bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathologic Effects of External-Beam Irradiation on Human Vocal Folds
Authors: Berg Eric E. , Kolachala Vasantha , Branski Ryan C. , Muller Susan , Johns Michael M. 
Published: October 2014

Objectives: We sought to better characterize pathologic changes that occur in the human vocal fold after radiotherapy for head and neck cancer. Methods: In a blinded, controlled study of archived tissue, we evaluated postirradiation salvage laryngectomy vocal fold tissue without evidence of malignant disease. Clinical and demographic patient data were collected. In a blinded fashion, irradiated tissue was compared to nonirradiated, benign control tissue. Histomorphometric analysis was used to assess muscle and collagen organization, superficial lamina propria (SLP) and vocal ligament thickness, vocalis muscle fiber area, collagen content, and hyaluronic acid content. Immunohistochemical analysis was used to assess the content of type I collagen, type IV collagen, vimentin, fibronectin, α–smooth muscle actin, matrix metalloproteinase 9, and laminin. Results: Twenty irradiated vocal folds were evaluated and compared to control specimens. Collagen and muscle disorganization was noted in the irradiated specimens. The SLP and vocal ligament thicknesses and the mean muscle fiber diameters did not differ significantly. The SLP fibronectin and the vocalis muscle and SLP collagen content were significantly increased in the irradiated vocal folds, and the SLP collagen content increased significantly with time between irradiation and resection. The laminin content of irradiated vocalis muscles was significantly decreased. Conclusions: Radiotherapy results in significant vocal fold tissue changes. Having more precisely defined these changes, we plan continued investigation seeking targeted preventive and therapeutic interventions for improved vocal quality following radiotherapy.
Neuronal Mechanisms Underlying the Laryngeal Adductor Reflex
Authors: Sun Qi-Jian , Chum Jia Min , Bautista Tara G. , Pilowsky Paul M. , Berkowitz Robert G. 
Published: October 2014

Objectives: Electromyographic studies of the laryngeal adductor reflex, glottal closure occurring in response to laryngeal stimulation, have demonstrated an early ipsilateral response (R1) and a late bilateral response (R2). To better define the physiologic properties of these responses, we recorded responses from expiratory laryngeal motoneurons (ELMs) in rats during stimulation of the superior laryngeal nerve (SLN). Methods: Single unit extracellular recordings were obtained from 5 ELMs, identified by their antidromic responses to recurrent laryngeal nerve stimulation and postinspiratory firing pattern, in 4 Sprague-Dawley rats. Results: Unilateral stimulation of the SLN (at 20 Hz) stopped both phrenic nerve inspiratory activity and ELM postinspiratory activity. However, the ELMs displayed robust tonic firing, consisting of non-respiratory burst activity and single action potentials. The single action potentials were identified as short-latency ones (5 to 10 ms) activated by ipsilateral SLN stimulation, with an occurrence rate of 90%, and long-latency ones (20 to 50 ms) activated by bilateral SLN stimulation, with occurrence rates of 47% on the ipsilateral side and 58% on the contralateral side. Conclusions: The R1 response appears to be the result of the short-latency action potentials, orthodromically activated by ipsilateral stimulation of the SLN. The R2 response is likely to be a result of the long-latency action potentials that can be recorded from ELMs on both sides.
In Vitro Evaluation of the iValve: A Novel Hands-Free Speech Valve
Authors: van der Houwen Eduard B. , van Kalkeren Tjouwke A. , Burgerhof Johannes G. M. , van der Laan Bernard F. A. M. , Verkerke Gijsbertus J. 
Published: October 2014

