bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional laryngeal dyskinesia in children and adults
Authors: Ferris Robert L. , Eisele David W. , Tunkel David E. 
Published: November 2003

AbstractObjective: Functional laryngeal dyskinesia (FLD) is characterized by signs and symptoms of airway obstruction without anatomic basis. Failure to recognize its features often leads to inappropriate diagnostic studies and therapies. A systematic approach is presented for the recognition and management of patients with this disorder. Design: A retrospective case series at a large, urban tertiary care academic hospital. Methods: Retrospective review of charts of adults and children diagnosed with FLD between 1979 and 1996. Presenting symptoms and signs of FLD were categorized and methods of diagnosis were recorded. Therapeutic interventions and resolution of FLD at follow‐up were also analyzed. Results: Ten patients were identified with FLD, seven females and three males, with mean age of 25.9 years at diagnosis (range, 10–59 y). Patients were hospitalized a mean of three times (range, 1 to 6 admissions) before FLD was correctly diagnosed. Nine patients were receiving treatment for asthma prior to diagnosis. Flow volume loops most often showed a fixed extrathoracic inspiratory. Arterial blood gas and radiographic data were essentially normal. The most useful diagnostic test was fiberoptic laryngoscopy, which showed abnormal adduction of the vocal cords on inspiration in the nine patients in this series who underwent laryngoscopy. Conclusions: The authors' experience with FLD shows that its early recognition is associated with fewer interventions and their accompanying risks. A high degree of suspicion is required in these patients, who are often young and well educated. They present with stridor that may disappear while they are asleep or after distraction techniques. Laryngoscope, 108:1520–1523, 1998
Prospective randomized comparative study of tracheoesophageal voice prosthesis: Blom‐singer versus provox
Authors: Delsupehe Kathelijne , Zink Inge , Lejaegere Maryline , Delaere Pierre 
Published: November 2003

AbstractObjectives: Compare the most commonly used types of tracheoesophageal voice prostheses, Blom Singer and Provox. Study Design: Prospective study of 113 prostheses placed in 52 patients randomly selected to receive Blom‐Singer and Provox. Methods: Postoperative voice was recorded at 1 and 4 months after valve placement. Survival time of the prosthesis and four objective voice parameters were analyzed. Eight judges rated all recordings in a random order for six subjective voice parameters. Subgroup analysis for primary versus secondary placements and type of procedure was performed. In addition, patients were asked for their subjective assessment. Results: Overall, Blom‐Singer and Provox prostheses give very similar voice quality, lifetime, and patient satisfaction. Cleaning management is somewhat better for Provox, but there is a trend toward better overall voice quality for the Blom‐Singer prosthesis. In subgroup analysis secondarily placed prostheses score somewhat better than primary placements, and patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial pharyngectomy. Conclusions: Given the equal and good results in terms of voice quality, other factors (e.g., costs, surgery‐related factors, maintenance, patient preference) should be taken into account when deciding which type of tracheoesophageal voice prosthesis to use. Laryngoscope, 108:1561–1665, 1998
Tissue‐conserving surgery for prognosis, treatment, and function preservation
Authors: Schuller David E. , Laning Carol M. Bier , Sharma Pramod K. , Siegle Ronald J. , Pellegrini Arthur E. , Karanfilov Boris , Bellisari Greg , Miller Ryan , Young Donn C. 
Published: November 2003

