bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design and Implementation of an Ambulatory pH Monitoring Protocol in Patients with Suspected Laryngopharyngeal Reflux
Authors: Harrell Steve , Evans Ben , Goudy Steve , Winstead Welby , Lentsch Eric , Koopman Jennifer , Wo John M. 
Published: February 2009

AbstractObjective/Hypothesis: Adding a hypopharyngeal sensor to esophageal pH monitoring has been advocated for laryngopharyngeal reflux (LPR). However, selecting the proper pH catheter is problematic because esophageal lengths are variable among individuals.Objective: To design and implement a new pH monitoring protocol for LPR.Study Design/Methods: Design parameters were defined prospectively: single‐probe, triple‐sensor pH catheter with sensors located in the hypopharynx (1–3 cm above upper esophageal sphincter) and in proximal and distal esophagus (20 cm and 5 cm above lower esophageal sphincter, respectively). Esophageal lengths were determined in a study population undergoing esophageal manometry. Optimal pH sensor spacings were determined using the least number of catheters to satisfy the design parameters. The protocol was implemented in consecutive subjects with suspected LPR.Results: Distribution of esophageal lengths was determined in 1,043 subjects. In 92% of the study population, three pH catheters (3–15, 6–15, and 9–15 sensor‐spacings) would satisfy the design criteria. Forty‐one subjects with suspected LPR underwent the pH protocol. An abnormal pH test was found in 40 subjects (98%) with triple‐sensor combination compared with 29 subjects (71%) if only dual esophageal sensors were used.Conclusions: Single‐probe pH monitoring of the hypopharynx and esophagus was feasible. Adding a hypopharyngeal pH sensor increased the detection of abnormal acid reflux more often than traditional dual‐sensor esophageal pH monitoring.
Function of the Laryngeal Mechanoreceptors During Vocalization
Authors: Gozaine Teofilo C. , Clark Keith F. 
Published: February 2009

AbstractObjectives/Hypothesis: The objective was to compare the activity of superior laryngeal nerve mechanoreceptors based on a respiration‐based classification protocol with activities found using a vocalization‐based classification protocol in adult cats.Study Design: Animal study.Methods: In the first part of the experiment, single fiber action potentials from the internal branch of the superior laryngeal nerve were recorded in decerebrated cats using a respiration‐based classification protocol to identify laryngeal mechanoreceptors as pressure, flow, and drive receptors, as described in the literature. A tracheal T‐tube and a laryngeal mask airway were necessary modifications to perform this protocol. In the second part of the experiment, a vocalization‐based classification protocol as described in the literature was used to classify the activity of the same fiber into the following groups: peak prephonatory, frequency‐following, frequency‐nonfollowing, inspiratory‐modulated, or mixed. Vocalization was evoked by electrical stimulation of the midbrain in the region of the periaqueductal gray.Results: In all, eight cats were used for the experiment. Data were obtained from only three cats for a total of five single fibers. Results from five cats were not obtained because of inability to phonate (in three cats) and inability to record from the superior laryngeal nerve (in two cats). We identified two flow receptors, a drive receptor, a frequency‐following receptor, and a frequency‐nonfollowing receptor. Both flow receptor fibers were almost silent during the phonation phase and reached the maximum activity after vocalization during the inspiratory phase. The drive receptor was active during all four airway maneuvers and was most active during tracheal occlusion. It also kept a high level of activity during the phonatory phase, suggesting a role in the modulation of vocalization and respiration. The next two receptors, a frequency‐following and a frequency‐nonfollowing receptor, were active only during the phonatory phase and were totally inactive during the airway maneuvers, suggesting a role only during the vocalization behavior.Conclusion: Because vocalization is an important stimulus for the activation of certain superior laryngeal nerve receptors, a classification protocol based on respiration alone is incomplete. Classification into pressure, flow, and drive receptors alone is not appropriate for the study of laryngeal receptors during vocalization. Some frequency‐following and frequency‐nonfollowing receptors may be active only during phonation and would otherwise be missed without vocalization stimuli.
Osteoprotegerin in the Inner Ear May Inhibit Bone Remodeling in the Otic Capsule
Authors: Zehnder Andreas F. , Kristiansen Arthur G. , Adams Joe C. , Merchant Saumil N. , McKenna Michael J. 
Published: February 2009

