bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of the Pulse Dye Laser in the Treatment of Vocal Fold Scar: A Preliminary Study
Authors: Mortensen Melissa M. , Woo Peak , Ivey Chandra , Thompson Chandler , Carroll Linda , Altman Kenneth 
Published: September 2008

AbstractObjectives/Hypothesis: Dysphonia due to vocal fold scarring is a challenging problem to the laryngologist. Vocal fold scarring after radiation, phonosurgery, and laser cordectomy causes moderate to severe dysphonia. Surgical attempts at scar removal and voice restoration have limited success. Pulsed dye laser (PDL) treatment has been shown to be effective in softening scarred skin by serial office treatments. The objective of this preliminary study was to evaluate the use of the PDL in the management of patients with established vocal fold scar.Study Design: This is an Institutional Review Board‐approved prospective study involving 11 patients. The causes of scarring were phonosurgery (n = 7), radiation (n = 2), and partial laryngectomy (n = 2). The subjects were evaluated pre‐ and postprocedure using the voice handicap index (VHI), laryngeal stroboscopy rating, voice recordings with acoustic and aerodynamic analysis, and self‐evaluation.Methods: The PDL was applied with the fiberoptic delivery system by three treatments at 1‐month intervals in the office setting. Each treatment endpoint was blanching of the treatment site.Results: There were three women and eight men in our study group. Ten of 11 patients subjectively improved by self‐rating. No patients were worse. VHI improved from 48.44 pretreatment to 35.55 at 6 months posttreatment (P < .05). The jitter at 6 months improved from 2.230% to 1.654% (P = NS) and shimmer improved from 3.679% to 3.196% (P = NS). The noise to harmonic ration improved from 0.1428 to 0.1316 (P = NS). The mean phonotory flow went from 0.177 to 0.254 L/S (P < .05).Three raters blinded to treatment sequence rated the posttreatment stroboscopy findings as better than pretreatment in a forced choice comparison, kappa score 0.903.Conclusion: PDL is a safe and potentially promising treatment for established vocal fold scar. Subjectively, no patients were worse and 10 of 11 patients reported improved voice. There was improvement in the VHI, acoustic measures of shimmer and jitter, and stroboscopy findings. Further study using this approach in a larger cohort seems to be warranted.
Radiofrequency Ablation for the Treatment of Obstructive Sleep Apnea: A Meta‐analysis
Authors: Farrar Joshua , Ryan James , Oliver Eric , Gillespie M Boyd 
Published: September 2008

AbstractObjectives/Hypothesis: Recent studies suggest that radiofrequency ablation (RFA) is a treatment option for patients with obstructive sleep apnea (OSA). This study investigates the effectiveness of RFA in treating OSA using a critical literature review and meta‐analysis.Study Design: Critical literature review and meta‐analysis.Methods: Two independent searches of PubMed 1966‐present were performed to identify publications pertaining to RFA and OSA. Effectiveness of the procedure was measured by comparing the Epworth Sleepiness Scale (ESS), respiratory disturbance index (RDI), and lowest O2 saturation before and after tissue ablation.Results: Sixteen studies met the inclusion criteria. The study found a 31% reduction in short‐term ESS (odds ratios (OR) 0.69, 95% confidence interval (CI) 0.63–0.75), which was maintained beyond 12 months (OR 0.68, 95% CI 0.43–0.73). Likewise, RFA resulted in a 31% reduction in short term (<12 month) (OR 0.69, 95% CI 0.61–0.77) and 45% reduction (OR 0.55, 95% C.I. 0.45–0.72) in long‐term (>24 month) RDI levels. Short‐term results of the lowest O2 saturations failed to demonstrate improvement (OR 1.03, 95% CI 0.88–1.20).Conclusion: RFA seems to be a clinically effective tool that reduces ESS scores and RDI levels in patients with OSA syndrome. The procedure should be considered a valid treatment option for patients who refuse or are unable to tolerate continuous positive airway pressure.
Cricothyroidotomy vs. Sternal Tracheotomy for Challenging Airway Anatomy
Authors: Patel Krishna G. , Zdanski Carlton J. 
Published: September 2008

