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Laryngoscope
Kinds of Laryngoscope Terms modified by Laryngoscope Selected AbstractsImproved treatment of sudden hearing loss by specific fibrinogen aphaeresisJOURNAL OF CLINICAL APHERESIS, Issue 2 2004Heidrun Ullrich Abstract The etiology of sudden sensorineural hearing loss is still unclear and is thought to result from disturbances of microcirculation, infectious causes, or autoimmune disorders. So far standard therapy did not show clear improvement over spontaneous remission rate, which is assumed to be about 50% [Nakashima et al., Acta. Otolaryngol. Stockh. 514:14,16, 1994; Schuknecht and Donovan, Arch. Otorhinolaryngol. 243:1,15, 1986; Harris and Sharp, Laryngoscope 100:516,524, 1990; Mayot et al., Clin. Immunol. Immunopath. 68:41,45, 1993; Gussen, Ann. Otol. Rhinol. Laryngol. 85:94,100, 1976]. Elevated blood viscosity due to high fibrinogen levels is supposed to cause decreased cochlear blood flow and thus initiate sudden hearing loss. The specific lowering of fibrinogen immediately decreases plasma viscosity exactly to the desired extent and should lead to improved cochlear blood flow [Suckfüll et al., Acta. Otolaryngol 119:763,766, 1999; Suckfüll, Lancet 360:1811,1817, 2002; Walch et al., Laryngol. Rhino. Otol. 75:641,645, 1996; Suckfüll et al., Otol. Neurotol. 23:309,311, 2002]. In a prospective uncontrolled pilot study on 36 patients with unilateral sudden onset sensorineural hearing loss (SHL) we tried to establish that 1,3 specific fibrinogen aphaereses alone improve recovery of hearing and that it is possible to lower fibrinogen to the target of 80,100 mg/dl without important side effects. Pure tone audiometry was carried out immediately before and after each aphaeresis as well as at 2 and 4 weeks and 6 months after treatment. Sixteen patients recovered spontaneously before undergoing fibrinogen adsorption. All 20 aphaeresis patients improved during immunoadsorption; in 60% of patients auditory thresholds returned to normal after the first immunoadsorption and treatment could be discontinued, in another 20% of patients complete recovery was reached after 4 weeks. The mean plasma fibrinogen concentration of the 20 patients before the first aphaeresis session was 308.1 ± 51.5 mg/dl. Immediately after the first treatment session, the fibrinogen concentration was lowered to 100.7 ± 25.3 mg/dl (P < 0.001). The second and third sessions also showed highly significant reductions in plasma fibrinogen. No important side effects were seen. In conclusion, specific fibrinogen adsorption is a promising new treatment modality that should be tested in a prospective, randomized controlled trial in patients with sudden hearing loss. J. Clin. Apheresis 19:71,78, 2004. © 2004 Wiley-Liss, Inc. [source] This Month in LaryngoscopeTHE LARYNGOSCOPE, Issue 10 2010This Month in Laryngoscope No abstract is available for this article. [source] Automated high-level disinfection of nonchanneled flexible endoscopes: Duty cycles and endoscope repair,,§THE LARYNGOSCOPE, Issue 10 2010Melissa McCarty Statham MD Abstract Purpose: Guidelines issued by the Association of Operating Room Nurses and the Association of Professionals in Infection Control and Epidemiology recommend high-level disinfection (HLD) for semicritical instruments, such as flexible endoscopes. We aim to examine the durability of endoscopes to continued use and automated HLD. We report the number of duty cycles a flexible endoscope can withstand before repairs should be anticipated. Methods: Retrospective review. Results: A total of 4,336 endoscopic exams and subsequent disinfection cycles were performed with 60 flexible endoscopes in an outpatient tertiary pediatric otolaryngology practice from 2005 to 2009. All endoscopes were systemically cleaned with mechanical cleansing followed by leak testing, enzymatic cleaning, and exposure to Orthophthaldehyde (0.55%) for 5 minutes at a temperature of at least 25°C, followed by rinsing for 3 minutes. A total of 77 repairs were performed, 48 major (average cost $3,815.97), and 29 minor (average cost $326.85). On average, the 2.2-mm flexible endoscopes were utilized for 61.9 examinations before major repair was needed, whereas the 3.6 mm endoscopes were utilized for 154.5 exams before needing minor repairs. No major repairs have been needed to date on the 3.6-mm endoscopes. Conclusions: Automated endoscope reprocessor use for HLD is an effective means to disinfect and process flexible endoscopes. This minimizes variability in the processing of the endoscopes and maximizes the rate of successful HLD. Even when utilizing standardized, automated HLD and limiting the number of personnel processing the endoscopes, smaller fiberoptic endoscopes demonstrate a shortened time interval between repairs than that seen with the larger endoscopes. Laryngoscope, 2010 [source] Human papillomavirus and WHO type I nasopharyngeal carcinoma,,THE LARYNGOSCOPE, Issue 