bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Treating Institution on Outcomes in HNCA
Authors: Lassig Amy Anne D. , Lindgren Bruce , Reynolds Margaret , Fernandes Patricia , Khariwala Samir , Yueh Bevan 
Published: September 2011

ObjectiveFactors leading HNCA patients to seek radiation in a community vs academic center are incompletely described as are the effects of treating institution on outcomes. We investigated HNCA patient characteristics associated with community vs academic radiation, likelihood of successful treatment completion in both settings, and resulting survival data.MethodA retrospective chart review was completed of all mucosal head and neck cancer patients who were treated at our institution from 2003 to 2008. Patients who received primary and adjuvant radiation were included. Numerous demographic and clinical variables were recorded, and statistical analysis was completed.ResultsA total of 386 patients were identified of which 146 patients completed treatment in the community and 213 at an academic center (27 excluded, location unknown). There was no significant difference in rate of planned treatment completion between community (94.5%) and academic centers (93.8%) (P = 1.000), or rate of treatment breaks, 23.1% and 26.9%, respectively (P =. 506). The academic group, however, had more advanced disease (P =. 021). The survival rate over time was statistically significant (P =. 003), with academic hospitals having better survival. The 5‐year survival rate for academic and community hospitals was 55.9% (95% CI = 48.1% ‐ 63.7%) and 42.9% (95% CI = 31.1% ‐54.6%), respectively.ConclusionAt our institution, HNCA patients more frequently received radiation in an academic clinic. While rate of treatment completion and treatment breaks were similar between academic and community centers, academic centers treated more advanced cancer. Despite this, survival rates were better in patients treated in an academic setting.
Voice Quality after Recurrent Laryngeal Nerve Resection and Primary Reconstruction
Authors: Rohde Sarah L. , Wiggleton Jamie G. , Muckala Jennifer , Netterville James L. , Wright Charles T. , Rousseau Bernard 
Published: September 2011

ObjectiveEvaluate clinician and patient perception of voice quality in patients who have undergone resection of the recurrent laryngeal nerve (RLN) and primary operative reconstruction with anastomosis or nerve graft during thyroid surgery.MethodProspective observational study of 9 patients who underwent primary operative reconstruction of the RLN by the senior author from 2002 to present. Outcome measures included: 1) speech pathologist perception of voice scored using the GRBAS scale, 2) patient perception of voice assessed by the Voice Handicap Index (VHI) questionnaire, and 3) visual laryngeal analysis from videostroboscopy examinations.ResultsThe RLN was reconstructed with primary anastomosis (4), free nerve graft (3), or vagus‐RLN anastomosis (2). Seven patients had voice samples and videostroboscopy examinations obtained at a minimum of nine months from surgery. Six were judged to have slight disturbance of voice based on overall Grade scoring (G = 1). Five rated their voice normal or with a mild degree of severity on the VHI questionnaire (score range, 8‐29). Laryngeal analysis revealed the immobile vocal fold in the median, physiologic phonating position with preserved bulk, recovered tension, and glottic closure during phonation. Two patients less than 9 months from surgery had expected severe self perceived voice quality.ConclusionPrimary anastomosis, free nerve grafting, and vagus‐RLN anastomosis are viable options for RLN reconstruction. VHI scores are comparable to VHI scores of patients who have undergone silastic medialization laryngoplasty. Patients who undergo resection and immediate reconstruction of the RLN are able to regain self‐perceived functional and pleasing voices.
A Meta‐analysis of Injection Laryngoplasty vs Thyroplasty
Authors: Shen Tianjie , Morzaria Sanjay 
Published: September 2011

