bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Laryngeal Movement and Effect of Aging on Swallowing Pressure in the Pharynx and Upper Esophageal Sphincter
Authors: Yokoyama Masato , Mitomi Natsuhiko , Tetsuka Katsuhiko , Tayama Niro , Niimi Seiji 
Published: November 2003

AbstractObjectives Describe contribution of laryngeal movement to pressure changes at the upper esophageal sphincter (UES) and the effect of aging on the swallowing function.Study Design Manofluorography on 56 nondysphagic adults divided into three age groups: the 21‐ to 31‐year‐old group (n = 32), the 61‐ to 74‐year‐old group (n = 12) and the 75‐ to 89‐year‐old group (n = 12). Analyses of the bolus transit time, the amplitudes and durations of pharyngeal pressures, the timing of a pressure fall at the UES and the laryngeal movements.Methods Intraluminal strain‐gauge sensors recorded pressure changes in the oropharynx, hypopharynx and the UES. Motion pictures of the videotapes were fed into a personal computer, and movements of the hyoid bone were measured in both the horizontal and vertical directions as an indication of laryngeal movement.Results In 26‐ and 70‐year‐old men with calcification of the thyroid cartilage, it was determined that the larynx and hyoid bone moved in consonance until the end of the rapid hyoid movements in both the superior and anterior directions. In the 21‐ to 31‐year‐old group, the magnitude of the pressure fall at the UES was maximal before or almost at the same time as the bolus arrival, in preparation for smooth passage of the bolus from the pharynx to the esophagus. The rapid superior movements of the hyoid bone started significantly early as compared with its anterior movements (P = .0001). The rapid anterior movements of the hyoid bone started simultaneously with the pressure fall at the UES. In the elderly, all segmental transit times were significantly increased. The timing of the pressure fall at the UES was significantly delayed and the UES pressure reached its minimum value after arrival of the bolus at the UES. The minimum pressure at the UES increased to a significantly positive value. The rapid anterior movements of the hyoid were significantly delayed, suggesting that this delay causes the delay in the pressure fall at the UES.Conclusions The rapid superior and anterior movements of the hyoid bone are considered to start at the same time as those of the larynx. In the young group, it is suggested that superior laryngeal movement protects the lower airway prior to the anterior laryngeal movement, causing the pressure fall at the UES to enable the passage of a bolus into the UES. In the elderly, smooth passage of the bolus from the pharynx to the esophagus is hindered and the system that prevents aspiration is rendered inefficient by changes in the swallowing pressures and laryngeal movements with aging.
Two‐Dimensional Analysis of Vocal Fold Vibration in Unilaterally Atrophied Larynges
Authors: Kobayashi Joji , Yumoto Eiji , Hyodo Masamitsu , Gyo Kiyofumi 
Published: November 2003

AbstractObjective Considerable inconsistencies regarding the vibratory pattern of the vocal fold among patients with unilateral vocal fold paralysis (UVFP) have been reported. These differences are derived from differences in the position, stiffness, and atrophy of the paralyzed vocal fold and other factors among patients. The purpose of this study was to assess the effects of unilateral atrophy of the vocal fold on vocal fold vibration.Methods Seven excised canine larynges were studied. The unilateral recurrent laryngeal nerve was severed to cause vocal fold atrophy in four of the seven. The lateral and vertical displacements were monitored simultaneously with photoglottography and a laser Doppler vibrometer, respectively. Videostroboscopy of each larynx was also performed before and after the experiment to translate photoglottographic output into absolute lengths. Atrophy of the unilateral vocal fold was confirmed histologically.Results The lateral amplitude was significantly greater than the vertical amplitude in all larynges. The Lissajous trajectories in the normal larynges were shaped like a reverse crescent. Vibration in the unilaterally atrophied larynges was periodical and symmetrical in phase when the thyroid ala on the atrophied side was pressed medially. The lateral and vertical amplitudes on the atrophied side were significantly greater than those on the normal side. The Lissajous trajectories differed from those of the normal larynges.Conclusions In the absence of a prephonatory glottal gap, periodical vibration occurs in unilaterally atrophied larynges and the amplitude of vibrations of the atrophied vocal fold is greater in the lateral and vertical directions than that of the normal fold. This implies that phonosurgical procedures aiming at closure of the prephonatory glottal gap may have a beneficial effect on hoarseness in UVFP patients, although displacements of the vocal folds during vibration are not symmetrical.
Hearing Loss in the Nonocular Stickler Syndrome Caused by a COL11A2 Mutation
Authors: Admiraal Ronald J. C. , Brunner Han G. , Dijkstra Tjard L. , Huygen Patrick L. M. , Cremers Cor W. R. J. 
Published: November 2003