10 2010Emily J. Lo BA Abstract Objectives: Nasopharyngeal carcinoma (NPC) is a rare cancer in the United States. An association between NPC and Epstein-Barr virus (EBV) is well-established for World Health Organization (WHO) types II and III (WHO-II/III) NPC but less well-established for WHO type I (WHO-I) NPC. Given the rise in oropharyngeal tumors positive for high-risk human papillomavirus (HPV) and the unique biology of WHO-I NPC, we examined the relationship between HPV and WHO-I NPC. Study Design: Retrospective case-comparison study. Methods: A search of a large multidisciplinary cancer center tumor registry identified 183 patients seen from January 1999 to December 2008 with incident NPC and no prior cancer. Available paraffin-embedded tumor specimens (N = 30) were analyzed for oncogenic HPV status by in situ hybridization (ISH) and polymerase chain reaction (PCR) for HPV-16 and HPV-18; EBV status by ISH; and p16 expression by immunohistochemistry. Demographic parameters, including race and smoking, were obtained from the medical records. Results: Among the 18 WHO-I NPC patients, 66% (N = 12) were smokers and 17% (N = 3) Asian; among the 165 WHO-II/III NPC patients, 44% (N = 73) were smokers and 24% (N = 39) Asian. Eight WHO-I NPC patients had available paraffin blocks; five of six were HPV-16-positive by PCR and four of eight were HPV-positive by ISH; only two of eight (25%) were EBV-positive. Twenty-two WHO-II/III NPC patients had available paraffin blocks; only 1 was HPV-positive by ISH, and 13 of 22 (60%) were EBV-positive. Conclusions: These results suggest that WHO-I NPC is associated with oncogenic HPV, although larger studies are needed to verify these findings. Laryngoscope, 2010 [source] Isolated laryngeal myokymia: Diagnosis and treatment,THE LARYNGOSCOPE, Issue 10 2010Jacob Sedgh MD Abstract Myokymia is an uncommon neuromuscular disorder that rarely affects the human larynx. No previous reports of isolated laryngeal myokymia are present in the literature, and as such, established treatment protocols are lacking. We report the first case of isolated laryngeal myokymia in a 48-year-old woman with no other neurological findings, and our successful results in initial treatment and maintenance therapy with focal intralaryngeal injections of botulinum toxin A. Laryngoscope, 2010 [source] Laser stimulation of single auditory nerve fibers,,§¶,THE LARYNGOSCOPE, Issue 10 2010Philip D. Littlefield MD Abstract Objectives/Hypothesis: One limitation with cochlear implants is the difficulty stimulating spatially discrete spiral ganglion cell groups because of electrode interactions. Multipolar electrodes have improved on this some, but also at the cost of much higher device power consumption. Recently, it has been shown that spatially selective stimulation of the auditory nerve is possible with a mid-infrared laser aimed at the spiral ganglion via the round window. However, these neurons must be driven at adequate rates for optical radiation to be useful in cochlear implants. We herein use single-fiber recordings to characterize the responses of auditory neurons to optical radiation. Study Design: In vivo study using normal-hearing adult gerbils. Methods: Two diode lasers were used for stimulation of the auditory nerve. They operated between 1.844 ,m and 1.873 ,m, with pulse durations of 35 ,s to 1,000 ,s, and at repetition rates up to 1,000 pulses per second (pps). The laser outputs were coupled to a 200-,m-diameter optical fiber placed against the round window membrane and oriented toward the spiral ganglion. The auditory nerve was exposed through a craniotomy, and recordings were taken from single fibers during acoustic and laser stimulation. Results: Action potentials occurred 2.5 ms to 4.0 ms after the laser pulse. The latency jitter was up to 3 ms. Maximum rates of discharge averaged 97 ± 52.5 action potentials per second. The neurons did not strictly respond to the laser at stimulation rates over 100 pps. Conclusions: Auditory neurons can be stimulated by a laser beam passing through the round window membrane and driven at rates sufficient for useful auditory information. Optical stimulation and electrical stimulation have different characteristics; which could be selectively exploited in future cochlear implants. Laryngoscope, 2010 [source] This Month in LaryngoscopeTHE LARYNGOSCOPE, Issue 9 2010This Month in Laryngoscope No abstract is available for this article. [source] Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: A subset analysis of the university of pennsylvania transoral robotic surgery trial,THE LARYNGOSCOPE, Issue 9 2010Gregory S. Weinstein MD Abstract Objectives/Hypothesis: The purpose of this study was to determine the regional recurrence rate of node-positive oropharyngeal squamous cell carcinoma (OPSCC) in patients undergoing transoral robotic surgery (TORS) and selective neck dissection (SND) followed by observation, radiation, or concurrent