Objectives: We performed in vitro evaluation of a novel, disposable, automatic hands-free tracheostoma speech valve for laryngectomy patients based upon the principle of inhalation. The commercially available automatic speech valves close upon strong exhalation and open again when the pressure drops. This method makes long sentences or pauses difficult. The novel iValve is designed to allow almost natural speech, with mid-sentence pausing and whispering. Methods: The inhalation closing flows and exhalation opening pressures of 6 iValve prototype versions at different settings were compared with physiological values. The airflow resistance at inhalation was compared to physiological values and to commercial valve values. Results: The iValve prototypes showed flow and pressure ranges in concordance with the physiological values in the literature. The airflow resistance in the breathing mode was within the physiological airflow resistance range, yet above the values from the two commercial valves. The resistance in the speaking mode was above the physiological airflow resistance range. Conclusions: In vitro tests show that the iValve versions can be selected and adjusted to operate within the physiological range. The airflow resistance in the breathing mode is good. In speaking mode, inhalation should, and can, be decreased. The iValve should offer the patient a more intuitively useable alternative with more dynamic speech. Its low cost allows disposability and wider use.
Validation of a Pediatric Vocal Fold Nodule Rating Scale Based on Digital Video Images
Authors: Nuss Roger C. , Ward Jessica , Recko Thomas , Huang Lin , Woodnorth Geralyn Harvey 
Published: October 2014

Objectives: We sought to create a validated scale of vocal fold nodules in children, based on digital video clips obtained during diagnostic fiberoptic laryngoscopy. Methods: We developed a 4-point grading scale of vocal fold nodules in children, based upon short digital video clips. A tutorial for use of the scale, including schematic drawings of nodules, static images, and 10-second video clips, was presented to 36 clinicians with various levels of experience. The clinicians then reviewed 40 short digital video samples from pediatric patients evaluated in a voice clinic and rated the nodule size. Statistical analysis of the ratings provided inter-rater reliability scores. Results: Thirty-six clinicians with various levels of experience rated a total of 40 short video clips. The ratings of experienced raters (14 pediatric otolaryngology attending physicians and pediatric otolaryngology fellows) were compared with those of inexperienced raters (22 nurses, medical students, otolaryngology residents, physician assistants, and pediatric speech-language pathologists). The overall intraclass correlation coefficient for the ratings of nodule size was quite good (0.62; 95% confidence interval, 0.52 to 0.74). The p value for experienced raters versus inexperienced raters was 0.1345, indicating no statistically significant difference in the ratings by these two groups. The intraclass correlation coefficient for intra-rater reliability was very high (0.89). Conclusions: The use of a dynamic scale of pediatric vocal fold nodule size most realistically represents the clinical assessment of nodules during an office visit. The results of this study show a high level of agreement between experienced and inexperienced raters. This scale can be used with a high level of reliability by clinicians with various levels of experience. A validated grading scale will help to assess long-term outcomes of pediatric patients with vocal fold nodules.
Novel Use of a Suction-Irrigation Device to Remove Impacted Blood Clot from the Airway
Authors: Westbrook Benjamin J. , Wilhelm Michael , Shvidler Joseph 
Published: October 2014

Objectives: We sought to describe the novel use of a suction-irrigation device to remove a large blood clot that was causing critical obstruction of the trachea and main stem bronchi in our patient. Methods: A large-bore suction-irrigation device designed for use in gynecologic cases was adapted for use in removal of an obstructing blood clot in the face of patient decompensation after several unsuccessful attempts at removal with standard otolaryngological instruments. Results: The tracheal obstruction and the significant bronchial obstructions were successfully removed with the suction-irrigation device. The patient's ventilatory status quickly stabilized. He was extubated the following day and discharged home. Conclusions: The suction-irrigation device proved highly successful in removing a large blood clot from the airway. A similarly designed device made specifically for the airway could prove useful in similar cases in the future.
Yeast Colonization of Voice Prostheses: Pilot Study Investigating Effect of a Bovine Milk Product Containing Anti—Candida Albicans Immunoglobulin A Antibodies on Yeast Colonization and Valve Leakage
Authors: Holmes Ann R. , Chong Kenneth , Rodrigues Ely , Cannon Richard D. , Carpenter Elizabeth , Ruske Dean R. , Dawes Patrick J. D. 
Published: October 2014

