45000 to $192000 (P <. 01). The use of rotational/free flaps more than doubled, and the use of PEG tubes increased seven folds (P <. 01).Conclusions:The total number of patients undergoing TL in California has declined, and the surgery is increasingly being performed at academic medical centers. The use of rotational and free flaps has increased over the last 15 years.
Ablation of Bone without Thermal or Acoustic Injury via a Novel Ultrafast Picosecond Infrared Laser
Authors: Jowett Nathan , Wollmer Wolfgang , Wiseman Paul , Mlynarek Alex M. , Lorincz Balazs B. , Knecht Rainald , Miller R.J.D. 
Published: August 2013

Objectives:A precise method to ablate bone without significant thermal or acoustic injury has remained elusive. A novel non‐ionizing ultrafast pulsed picosecond infrared laser (PIRL) may provide the solution. The PIRL ablates tissue through purely photomechanical means, via a thermoelastic front spallation effect, with near complete thermal and acoustic transient confinement. In contrast, the Er:YAG laser ablates tissue via a micro‐explosive vaporization mechanism. This study compares PIRL and Er:YAG laser ablation of bone by infrared thermography (IRT), digital microscopy, and electron microscopy.Methods:Ten cuts were made in fresh ex‐vivo cortical bone via PIRL and Er:YAG laser ablation under IRT imaging. Lasers were operated using similar average power settings (68 mW) at fluence levels (0.78 J/cm2 and 8.15 J/cm2) in the treatment window above the ablation threshold and below ionization threshold for the PIRL and Er:YAG laser respectively. Digital and electron microscopy were used to image the ablation zones.Results:Peak temperature was negligible and significantly lower for PIRL in comparison to Er:YAG laser ablation (1.56 ± 2.71°C vs. 12.99 ± 2.71°C, P = 0.008). Digital microscopy revealed similar cortical surface ablation volumes for both lasers. Electron microscopy demonstrated well delineated ablation zone margins with no sign of micro‐fracture or thermal injury for PIRL ablation.Conclusions:The PIRL provides a means of bone ablation without acoustic shockwave induced micro‐fractures or thermal injury. This novel laser has great potential in advancing surgical techniques and outcomes in otologic, neurotologic, implant, cranio‐maxillofacial, and head and neck reconstructive surgery.
Audiovestibular Characteristics of Small Cochleovestibular Schwannomas in Neurofibromatosis Type 2
Authors: Holliday Michael A. , Zalewski Christopher K. , Wafa Talah , Dewan Ramita , Butman John , Asthagiri Ashok R. , Kim Hung J. 
Published: August 2013

Objectives:Describe the relationship between cochleovestibular schwannoma (CVS) volume, audiovestibular changes, and magnetic resonance imaging (MRI) findings in patients with neurofibromatosis Type 2 (NF‐2).Methods:Subgroup analysis of NF‐2 prospective natural history study from June 2008 to June 2011. Subjects: NF‐2 patients with small treatment‐ naïve CVS (volume < 1cm3) by ear. N = 49 ears, 32 patients. Setting: Quaternary medical research institute. Intervention: None. Outcome Measurements: Tumor size, auditory brainstem response (ABR), audiogram (4‐frequency PTA ‐ 0.5, 1, 2, 4KHz), vestibular evoked myogenic potential (VEMP), caloric videonystagmography (VNG), rotary chair testing (240°/sec velocity step test), and magnetic resonance imaging (MRI) findings.Results:Larger tumor volume (mean 0.489cm3; 95% confidence interval [CI] 0.313‐0.664) correlated with abnormal ABR findings, compared to smaller tumors with normal ABR (mean 0.151cm3; 95%CI 0.89‐0.213). Larger tumors also correlated with weak caloric response (mean 0.520cm3; 95%CI 0.300‐0.741 vs. mean 0.199cm3; 95%CI 0.102‐0.296). Tumor volume was not significantly correlated with PTA, VEMP, or rotary chair testing. Elevated intralabyrinthine protein on MRI fluid‐attenuated inversion recovery sequences was correlated with larger tumor size (mean volume 0.331cm3; 95%CI 0.246‐0.419 vs. 0.055cm3; 95%CI 0.008‐0.103) and abnormal ABR and PTA (P < 0.05), but it did not correlate with VEMP or caloric responses.Conclusions:In our sample, ABR, caloric response, and intralabyrinthine protein correlated with tumor volume, but PTA, VEMP, and high velocity step testing did not. Abnormal ABR and PTA were correlated with elevated protein. These findings may provide insight on the effect of small CVS on the inner ear and cochleovestibular nerves, which may aid in their management.