bluuebunny/crossref_metadata_2025_split huggingface dataset:
C02 Laser‐assisted Phonosurgery for Benign Glottic Lesions
Authors: Geyer Marcel , Ledda Gian‐Peppino , Tan Neil C , Consultant Roberto Puxeddu 
Published: August 2008

Objective(1) To determine glottic function following carbon dioxide (CO2) laser‐assisted phonosurgery of benign laryngeal disease. (2) To evaluate post‐operative glottic morphology and disease recurrence rate.MethodsComparative retrospective case series of patients with benign glottic pathology treated by laser‐assisted phonosurgery over 10 years. 235 consecutive patients had pre‐ and postoperative data collected from objective laryngeal examination, videostroboscopy recording of vocal fold mucosal wave movement, electroacoustic voice analysis of fundamental frequency, jitter, shimmer, and harmonics to noise ratio, as well as perceptual voice evaluation. This data was also compared to that of 20 healthy volunteers. (Statistical analysis: Wilcoxon test and Mann‐Whitney test respectively). Definitive voice and morphologic evaluation was completed after 6 months.ResultsEvaluation of the pre‐ and postoperative functional results demonstrated a statistically significant improvement in all spectrographically analysed objective voice parameters (p<0.001), with a restored voice quality as good as the control group (p<0.001). Postoperative morphological analysis using videostroboscopic examination confirmed 3 recurrences of granuloma and 1 of Reinke's oedema. Recurrence was estimated objectively if the lesion was analogous to the original pathology. Glottic closure was complete in 96.5% of cases. False vocal fold adduction was normal in 88.5% of cases, with forced hyper‐adduction being present in 11.5%. Phonatory vibration was cord‐cord type in 100% of cases.ConclusionsOur study demonstrates a statistically significant improvement in all acoustic parameters recorded. Postoperative vocal fold function and mucosal wave morphology were largely restored. CO2 laser‐assisted voice restoration for benign glottic disease is effective.
Calcium Hydroxylapatite Paste for Vocal Rehabilitation
Authors: Gillespie Marion B , Curry Jason A , Dozier Thomas S 
Published: August 2008

ObjectiveDetermine the effectiveness of calcium hydroxylapatite paste in vocal rehabilitation in routine clinical practice.MethodsRetrospective series of adult patients undergoing calcium hydroxylapatite paste injection for vocal fold rehabilitiation over a 3‐year period. Outcomes include change in Voice Handicap Index (VHI) scores, procedure‐related complications, and need for follow‐up vocal procedures.ResultsA total of 23 patients with an average age of 65 years underwent vocal fold rehabilitation with calcium hydroxylapatite injection performed by operative endoscopy. Indications for injection included recurrent laryngeal nerve paralysis in 17 patients and partial cordectomy defects in 6 patients. There were no observed procedure‐related complications. Following injection, 17 patients (74%) had improvement in voice as measured by VHI, 4 had worsening of voice, and 2 were essectially unchanged from baseline. The mean VHI scores improved from 66 (S.D. 4.4) to 35 (S.D. 4.5) after a mean follow‐up time of 2 months (p=0.00001). There was a non‐significant trend toward greater improvement in the VHI scores for the paralysis group compared to the cordectomy group (p=0.09). Six patients required subsequent vocal procedures after the first injection to improve the voice, 4/6 in the cordectomy group and 2/17 in the paralysis group (p=0.02).ConclusionsCalcium hydroxylapatite injection results in significantly improved vocal scores in the majority of patients. The paste was less satisfactory in patients with cordectomy defects due to poor retention of paste in the scarred vocal remnant. External medialization is usually required in these cases in order to adequately mobilize the scar to produce the volume necessary for satisfactory voice.
CO2 Laser Zenker's Diverticulotomy: 10‐year Experience
Authors: Rebeiz Elie E , Bhatia Nitin 
Published: August 2008