AbstractObjective Evaluation of hearing impairment as a feature of the nonocular Stickler syndrome (type II) linked to COL11A2.Study Design Family study.Methods General, orthopaedic, ophthalmologic, and otorhinolaryngologic examinations were performed on 15 affected persons in a Dutch family. Audiograms were obtained and/or retrieved from elsewhere. Cross‐sectional and longitudinal analyses were conducted on the hearing threshold (sensorineural component) in relation to the patient's age to evaluate whether hearing impairment was progressive.Results Mixed hearing loss, i.e., including a substantial air‐bone gap of up to 20 to 60 dB, was present in six cases, concomitantly with a submucous or overt cleft palate in five of them. The audiograms in 14 evaluable cases showed the following types of threshold: U‐shaped (n = 3), flat (n = 2), flat or gently (downward) sloping (n = 3), gently sloping (n = 3), or steeply sloping (n = 3). Cross‐sectional analysis did not reveal any significant effect of age on sensorineural hearing impairment.Conclusion In contrast to the classic Stickler syndrome (type I) with high myopia, this nonocular type shows a high prevalence of sensorineural hearing impairment. The mean sensorineural hearing threshold in our patients was about 40 dB HL (95% CI,15–65 dB) and was liable to increase (presumably by presbycusis) by several tens of decibels at the highest frequencies. Given the tendency for otitis media to develop in many of these patients, appropriate otologic care is of major importance.
Long‐Term Results of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome
Authors: Boot Henk , van Wegen Robert , Poublon René M. L. , Bogaard Jan M. , Schmitz Paul I. M. , van der Meché Frans G. A. 
Published: November 2003

AbstractObjectives Assessment of the long‐term effect of uvulopalatopharyngoplasty (UPPP) on snoring, excessive daytime sleepiness, and nocturnal oxygen desaturation index (ODI) in patients with obstructive sleep apnea syndrome.Study Design Evaluation of snoring, excessive daytime sleepiness, and ODI in patients treated by UPPP earlier.Materials and Methods Patients (n = 58) with a follow‐up period of 11 to 74 months (median, 34 mo) were included in this study. Snoring and excessive daytime sleepiness were scored on specially designed semiquantitative scales. In all patients ODI was calculated from pulse‐oximetry combined with polysomnography at base line and by polygraphy (MESAM 4) during follow‐up in 38 patients. Long‐term response was compared with 6‐month response in the same cohort.Results There was a long‐term improvement of snoring in 63% of patients, no change in 23%, and a deterioration in 14% (P < .00001). Overall snoring increased slightly between 6 months and long‐term follow‐up. There was an improvement of excessive daytime sleepiness in 38%, no change in 27%, and a deterioration in 35% (P = .80). Excessive daytime sleepiness showed a relapse to preoperative levels between 6 months and long‐term follow‐up. The median improvement of ODI was −1 (95% interpercentile range, 73–51) and was not significant (P = .35). In 5 of 13 patients in whom ODI at baseline exceeded 20, ODI was reduced to less than 20. In 4 of the 38 patients ODI was reduced to less than 5. The improvement of ODI decreased significantly between 6 months and long‐term follow‐up (P = .03). No relation was found between body mass index, Mueller maneuver, X‐cephalometry, and long‐term outcome. An additional finding was that the ODI decreased after UPPP in combination with tonsillectomy, compared with a slight increase after UPPP alone; the difference was significant (P = .008).Conclusion The response to UPPP for obstructive sleep apnea syndrome decreases progressively over the years after surgery. UPPP in combination with tonsillectomy was more effective than UPPP alone.
A Clinicopathologic Series of 22 Cases of Tonsillar Granulomas
Authors: Kardon David E. , Thompson Lester D. R. 
Published: November 2003