AbstractObjectives: To describe an approach based on initial tissue‐conserving surgery used to obtain histologically determined prognostic information that has therapeutic implications and the potential to enhance preservation of function. Study Design: Analysis of a group of patients with head and neck cancer treated initially with tissue‐conserving surgery based on Mohs' histographic sectioning and selected neck dissection to derive histologically determined prognostic information with therapeutic implications and preservation in function. Methods: This study is primarily based on an analysis of patients from January 1, 1989, through June 4, 1996 assigned to a protocol evaluating resection of oral cavity squamous cell cancer with margin control using Mohs' histographic technique and/or a group of patients with neck assessment of N0 on clinical examination who are undergoing supraomohyoid neck dissections. Results: Thirty‐three primary tumor resections were performed using the Mohs' technique, and 54% required two or more Mohs' sections before clear histologic margins were obtained following resection based on clinically determined negative margins. There were 44 patients who underwent unilateral or bilateral supraomohyoid neck dissections, and 33% had occult, histologically positive nodes. When compared with the disease of the neck specimens, a preoperative computed tomography scan had a sensitivity of 25%, a specificity of 77%, and an accuracy of 63%. Conclusions: This report describes the effectiveness of Mohs' histographic sectioning and selective neck dissection as a means of determining prognostic information that can be used to develop a focused and cost‐effective treatment program that, along with contemporary reconstructive techniques, provides a potential enhancement of function preservation. Laryngoscope, 108:1599–1604, 1998
Management of substernal goiter
Authors: Netterville James L. , Coleman Sean C. , Smith Jonathan C. , Smith Michelle M. , Day Terrence A. , Burkey Brian B. 
Published: November 2003

AbstractObjective: To analyze the presentation, evaluation and treatment of patients with large substernal goiters, with emphasis on the radiographic evaluation and the results of treatment. Study Design: A retrospective chart review of 150 patients undergoing thyroidectomy at the Vanderbilt University Department of Otolaryngology—Head and Neck Surgery. Methods: Charts of patients undergoing thyroidectomy were reviewed. Those with substernal goiter, defined as a major portion of the goiter within the mediastinum, were included in the study. When available, the radiographic studies were reviewed by a staff neuroradiologist. Results: Twenty‐three patients (15.3%) presented with substernal extension of the goiter. Characteristics of these patients included mean age of 59 years, 78% female, symptoms of compression such as dyspnea, choking, and dysphagia (65%), hoarseness (43%), and previous thyroid surgery (30%). Seventeen percent were asymptomatic. Preoperative radiographs demonstrated tracheal compression (73%), tracheal deviation (77%), esophageal compression (27%), and major vessel displacement (50%). Histology revealed multinodular goiter (16/23, 70%), thyroiditis (3/23, 13%), and malignancy (4/23, 17%). The average size of the resected specimen in greatest dimension was 8.0 cm (range, 3.0–14.0 cm) and weighed 148 g (range, 39–426 g). All were successfully approached through a transcervical incision without the need for sternotomy, and total thyroidectomy was performed in 83% of the cases. No major complications have been documented, and no evidence of tracheomalacia was encountered. Conclusion: Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning. Laryngoscope, 108:1611–1617, 1998
Repair of nasal defects using collagen gels containing insulin‐like growth factor 1
Authors: Toung James S. , Griffin Adam , Ogle Roy C. , Lindsey William H. 
Published: November 2003

AbstractObjective: Facial osseous defects are a common and challenging problem for the otolaryngologist—head and neck surgeon. Current methods of repair including synthetic grafts, cadaveric material, and autologous tissue have drawbacks of foreign body reactions, infectious agent transmission, and the morbidity of a second surgical site. In the effort to develop an ideal technique for osseous reconstruction, a critical‐size facial defect has previously been developed in the Sprague‐Dawley rat. This model exhibits less than 10% healing by surface area over 6 months. A novel approach to osseous reconstruction is attempted using this model with type I collagen gel augmented with insulin‐like growth factor 1 (IGF‐1). Study Design: Randomized controlled trial using a rodent model. Methods: Twelve adult male Sprague‐Dawley rats underwent a surgical procedure to produce a critical‐size nasal defect by removing the nasal bones with a cutting burr. Six animals were repaired with 300 μg of type I collagen gel. Six animals were repaired with 300 μg of type I collagen gel augmented with 3.0 μg of IGF‐1. Thirty days later, the animals were examined after necropsy. Precise planimetry, radiodensitometric analysis, and histologic sectioning were performed. Results: All animals had complete coverage of this defect with a thin layer of bone. Radiodensitometric analysis indicated that there was a statistically significant (P < .037) increase in bone density in the collagen plus IGF‐1 group compared with that of collagen only. In addition, histologic evaluation revealed increased bone density and thickness in the IGF‐1 group. Conclusion: Type I collagen gel augmented with IGF‐1 results in a significant increase in healing of a nasal critical‐size defect in a rodent model. Laryngoscope, 108:1654–1658, 1998
Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma
Authors: Zhang Ming , Garvis William , Linder Thomas , Fisch Ugo 
Published: November 2003

