bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of Herpes Simplex and Varicella-Zoster Viruses in Patients with Bell's Palsy by the Polymerase Chain Reaction Technique
Authors: Stjernquist-Desatnik Anna , Skoog Eva , Aurelius Elisabeth 
Published: October 2014

Objectives: Infectious causes of peripheral facial paralysis are well known. Bell's palsy, however, is an idiopathic facial paralysis, and the genesis is still unknown. Herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) have been suggested as etiologic agents. Methods: Twenty consecutive adult patients with Bell's palsy were included in the study. Ten adult patients operated on for chronic otitis served as controls. A biopsy specimen from the posterior auricular muscle was resected within 72 hours after the onset of Bell's palsy and was analyzed together with cerebrospinal fluid (CSF) by nested polymerase chain reaction for HSV-1 and VZV DNA. Serum samples were analyzed for antibodies to HSV-1 and VZV. Results: HSV-1 DNA was found in the muscle biopsy specimen from 1 of the 20 patients, but was not found in any of the CSF samples. VZV DNA was detected in the muscle biopsy as well as the CSF from 1 other patient. All controls were negative. Seventeen of 19 patients had stationary serum antibody concentrations to HSV-1, and none displayed an antibody titer rise. A significant antibody titer rise to VZV was found in 1 of 19 patients, whereas 17 of 19 had stationary antibody levels. Conclusions: HSV-1 or VZV DNA was detected in 10% of patients with Bell's palsy in the present study. Viral replication might already have declined in many cases at the onset of the palsy. Use of an HSV-1/VZV polymerase chain reaction on a muscle biopsy specimen or CSF does not seem to be the method of choice for rapid etiologic diagnosis in the acute phase of Bell's palsy.
Tympanoplasty for Chronic Otitis Media in Post-Irradiated Nasopharyngeal Carcinoma Patients
Authors: Hsu Yao-Chung , Su Chih-Ying 
Published: October 2014

Objectives: We evaluated the surgical outcome of tympanoplasty for chronic otitis media in post-irradiated patients with nasopharyngeal carcinoma. Methods: Nineteen ears were treated in 15 patients with nasopharyngeal carcinoma who had undergone radiotherapy in this retrospective clinical series. Only patients with simple perforations of the tympanic membrane and normal or near-normal eustachian tube function were enrolled in this study. All patients underwent type I tympanoplasty. Results: All patients had been treated with radiotherapy of 64.8 to 81.0 Gy. The intervals between radiotherapy and surgery ranged from 17 months to 20 years. The tympanic membranes in 10 of 19 ears were intact after surgery. Otorrhea had subsided in 11 ears (58%), and the incidence of otorrhea was decreased in 6 ears (32%). Thirteen of the 15 patients (86.7%) reported that their quality of life had improved. Conclusions: Surgical intervention benefits some patients with nasopharyngeal carcinoma with chronic otitis media resulting from radiotherapy.
Cost-Effectiveness of Tonsillectomy for Recurrent Acute Tonsillitis
Authors: Fujihara Keiji , Koltai Peter J. , Hayashi Masaki , Tamura Shinji , Yamanaka Noboru 
Published: October 2014

Objectives: We used a retrospective case series to perform a preliminary study to determine the clinical effectiveness and cost-effectiveness of tonsillectomy for recurrent acute tonsillitis. Methods: We studied 25 children and 16 adults who had tonsillectomy for recurrent acute tonsillitis. The adult patients and the children's caregivers were asked to respond to a questionnaire regarding the efficacy of their tonsillectomy. The cost of medical care and the work disability cost for tonsillitis and for tonsillectomy were calculated. We then applied the technique of break-even time analysis to assess when the total health care cost savings from surgery overtook the total cost of tonsillectomy. Results: In children, the overall economic costs (medical costs and work-related costs) were recovered at 1.6 years after tonsillectomy (break-even point). In adults, the overall economic costs (medical costs and work-related costs) were recovered at 2.5 years after tonsillectomy (break-even point). Conclusions: Tonsillectomy for recurrent acute tonsillitis is both clinically effective and cost-effective for children and adults in Japan.
Releasing Tension on a Tracheal Anastomosis: An Ex Vivo Study on a Sheep Model
Authors: Zaugg Yannick , Cuffel Cyril , Monnier Philippe 
Published: October 2014