ObjectiveCompare the long‐term voice outcome following calcium hydroxylapatite injection laryngoplasty (IL) vs silicone medialization laryngoplasty (ML) as the long‐term treatment modalities for the treatment of unilateral vocal fold paralysis (UVFP) through a meta‐analysis study.MethodA systematic literature review was performed from MEDLINE, Google Scholar, Web of Science, Scopus, and Cochrane between January 1, 1980, and December 31, 2010. Studies reporting voice outcome after IL with calcium hydroxylappatite and/or ML with silicone for the treatment for UVFP were included. The primary outcome measure was change in Voice Handicap Index (VHI).ResultsSeven hundred and forty‐two abstracts were screened for relevancy. Seventy‐one articles were reviewed in detail. Twelve studies satisfied the inclusion criteria. The mean VHI score, following IL (n = 209), improved from 68.36 (±6.88) to 32.24 (±7.33). The mean VHI score, following ML (n = 110), improved from 72.22 (±11.06) to 34.02 (±6.48). The improvement in VHI following both techniques was statistically significant.ConclusionInjection laryngoplasty with calcium hydroxylapatite and medialization laryngoplasty with silicone offer comparable voice improvement as long‐term treatment modalities for UVFP. The choice of procedure should be based on planned duration of medialization, patient’s preference, and physician’s preference.
Complications of Thyroplasty Type I with Montgomery Implant
Authors: Laccourreye Ollivier , Ménard Madeleine 
Published: September 2011

ObjectiveDocument the incidence and risk factors for significant complications in patients with a unilateral laryngeal nerve paralysis managed with thyroplasty type I and Montgomery implant insertion.MethodInception cohort of 181 patients with 104 patients followed for a minimum of 12 months or until death. Data regarding significant complication were obtained at regular visits to our clinic. Univariate analysis was performed for potential statistical relation between the complications noted and various variables.ResultsThe intraoperative and postoperative course was unremarkable in 85.6% and 92.3% of cases. No patient died from the procedure. Significant complications included Montgomery implant replacement by a Gore‐tex implant (7), difficulty to stabilize the implant (8), misplacement of the implant (3), hematoma (8), severe dyspnea (5), and extrusion of the implant (5). A 5.5% revision rate was found (10/181). No significant statistical relation was noted between the complications noted and the variables under analysis.ConclusionThe reported data suggest that the Montgomery implant insertion is a safe technique with a low incidence for complication. The lack of a statistically significant difference between senior and junior surgeons also suggests the absence of a learning curve in this procedure.
Enhanced Laryngeal Suspension: A Preliminary Experience
Authors: Al Yaghchi Chadwan , Ferguson Louisa , Sandhu Guri 
Published: September 2011

ObjectiveDescribe and evaluate the effectiveness of enhanced laryngeal suspension on dyspagia and aspiration secondary to skull base surgery and lower cranial nerve injuries.MethodProspective study in a tertiary ENT unit between 2007 and 2010 of patients who underwent enhanced laryngeal suspension. Demographics, pathology, and cranial nerve injuries were documented. Nutrition, oral intake, and aspiration risk grade (G 0‐3) were compared pre‐ and postoperatively. All patients had videofloroscopy evaluation, and aspiration‐penetration scale changes were documented.ResultsEnhanced laryngeal suspension involves removal of the thyroid cartilage above the vocal folds and suture suspension to the hyoid bone. It can be combined with a medialization thyroplasty and botox to cricopharyngeus if indicated. To date we performed this procedure on 9 patients. At first presentation, 77% (n = 7) were nil by mouth. Today, only 22% (n = 2) remains NBM. Gastrostomy tube dependance dropped from 77% (n = 7) to 44% (n = 4), and of those only 2 are on total enteral feed. Aspiration risk improved through the follow‐up period (from 66% grade 3 down to 11%).ConclusionEnhanced laryngeal suspension is an important tool in the multimodality approach to management of dyspagia and aspiration caused by skull base surgery and lower cranial nerve injuries. This is a preliminary study with a small sample, and results must be interpreted with this in mind.
Evaluation of Safety of Endoscopic Harmonic Diverticulostomy
Authors: Whited Chad , Scher Richard L. 
Published: September 2011