ObjectiveZenker's diverticula occur primarily in older patients, resulting in dysphagia, aspiration, and weight loss. A number of surgical options are available for treatment. While small diverticula (smaller than 2 cm) may require no surgical treatment, the presence of dysphagia, asiration, may necessitate surgery. Surgical options include both traditional open and endoscopic procedures. Many patients are elderly and cannot undergo open surgical procedures. Endoscopic techniques have become the preferred approaches by physicians because of their safety, effectiveness, and fewer complications.MethodsRetrospective chart review of 65 patients who underwent endoscopic carbon dioxide (CO2) laser treatment of Zenker's diverticulum at a single tertiary care institution. In some of the procedures, the incision was sealed with a tissue sealant.ResultsAge ranged from 56 to 89 years. All patients had significant improvement in their symptoms such as dysphagia, aspiration, and weight gain. The endoscopic incision was performed in 1 session using the CO2 laser and a microscope. 2 complications (cervical emphysema) were managed conservatively and 1 postoperative bleeding required return to the operating room. The endoscopic exposure was not achieved in 2 patients due to difficult exposure. There were no mortalities. Mean follow‐up was 27 months. There was no recurrence of dysphagia and all patients remained asymptomatic.ConclusionsCO2 laser endoscopic treatment of symptomatic Zenker's diverticulum is an effective and safe method. It is quick and simple, and permits a short hospital stay and quick return to activities. Tissue sealant provides additional safety and reduces the incidence of postoperative complications.
Impact of Voice and Swallowing Problems in the Elderly
Authors: Turley Richard , Cohen Seth M 
Published: August 2008

Objective1) Evaluate the prevalence of and quality of life impact of voice and swallowing problems in the elderly. 2) Determine treatment trends and barriers to treatment.MethodsCross‐sectional study of independent living residents in 2 retirement communities. Main outcome measures include prevalence of dysphonia and dysphagia, Voice Related Quality of Life (VRQOL), 7‐point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES‐D) scale, and barriers to treatment. Relationship between continuous variables were analyzed with Spearman correlation and between categorical and continuous variables with a t‐test.Results248 residents responded, with a mean age of 82.4 years. 19.8% had dysphonia, 13.7% dysphagia, and 6% both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL (p = 0.04, Spearman correlation = −0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES‐D score 15.5 versus 9.9, p = 0.008, t‐test). While 75% of respondents with dysphonia were interested in treatment, only 20.4% and 2.1% had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options, and viewing voice and swallowing trouble as a normal part of aging, were the two most common reasons for not seeking treatment.ConclusionsVoice and swallowing problems are common in the elderly but they are not realizing potential treatment benefits. Improved health care services for voice and swallowing problems in the elderly are essential.
p63 Expression in 127 Patients with Laryngeal Cancer
Authors: Cernea Claudio R , De Mello Borba Marcus Antonio , Dias Fernando Luiz , Faria Paulo , Bacchi Carlos , De Castro Costa Andre Leonardo 
Published: August 2008

Objective(1) To evaluate the expression of p63 in laryngeal squamous cell carcinoma (2) To analyze its prognostic significance.Methodsp63 expression was examined in 127 patients submitted to total laryngectomy between 1998 and 2000 (111 male/16 female; 69 Caucasian/58 non‐Caucasian; 36‐ to 93‐years‐old, median: 58 years). 19 tumors were glottic, 16 supraglottic and 92 transglottic(15%, 13% and 72%, respectively). Two cases were stage I(1.6%), 21 were stage II(16.5%), 82 were stage III(64.6%) and 22 were stage IV(17.3%). 96 patients(75.6%) received adjuvant radiotherapy. The immunohistochemical analysis of the expression of p63 included the following scores: 0: no immunostaining; 1: immunostaining in <30% of neoplastics cells; 2: immunostaining in >30% and <70% of neoplastics cells; and 3: immunostaining in >70% of neoplastics cells.Results62 cases had score 3; 60 had score 2; 4 had score 1; and one case did not show any expression (48.8%, 47.2%, 3.1% and 0.8%). Overall survival was 73.9% at 24 months and 59.5% at 60 months. The disease‐free survival was 77.2% and 75.1%, and the disease‐specific survival was 79% and 67% at 24 and 60 months respectively. Uni and multivariate analysis identified that decreased immunoexpression of protein p63 and the involvement of the hypopharynx were statistically significant factors for the risk of recurrence and death by cancer.Conclusionsp63 expression was highly prevalent in laryngeal squamous cell carcinomas in the present study. Decreased p63 protein expression was statistically associated to the recurrence and death.
The Validity of the Pharyngeal Squeeze Maneuver
Authors: Fuller Scott C. , Belafsky Peter C , Aminpour Shervin , Leonard Rebecca , Rees Catherine J 
Published: August 2008