chemoradiation. Study Design: A prospective, phase I, single-arm study was conducted. All OPSCC patients who voluntarily participated in a surgical trial with TORS and SND at an academic tertiary referral center from May 2005 to July 2007 were included. Methods: Thirty-one patients with previously untreated OPSCC undergoing TORS and SND (29 unilateral and two bilateral) were included. There were 29 males and two females, with ages ranging from 36 to 76 years (median = 55 years) with one palate, one lateral wall, 17 tonsil, 11 base of tongue, and one vallecula primary tumor classified as follows: T1 (n = 9, 29%), T2 (n = 15, 48.4%), T3 (n = 7, 22.6%), N0 (n = 6, 19.4%), N1 (n = 15, 48.4%), N2b (n = 10, 32.3%), and N2c (n = 1, 3.2%). There were three stage I (9.7%), two stage II (6.5%), 15 stage III (48.4%) and 11 stage IVa (35.5%) patients. Twenty-two patients were treated postoperatively with adjuvant therapy (12 radiation alone and 12 combined radiation and chemotherapy). Primary outcome measured was regional recurrence rate. Results: There was one regional recurrence on the contralateral, non-operated neck and one distant recurrence among the 31 patients who underwent SND. Conclusions: SND after TORS resection of primary OPSCC enables the use of selective and deintensified adjuvant therapy to reduce regional recurrence rates. Laryngoscope, 2010 [source] Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis,THE LARYNGOSCOPE, Issue 9 2010Follow-Up at Six Months Abstract Objectives/Hypothesis: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the long-term treatment of unilateral vocal fold paralysis (UVFP). Study Design: A retrospective study of patients with UFVP who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and November 18, 2005. Methods: The data analyzed included patient characteristics and type of intervention, along with the pretreatment and post-treatment parameters of videostrobolaryngoscopy, perceptual voice analysis, and patients' subjective assessment of voice handicap. Results: Thirty-four patients were evaluated, 15 new and 19 from a previous study. The average time from intervention to post-treatment evaluation in the new cohort was 4.8 months (range, 1.5,10.5 months). The average time from intervention to post-treatment in the combined cohort was 6.4 months (range, 1,24 months). Improvements were demonstrated in each of the measured voice parameters in both the injection and the medialization groups, and no significant differences were found in the degree of improvement between the two groups. Limited data on aerodynamic and acoustic voice measurements showed a trend toward improvement in each treatment group. Conclusions: Injection and medialization laryngoplasty were comparable in achieving voice improvement at the average long-term follow-up of 6 months. Laryngoscope, 2010 [source] A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility,THE LARYNGOSCOPE, Issue 9 2010M. Kür, at Gökcan MD Abstract Objectives/Hypothesis: To evaluate airway sufficiency and airflow dynamics in a group of patients who underwent a posterior transverse laser cordotomy (PTLC) procedure. Study Design: Mixed methods research, university hospital setting. Methods: Sixteen patients who underwent a PTLC procedure volunteered to be involved in this study. Dyspnea levels, voice, and glottic opening in indirect laryngoscopy were evaluated subjectively. The airway was evaluated objectively by pulmonary function tests, and glottic areas were measured from axial computed tomography (CT) images. The control group consisted of 63 subjects from the tomography archive. For computational fluid dynamics (CFD) analyses, two subjects from the study group were chosen on the basis of obstruction level, and a normal female subject was selected from the control group. Cartesian coordinates for airway boundaries were determined from axial CT images, and a three-dimensional computational model of the larynx was constructed. Flow simulations were performed with two different flow conditions during inspiration. Comparison of velocity, static pressure, turbulence intensity, and wall shear stress distribution values were made between selected cases and control. Results: Pulmonary data varied widely and did not correlate with the size of the glottic area or dyspnea level. CFD analyses revealed that in addition to obstruction at the glottic level, aerodynamic properties of the larynx are altered due to loss in muscular tonus. Also, the contour of the glottic opening was found to be very important in determining the character of airflow as laminar or turbulent. Conclusions: Patients have considerable differences in their flow patterns and force distributions during respiration. Patient-specific models may help in evaluation and treatment planning. Laryngoscope, 2010 [source] Systemic steroid reduces long-term hearing loss in experimental pneumococcal meningitis,THE LARYNGOSCOPE, Issue 9 2010Lise Worsøe