AbstractObjectivesTonsils are uncommonly affected by granulomatous inflammation, often with an obscure cause. This study attempts to elucidate the nature of tonsillar granulomatous inflammation.DesignRetrospective clinicopathologic review.MethodsTwenty‐two cases of tonsillar granulomas diagnosed between 1940 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. H&E slides and a series of histochemical stains were reviewed, and patient follow‐up was obtained.ResultsThere were 11 males and 11 females, aged 7 to 64 years (mean, 29.9 y). Most of the cases presented bilaterally (n = 19) with sore throat, dysphagia, and/or nasal obstruction. The clinical differential included chronic tonsillitis, tuberculosis, nonspecific infection, sarcoidosis, and a neoplasm. Histologically, the granulomas were focal and scattered, or diffuse, identified in the interfollicular zones (n = 16) and/or the germinal centers (n = 13), and occasionally associated with necrosis (n = 6). Based on histochemical and clinical follow‐up information, the etiology of the granulomas included sarcoidosis (n = 8), tuberculosis (n = 3), Hodgkin's lymphoma (n = 2), toxoplasmosis (n = 1), squamous cell carcinoma (n = 1), and no specific known cause (n = 7). Twelve patients were either alive at last follow‐up or had died with no evidence of disease (mean, 12.4 y), and 9 were either alive at last follow‐up or had died with disease (mean, 24.9 y). One patient was alive with unknown disease status (lost to follow‐up after 13.3 y).ConclusionsAlthough a cause for tonsillar granulomas is frequently identified, a number may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis. However, a careful work‐up must be conducted to exclude specific causes and avoid clinical mismanagement.
The Uvulopalatal Flap for Reconstruction of the Soft Palate
Authors: Gillespie M. Boyd , Eisele David W. 
Published: November 2003

AbstractObjective To determine the indications, complications, and outcomes of the uvulopalatal flap in the reconstruction of defects of the soft palate.Study Design Retrospective review.Methods Patient data were obtained from the hospital records of 18 patients who had soft palate defects reconstructed with the uvulopalatal flap over a 5‐year period at a tertiary academic medical center.Results Eleven patients had the uvulopalatal flap as the sole method of reconstruction, whereas this flap was used in combination with a radial forearm free flap, pectoralis flap, and skin graft in 4, 2, and 1 patients, respectively. All flaps were successful in soft palate reconstruction. One flap was successfully revised after additional tumor resection. A partial flap dehiscence occurred in one patient and healed uneventfully. Speech and swallowing function was dependent on initial tumor stage and the scope of tumor resection.Conclusions The uvulopalatal flap is a simple and effective method of soft palate reconstruction either alone or in combination with other methods of reconstruction for selected oropharyngeal defects.
The Minimally Invasive Approach to Olfactory Neuroblastoma: Combined Endoscopic and Stereotactic Treatment
Authors: Walch Christian , Stammberger Heinz , Anderhuber Wolfgang , Unger Frank , Köle Wolfgang , Feichtinger Karlheinz 
Published: November 2003

AbstractObjectives To describe a new treatment modality of olfactory neuroblastoma consisting of endoscopic nasal and paranasal sinus surgery and stereotactic radiosurgery.Study Design Retrospective review of three patients suffering from olfactory neuroblastoma.Methods Review of the charts, the computed tomography, and magnetic resonance imaging scans, the operation reports, radiosurgical data, and follow‐up.Results All three patients remained free of disease with excellent quality of life in respective follow‐up periods of 71, 50, and 39 months.Conclusion The combination of two minimally invasive therapies, endoscopic sinus surgery and stereotactic radiosurgery, provide a reliable new approach to the treatment of a series of olfactory neuroblastomas that offers excellent quality of life, less injury to the patient, fewer side‐effects, and fewer long‐term effects than other treatment strategies.
Investigation of the Causal Relationship Between Tracheotomy and Aspiration in the Acute Care Setting
Authors: Leder Steven B. , Ross Douglas A. 
Published: November 2003