Objectives: Tension is the limiting factor in long tracheal resection with end-to-end anastomosis. Complications such as dehiscence and restenosis are well correlated with the degree of anastomotic tension. The objective of our study was to investigate the effects of patches of auricular cartilage glued craniocaudally along a tracheal anastomosis. Methods: Rupture tests were performed on sheep tracheas collected from a slaughterhouse. In group A (n = 5), 3 patches of auricular cartilage of 0.5 × 5 cm were glued with albumin-glutaraldehyde tissue adhesive (BioGlue) craniocaudally along the left, right, and anterior borders of the transected tracheas. In group B (n = 10), the patches were fixed with 2 transparietal intercartilaginous stitches without adhesive. In group C (n = 10), adhesive and stitches were used. Results: Three patches of cartilage glued along the tracheal anastomosis held tension as high as 11.1 N. Adhesive maintained the tracheal extremities in closer contact than did stitches alone. It increased the anastomotic resistance strength (50.8 N in group C versus 29.6 N in group B). This increase was statistically significant. Conclusions: Gluing auricular cartilage patches along ex vivo tracheal anastomoses strengthened them and helped diminish tension on the suture line.
Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy for Recurrent Laryngeal Cancer
Authors: Sewnaik Aniel , Hakkesteegt Marieke M. , Meeuwis Cees A. , de Gier Henriëtte H. W. , Kerrebijn Jeroen D. F. 
Published: October 2014

Objectives: Recurrent laryngeal cancer can be treated either with total laryngectomy or in selected cases with supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP). We performed a retrospective study to analyze the functional and oncological results of supracricoid laryngectomy with CHEP. Methods: Fourteen patients were treated with supracricoid laryngectomy with CHEP. In 8 patients, flexible endoscopic evaluation of swallowing was performed. Preoperative and postoperative voice evaluation was performed in 5 patients. Oncological and functional follow-up, postoperative complications, and data concerning rehabilitation were recorded on standard forms. Results: After the supracricoid laryngectomy with CHEP, 11 of the 14 patients were alive and disease-free. No local recurrences were found, but 2 patients had regional recurrences. The voice was worse after the operation; however, most patients were satisfied. Swallowing was uncompromised. Conclusions: Supracricoid laryngectomy with CHEP for recurrent glottic laryngeal cancer after radiotherapy appears to be oncologically safe and functional.
Effects of Converting Bilateral Cochlear Implant Subjects to a Strategy with Increased Rate and Number of Channels
Authors: Dunn Camille C. , Tyler Richard S. , Witt Shelley A. , Gantz Bruce J. 
Published: October 2014

Objectives: Three different Advanced Bionics processing strategies were evaluated: 1) 8-channel, 813 pulses per second (pps), Continuous Interleaved Sampling (CIS); 2) 16-channel, 5,100 pps, HiResolution Paired (HiRes P); and 3) 16-channel, 2,900 pps, HiResolution Sequential (HiRes S). Methods: Seven adult bilateral Clarion CII cochlear implant recipients who had been using a CIS processing strategy for at least 18 months participated in this study. Sentence recognition in multitalker babble from the front was collected on subjects using their CIS strategy and after subjects were programmed for the first time with HiRes P and HiRes S strategies. An ABAB design was implemented for 1 month whereby subjects used each HiResolution strategy every other day. Sentence recognition testing was repeated at the 1- and 3-month post-HiResolution test intervals. Results: Comparisons between the CIS and HiResolution strategies showed immediate improvements for 5 subjects in favor of the HiResolution strategies. After 1 month of alternating between the HiRes P and HiRes S strategies, remarkably, 2 subjects showed improvements of 60%, 2 subjects showed improvements of 40%, and 2 subjects showed improvements of 30% over the CIS strategy that they had previously used for at least 18 months. The results after 3 months of use were consistent with those obtained at 1 month. Conclusions: The HiRes S and HiRes P strategies resulted in dramatic improvements in speech perception in noise for a subset of subjects who had been using the CIS strategy bilaterally. This finding demonstrates that these subjects were able to tolerate a more difficult signal-to-noise ratio. Further work is needed to determine the independent effects of rate versus number of channels.
Laryngoscopy in Bilateral Vocal Fold Immobility: Can You Make a Diagnosis?
Authors: Cohen Seth M. , Garrett C. Gaelyn , Netterville James L. , Courey Mark S. 
Published: October 2014