AbstractAlthough tracheotomies are the standard procedure for elective surgical airways, some patients present with challenging anatomy. In circumstances of abnormal skeletal deformities, such as kyphoscoliosis, the airway is also often tortuous and access to the trachea may be difficult. In the situation of severely distorted tracheal anatomy, where access to the trachea may require a mediansternotomy, a cricothyroidotomy may be the safer option. This article details the technique involved in approaching a substernal larynx and stomatizing a cricothyroidotomy for a patient who required a long‐term surgical airway secondary to severe kyphoscoliosis from Proteus syndrome and failure to extubate.
Esophageal Reconstruction With Larynx Preservation Using Forearm‐Free Flap
Authors: Agrawal Amit , Husein Omar F. , Schuller David E. 
Published: September 2008

AbstractSurgery for cervical esophageal malignancy frequently involves comcomitant total laryngectomy carried out because of either oncologic or functional concerns. Though uncommon, preservation of the larynx has, in recent years, been described in patients undergoing cervical esophagectomy with reconstruction of the resulting circumferential esophageal defect achieved using either free jejunal flaps or gastric pullup procedures. The use of tubed‐free cutaneous flaps for circumferential cervical esophageal reconstruction, however, has been rarely described in situations where the larynx has been preserved. We describe successful use of a tubed radial forearm‐free flap for reconstruction of a circumferential cervical esophageal defect with preservation of the larynx. Use of the radial forearm flap in this situation resulted in minimal donor site‐related morbidity, avoided the need for laparotomy and excellent voice and swallowing function were maintained. As such, use of tubed cutaneous free flaps can be considered an option for cervical esophageal reconstruction when the larynx has been preserved
Assessment of Operative Competency in Otolaryngology Residency: Survey of US Program Directors
Authors: Brown David J. , Thompson Richard E. , Bhatti Nasir I. 
Published: September 2008

AbstractObjectives/Hypothesis: 1) Assess current status of operative competency assessment and feedback among US Otolaryngology residency programs. 2) Evaluate correlations between assessment or feedback tools and remediation.Study Design: Survey of Program Directors.Methods: The survey was sent to 100 Program Directors inquiring about program size, mode of feedback, assessment tools, surgical portfolios, remediation, and number of residents requiring remediation in past 5 years. Associations between assessment questions and remediation (yes or no) were statistically assessed with the χ2 goodness‐of‐fit test. For more complicated analyses, multiple logistic regression models were created to assess predictors of the binary outcome of radiation.Results: Among 72 respondents, subjective evaluations are used by 95.8% (69 of 72). Formative feedback after cases is used by 38.9% (28 of 72). Summative feedback at end of the rotation is done by 57.0% (41 of 72). Objective Structured Assessments of Technical Skills is used by 15.3% (11 of 72) of programs, most are large on the basis of number of residents or faculty or both. Operative portfolios are kept by 48.6% (35 of 72) of programs. The percentage of programs with mechanisms for remediation is 41.7% (30 of 72). Similarly, of the programs who responded to the remediation question, the percentage with at least one resident requiring remediation is 37.5%. Programs who report at least one resident remediation are statistically more likely to have a remediation mechanism in place (75% vs. 27.5%; P <.001). There is also a statistically significant association with formative feedback and having resident remediation (58.3% vs. 30%; P = .025).Conclusions: Standardized surgical curricula and assessment tools are needed. Programs with more intensive evaluation or remediation mechanisms are statistically more likely to report residents requiring remediation. This may reflect their ability to better identify the struggling resident. Alternatively, having a resident requiring remediation may be the catalyst that initiates the need for more intensive evaluation tools and remediation mechanisms. The Accreditation Council for Graduate Medical Education's and society will demand that we produce competent surgeons. Therefore, all Otolaryngology training programs should be developing and implementing formal surgical assessment tools, methods to identify residents requiring remediation, and remediation mechanisms.
Supraglottoplasty for Laryngomalacia With Obstructive Sleep Apnea
Authors: Zafereo Mark E. , Taylor Rodney J. , Pereira Kevin D. 
Published: September 2008