AbstractObjectives: Review of preoperative evaluation, surgical management, and outcome of patients operated on for nasopharyngeal angiofibroma using lateral infratemporal fossa approaches. Study Design: Retrospective review of 20 patients with either extensive (Fisch class IIIa to IVb, n = 17) or less massive (Fisch class II, n = 3) nasopharyngeal angiofibromas. Analysis of preoperative radiologic classification and angiography and description of indications and surgical techniques of the infratemporal fossa approaches types C and D. Evaluation of the surgical morbidity and radicality of tumor removal. Methods: Clinical data were obtained from medical records from 1987 to 1994. Tumor classification, preoperative symptoms, type of surgery, and neuroradiologic and surgical complications were evaluated. The completeness of tumor removal was assessed using postoperative magnetic resonance imaging. Results: Temporary visual disturbance or headache, or both, was seen in two of 20 patients after superselective tumor embolization, and further visual diminution was observed in one of six patients after balloon occlusion of the internal carotid artery. Radical resection was obtained in 80% of the cases. The infratemporal fossa type C approach was used in 16 of the cases, with type D approaches used in the other four. There were no deaths. The major morbidity was the conductive hearing loss associated with the type C approach. Conclusions: Preoperative embolization (and balloon occlusion in selected cases) remains an important adjunct with minimal morbidity. The lateral infratemporal fossa approaches yield a high rate of radical tumor removal (80%) and a low rate of recurrence (6%). If applicable, the type D approach avoids the conductive hearing loss but allows direct tumor access into the infratemporal and pterygopalatine fossae. Laryngoscope, 108:1717–1723, 1998
Acoustic and perceptual evaluation of laryngeal reinnervation by ansa cervicalis transfer
Authors: Olson David E. L. , Goding George S. , Michael Deirdre D. 
Published: November 2003

AbstractObjectives/Hypothesis: To evaluate the acoustic and perceptual results of laryngeal reinnervation with ansa cervicalis to recurrent laryngeal nerve anastomosis. Study Design: Retrospective study of voice samples from 12 patients with unilateral recurrent laryngeal nerve paralysis, treated with ansa cervicalis to recurrent laryngeal nerve anastomosis. Samples were recorded before surgery and at least 8 months after surgery. Methods: The samples were subjected to several acoustic analyses sensitive to paralytic dysphonia, including cepstral peak prominence, noise‐to‐harmonics ratio, and measures of frequency and amplitude perturbation. The voice samples from the patients were randomized with age‐ and sexmatched samples from normal subjects and judged by trained listeners for overall dysphonia, roughness, breathiness, asthenia, and strain. The preoperative and postoperative results were compared statistically, and the postoperative results were compared with the matched normal subjects. Results: As a group, the patients showed improvement (P < .05) in cepstral peak prominence, frequency perturbation, and perceptual judgments of overall dysphonia, breathiness, and asthenia. The best results occurred in patients with isolated vocal fold paralysis. The postoperative group as a whole did not improve to the level seen in matched normals. Suboptimal results were seen primarily in patients with untreated laryngeal or extralaryngeal pathology beyond the laryngeal paralysis. Conclusions: These data suggest that laryngeal reinnervation has the potential to bring about a return to normal or near‐normal voice in patients with isolated unilateral vocal fold paralysis.
Congenital aural atresia: Stability of surgical results
Authors: Lambert Paul R. 
Published: November 2003