Objectives: Our goals were to determine whether a bovine milk product containing anti– Candida albicans immunoglobulin A antibodies (“immune milk”) could reduce the adherence of C albicans to voice prosthesis silicone in vitro, and whether administration of the milk could reduce C albicans colonization and voice prosthesis damage in vivo. Methods: An in vitro assay of C albicans attachment to silicone was developed with radiolabeled C albicans. A pilot crossover in vivo trial, over 3 periods of 3 months, was also undertaken for 4 patients with voice prostheses, comparing daily administrations of immune milk and a control milk product. The prosthesis valves were replaced at each change-over and were assessed for wet weight of removable biofilm, yeast numbers in removable biofilm, valve leakage, and valve damage. Results: Immune milk inhibited C albicans adherence to silicone in vitro. However, in a small clinical pilot study, this effect was not replicated. Conclusions: There is scope to further investigate the topical use of immune milk for management of voice prosthesis biofilms.
Audiometric Characteristics in Patients with Noise-Induced Hearing Loss after Sodium Enoxaparin Treatment
Authors: Mora Renzo , Mora Enzo , Salzano Francesco Antonio , Guastini Luca 
Published: October 2014

Objectives: The aim of this study was to evaluate the effect of sodium enoxaparin treatment on patients with noise-induced hearing loss. Methods: Sixty patients with noise-induced hearing loss were included and randomly divided into two numerically equal groups. Group A underwent therapy with sodium enoxaparin for 10 days, followed by an additional 10 days of treatment after 10 days of no treatment. Group B received placebo as a control. Before treatment, at the end of treatment, and 2 months after the end of treatment, all patients underwent evaluation by laboratory tests, pure tone audiometry, transient evoked otoacoustic emissions (TEOAEs) testing, distortion product otoacoustic emissions (DPOAEs) testing, and auditory brain stem response testing. Results: In contrast to group B, at the end of the treatment in group A pure tone audiometry showed a significant (p < 0.05) improvement of the audiometric thresholds at 0.5, 1, 2, 4, and 8 kHz. Depending on the air and bone conduction thresholds, TEOAEs and DPOAEs, which had previously been absent, were evoked at the frequencies examined. These improvements were confirmed at last follow-up. We found no significant differences in auditory brain stem responses or laboratory results. Conclusions: These preliminary data encourage further studies to collect additional evidence on the effect of sodium enoxaparin in preventing the development of noise-induced hearing loss.
Pseudo—Sudden Deafness
Authors: Song James E. , Sapthavee Andrew , Cager Gabrielle R. , Saadia-Redleaf Miriam I. 
Published: October 2014

Objectives: We describe the symptom complex and management of a clinical entity we refer to as “pseudo–sudden deafness,” which is an episode of acute otitis media that leads to sensorineural hearing loss with reduced speech discrimination. Methods: We included 8 adult patients with audiometrically confirmed, asymmetric sensorineural hearing loss with decreased speech discrimination that presented after an episode of acute otitis media. Magnetic resonance imaging ruled out retrocochlear disease. Both physical examination and myringotomy helped confirm the diagnosis of serous otitis media (SOM). Myringotomy, tympanostomy tubes, oral antibiotics, and otic antibiotic-steroid drops were used to treat the SOM. Oral steroids were used to treat the sensorineural component. Results: Pretreatment and posttreatment audiograms showed an improvement in speech discrimination score, pure tone thresholds, or both after treatment for underlying SOM and sensorineural hearing loss in 6 of the 8 patients. Conclusions: Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.
Parotidectomy: A 17-Year Institutional Experience at a Rural Academic Medical Center
Authors: Maddox Patrick Tate , Paydarfar Joseph Ali , Davies Louise 
Published: October 2014