AbstractObjectives: To elucidate factors that may be responsible for the inhibition of remodeling of bone within the otic capsule.Methods: Expression of osteoprotegerin (OPG), receptor activator of nuclear factor kappa B (RANK), and RANK ligand (RANKL) were assayed in samples of bone obtained from the otic capsule, calvarium, and femur, and from the soft tissue within the cochlea using semiquantitative reverse transcriptase polymerase chain reaction (RT‐PCR) in mice. Immunostaining was used for histologic localization of the gene products. An enzyme‐linked immunosorbent assay (ELISA) was used to quantify the amount of OPG within perilymph, serum, and cerebrospinal fluid. The micro‐anatomy of the interface between the otic capsule and the fluid spaces of the cochlea was investigated by brightfield and phase‐contrast microscopy and by three‐dimensional reconstruction in the mouse and human.Results: OPG, a powerful inhibitor of bone remodeling, was expressed at extremely high levels within the soft tissue of the cochlea and was present in the perilymph at very high concentrations. The OPG produced within the inner ear may diffuse into the surrounding otic capsule, where it may be responsible for inhibition of bone turnover. Our anatomic studies revealed an extensive system of interconnected canaliculi within the otic capsule that had direct openings into the fluid spaces of the inner ear, thus providing a possible anatomic route for the diffusion of OPG from the inner ear into the surrounding bone.Conclusion: OPG, a potent inhibitor of osteoclast formation and function, is expressed at high levels within the inner ear and is secreted into the perilymph and the surrounding bone and may serve to inhibit active bone remodeling within the otic capsule, especially immediately adjacent to the cochlea. By this means, the cochlear soft tissue may control the nature of the surrounding petrous bone.
The Dix‐Hallpike Test and The Canalith Repositioning Maneuver
Authors: Viirre Erik , Purcell Ian , Baloh Robert W. 
Published: February 2009

AbstractThe Dix‐Hallpike test and the canalith repositioning maneuver (CRM) are used to diagnose and treat benign positional vertigo (BPV). Dix‐Hallpike is the standard procedure for diagnosis of BPV, but if the horizontal canal is not tested for BPV and the Dix‐Hallpike is only carried out once, the condition may not be diagnosed and appropriately treated. We describe our method of testing for BPV and treating it with CRM. The Dix‐Hallpike test involves rapidly moving the patient from a sitting position to “head hanging,” where the patient's head is at least 10 degrees below horizontal. This is performed initially for the posterior semicircular canals. If these movements fail to elicit vertigo and nystagmus, tests of the horizontal semicircular canals are performed by laying the patient on each side. Importantly, if there is no vertigo or nystagmus elicited by testing the horizontal semi‐circular canals, the posterior semicircular canals are tested again. It appears that being held in the head hanging positions and then left and right lateral positions will often allow the canaliths to collect such that the Dix‐Hallpike test will become positive. Failure to repeat the tests of the posterior semicircular canals may result in a falsely negative test. Testing the horizontal canals and repeating the Dix‐Hallpike test will reduce the likelihood of patients undergoing extra testing or other consequences of misdiagnosis. If, during any of this testing, a movement elicits vertigo or nystagmus, the appropriate CRM is then carried out.
Influence of Polyps on Outcomes After Endoscopic Sinus Surgery
Authors: Bhattacharyya Neil 
Published: February 2009