Objectives: This study explores whether videoendoscopic findings and patient history help make the diagnosis in bilateral vocal fold immobility (BVFI). Methods: Medical records from 1995 to 2003 were searched to identify patients with posterior glottic stenosis (PGS) and bilateral vocal fold paralysis (BVFP) who also had videoendoscopic examinations. Videoendoscopic examination findings that could help differentiate PGS from BVFP were identified a priori. A weighted scoring index, based on the adjusted odds ratios of significant examination findings on multiple logistic regression, was derived. Associations between the weighted scoring index, patient history, and diagnosis were then evaluated. Results: Twenty-six patients with BVFP and 28 patients with PGS were identified. Posterior glottic scar (weight = 2), medial arytenoid erosion with a widened posterior glottis (weight =1), and appropriate vocal fold motion (weight = 1) were significant variables (p ≤ .05, multiple logistic regression) and constituted the weighted scoring index. A weighted scoring index of ≥ 2 and a history of prolonged intubation predicted PGS in 95.2% of cases. A weighted scoring index of ≤ 1 and a history of neck surgery predicted BVFP in 95.0% of cases. Conclusions: The weighted scoring index with the patient history provides an objective tool for diagnosing BVFI.
Multichannel Intraluminal Impedance in the Evaluation of Patients with Persistent Globus on Proton Pump Inhibitor Therapy
Authors: Anandasabapathy Sharmila , Jaffin Barry W. 
Published: October 2014

Objectives: Studies suggest an association between globus sensation (“globus”) and gastroesophageal reflux. Although globus often persists despite proton pump inhibitor (PPI) therapy, the role of nonacid reflux has never been determined. Our goal was to use 24-hour multichannel intraluminal impedance (pH/MII) to determine 1) reflux characteristics in patients with globus despite PPI therapy; 2) whether there are differences in reflux patterns between patients with globus and patients with heartburn alone; and 3) whether there are differences in the number of positive symptom indices when standard pH testing is compared to pH/MII. Methods: Twenty-one adult patients with globus and 12 with heartburn symptoms alone underwent 24-hour pH/MII on PPI therapy. Reflux frequencies and characteristics were compared in both groups. For patients with globus, the symptom index and symptom sensitivity index were calculated. Logistic regression was performed to determine which reflux characteristics correlated with symptoms. Results: With pH/MII, we detected 1,160 reflux episodes; 64.7% were nonacid, and 55% reached the proximal sensor. In identifying patients with positive symptom indices, pH/MII increased the yield of standard pH testing by 27.8%. Proximal reflux was a significant predictor of globus symptoms (p = .04). Nonacid reflux approached significance in predicting globus (p = .08). Compared to patients with heartburn alone, those with globus had a higher mean frequency of proximal reflux (27.76% versus 15.63%; p = .04). Conclusions: In adults on PPI therapy with refractory globus, acid reflux does not predict globus symptoms. Through detection of nonacid reflux, pH/MII increased the yield of standard pH testing in identifying positive symptom indices. Additionally, pH/MII provided important information regarding reflux-symptom correlation. Proximal reflux may be predictive of globus symptoms.
Computerized Dynamic Visual Acuity with Volitional Head Movement in Patients with Vestibular Dysfunction
Authors: Roberts Richard A. , Gans Richard E. , Johnson Erika L. , Chisolm Theresa Hnath 
Published: October 2014