AbstractObjective To investigate the causal relationship, if any, between tracheotomy and incidence of aspiration in the acute care setting.Study Design Prospective, consecutive.Patients and Methods Twenty adult patients evaluated between February 1997 and October 1999 participated. Criteria for inclusion were a dysphagia evaluation before tracheotomy, subsequent tracheotomy and placement of a tracheotomy tube, and then a repeat dysphagia evaluation after tracheotomy prior to decannulation. This permitted the causal relationship between tracheotomy and incidence of aspiration to be investigated. Differences between duration of tracheotomy placement and age were analyzed with the Student t test and for nonparametric nominal data the ξ2 test was applied.Results No causal relationship between tracheotomy and aspiration was exhibited, as 19 of 20 (95%) subjects exhibited the same aspiration status before and after tracheotomy. All 12 (100%) subjects who aspirated before tracheotomy also aspirated after tracheotomy and 7 of 8 (88%) subjects who did not aspirate before tracheotomy also did not aspirate after tracheotomy (P > .05). In addition, no significant differences were observed between aspiration status and days since tracheotomy or age (P > .05).Conclusion In the acute care setting, no causal relationship between tracheotomy and aspiration status was exhibited.
Temperature Profile in the Nasal Cavity
Authors: Keck Tilman , Leiacker Richard , Riechelmann Herbert , Rettinger Gerhard 
Published: November 2003

AbstractObjectives/Hypothesis Inspired air is heated and moistened as it passes the nasal cavity. The temperature increase should be similar to a heated tube model, depending on the airflow.Study Design Intranasal temperature values of 50 volunteers were measured after inspiration at different locations: nasal vestibule, nasal valve area, anterior to the head of the middle turbinate, and the nasopharynx. Temperature values were related to nasal airway resistance data.Methods Intranasal temperature measurements were made with a miniaturized thermocouple. Nasal airway resistance was detected by active anterior rhinomanometry.Results A logarithmic increase of air temperature from the anterior segment of the nose to the posterior part was noted. In the nasopharynx temperature was approximately 34°C. The highest increase in temperature was observed in the nasal valve area.Conclusions The temperature increase of ambient air in the nasal airways can be compared with a logarithmic curve of the heating of air passing a heated tube. As the heating of air is important for water transport, the space between the nasal valve and the middle turbinate is of special functional importance. No correlation to the results of rhinomanometry was found.
Rabbit Facial Nerve Regeneration in Autologous Nerve Grafts After Antecedent Injury
Authors: Spector J. Gershon , Lee Patty , Derby Albert 
Published: November 2003

AbstractObjective The effect of incomplete antecedent injuries on subsequent facial nerve regeneration within cable graft repairs is not known. The purpose of this study is to compare facial nerve regeneration after an immediate and delayed neural cable graft repair.Method Rabbit facial nerve regeneration after complete transectional injuries of the buccal division was compared in two experimental models. In one, a 10‐mm segment of the nerve was transected, rotated 180°, and immediately repaired as a cable graft (N=8). In the second, a preliminary nerve crush was allowed to recover over a 4‐week period and a 10‐mm segment of nerve centered on the crush site was then transected, rotated 180°, and delay repaired as a cable graft (N = 7). Data are presented as total numbers of regenerating myelinated axons that traverse the surgical repair to innervate the cable graft and distal nerve stumps, as well as the percentage of regenerating neurites compared with preoperative pooled and individual controls. Subpopulations of regenerating neurons are delineated to quantify the pattern of neural innervation.Results Five weeks after cable graft repair both groups had similar myelinated outgrowth from the proximal nerve stump across the proximal anastomosis to innervate the cable graft (3995 ± 1209 vs. 3284 ± 651;P = .89). However, the delayed repair group had more intrafascicular regeneration within cable grafts (2261 ± 931 vs. 1660 ± 1169;P = .02) and distal nerve stump (1532 ± 281 vs. 445 ± 120;P = .004) than the immediate repair group. The immediate repair group had greater extrafascicular nerve regeneration in the cable graft (2335 ± 1954 vs. 437 ± 236;P = .001) and more myelin and axonal debris in pre‐existing neural fascicles of the cable graft (P = .02) and distal nerve stump (463 ± 187 vs. 103 ± 87;P = .02).Conclusions Antecedent priming lesions do not enhance axonal survival as determined by regenerating myelinated axonal counts. However, antecedent injuries enhance the efficiency of neural innervation of the affected mimetic musculature by increasing the number of myelinated intrafascicular neural regenerants in the cable graft and distal nerve stump. This is accomplished by two factors: increased perineural fibrosis and decreased intrafascicular myelin and axonal debris.
Head and Neck Cancer: The Importance of Oxygen
Authors: Terris David J. 
Published: November 2003