AbstractObjectives/Hypothesis: To determine if supraglottoplasty (SGP) is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea (OSA).Study Design: Retrospective case series at a tertiary referral children's hospital.Methods: Ten patients with laryngomalacia and OSA as documented by polysomnography underwent SGP between 2005 and 2007. Data collected included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index, obstructive apnea/hypopnea index, respiratory disturbance index, and low arterial oxygen saturation (O2 nadir) after SGP.Results: All 10 patients were successfully extubated after SGP. There were no peri‐ or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed after SGP at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow‐up visit 4 weeks after discharge. Marked improvements were observed in obstructive apnea index, obstructive apnea/hypopnea index, respiratory disturbance index and O2 nadir, all of which were statistically significant (P < .05).Conclusions: Polysomnography should be considered in the initial evaluation of infants with moderate laryngomalacia to rule out OSA. SGP is an effective treatment for infants with laryngomalacia and OSA. The significant benefits of the procedure outweigh thelow morbidity. Improvement after surgery was reliably confirmed by polysomnography in this study.
Artificial Manipulation of Voice in the Human by an Implanted Stimulator
Authors: Broniatowski Michael , Grundfest‐Broniatowski Sharon , Zobenica Nina S. , Tyler Dustin J. 
Published: September 2008

AbstractObjectives/Hypothesis: Traditional approaches influencing voice quality (e.g., anatomical and chemical denervation for spasmodic dysphonia, surgical medialization for paralysis) have ignored the dynamic nature of the larynx.Study Design: We report here the first attempt to manipulate voice using an implanted stimulator to systematically control vocal fold adduction.Methods: Devices placed for aspiration in three subjects retaining speech after stroke, cerebral palsy, and multiple sclerosis were used to stimulate recurrent laryngeal nerves with 42 Hz, 52 to 200 microsecond pulses of incremental amplitudes during phonation with the tracheostomy tube occluded. Vocal fold adduction increased with stimulation strength (P < .05). Speech was analyzed with the Vox Metria program.Results: We found highly significant differences for fundamental frequency (P < .007), jitter (P < .004), and shimmer (P < .005), between natural and stimulated voice (aah and eeh) when using higher charges.Conclusions: Dynamic vocal fold manipulation seems promising in terms of versatility lacking with static approaches to voice control.
The Perichondrial Cutaneous Graft: A Facial Reconstructive Option for the Ages (Ages 1 Week to 94 Years)
Authors: Stucker Frederick J. , Walsh William E. , Dammert Mark , Lian Timothy 
Published: September 2008

AbstractObjectives/Hypothesis: The perichondrial cutaneous graft (PCCG) possesses unique characteristics that make them a propitious reconstructive option in facial plastic surgery. The PCCG is easily harvested from the conchal bowl. Notable characteristics are that it does not contract, unexcelled color match for resurfacing facial skin, and minimal donor site morbidity. This free graft frequently offers an expeditious solution to an otherwise more complicated reconstructive effort.Study Design: Retrospective review of an academic otolaryngology and facial plastic surgery practice.Methods: Patients requiring head and neck reconstruction for cutaneous deficiencies were studied. The PCCG is harvested from the anterior conchal bowl. This is technically easy, and the perichondrium is tightly adherent to the dermis in this area. The donor site is closed by resecting a fenestra of conchal cartilage and rotating a posterior auricular interpolated island flap into the defect (the “flip‐flop‐flap”). The posterior auricular defect is easily closed in a linear fashion. The main outcome measures were cosmetic result, graft survival, donor site morbidity, and complications.Results: There are 406 PCCGs in our series. Patients ranged in age from 7 days to 94 years. There were 170 grafts used for trauma and 236 used for reconstruction after skin cancer resection. Over the past 30 years in observing these grafts, there are no contractions noted in infants and children, growth with maturity is noteworthy. Cosmesis is excellent and in most cases superior to other skin grafting techniques. We have had four total failures and six partial losses of less than 30% for the PCCG. All complete failures were in patients with a smoking history.Conclusions: The PCCG is a very reliable flap for reconstruction of facial defects. It has been used in elderly and heavy smoking patients with minimal complications, attesting to its viability. The graft provides excellent cosmesis and it is an expeditious alternative to commonly used local flaps. It is especially useful in pediatric patients because the graft actually expands with growth. This is in contrast to the disadvantages of split thickness and full thickness skin grafts that predictably contract with maturity. Local flaps often lack adequate laxity for common implementation and make the PCCG a propitious choice in the pediatric patient.
Platelet‐Rich Plasma for Pediatric Tonsillectomy Patients
Authors: Sidman James D. , Lander Timothy A. , Finkelstein Marsha 
Published: September 2008