AbstractObjective: To determine clinical and comparative outcomes for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) with polyposis.Methods: Two cohorts of adult patients with refractory CRS with and without nasal polyps were prospectively studied before and after ESS (minimum follow‐up, 12 months) with the Rhinosinusitis Symptom Inventory (RSI). For the non‐polyp and polyp cohorts, RSI symptom domains and medical resource utilization were compared in the preoperative and postoperative states. Corresponding effect sizes were computed and compared between cohorts to determine the effect of polyps on prognosis after ESS.Results: A total of 165 non‐polyp and 86 polyp patients were enrolled. Polyps were more common in female patients (2:1, P = .025); age (mean, 42.9 years) and follow‐up (18.5 months) were similar between groups. Lund scores were significantly higher for polyp patients (13.7, SD 4.8) vs. non‐polyp patients (8.1, SD 5.3, P < .001). At baseline, polyp patients reported lower symptom scores for facial, oropharyngeal, and systemic RSI symptom domains (all P < .012); nasal and total symptom domains were similar between groups. Both non‐polyp and polyp groups obtained significant symptomatic benefit from ESS with effect sizes for RSI symptom domain improvements ranging from 0.89 to 1.38 and 0.43 to 1.19, respectively (all P < .001). There were no significant differences between groups in symptomatic improvement, excepting oropharyngeal symptoms (better improvement in non‐polyp group, P = .024). Non‐polyp patients decreased medical resource consumption more significantly than did polyp patients.Conclusions: Both non‐polyp and polyp patients derive similar clinically significant symptomatic improvement after ESS. These similarities suggest that polyp patients do not necessarily have a poorer symptomatic outcome after ESS.
Voice Outcomes of Polyacrylamide Hydrogel Injection Laryngoplasty
Authors: Lee Seung Won , Son Young‐Ik , Kim Chan Hee , Lee Jae Yong , Kim Shi Chan , Koh Yoon Woo 
Published: February 2009

AbstractObjectives: Polyacrylamide hydrogel (PAAG, Aquamid) is widely used as permanent facial tissue filler during facial plastic surgery. In this study, we examined the long‐term effects and safety aspects of PAAG as a vocal fold augmentation material for patients with permanent unilateral vocal cord paralysis.Study Design: Prospective clinical trials.Methods: PAAG injection laryngoplasty was performed in 34 consecutive patients with permanent unilateral vocal cord paralysis. Percutaneous injection was performed under local anesthesia into the vocalis muscle using disposable 25 gauge long needles. Of the 34 patients, 16 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 6 and 12 months after the injection.Results: Acoustic and perceptual parameters (GRBAS [Overall grade of dysphonia, Roughness, Breathiness, Aesthenia, Strain], Maximal phonation time [MPT], jitter, and shimmer) were significantly improved (P < .05) after injection and remained stable over 12 months. The grades of mucosal waves and glottic closure were also significantly improved (P < .01). The voice handicap index (VHI), as well as the visual analogue scale (VAS) of hoarseness and aspiration significantly improved over 12 months. No adverse effects were observed except for a decrease in the mucosal wave of one patient, after injection into a superficial area of the vocal fold.Conclusion: Based on the preliminary results of this trial, PAAG appears to be a long‐lasting and safe injection material that is suitable for the treatment of glottal insufficiency caused by permanent unilateral vocal cord paralysis.
The Variant Type of Preauricular Sinus: Postauricular Sinus
Authors: Choi Seong Jun , Choung Yun‐Hoon , Park Keehyun , Bae Junho , Park Hun Yi 
Published: February 2009