ObjectiveReview a series of patients with Zenker diverticulum who were treated with endoscopic diverticulostomy using Harmonic Ultrasonic Surgical Instrumentation (Ethicon Endosurgery, Cincinnati, Ohio) in order to evaluate the safety and optimal application of this technology to the treatment of patients with this disorder.MethodRetrospective chart review of patients undergoing endoscopic surgical correction of Zenker diverticulum with Harmonic Ace curved shears between July 1, 2009 and November 1, 2010. Presenting symptoms, size of diverticulum, operative times, length of hospital stay, outcomes, and complications were reviewed.ResultsA total of 60 endoscopic diverticulostomies were performed, and 24 were Harmonic‐assisted. Eight required hospital stays, with their average stay being 2.13 days (0.7 days for all Harmonic patients). There were 6 complications with Harmonic treatments (25%). Two patients had chest pain with negative work‐ups. Two patients had subcutaneous air. One had a documented salivary leak. One patient had diverticulum recurrence. No patients had hemorrhage, mediastinitis, or death. The average diverticulum size was 3.24 cm, and there were no complications with diverticula less than 2 cm. There were two complications with the staple technique (6.45%).ConclusionEndoscopic staple diverticulostomy is a proven safe treatment for Zenker diverticulum with few limitations. Harmonic instrumentation may be effective with diverticula less than 2 cm. However, based on observed complication rates, additional evaluations are warranted before endoscopic Harmonic diverticulostomy can be recommended as treatment for the majority of cases.
Histologic vs pH Probe Results in Laryngopharyngeal Reflux
Authors: Andrews Thomas 
Published: September 2011

ObjectiveLaryngopharyngeal reflux (LPR) is well documented in children. However, methods of obtaining accurate diagnosis are controversial. As a prelude to establishing normative values in children, we retrospectively reviewed comparison data of 63 consecutive children tested by pH probe and post‐cricoid biopsy.MethodSixty‐three consecutive patients with symptoms of reflux without evidence of sinusitis, allergic rhinitis, or adenoid disease were studied by pH probe (Restech Dx Measurement System, San Diego, California) simultaneous with posterior cricoid biopsy (our previous diagnostic method). All testing was done through outpatient ambulatory surgery under general anesthesia.ResultsOf the 63 total patients (age 6 months‐17 years), 37 (60%) were positive for reflux by probe with a negative biopsy. Eleven (17%) tested negative to probe and biospy. Ten (15%) were excluded (pulled probe). Five (8%) were positive by probe and biopsy.ConclusionNormative values in children have not been determined in this instrument. We believe it may offer a satisfactory diagnostic tool. These results, and previous studies, suggest that pH probe testing is superior to histologic diagnosis in determining LPR. However, normative values must be determined in children prior to further comparative studies.
Long‐Term Repeated Cricopharyngeal Dilatation for OPMD
Authors: Manjaly Joseph G. , Corlett Jonathan C. , Dale Oliver , Vaughan‐Shaw Peter G. , Frost Roger 
Published: September 2011

ObjectiveOculopharyngeal muscular dystrophy (OPMD) is a rare, autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. Cricopharyngeal myotomy improves symptoms, yet dysphagia frequently recurs, failing to prevent aspiration and enteral feeding. The objective is to evaluate safety and efficacy of repeated endoscopic dilatation for OPMD over a 15‐year period.MethodAll patients at our unit with genetically confirmed OPMD were included. Cricopharyngeal dilatation was performed with a wire‐guided 18 mm Savary‐Gilliard bougie. Repeat dilatation was offered when symptoms recurred. Symptom severity prior to initial dilatation and at follow‐up was evaluated using the Sydney Swallow Questionnaire (SSQ).ResultsNine patients (7 female, 2 male) were included. Median total treatment period was 13 years (range, 3‐15 years), median number of dilatations per patient was 7.2 (1‐16), and median interval between treatments was 15 months (range, 4.5‐45 months). All patients recorded sustained symptom improvement. Mean SSQ score was 1108 out of 1700 (SD ± 272.9) prior to first dilatation and 298 out of 1700 (SD ± 189.1) at last follow‐up, representing a 73% decrease (95% CI 52‐94) in degree of dysphagia symptoms (Paired t test, P =. 0001). All mean scores for individual questions also showed significant improvement (P <. 05). No adverse events were reported with all patients maintaining oral feeding at last follow‐up.ConclusionRepeated cricopharyngeal dilatation is a safe, effective, well‐tolerated, and long‐lasting treatment for dysphagia in OPMD.
Mometasone Furoate in Patients with Eosinophilic Esophagitis
Authors: Bergquist Henrik , Larsson Helen , Johansson Leif , Bove Mogens 
Published: September 2011