AbstractObjectives/Hypothesis: To determine if placement of autologous platelet‐rich plasma (PRP) on the tonsil beds at the time of tonsillectomy would decrease postoperative pain and complications.Study Design: Double blind, randomized, prospective study.Methods: Seventy children were recruited to participate in the study, ranging in age from 4 to 15 years. They were randomized to treatment (PRP) or control groups. The parents, patients, and nurses were blinded as to which group they were in. Postoperative pain scores were obtained using the FACES pain scale and recorded in a home diary.Results: Seventy patients were recruited to the study, and 12 did not submit their diaries and were considered to drop out of the study. Demographic data were similar for both control and treatment groups. Median pain scores, medication use, days to normal diet, and office visits did not differ between the two groups.Conclusions: PRP applied once at the time of tonsillectomy does not improve postoperative pain or recovery in pediatric patients.
Reconstruction of the Internal Nasal Valve: Modified Splay Graft Technique With Endonasal Approach
Authors: Islam Ahmet , Arslan Necmi , Felek Sevim Aslan , Celik Hatice , Demirci Munir , Oguz Haldun 
Published: September 2008

AbstractObjective/Hypothesis: The aim of this study was to determine the reliability and feasibility of modified splay graft technique in the surgical correction of internal nasal valve (INV) incompetence and nasal valve collapse.Study Design: Eleven patients operated with the diagnosis of INV incompetence were followed for 6 to 30 months after operation.Methods: Between 2004 and 2007, 11 patients with the complaint of shortness of breath, and in whom nasal valve incompetence was detected, and who were positive for Cottle and modified Cottle tests were operated. In the operation, splay graft was used endonasally with the technique we describe. Before and at least 6 months after the operation, patients were evaluated with acoustic rhinometry, linear symptom scale, and nasal obstruction symptom evaluation scale in addition to endoscopic examination, and the results were compared.Results: In 10 of 11 (90.9%) patients operated with modified splay graft technique, marked improvement was observed in INV region with endoscopic examination and acoustic rhinometry. In the evaluation made with linear symptom scale and nasal obstruction symptom evaluation scale, partial improvement was seen in nasal obstruction in one patient and marked improvement in 10 patients. No complications developed.Conclusions: Modified splay technique is an effective graft method that can be easily applied and has minimal complications and morbidity.
Quantitative Assessment of Laryngeal Muscle Morphology After Recurrent Laryngeal Nerve Injury: Right vs. Left Differences
Authors: Woodson Gayle E. , Hughes Larry F. , Helfert Robert 
Published: September 2008

AbstractObjectives/Hypothesis: Reports of laryngeal response to denervation are inconsistent. Some document atrophy and fibrosis in denervated laryngeal muscles, whereas others indicate resistance to atrophy. Spontaneous reinnervation has also been documented. The goal of this study was to clarify the effects of nerve injury and reinnervation on thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles.Study Design: Laboratory experiment.Methods: TA and PCA muscles of cats were harvested 5 to 6 months after transecting right or left recurrent laryngeal nerve (RLN). Images of muscle cross‐sections were acquired and studied using an image analysis workstation. Cross‐sectional areas as well as total cross‐sectional area of randomly selected muscle fibers were recorded.Results: TA reinnervation was robust on both sides, but there was less reinnervation of the PCA muscle after left‐sided RLN lesion than after right‐sided injury.Conclusions: Differences in reinnervation after RLN injury could contribute to the higher clinical incidence of left‐ vs. right‐sided laryngeal paralysis.
Down‐Regulation of Carbonic Anhydrase Isoenzymes in Nasal Polyps
Authors: Kim Tae Hoon , Lee Heung Man , Lee Seung Hoon , Kim Ha Kyun , Lee Jung Hoon , Oh Kyoung Ho , Lee Sang Hag 
Published: September 2008