AbstractObjectives/Hypothesis: To compare early (<1 y) and longer‐term (1.0–7.5 y; mean follow‐up, 2.8 y) hearing results following surgery for congenital aural atresia and to analyze revision cases for cause of failure, time of occurrence, and outcome. Study Design: Retrospective study of 55 consecutive patients (59 ears) undergoing surgery during an 11‐year period for congenital aural atresia. Methods: The best speech reception threshold (SRT) during the first postoperative year was compared with the most recent SRT beyond the first postoperative year. The complication rate and long‐term hearing results (>1 y) for initial and revision surgeries were compared. Results: In the early postoperative period, an SRT of ≤25 dB was achieved in 60% and an SRT of ≤30 dB in 70%. With longer follow‐up (mean, 2.8 y), 46% of patients maintained an SRT ±25 dB. Revision surgery was necessary in approximately one third of patients. Longer‐term hearing results following initial surgery only or after revision surgery showed an SRT ±25 dB in 53% and an SRT ±30 dB in 64%. For primary and revisions surgeries the incidence of temporary facial paralysis was 1.5% and for significant hearing loss, 3.0%. Conclusions: Some degradation in hearing does occur as patients are followed beyond the first postoperative year. Revision surgery will be necessary in approximately one third of cases. With revisions, an SRT ±25 dB can be expected in half of cases and an SRT ±30 dB in two thirds of cases. The ability to provide these hearing results supports this surgery in unilateral cases.
Second malignant neoplasia in patients with T1 glottic cancer treated with radiation
Authors: Fujita Mihoko , Rudoltz Marc S. , Canady Daniel J. , Patel Pushpa , Machtay Mitchel , Pittard Ms Melissa Q. , Mohiuddin Mohammed , Regine William F. 
Published: November 2003

AbstractObjective/Hypothesis: To evaluate incidence, site of occurrence and outcome of second malignant neoplasia (SMN) in patients with T1 glottic cancer treated with radiation. Study Design: Retrospective. Methods: Between February 1964 and May 1993, 158 patients with T1 squamous carcinoma of the larynx were treated with definitive radiation. Incidence, site (aerodigestive tract or not) and outcome of SMN were analyzed. Median follow‐up was 63 months (range, 12–245 mo). Results: Thirty‐four patients developed SMN, for an overall incidence of 22%. Twenty‐four (67%) SMNs occurred in an aero‐upper‐digestive‐tract site compared with nine (25%) occurring in a non‐aero‐upper‐digestive tract site. The incidence of SMN observed was higher than would be expected for the general population at risk. The observed‐to‐expected ratios (OER) for all SMN, aero‐upper‐digestive SMN and non‐aero‐upper‐digestive SMNs were 1.73, 5.53, and 0.62, respectively. Overall 5‐ and 10‐year survivals were 76% and 57%, respectively, for those who did not develop SMN, as compared with 68% and 26%, for those who developed SMN (P = .003). Overall, 13 patients (8.2%) have died from laryngeal cancer, while 23 (15%) died from SMN (P = .001). Conclusion: This study confirms a higher incidence of SMN in T1 glottic cancer patients, compared with the general population. The majority of cases occur in aero‐upper‐digestive sites. These patients are more likely to die from their SMN than from glottic cancer. Patients with T1 squamous cell carcinoma of the glottic larynx represent a group of head and neck cancer patients who should be targeted in studies evaluating the potential benefits of chemoprevention, and aggressively counseled for social and/or behavioral modifications.
Myringoplasty in Children: Predictive Factors of Outcome
Authors: Denoyelle Françoise , Roger Gilles , Chauvin P. , Garabedian Eréa‐Noël 
Published: November 2003