ObjectiveThe treatment of patients with eosinophilic esophagitis remains challenging. The effects of the current first‐choice treatment, ie, topical corticosteroids, are still inadequately surveyed. Our aim was to assess dysphagia and health‐related quality of life using validated scales and questionnaires before and after treatment with mometasone furoate.MethodNewly diagnosed, untreated adult patients with eosinophilic esophagitis were included and given 200 µg of orally administered topical mometasone furoate 4 times daily. Questionnaires, incorporating the Watson Dysphagia Scale, the EORTC QLQ‐OES18, and the SF‐36, were completed before and after 2 months of treatment.ResultsThirty‐one consecutive patients (22 males, mean age 45, range 18‐89) completed the trial. At inclusion, the mean scores of the Watson Dysphagia Scale, the EORTC QLQ‐OES18 dysphagia scale, eating scale and choking item, and the SF‐36 global health dimension and social functioning dimension were 21.3, 20.4, 35.0, 38.6, 71.1, and 82.3, respectively. Posttreatment, these scores improved to 8.9 (P <. 0001), 4.6 (P <. 00001), 17.8 (P <. 001), 16.0 (P <. 01), 76.1 (P <. 05) and 91.9 (P =. 0001), respectively. Except for one case of oral candidiasis, no significant side effects were reported.ConclusionTreatment with 2 months of orally administered mometasone furoate seems to have a beneficial effect on dysphagia and health‐related quality of life in the majority of adult patients with eosinophilic esophagitis. However, a randomized placebo‐controlled trial is warranted in order to verify this.
Pulse Steroid Therapy Inhibits Murine Subglottic Granulation
Authors: Ghosh Ankona , Einhorn Eugene , Lee Jennifer , Mirza Natasha , Singhal Sunil , Leahy Kevin , Cohen Noam A. 
Published: September 2011

ObjectiveUsing a functional model of airway granulation tissue in subglottic stenosis, we investigated changes in inflammatory markers within granulation tissue in response to intraperitoneal dexamethasone injections. Changes in inflammatory markers will allow us to identify potential targets for immunological therapy.MethodLaryngotracheal complexes (LTCs) of donor mice underwent airway injury. Donor LTCs were transplanted into subcutaneous tissue of recipient mice in 2 groups: steroid‐treated and untreated. The steroid‐treated arm received intraperitoneal dexamethasone for 3 weeks. LTCs were then harvested. Granulation formation was measured; mRNA expression of TGF‐beta and IL‐1b was quantified.ResultsAt 3 weeks’ posttransplantation, there were statistically significant differences in observable granulation formation as well as mRNA expression of TGF‐beta 1 and IL‐1b in all groups within the steroid treated arm as compared to the untreated arm.ConclusionSystemic steroids have been used to prevent formation of granulation tissue. However, the study of immunologic markers and the corresponding changes with steroid treatment has not been well studied in animal models. Using a previously described novel murine model, we begin to delineate inflammatory markers for potential therapeutic targets.
The Effect of Singing on Laryngopharyngeal Reflux
Authors: Fink Daniel Steven , Bhatnagar Sugam , Song Phillip , Bunting Glenn 
Published: September 2011

ObjectiveWhile there has been widespread conjecture regarding the role of laryngopharyngeal reflux in singing, there remains no objective data demonstrating that voice use causes increased reflux. We attempted to objectively analyze pharyngeal pH changes during singing to better understand how it is affected by singing.MethodEight singers underwent 24‐hour pharyngeal pH probe testing with the Restech Dx‐pH measurement systemTM, one hour of which was spent singing. The mean pH and number of pH drops were recorded. A one‐tailed t test was used to compare the mean pH of the time singing with the 2 control values.ResultsThe mean pH for the control time was 6.8347, for the control time without the time supine was 6.9164, and for the time singing was 7.0286. We were thus able to reject the null hypothesis that singing decreases laryngeal pH (P =. 035). There was an increase in mean pH during the time singing as compared with the 2 control groups.ConclusionWhile singers may have increased reflux complaints, our data suggest that the singing itself does not cause an increase in acid exposure to the laryngopharynx.
Validation of a Theater‐Based Immersive Microlaryngoscopy Simulator
Authors: Fleming Jason , Sevdalis Nick , Harries Meredydd , Kapoor Karan 
Published: September 2011