AbstractObjective: Preauricular sinuses (PAS) are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix, but the positions of PAS and directions on the fistular tracts are rarely posterior to the external auditory canal (EAC), which presents as a postauricular swelling. We named these cases as the variant type of PAS (‘postauricular sinuses’), and compared their clinical manifestations with those of the classical type.Study Design: A retrospective study.Methods: We retrospectively reviewed the charts of patients who had undergone preauricular fistulectomy from 2002 to 2006. These patients were then categorized into two groups according to the position of the preauricular sinus sac. The classical group was defined as the group of patients with sacs located on the (superior) anterior to the EAC, and the variant group as those whose sacs are located on the posterior site of the EAC. We analyzed the incidence, previous histories, clinical manifestations, recurrence rates, and surgical techniques of the variant type of preauricular sinuses and compared them with those of the classical type.Results: Eleven (10.9%) of 101 patients were diagnosed with preauricular sinuses of the variant type. The male to female ratios of the classical and the variant groups were 44:46 and 7:4, respectively. The average age of the patients was approximately 11 to 13 years in both groups. All variant types of preauricular sinuses showed preauricular pits located posterior to the imaginary line that connects the tragus with the posterior margin of the ascending limb of the helix, unlike the classical type. Most (72.8%) of the fistular tracts of the variant type were directed in the posterior‐middle direction from the pits. The variant types were operated with a dual approach using preauricular and retroauricular incisions, unlike the classical type, and the recurrence rate was 0% (compared with 2.2% in the classical type).Conclusion: Frequent postauricular infected swellings may indicate the presence of the variant type of preauricular sinuses. The variant type of preauricular sinuses presenting in the postauricular area were found to have an unusual location of the fistula pit that was positioned posterior to the imaginary tragal extended line. A comprehensive physical examination of the preauricular pits should be performed to avoid incomplete excision of the variant types.
Effect of Ototopical Medications on Tympanostomy Tube Biofilms
Authors: Oxley K Scott , Thomas John G. , Ramadan Hassan H. 
Published: February 2009

AbstractObjective: Examine how ototopical medications affect biofilms on fluoroplastic tympanostomy tubes.Study Design: In vitro comparison of different ototopical medications against a clinical isolate of Pseudomonas aeruginosa biofilm on tympanostomy tubes treated for 5, 10, 14, and 21 days.Methods: Under sterile conditions 21 tympanostomy tubes were cut in half. These were attached to pegs of two Calgary Biofilm Devices via rubber cement. Device 1 evaluated microbial growth as colony forming units (CFUs). Device 2 evaluated presence of biofilms. Tubes were prepped for biofilm growth, incubated, and stressed for 72 hours. Afterward, one tube per device was removed and forcefully washed. One was sonificated for 5 minutes, serially diluted, and plated for CFUs. Formalin preserved the other for biofilm evaluation by scanning electron microscopy. Next, tubes were exposed to five drops of Ciprofloxacin, Ciprofloxacin/Dexamethasone, Dexamethasone, Ofloxacin, or saline for 1 hour. Afterward, the ototopicals were removed and sterile broth was placed in the wells as a nutrient. This was repeated every 12 hours for 5, 10, 14, and 21 days of treatment. Prior to the last dose of treatment intervals, a streak plate was performed to evaluate for microbial growth in the wells. The tubes were evaluated for CFUs and biofilms at each interval as previously described.Results: Microbial activity in CFUs decreased by day 5 and continued through day 21 for the antibiotic containing drops. Despite treatment, the biofilm was never eradicated and continued to progress.Conclusions: Infectivity of the biofilm is neutralized by antibiotic ototopicals; however, the biofilm will progress despite treatment.
Predictors of Prolonged Length of Stay After Major Elective Head and Neck Surgery
Authors: BuSaba Nicolas Y. , Schaumberg Debra A. 
Published: February 2009