Objectives: Patients with uncompensated vestibular dysfunction frequently report blurred vision during head movement, a symptom termed oscillopsia. One way to measure the functional deficit associated with an impaired vestibulo-ocular reflex is by comparing visual acuity from a baseline condition in which there is no head movement to visual acuity obtained during a dynamic condition with head movement. A previously described test incorporated a treadmill upon which patients walked during assessment of visual acuity. The objective of the current investigation was to evaluate an alternative method of assessing dynamic visual acuity that uses volitional head movement instead of walking on a treadmill. Methods: Fifteen participants with normal vestibular function and 16 participants with impaired vestibular function were enrolled. All participants performed the visual acuity task under baseline conditions with no movement and also under dynamic conditions that included 1) walking on a treadmill and 2) volitionally moving their head in the vertical plane. Results: No difference in performance was observed between the treadmill task and the volitional head movement task. Participants with impaired vestibular function performed more poorly under the dynamic conditions than did participants with normal vestibular function. Conclusions: The results suggest that the volitional head movement paradigm may be useful in identification of patients with functional deficits of the vestibulo-ocular reflex.
Office-Based 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis and Dysplasia
Authors: Zeitels Steven M. , Akst Lee M. , Burns James A. , Hillman Robert E. , Broadhurst Matthew S. , Anderson R. Rox 
Published: October 2014

Objectives: Treatment of glottal papillomatosis and dysplasia was mirror-guided and done in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. The primary treatment goals, which are disease regression and voice restoration and/or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. To obviate general anesthesia, office-based laser laryngeal surgery was first done in 2001 with the 585-nm pulsed dye laser (PDL), because it employs a fiber delivery system and its energy is selectively absorbed by oxyhemoglobin. Since then, this new angiolytic laser treatment paradigm has become a mainstay of management for many surgeons; however, there are a number of shortcomings of the PDL. To further develop this concept and address the limitations of the PDL, we used a 532-nm pulsed potassium titanyl phosphate (KTP) laser. Methods: A prospective assessment was performed on 48 patients in 72 cases of recurrent glottal dysplasia (36) or papillomatosis (36). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Results: Two dysplasia patients did not tolerate the procedure. Of the treatable dysplasia cases, there was follow-up in 29 of 34. Disease regression was at least 75% in 18 of 29 cases (62%), 50% to 75% in 7 of 29 (24%), and 25% to 50% in the remaining 4 of 29 (14%). Papilloma patients returned for treatment when symptoms recurred, so disease regression could not be assessed accurately. Similar to data obtained with the PDL, these data confirmed that dysplastic mucosa could normalize without resection. Conclusions: Our observations revealed that the 532-nm pulsed KTP laser provided enhanced performance over the PDL laser in a number of ways. The ability to use smaller glass fibers precluded mechanical trauma to the channels of the flexible laryngoscopes and allowed for improved suctioning of secretions. Oxyhemoglobin absorbs energy better at 532 nm than at 585 nm, and the KTP laser can be delivered through a longer pulse width. These factors provide enhanced hemostasis and improved intralesional energy absorbance. Finally, unlike the PDL, the KTP laser is a solid-state laser and is not prone to mechanical failure.
Headache with Unilateral Pulsatile Tinnitus in Women Can Signal Dural Sinus Thrombosis
Authors: Sigari Farhad , Blair Elizabeth , Redleaf Miriam 
Published: October 2014

Objectives: Dural sinus thrombosis commonly presents with headache, and rarely with tinnitus. These thromboses can progress to neurologic impairment and death. We are sharing recent clinical experiences with these thromboses as they present to the otologist. Methods: We report the presentation, physical examination, and imaging studies of 4 patients. Results: Four women had thrombotic occlusion of the sigmoid sinus. Their only symptoms were focal headache in all 4 patients, and unilateral pulsatile tinnitus in 2 of them. Imaging studies had to be repeated or alternative testing performed in order to conclusively identify the problem. Conclusions: It is important to be vigilant for the possibility of sigmoid sinus thrombosis in women who complain of unilateral head pain or unilateral pulsatile tinnitus. Appropriate imaging must be performed.
Impact of Facial Dysfunction on Quality of Life after Vestibular Schwannoma Surgery
Authors: Lassaletta Luis , Alfonso Carolina , Del Rio Laura , Roda Jose Maria , Gavilan Javier 
Published: October 2014