ObjectiveAssess the face and construct validity of 2 assessment tools: a Checklist Assessment for Microlaryngeal Surgery (CAMS) and a Global Rating Assessment for Microlaryngeal Surgery (GRAMS) on a new theater‐based immersive microlaryngscopy simulator.MethodFifteen candidates were divided into the novice or experienced group depending on their previous microlaryngoscopy experience. Each candidate undertook a 10‐minute simulation of a microlaryngoscopy and excision biopsy, and 2 blinded experts rated their performance live. Candidates subsequently completed a questionnaire on their opinion of the simulator.ResultsThe model demonstrated good face validity across all levels of experience. The GRAMS demonstrated excellent interrater reliability (0.9) compared with the CAMS (0.7). The CAMS assessment was able to differentiate experienced and novice candidates and, therefore, demonstrated construct validity. The GRAMS tool, however, was unable to differentiate candidates. There was a significant correlation between the 2 assessment tools (correlation coefficient = 0.624).ConclusionThis study is the first reported trial of a high fidelity microlaryngoscopy simulator with task‐specific rating tools. Use of these tools is recommended within otolaryngology training programs, with GRAMS for use as a frequently used feedback tool and CAMS as a confirmatory evaluation of competency at transitions of professional training.
Vocal Cord Lesions in Professional Voice Users
Authors: Azevedo Julia , Cruz Camilla , Mury Isabelle , Osorio Marcio , Steffen Ricardo E. , Quintão Everson , Rangel Gustavo 
Published: September 2011

ObjectiveThe aim of this study was to survey professional voice users referred to an otorhinolaryngology center in a tertiary hospital in Rio de Janeiro, Brazil, and evaluate the incidence of vocal cord diseases in these patients.MethodProfessional voice users’ records were analyzed using database from a videolaryngoscopic service in a tertiary hospital, from January 2000 to 2010. Patients’ diagnoses were divided into the following categories: nodules, polyps, minor structural changes, Reinke edema, papilloma, neoplasm, vocal fold palsy, functional dysphonia, vocal cord paralyis, and laryngitis. Age, gender, and smoking habit were also annotated.ResultsA total of 409 professional voice users were referred to the otorhinolaryngology service. The majority of patients were female (69.3%). Dysphonia was the most common complaint, found in 76.3% of patients. The most common vocal cord lesions were polyps, found in 13.7% of patients. Laryngitis due to laryngopharyngeal reflux was found in 11.3% of patients, followed by vocal cord cysts, found in 8.1% of patients. Reinke edema was found in 5.6% of patients. The examination was normal in 45.2% of patients. Smoking was found in 19.7% of patients with any abnormal finding and only 9.7% of patient with no visible alterations (OR = 2.3, CI = 1.3‐4.1).ConclusionProfessional voice users are at increased risk of vocal cord lesions. In this study, the most common lesions identified were polyps. Followed by laryngitis due to laryngopharyngeal reflux disease. Smoking was higher in the group with abnormal findings. Smoking cessation is an important aspect of the treatment of professional voice users.
Voice Quality of Life after Type II Thyroplasty for Spasmodic Dysphonia
Authors: Sanuki Tetsuji , Kodama Narihiro , Yumoto Eiji 
Published: September 2011

Objective1) Determine the effectiveness of type II thyroplasty for adductor spasmodic dysphonia (AdSD), through perceptual and accoustic analysis. 2) Assess the pre‐ and postoperative quality of life of AdSD patients using the Voice Handicap Index‐10 (VHI‐10).MethodRetrospective study. Twelve patients with AdSD underwent type II thyroplasty between March 2007 and December 2010. Measured outcomes included perceptual assessment, acoustic analyses (DVB, SDF0, jitter, shimmer, and HNR), and VHI‐10 and were performed prior to and six months or more after surgery. VHI‐10 and acoustic evaluation scores were compared.ResultsAverage follow‐up interval was 12.6 months. In perceptual analysis (GRBAS), overall grade and strain significantly improved after surgery (P =. 0017, P =. 0002). There were no significant difference in roughness, breathiness, and asthenia. In acoustic analysis, DVB, SDF0, jitter, shimmer, and HNR (P =. 039, P =. 0003, P =. 0016, P =. 0011, P =. 0003) improved significantly after surgery. Mean VHI‐10 scores significantly improved from a mean of 26.5 to 3.75.ConclusionTreatment of AdSD with type II thyroplasty significantly improved voice‐related quality of life and acoustic findings. The study revealed a significant relationship between the acoustic parameters and the VHI‐10. The results confirmed that VHI‐10 can be a valuable tool for assessing type II thyroplasty for AdSD.