ObjectivePharyngeal strength is essential for safe bolus transit during deglutition. The pharyngeal squeeze maneuver (PSM) is a surrogate measure of pharyngeal strength determined on endoscopic swallow evaluation (FEES). Although several investigations have utilized the PSM, the validity of this diagnostic assessment has never been tested. The purpose of this investigation was to evaluate the clinical validity of the PSM.MethodsSimultaneous FEES and fluoroscopic swallow evaluations were prospectively performed on 30 consecutive patients being evaluated for dysphagia. The PSM was assessed on all patients and compared to a validated measure of pharyngeal strength on fluoroscopy, the pharyngeal constriction ratio (PCR). As pharyngeal strength diminishes, the PCR increases. The PCR in patients with an intact PSM was compared to the PCR in persons with an absent PSM, with the independent samples t‐test and confirmed with the non‐parametric Mann‐Whitney test.Results29 simultaneous FEES‐fluoroscpic swallow studies were performed. 75% (22/29) had an intact PSM and 25% (7/9) had an absent PSM. The mean PRC for the group with an intact PSM was 0.06 (± 0.08), compared to a mean PCR of 0.31 (± 0.20) for individuals with an absent PSM. The PCR was significantly higher, indicating a weaker pharynx, in persons with an absent PSM (p < 0.001).ConclusionsPharyngeal strength, as assessed with the PCR, is significantly weaker in persons with an absent PSM. These data suggest that the PSM is a valid surrogate measure of pharyngeal motor integrity.
Transoral Laser Surgery: The Learning Curve
Authors: Bernal‐Sprekelsen Manuel S , Vilaseca Isabel , Alejandro Jose Luis Blanch 
Published: August 2008

ObjectiveTo assess the learning curve in transoral laser surgery for malignant tumors of the larynx and hypopharynx.MethodsProspective data collection in a SPSS data base from 1998 to 2004. Inclusion criteria: Patients with untreated malignant tumors of the aerodigestive tract treated with curative intent. Patients were divided into consecutive subgroups of n= 50 depending on the experience of the surgeons. Outcome assessment was prformed specifically for number of surgeries per patient, complications, recurrence rates and adjusted survival.Results680 patients met the inclusion criteria. Up to 4 groups of increasing consecutive experience could be formed. The number of operations per patients (1,87 operation for group #1 compared to 1.36 for group #4) and the complication rates were significantly reduced with increased experience. Complication rates were linked with a statistical significance to larger tumors (p< 0.0001). Free tumor margins were not related to experience (p=0.307), neither the recurrence rates (the lowest Chi‐square achieved a p=0.088 for the first group of 50 compared to the fourth group of 50). Adjusted survival rates showed a trend of improvement with larger experience when studied individually, but no significant statistical difference was observed (p >0.05).ConclusionsAssessing surgical experience for new technologies is not as simple, as new joining surgeons profit from experienced colleagues. The complication rate clearly seems to depend on experience; however, patient adjusted survival rates do not.
Vox‐Implants Injection after Partial Laryngectomy
Authors: Ghidini Angelo , Bergamini Giuseppe , Alicandri‐Ciufelli Matteo , Molteni Gabriele , Mattioli Francesco , Presutti Livio , Marchioni Daniele 
Published: August 2008

ObjectiveTo illustrate a surgical technique for swallowing rehabilitation of patients after partial laryngectomy and to evaluate quality of life after treatment.MethodsA longitudinal prospective study. 11 patients with persistent swallowing impairment after partial laryngectomy were included in the study. Swallowing disorders were diagnosed with videofluoroscopy and FEES (fiberoptic endoscopic evaluation of swallowing), and were quantified by 2 scales (a dysphagia score and a modified Penetration‐Aspiration scale). A self‐evaluation questionnaire about quality of life after polydimethylsiloxane (PDMS) injection was submitted to each patient (EORTC‐QLQ 30). After identification of site of inhalation of bolus, PDMS was injected into the neoglottis to fill the neoglottic gap in order to obtain a better continence of the neolarynx. Aerodynamics and acoustic analysis were assessed before and after treatment.ResultsAverage follow‐up was 25 months (range 5–39). All patients showed an improvement both in the dysphagia score and in the modified Penetration‐Aspiration scale. Average improvement was 2.6 points in the dysphagia score (p=0.0042) and 2.1 in the modified Penetration‐Aspiration scale (p=0.0043). MPT showed an average improvement of 5 sec (p=0,037). The quality of life assessment showed a subjective improvement in each patient.ConclusionsPDMS injection can be a useful technique in surgical rehabilitation of swallowing in patients who underwent partial laryngectomy. FEES is a very important tool in identifying anatomical alterations that can cause incorrect passage of bolus in the airways during deglutition. Filling these regions with PDMS can avoid passage of food into the airways, thus improving deglutition and voice and by consequence, patients’ quality of life.
Chorda Tympani in Chronic Inflammatory Middle Ear Disease
Authors: Goyal Arun , Singh P P , Dash Gautam 
Published: August 2008