Objectives: This study was performed to evaluate the impact of facial dysfunction on quality of life in patients who underwent surgery for vestibular schwannoma. Other factors with a possible impact on quality of life were also assessed. Methods: We performed a retrospective review of 95 patients who underwent removal of a unilateral vestibular schwannoma. The Glasgow Benefit Inventory, an open-ended questionnaire, and a pain scale were sent to each patient. The questions were answered by 70 respondents (74%). After a minimum 1-year follow-up, the overall House-Brackmann postoperative facial function was grade I-II in 61% of patients, grade III-IV in 36%, and grade V-VI in 3%. Results: The open-ended questionnaire showed that 33% of patients stated a complaint related to facial dysfunction; it was the main complaint for 13% of patients. No significant difference was found in terms of Glasgow Benefit Inventory scores between patients with and without facial dysfunction, nor between those with different House-Brackmann grades. The most frequent complaint after surgery was hearing loss (46%). Postoperative pain was significantly associated with a worse postoperative quality of life. Conclusions: An overestimation of the effect of facial paralysis after vestibular schwannoma resection may exist on the surgeon's part. Detailed information about the possibility of hearing loss, vestibular problems, and pain must be given to all patients.
Relationship between Time of Exposure of Laryngopharyngeal Reflux and Gene Expression in Laryngeal Fibroblasts
Authors: Ylitalo Riitta , Thibeault Susan L. 
Published: October 2014

Objectives: Acid reflux is damaging to the laryngeal mucosa; however, the significance of the duration of reflux episodes has not been evaluated. The purpose of this study was to determine whether varying the exposure times at low pH with or without pepsin alters gene expression in laryngeal fibroblasts. Methods: Human false vocal fold and postcricoidal cultures were exposed to pH 4 or pH 5 media with and without pepsin for 10, 30, 60, and 240 seconds. Using a real-time polymerase chain reaction, we determined the messenger RNA expression of TGFβ-1, VEGF, FGF-2, EGR-1, ATF-3, CTGF, MMP-1, MMP-2, and decorin. Results: Molecular responses were initiated at pH 5. Postcricoidal fibroblasts were more sensitive than false vocal fold fibroblasts to the presence of pepsin. Changes in transcript levels were dependent on acid exposure time, and the most significant changes were measured during the first 60 seconds after exposure. Conclusions: Time of exposure to acid and pepsin needs to be taken into consideration when determining limit of pathology in pharyngeal reflux. Genes are identified that are induced by low pH and that may be of potential importance in the pathogenesis of reflux laryngitis.
Partial Neurolysis of the Hypoglossal Nerve for Selective Lingual Atrophy in a Porcine Model
Authors: Licup Ana Teresa , Arkia Homan , Mabel Anita , Cohen-Kerem Raanan , Forte Vito 
Published: October 2014

Objectives: Obstructive sleep apnea in children is most commonly treated with adenotonsillectomy; however, in cases of significant tongue base prolapse, this may prove inadequate. Surgical procedures used to increase the retroglossal airway have significant morbidities and low patient acceptability. We theorized that effective reduction of the tongue base can be achieved through partial denervation of the hypoglossal nerve, which is easily accessed in the submandibular space with minimal morbidity. Methods: We performed a prospective, experimental study in which topographic innervation maps of porcine tongue were generated by stimulating the hypoglossal main trunk and peripheral branches. The effects of complete unilateral nerve sectioning on tongue base volume and linear dimensions were measured and compared to the contralateral control side. In the final stage, only the peripheral nerve that was determined as the main supply to the tongue base was sectioned, and the results were compared to those in the matched controls. Results: A medial branch of the hypoglossal nerve was consistently identified as the main motor supply to the tongue base. Complete denervation resulted in a measurable decrease in the volume of the tongue base as compared to that of controls. Partial neurolysis produced inconsistent changes in 2 subjects, with decreases in linear dimensions that were not proportional to the decrease in volume. Histologically, complete denervation was followed by a significantly greater replacement of muscle with fat and connective tissue as compared with partial neurolysis. Conclusions: There were inconsistent changes in volume and linear dimensions of the tongue base following partial neurolysis of the hypoglossal nerve over the 3-month experimental period.