Objectives: We describe the parotidectomy experience at a single rural institution over 17 years. Methods: We retrieved the records of all patients who underwent parotidectomy for any nontrauma indication (current procedural terminology codes 42410, 42415, 42420, 42425, and 42426) from January 1990 to June 2007 at Dartmouth-Hitchcock Medical Center, a rural medical center that provides both primary and tertiary care to a local population of 14,000, with a catchment area of 600,000 people. Information was collected on initial patient presentation, use of fine-needle aspiration, extent of surgery, final pathologic diagnosis, and complications. Results: We performed 341 parotidectomy procedures in 334 patients. The largest number of malignancies came from metastatic tumors; squamous cell carcinoma was the most common (37% of malignancies). The most common presenting complaint overall was a painless mass. The most common complication was facial weakness in 17% (57 of 341); 36 of the 57 cases of facial weakness (63%) were associated with surgery for malignancy. The most common benign tumor was pleomorphic adenoma (114 of 186; 61%). Mucoepidermoid carcinoma was the most common primary parotid malignancy (12%). Conclusions: In this 17-year rural case series of all parotidectomy procedures done for nontrauma indications, the largest number of malignancies came from metastatic tumors. Although facial nerve paralysis is not a common complication, it occurs most often when surgery is performed for either primary or metastatic malignancy. Surgeons will benefit from this information as they counsel patients who are considering parotidectomy.
Endoscopic Treatment of Benign and Malignant Strictures of the Cervical Esophagus and Hypopharynx
Authors: Gallo Andrea , Pagliuca Giulio , de Vincentiis Marco , Martellucci Salvatore , Iallonardi Elsa , Fanello Gianfranco , Cereatti Fabrizio , Fiocca Fausto 
Published: October 2014

Objectives: We evaluated the efficacy of endoscopic techniques employed in the management of cervical esophageal and hypopharyngeal strictures. Methods: A series of 45 patients with cervical esophageal (35) and/or hypopharyngeal strictures (10) were included. Twenty-five patients (55.6%) with neoplastic strictures were treated for palliation alone. The stenosis was related to radiotherapy in 11 patients (24.4%) and to postsurgical complications in 9 (20%). A group of 23 patients was treated with dilation alone (group 1). A second group included 22 patients treated with insertion of a self-expandable stent after failure of dilation treatment (group 2). The swallowing test data, clinical notes, and surgical reports were reviewed. Results: All of the patients showed some degree of relief of dysphagia. In group 1, 19 of the 23 patients required multiple dilation treatments to maintain normal deglutition. In group 2, 7 of the 22 patients recovered regular oral feeding after stent placement, 10 patients reported pain and foreign body sensation, 2 patients reported pain so severe that stent removal was required, and 3 patients experienced stent migration. All but 3 of the 25 patients with inoperable tumors died during follow-up, but no patients with benign stenosis died. Conclusions: The two groups showed comparable functional results. Dilation often requires multiple procedures, but is usually well tolerated. Placement of self-expandable stents is effective, but is generally less well tolerated.
Effects of Early Commercial Air Travel on Graft Healing Rates after Tympanoplasty
Authors: Konishi Masaya , Sivalingam Shailendra , Shin Seung-Ho , Vitullo Francesca , Falcioni Maurizio 
Published: October 2014

Objectives: We sought to determine whether commercial air travel soon after tympanoplasty significantly affects graft healing rates. Methods: We performed a retrospective analysis of 169 patients who underwent tympanoplasty from 1993 to 2009, comparing two groups of patients: 69 patients who flew 1 day after surgery and 100 who did not. The confounding factors analyzed were side of surgery, size of perforation, surgical approach, graft material, and grafting technique. The primary outcome measure analyzed was successful closure of the perforation at the first follow-up visit, at 4 weeks, evidenced by direct otoendoscopic examination. Results: There was no significant difference in the confounding variables between the two groups. There was no significant difference in the primary outcome measure of graft healing rates between the two groups (p = 0.494). Additionally, the overall graft healing rates compared favorably with previously published data from other authors. Conclusions: Early commercial air travel after tympanoplasty does not significantly affect graft healing rates and should be considered a relatively safe option.
Patients with Phantogeusia Show Increased Expression of T2R Taste Receptor Genes in Their Tongues
Authors: Hirai Ryoji , Takao Kyoichi , Onoda Keiko , Kokubun Shinichiro , Ikeda Minoru 
Published: October 2014