ObjectiveTo study the effect of chronic inflammatory middle ear disease on gustatory function of chorda tympani nerve.MethodsA prospective study was performed in 2007 on 85 patients of unilateral chronic inflammatory middle ear disease of both cholesteatomatous and noncholesteatomatous type. Gustatory assessment on both sides of the tongue was performed using dry taste strips. Taste strips were made of filter paper soaked in four different taste solutions of four different concentrations each and dried. The taste score is the number of correctly identified taste strips. Results were analyzed using Analysis of Variance (ANOVA) and t‐test.ResultsComparison of mean taste scores on the side of diseased ear with normal ear was done. On the diseased side, the mean taste score was 9.16 and on the normal side, the mean taste score was 13.24. The difference between the two was found to be statistically significant (p<0.0001). The results were also analyzed for various other parameters like type, duration, and location of disease. Site of cholesteatoma was found to have a significant effect on the taste score of the diseased side. Patients having postero‐superior retraction pocket cholesteatoma had significantly lower taste scores as compared to those having cholesteatoma at other sites (p=0.008).ConclusionsA patient of chronic inflammatory middle ear disease already has dysfunctional chorda tympani and is unlikely to notice a change in the taste sensation in the event of cutting of the nerve during the course of an ear surgery.
Clinical Usefulness of the VEMP Test in Vestibular Diagnosis
Authors: Bhansali Sanjay 
Published: August 2008

Objective1) Assess the clinical usefulness of the VEMP test in identifying vestibular disease. 2) Evaluate the criteria used for a positive VEMP test.MethodsWe prospectively evaluated 166 consecutive patients complaining of dizziness with a neurotologic examination including spontaneous nystagmus, head‐shake testing, gaze testing, and Hallpike maneuver. ENG testing and MRI scanning were done when indicated. All underwent VEMP testing. We considered 30% and 40% amplitude asymmetry criteria as abnormal for peripheral, and 17 msec latency abnormal for central disease and compared these with the complete clinical evaluation.Results44 patients had no VEMP response and were excluded. Analysis of the remaining 122 patients showed that 47% of patients with a peripheral vestibular disorder had an abnormal VEMP, using the 30% amplitude asymmetry criterion (p<0.001) (Fisher Exact Test), and 29% had an abnormal VEMP using the 40% criterion (p<0.001). The likelihood of a false positive was very low (3%, p<0.001). 42% of patients diagnosed with central vestibular dysfunction had delayed latency responses and the false positive rate was 2% (p<0.001).ConclusionsThe very low false positive rate (high specificity) indicates that an abnormal VEMP test is a good predictor of the presence of vestibular dysfunction, but a normal VEMP test does not exclude it. More patients with vestibular disease are identified (47% vs. 29%) just as accurately using a 30% rather than 40% criterion for a positive test. VEMP testing appears to be a valuable addition to the vestibular test battery and should be considered in the evaluation of dizzy patients.
cVEMP Testing in Patients with a Third Mobile Window
Authors: Eppsteiner Robert Walter , Lee Daniel J , Roditi Rachel E , Sauter Todd B 
Published: August 2008