AbstractObjectives To use recently introduced polarographic technology to characterize the distribution of oxygenation in solid tumors, explore the differences between severe hypoxia and true necrosis, and evaluate the ability to predict treatment outcomes based on tumor oxygenation.Study Design Prospective, nonrandomized trial of patients with advanced head and neck cancer, conducted at an academic institution.Methods A total of 63 patients underwent polarographic oxygen measurements of their tumors. Experiment 1 was designed to determine whether a gradient of oxygenation exists within tumors by examining several series of measurements in each tumor. Experiment 2 was an analysis of the difference in data variance incurred when comparing oxygen measurements using oxygen electrodes of two different sizes. Experiment 3 compared the proportion of tumor necrosis to the proportion of very low (≤2.5 mm Hg) polarographic oxygen measurements. Experiment 4 was designed to explore the correlation between oxygenation and treatment outcomes after nonsurgical management.Results No gradient of oxygenation was found within cervical lymph node metastases from head and neck squamous cell carcinomas (P > .9). Tumor measurements achieved with larger (17 μm) electrodes displayed smaller variances than those obtained with smaller (12 μm) electrodes, although this difference failed to reach statistical significance (P = .60). There was no correlation between tumor necrosis and the proportion of very low (≤2.5 mm Hg) oxygen measurements. There was a nonsignificant trend toward poorer locoregional control and overall survival in hypoxic tumors.Conclusions Hypoxia exists within cervical lymph node metastases from head and neck squamous carcinomas, but the hypoxic regions are distributed essentially randomly. As expected, measurements of oxygen achieved with larger electrodes results in lowered variance, but with no change in overall tumor mean oxygen levels. Polarographic oxygen measurements are independent of tumor necrosis. Finally, oxygenation as an independent variable is incapable of predicting prognosis, probably reflecting the multifactorial nature of the biological behavior of head and neck cancers.
Comparative Histology and Vibration of the Vocal Folds: Implications for Experimental Studies in Microlaryngeal Surgery
Authors: Garrett C. Gaelyn , Coleman John R. , Reinisch Lou 
Published: November 2003

AbstractObjectives/Hypothesis To determine the most suitable animal model for experimental studies on vocal fold surgery and function by a histological comparison of the microflap surgical plane and laryngeal videostroboscopy (LVS) in different species of animals. A second goal was to determine how the layered vocal fold structure in humans and three different animal species affects surgical dissection within the lamina propria.Study Design Prospective laboratory.Methods Three larynges each from dogs, monkeys, and pigs were compared with three ex vivo human larynges. Microflap surgery was performed on one vocal fold from each larynx. Both the operated and nonoperated vocal folds were examined histologically using stains specific for elastin, mature collagen, and ground substance. Based on the histological results, LVS was performed on two dogs and two pigs after first performing a tracheotomy for ventilation and airflow through the glottis. Arytenoid adduction sutures were placed to facilitate vocal fold adduction.Results The distributions of the collagen and elastin fibers were found to differ among the species with concentrations varying within species. Unlike the human vocal fold, which has a higher elastin concentration in the deeper layers of the lamina propria, both the pig and the dog had a thin band of elastin concentrated just deep to the basement membrane zone in the superficial layer. Just deep to this thin band, the collagen and the elastin were less concentrated. The monkey vocal fold had a very thin mucosal layer with less elastin throughout the mucosa. The microflap dissections in each of the dog, pig, and human vocal folds were similar, being located within that portion of the superficial lamina propria where the elastin and mature collagen are less concentrated. The microflap plane in the monkey vocal fold was more deeply located near the vocalis fibers. Despite the differences in elastin concentration, the microflap plane in both the dog and the pig was found to be similar to that in humans. The dog anatomy was much more suitable for microsuspension laryngoscopy and stroboscopic examination. The dog vocal folds vibrated in a similar fashion to human vocal folds with mucosal waves and vertical phase differences, features not seen in the pig vocal folds.Conclusions Based on both the histological and stroboscopic results, the dog was believed to be a more suitable animal model for studies on vocal fold surgery, acknowledging that no animal's laryngeal anatomy is identical to that of the human. The dog LVS model presented allows for longitudinal laryngeal studies requiring repeated examinations at multiple time periods with histological correlation applied at sacrifice.