AbstractObjective/Hypothesis: Longer length of stay (LOS) after elective surgery is associated with an increased use of health care resources and higher costs. The objectives of this study were to determine the perioperative factors that predict a prolonged LOS after elective major head and neck operations and to test the hypothesis that factors related to process of care (intra‐ and postoperative) independently predict prolonged LOS after adjustment for preoperative patient characteristics.Study Design: Prospective hospital‐based cohort study.Methods: The National VA Surgical Quality Improvement Program data were accessed for seven head and neck operations: radical neck dissection (RND) (n = 398), modified RND (n = 891), total laryngectomy (n = 431), total laryngectomy with RND (n = 747), hemiglossectomy with unilateral RND (n = 201), composite resection (n = 105), and composite resection with RND (n = 312). Prolonged LOS was defined as exceeding the 75th percentile for the LOS distribution of each operation. Multivariable logistic regression analysis was performed to identify factors that predicted prolonged LOS.Results: Sixty‐eight variables were analyzed among 3,050 patients who qualified for inclusion. Preoperative patient characteristics that predicted prolonged LOS were older age, poorer functional status, consumption of more than two drinks of alcohol per day, history of chronic obstructive pulmonary disease, and diabetes mellitus. Intraoperative processes that predicted prolonged LOS were a longer operative time and transfusion of erythrocytes. The postoperative variables that predicted a prolonged LOS were a return to the operating room within 30 days of the index operation and the occurrence of two or more operative complications.Conclusion: Several intraoperative processes and postoperative adverse events contributed additional predictive information for prolonged LOS, after consideration of preoperative patient characteristics.
Reliability of the Welling Scale (WS1) for Rating Temporal Bone Dissection Performance
Authors: Butler Nancy N. , Wiet Gregory J. 
Published: February 2009

AbstractObjective: To determine the inter‐ and intrarater reliability of using a new scale (Welling scale) for resident evaluation of temporal bone dissection performance.Study Design: Prospective, double‐blinded, randomized trial.Methods: Twelve residents in otolaryngology (postgraduate year [PGY] 2–5) drilled 26 temporal bones (21 cadaveric, 5 plastic) with the objective to perform a complete mastoidectomy with facial recess approach. These bones were then rated using the Welling scale by six independent raters on two separate occasions (4–6 wk apart). Raters were blinded to PGY year. The Kappa statistic was calculated for inter‐ and intrarater reliability.Results: Intrarater agreement was high for all raters, ranging from κ = 0.65 to 0.72 (all P < .001), whereas the interrater agreement scores were more moderate (range, κ = 0.49–0.64; all P < .01).Conclusion: The Welling scale can be used reliably to assess temporal bone dissection performance where performance is measured by assessment of end product (mastoidectomy with facial recess approach).
Laryngopharyngeal Abnormalities in Hospitalized Patients With Dysphagia
Authors: Postma Gregory N. , McGuirt W Frederick , Butler Susan G. , Rees Catherine J. , Crandall Heather L. , Tansavatdi Kristina 
Published: February 2009

AbstractObjectives: To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES).Study Design: Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video‐recorded by a speech‐language pathologist (SLP).Methods: Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings.Results: Sixty‐one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy‐six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty‐five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated.Conclusions: Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow‐up of mucosal and neuromuscular findings that do not respond to medical management.
Eosinophilic Bacterial Chronic Rhinosinusitis
Authors: Ferguson Berrylin J. , Seethala Raja , Wood William A. 
Published: February 2009

AbstractBackground: A subset of Chronic Rhinosinusitis (CRS) patients are those with eosinophilic CRS (ECRS). These patients remain the most refractory to medical and surgical intervention, and are thought to reflect an inflammatory process arising from a variety of causes. Recently the role of fungus in ECRS, defined as the presence of fungi in the eosinophilic mucin of CRS, has been proposed as causal in many cases. Other proposed causes of ECRS include bacterial superantigen induction of inflammation and aspirin sensitivity.Design: Retrospective review.Methods: Histopathology from patients with previously diagnosed ECRS was prospectively re‐reviewed for bacterial and fungal presence and correlated with patients' demographic data. The study population was comprised of 55 specimens with ECRS from 34 patients, over a 3‐year period from a single investigator at the University of Pittsburgh Medical Center.Results: Histologic presence of bacteria was shown in 34 of 55 (62%) of all ECRS specimens. Specimens with fungal colonization were more often associated with bacterial presence than without bacteria (17 of 22 [77%] vs. 5 of 22 [23%], P < .02).Conclusion: Bacteria were present in almost two‐thirds of all specimens, and most cases of fungal presence were accompanied by bacterial presence, potentially providing support for bacteria as a source of superantigen. Other possible reasons for the high rate of bacterial and fungal colonization of ECRS include increased pathogen exposure, or failure to eliminate pathogens.