ObjectiveTo determine the usefulness of cervical vestibular‐evoked auditory potential (cVEMP) testing for the evaluation of patients with and without a third mobile window (superior canal dehiscence or large vestibular aqueduct).MethodsA retrospective review of charts from patients who underwent cVEMP testing at a single tertiary referral center was performed. The cVEMP is a vestibular reflex generated by an air‐conducted stimuli, causing an inhibitory potential in the ipsilateral sternocleidomastoid muscle measured by external electrodes. cVEMP results were correlated with demographic characteristics, hearing testing, diagnosis, and imaging. Mean cVEMP thresholds (at 500 Hz) and amplitudes (@ 95dB nHL and 500 Hz) were compared between ears and between patients with and without a third mobile window (TMW). Unequal variance t‐Test was used to determine significance. Patients were excluded if they had a history of Meniere's disease, middle ear disease or otologic surgery.Results63 patients received cVEMP testing, of which 8 had either unilateral or bilateral TMW. 114 non‐TMW ears were compared to 10 ears with TMW. Ears with TMW had a lower mean threshold (68 dB nHL) vs. non‐TMW (83 dB nHL) (p<0.003) and a higher mean amplitude (321?V) vs. non‐TMW (78?V)(p<0.009).ConclusionsPatients with TMW have lower thresholds and higher amplitudes on cVEMP testing. This study supports the use of cVEMPs to diagnose TMW in patients who present with an unexplained air‐bone gap, autophony, aural fullness, or dizziness.
Endoscopic Management of Acquired Cholesteatoma
Authors: Molteni Gabriele , Marchioni Daniele , Mattioli Francesco , Ghidini Angelo , Alicandri‐Ciufelli Matteo , Presutti Livio 
Published: August 2008

ObjectiveThe purpose of this study was to examine the utility of using an endoscope in cholesteatoma surgery and to demonstrate how it allows a reduction in the incidence of residual disease.MethodsA prospective study. A total of 53 ears with acquired cholesteatoma (primary) were resected. 20 cases were resected using a canal wall up (CWU) technique, 6 cases using a canal wall down (CWD) technique, and in 27 cases a transcanal tympanotomyatticotomy was performed. All of the patients in our study group underwent an explorative and operative endoscopic ear surgery complementary to the operating microscope to uncover and remove residual cholesteatoma.ResultsIn the primary surgery after completion of microscopic cleaning, the overall incidence of intraoperative residual disease detected with the endoscope was 37.5%. The sinus tympani was the most common site of intraoperative residuals, followed by the anterior epitympanic recess and protympanum. Out of the 20 CWU cases, 12 second‐look endoscopies were performed. Two recurrences were identified, both in the sinus tympani. There were no significant complications associated with the 53 endoscopic procedures.ConclusionsThe endoscope allowed a better understanding of cholesteatoma and improved eradication of residual disease from hidden areas such as the anterior epitympanic recess, retrotympanum and hypotympanum not yet controllable by operating microscope.
Hearing Restoration with the RWI in Mixed Hearing Losses
Authors: Colletti Vittorio , Carner Marco , Veronese Sheila , Colletti Liliana 
Published: August 2008

ObjectiveThe indications of the Vibrant Soundbridge (VSB), presently limited to the patients with sensorineural hearing loss (HL) and normal middle ear function, have been extended to include patients with mixed HL due to congenital or acquired ossicular chain defects. The FMT of the VSB placed onto the RW, round window implant (RWI), has allowed optimal amplification in patients with moderate‐to‐severe mixed HL who, at present, do not have good options for adequate functional rehabiliation.Methods27 patients were unsuitable candidates for air and bone conductive hearing aids (BCHAs and ACHAs) and osseointegrative implants (BAHAs) and were treated with RWI. The patients were subdivided in 3 groups in relation to the etiologies and the performed surgeries. The first group includes 15 adults with unsuccessful OPLs (9 canal‐wall‐up (CWU) and 6 canal‐wall‐down (CWD) tympanoplasty); the second group includes 8 adult patients with CSOM, operated on dry radical or modified RCs; and the third group includes 4 patients, 2 children aged 1‐ and 10‐years‐old, and 2 adults with severe congenital malformations of the auricle combined with atresia of the outer ear canal and malformations of the ossicular chain. RWI surgeries will be illustrated in detail for each group.ResultsSignificant improvements were observed in puretone threshold and speech understanding after surgery and at different follow‐ups (12–24 months), with no complications.ConclusionsThe post‐operative results suggest that RWI offers a viable treatment option for patients with severe mixed HL, regardless of the etiology of HL and previous surgeries.