AbstractObjectives: To assess the results of myringoplasty in children and to determine which factors independently influence the postoperative results.Study Design: Retrospective study of the anatomic and functional results of 231 consecutive myringoplasties performed in 188 children between 1988 and 1992. Multivariate analysis of poor prognostic factors by cross‐sectional comparison 1 year after surgery.Methods: Myringoplasties were performed via an endaural approach with a fascia temporalis underlay graft.Results: In 216 of 231 ears (93.5%) the tympanic membrane was closed. A good anatomic outcome was considered to have been achieved in 188 ears (81.6%), although in 18 ears (7.8%) seromucous otitis media occurred, in 8 ears (3.5%) a progressive retraction pocket was encountered, and in 2 ears significant lateralization was present. One hundred thirty‐nine (67.5%) of the 206 ears tested in the postoperative period had a postoperative air‐bone gap of 10 dB or less. On average, mean bone conduction remained unaltered. The age of the patient and the size and the location of the perforation did not affect the outcome. Three prognostic factors for an abnormal postoperative tympanic membrane were found, with 95% confidence intervals: inflammatory changes in the middle ear mucosa (P< .05), contralateral tympanic perforation (P< .05), and contralateral cholesteatoma (P< .01).Conclusions: Myringoplasty with underlay grafting of the fascia temporalis in children gives good anatomic and functional results. Inflammatory changes within the middle ear mucosa, contralateral tympanic perforation, and contralateral cholesteatoma independently influence the risk of an abnormal postoperative tympanic membrane. The presence of one of these factors preoperatively should lead to the consideration of alternative, more durable graft material, such as autologous cartilage.
Electrocochleographic and Audiometric Evaluation of Hypobaric Effect in Meniere's Disease
Authors: Konrádsson Konrád S. , Carlborg Björn , Grenner Jan , Tjernström Örjan 
Published: November 2003

AbstractObjectives: To elucidate the effects of hypobaric pressure on cochlear hydrodynamics in patents with well‐defined Meniere's disease. Design: Sixteen patients were consecutively selected. Elevated hearing threshold levels and pathological transtympanal electrocochleography (tt‐ECOG) were confirmed at the day of trial. The patients were exposed to repeated episodes of hypobaric pressure in a pressure chamber. The rate (20 daPa/s) and magnitude (‐285 daPa) of chamber pressure change were low. The induced tympanic overpressure (+185 daPa) was continuously monitored and any tympanic equilibration was avoided. Methods: The results of Bekesy and speech audiometry as well as tt‐ECOG performed immediately before and after exposure were compared. The importance of chamber pressure change, number of hypobaric episodes, duration of exposure, and the induced relative tympanic overpressure was tested. Results: It is shown that the relative tympanic overpressure is the most important factor to affect the cochlear hydrodynamics. Higher relative overpressure was associated with improvement of hearing threshold levels, while the ECOG results tended to improve with lower induced tympanic overpressure. Conclusion: The importance of tympanic overpressure shown in this study is in agreement with previous findings from hypobaric animal experiments. The inverse relation of psychoacoustic and ECOG tests suggests that the two methods evaluate different parameters, perhaps contributing differently to the physiology of hearing.
Persisting Dysphagia After Uvulopalatoplasty Performed With Steel Scalpel
Authors: Levring‐Jäghagen Eva , Nilsson Mats E. , Isberg Annika 
Published: November 2003

AbstractObjectives/Hypothesis: The aim of the present study was to determine the incidence of postoperative persisting dysphagia after uvulopalatoplasty performed with conventional steel scalpel (UPP) and to videoradiographically evaluate the oral and pharyngeal phases of swallowing in patients reporting persisting dysphagia. The hypothesis to be tested was that patients treated with UPP would demonstrate a lower incidence of persisting dysphagia than previously found after uvulopalatoplasty performed with laser technique (LUPP). Study Design: Retrospective. Methods: Sixty‐eight of 76 consecutive patients treated with UPP answered a questionnaire concerning outcome and late complications after the operation. The patients who reported postoperative dysphagia were additionally interviewed at a minimum of 1 year postoperatively, and the oral and pharyngeal phases of swallowing were videoradiographically examined in those with persisting dysphagia. Results: The incidence of persisting dysphagia after UPP was 29%. Videoradiographically 71% of the dysphagic patients showed a deviant pharyngeal swallowing pattern. Conclusion: The incidence of persisting dysphagia after UPP did not differ from that reported after laser uvulopalatoplasty. Dysphagia after UPP was mostly associated with videoradiographic signs of deviant pharyngeal swallowing function. Patients should be informed that there is a risk of developing dysphagia after uvulopalatoplasty.