AbstractObjectives/Hypothesis: Carbonic anhydrase (CA) is a zinc metalloenzyme that participate in the biological processes of various fluid transporting epithelia, including ion and water transport. CA may thus play a role in the pathophysiology of normal nasal mucosa and nasal polyp. We evaluated the expression and pattern of distribution of mRNAs and proteins for CA isoenzymes in normal nasal mucosa and polyps.Study Design: This was a controlled, prospective study.Methods: The expression levels of 11 isoenzyme genes (I, II, III, IV, VA, VB, VI, VII, IX, XII, XIV) were evaluated in normal mucosa and polyps using semiquantitative reverse‐transcriptase polymerase chain reaction. The expression and pattern of distribution of CA I, II, and IX were also investigated using immunohistochemistry and Western blot.Results: mRNAs for the 11 CA isoenzymes were detected in all normal nasal mucosa and polyps tested. Their expression levels were decreased in nasal polyp in comparison with normal nasal mucosa. CA I was detected in the epithelial cells, endothelial cells, and submucosal gland of normal nasal mucosa, but only in the endothelial cells in nasal polyp. CA II in normal mucosa was intensely expressed in the submucosal gland cells and CA IX was noted in the cytoplasm and plasma membrane of epithelial cells and submucosal glands. However, these findings were not found in nasal polyp. Western blot also showed differences in their expression levels.Conclusions: These results indicate that CA may participate in the physiology of normal nasal mucosa, but also suggest that altered their expression in nasal polyps may cause impaired electrolyte and water transport across the epithelial cells.
Narrow Band Imaging for Detecting Metachronous Superficial Oropharyngeal and Hypopharyngeal Squamous Cell Carcinomas After Chemoradiotherapy for Head and Neck Cancers
Authors: Katada Chikatoshi , Nakayama Meijin , Tanabe Satoshi , Koizumi Wasaburo , Masaki Takashi , Takeda Masahiko , Okamoto Makito , Saigenji Katsunori 
Published: September 2008

AbstractWe present two cases of metachronous superficial squamous cell carcinomas at oropharyngeal and hypopharyngeal mucosal sites after chemoradiotherapy for head and neck cancers. These were detected by narrow band imaging combined with a magnifying gastrointestinal endoscopy. In one case, we successfully removed the tumor using endoscopic submucosal dissection. Narrow band imaging combined with magnifying gastrointestinal endoscopy illustrated well‐demarcated brownish area and scattered foci of microvascular proliferation. Thus, it may serve as an ideal surveillance mode after chemoradiotherapy for head and neck cancers
Functional Assessments of the Rodent Facial Nerve: A Synkinesis Model
Authors: Hadlock Tessa , Kowaleski Jeffrey , Lo David , Bermejo Roberto , Zeigler H Philip , Mackinnon Susan , Heaton James T. 
Published: September 2008

AbstractObjectives/Hypothesis: Rodent whisker movement has been used as a tool, after facial nerve manipulation, to quantify functional recovery. We have recently established a method to study functional correlates of aberrant regeneration of the facial nerve. Our objective was to establish normative parameters for both spontaneous and induced whisking and blinking behavior in a large group of normal rats.Study Design: Prospective animal study.Methods: Eighty animals underwent quantitative facial movement testing to measure simultaneous vibrissal movement and ocular closure for each side independently. Right and left C‐1 whisker positions were continuously recorded for 5‐minute sessions, and changes in infrared detection corresponding to eye closure were continuously recorded. Whisking and blinking were elicited by delivery of olfactory stimuli (10 s scented airflows) and corneal air puffs. Whisks were counted and analyzed, and eye closures were counted.Results: Whisking amplitude, velocity, and acceleration were consistent with literature values. Air puff delivery elicited an ipsilateral blink 99% of the time, a contralateral blink 18% of the time, and changes in or initiation of bilateral whisking 70% of the time. Olfactory stimulus delivery prompted a change in whisking behavior 83% of the time, and eye closure 20% of the time.Conclusions: This study establishes normative data for assessing cranial nerve VII‐controlled facial movement in four separate facial regions. We demonstrate the capability and tendency of animals to move their orbicularis oculi muscles independently of and simultaneously with their midfacial muscles. This model provides an excellent tool for the study of aberrant regeneration after facial nerve injury in the rodent.