Objectives: The taste receptor gene family T2R has been implicated in the sensation of bitter taste. Phantogeusia is a spontaneous abnormal taste with no external stimulus. We analyzed the expression of T2R taste receptor genes in the tongues of patients with phantogeusia to assess their role in the pathogenesis of phantogeusia. Methods: We obtained specimens from 43 patients with phantogeusia and 24 normal volunteers by scraping the foliate papillae and examined these specimens for the expression of 10 T2R taste receptor genes using reverse transcription–polymerase chain reaction and electrophoresis. Results: The expression rate (subjects with detectable expression) of the 10 taste receptor genes in the healthy subjects ranged from 16.7% to 100%; 3 receptor genes were found in 50% or fewer of these subjects. In the patients with phantogeusia, the expression rate was increased significantly compared to that in the healthy control subjects for 3 of the 10 receptor genes examined. Conclusions: Our results show that the expression rate of some of the T2R taste receptor genes was increased significantly in patients with phantogeusia. These results suggest that increased expression of taste receptor genes is involved in the pathogenesis of phantogeusia; this finding may contribute to elucidation of the mechanism of this disorder.
Oval Window Transport of Gd-DOTA from Rat Middle Ear to Vestibulum and Scala Vestibuli Visualized by in vivo Magnetic Resonance Imaging
Authors: Zou Jing , Poe Dennis , Ramadan Usama Abo , Pyykkö Ilmari 
Published: October 2014

Objectives: We tested our hypothesis that the oval window (OW) potentially functions as a route to carry substances from the middle ear to the vestibulum and then the scala vestibuli through the annular ligament across the stapediovestibular joint. Methods: Gd-DOTA was either injected into the lateral attic compartment of rats with a high-performance polyimide tube in a selective OW delivery group, or administered to the middle ear cavity of two groups of rats in which the OW was either sealed or not sealed. The dynamic uptake of Gd-DOTA in the inner ear was visualized with a 4.7-T magnetic resonance imaging machine. Results: In the selective OW delivery group, Gd-DOTA appeared in the vestibulum and in the basal turn of the scala vestibuli but not in the scala tympani on T1-weighted images acquired at 10 minutes after Gd-DOTA administration (the earliest available time point of magnetic resonance imaging). In the sealed-OW group, immediate uptake of Gd-DOTA was absent in the vestibulum and scala vestibuli. Measurement of the signal ratio of the vestibulum to that of the scala tympani showed that selective OW delivery induced the greatest signal ratio and that sealing of the OW induced the lowest signal ratio. Conclusions: The OW is a genuine and efficient pathway to transport Gd-DOTA from the middle ear to the vestibulum.
Decellularized Rabbit Cricoarytenoid Dorsalis Muscle for Laryngeal Regeneration
Authors: Fishman Jonathan M. , Ansari Tahera , Sibbons Paul , De Coppi Paolo , Birchall Martin A. 
Published: October 2014

Objectives: Although considerable progress has been made in regenerative medicine, a quantum step would be the replacement and/or regeneration of functional muscle tissue. For example, although patients' airways can now be successfully replaced with stem cell–based techniques, a much greater patient need would be addressed by regeneration of the muscles required for engineering a functional larynx, in which active movement is critical. The rabbit cricoarytenoid dorsalis muscle was chosen for the present study because it is equivalent to the posterior cricoarytenoid muscle, the only significant abductor muscle in human larynges. Methods: Rabbit cricoarytenoid dorsalis muscles were harvested, and different decellularization methods were compared by use of a combination of histologic, immunohistochemical, and molecular techniques. Decellularized scaffolds were implanted into Sprague-Dawley rats as part of a 2-week biocompatibility study to assess immunogenicity. Results: Decellularization with a combination of latrunculin B, potassium iodide, potassium chloride, and deoxyribonuclease resulted in total DNA clearance and reduced levels of major histocompatibility complex class II expression, with relative preservation of the scaffold's structural integrity (collagen, elastin, and glycosaminoglycan content). The scaffolds showed minimal signs of rejection at 2 weeks in a cross-species (xenotransplantation) study. Conclusions: Decellularized laryngeal muscles, which are nonimmunogenic, may provide the optimal scaffold source for the generation of a fully functional tissue-engineered larynx.