MD Abstract Objectives/Hypothesis: Sensorineural hearing loss is a common complication of pneumococcal meningitis. Treatment with corticosteroids reduces inflammatory response and may thereby reduce hearing loss. However, both experimental studies and clinical trials investigating the effect of corticosteroids on hearing loss have generated conflicting results. The objective of the present study was to determine whether systemic steroid treatment had an effect on hearing loss and cochlear damage in a rat model of pneumococcal meningitis. Study Design: Controlled animal study of acute bacterial meningitis. Methods: Adult rats were randomly assigned to two experimental treatment groups: a group treated with systemic steroid (n = 13) and a control group treated with saline (n = 13). Treatment was initiated 21 hours after infection and repeated once a day for three days. Hearing loss and cochlear damage were assessed by distortion product otoacoustic emissions (DPOAE), auditory brainstem response (ABR) at 16 kHz, and spiral ganglion neuron density. Results: Fifty-six days after infection, steroid treatment significantly reduced hearing loss assessed by DPOAE (P < .05; Mann-Whitney) and showed a trend toward reducing loss of viable neurons in the spiral ganglion (P = .0513; Mann-Whitney). After pooling data from day 22 with data from day 56, we found that systemic steroid treatment significantly reduced loss of spiral ganglion neurons (P = .0098; Mann-Whitney test). Conclusions: Systemic steroid treatment reduces long-term hearing loss and loss of spiral ganglion neurons in experimental pneumococcal meningitis in adult rats. The findings support a beneficial role of anti-inflammatory agents in reducing hearing loss and cochlear damage in meningitis. Laryngoscope, 2010 [source] Inferior retrotympanum revisited: An endoscopic anatomic study,THE LARYNGOSCOPE, Issue 9 2010Daniele Marchioni MD Abstract Objectives/Hypothesis: To describe the inferior retrotympanic anatomy from an endoscopic perspective. Study Design: This was an anatomic study on a retrospective case series. Methods: During November 2009 and December 2009, videos from endoscopic middle ear procedures carried out between June 2007 and November 2009 and stored in our database were retrospectively reviewed. Surgeries in which the inferior retrotympanic region was visualized were included in the study. Accurate descriptions of the anatomic findings were made for each ear included in the study group. Results: The final study group consisted of 25 videos from 25 ear procedures. In 14/25 subjects, a bony ridge connecting the inferior portion of the styloid prominence to the anterior and inferior lip of the round window niche (Proctor's sustentaculum promontory) was identified and renamed the finiculus (from the Latin finis, - is: borderline), representing the ideal limit between the inferior retrotympanum and hypotympanum. In 14/25 patients, a complete sinus subtympanicus could be identified, lying between the subiculum and finiculus. Conclusions: Endoscopic exploration of the middle ear might guarantee a very good exposure of the inferior retrotympanum, allowing detailed anatomic descriptions of this hidden area. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Laryngoscope, 2010 [source] A prospective study of cardiovascular risk factors and incident hearing loss in men,,THE LARYNGOSCOPE, Issue 9 2010Josef Shargorodsky MD Abstract Objectives/Hypothesis: Hearing loss is the most common sensory disorder in the United States, affecting more than 36 million people. Cardiovascular risk factors have been associated with the risk of hearing loss in cross-sectional studies, but prospective data are currently lacking. Study Design: Prospective cohort study. Methods: We prospectively evaluated the association between diagnosis of hypertension, diabetes mellitus, hypercholesterolemia, smoking, or body mass index (BMI) and incident hearing loss. Participants were 26,917 men in the Health Professionals Follow-up Study, aged 40 to 74 years at baseline in 1986. Study participants completed questionnaires about lifestyle and medical history every 2 years. Information on self-reported professionally diagnosed hearing loss and year of diagnosis was obtained from the 2004 questionnaire, and cases were defined as hearing loss diagnosed between 1986 and 2004. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox proportional hazards regression models. Results: A total of 3,488 cases of hearing loss were identified. History of hypertension (HR 0.96; 95% confidence interval [CI], 0.88-1.03), diabetes mellitus (HR 0.92; 95% CI, 0.78,1.08), or obesity (HR 1.02; 95% CI, 0.90,1.15 for BMI ,30 compared to normal range of 19,24.9) was not significantly associated with hearing-loss risk. Hypercholesterolemia (HR 1.10; 95% CI, 1.02,1.18) and past smoking history (HR 1.09; 95% CI, 1.01,1.17) were associated with a significantly increased risk of hearing loss after multivariate adjustment. Conclusions: A history of hypertension, diabetes mellitus, or obesity is not associated with increased risk of hearing loss; a history of past smoking or hypercholesterolemia has a small but statistically significant association with increased risk of hearing loss in adult males. Laryngoscope, 2010 [source] This Month in LaryngoscopeTHE LARYNGOSCOPE, Issue 8 2010This Month in Laryngoscope No abstract is available for this article. [source] Outcomes following temporal bone resection,,THE LARYNGOSCOPE, Issue 8 2010Nichole R. Dean DO Abstract Objectives/Hypothesis: To evaluate survival outcomes in patients undergoing temporal bone resection. Study Design: Retrospective review. Methods: From 2002 to 2009 a total of 65 patients underwent temporal bone resection for epithelial (n = 47) and salivary (n = 18) skull base malignancies. Tumor characteristics, defect reconstruction, and postoperative course were assessed. Outcomes measured included disease-free survival and cancer recurrence. Results: The majority of patients presented with recurrent (65%), advanced stage (94%), cutaneous (72%), and squamous cell carcinoma (57%). Thirty-nine patients had perineural invasion (60%) and required facial nerve resection; 16 (25%) had intracranial extension. Local (n = 6), regional (n = 2), or free flap (n = 46) reconstruction was required in 80% of patients. Free flap donor sites included the anterolateral thigh (31%), radial forearm free flap (19%), rectus (35%), and latissimus (4%). The average hospital stay was 4.9 days (range, 1,28 days). The overall complication rate was 15% and included stroke (n = 4), cerebrospinal fluid leak (n = 2), hematoma formation (n = 1), infection (n = 1), flap loss (n = 1), and postoperative myocardial infarction (n = 1). A total of 22 patients (34%) developed cancer recurrence during the follow-up period (median, 10 months), 17 (77%) of whom presented with recurrent disease at the time of temporal bone resection. Two-year disease-free survival was 68%, and 5-year disease-free survival was 50%. Conclusions: Aggressive surgical resection and reconstruction is recommended for primary and recurrent skull base malignancies with acceptable morbidity and improved disease-free survival. Laryngoscope, 2010 [source] Combinatorial treatments enhance recovery following facial nerve crush,,THE LARYNGOSCOPE, Issue 8 2010Nijee Sharma BS Abstract Objectives/Hypothesis: To investigate the effects of various combinatorial treatments, consisting of a tapering dose of prednisone (P), a brief period of nerve electrical stimulation (ES), and systemic testosterone propionate (TP) on improving functional recovery following an intratemporal facial nerve crush injury. Study Design: Prospective, controlled animal study. Methods: After a right intratemporal facial nerve crush, adult male Sprague-Dawley rats were divided into the following eight treatment groups: 1) no treatment, 2) P only, 3) ES only, 4) ES + P, 5) TP only, 6) TP + P, 7) ES + TP, and 8) ES + TP + P. For each group n = 4,8. Recovery of the eyeblink reflex and vibrissae orientation and movement were assessed. Changes in peak amplitude and latency of evoked response, in response to facial nerve stimulation, was also recorded weekly. Results: Brief ES of the proximal nerve stump most effectively accelerated the initiation of functional recovery. Also, ES or TP treatments enhanced recovery of some functional parameters more than P treatment. When administered alone, none of the three treatments improved recovery of complete facial function. Only the combinatorial treatment of ES + TP, regardless of the presence of P, accelerated complete functional recovery and return of normal motor nerve conduction. Conclusions: Our findings suggest that a combinatorial treatment strategy of using brief ES and TP together promises to be an effective therapeutic intervention for promoting regeneration following facial nerve injury. Administration of P neither augments nor hinders recovery. Laryngoscope, 2010 [source] Three-dimensional arytenoid movement induced by vocal fold injections,THE LARYNGOSCOPE, Issue 8 2010Ted Mau MD Abstract Objectives/Hypothesis: To quantitatively characterize arytenoid movement induced by vocal fold injection augmentation in an excised larynx model. Study Design: Laboratory and computational. Methods: Vocal folds of human cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained before and after injection. Densities corresponding to the arytenoid and cricoid cartilages were extracted and processed with custom MATLAB routines to generate selective three-dimensional reconstructions of the larynx. Pre- and postinjection positions of the arytenoid were compared. Results: Vocal fold injections resulted in predominantly small-magnitude medial rotation and medial translation of the arytenoid. Movements in other directions as would be expected in physiologic adduction were not observed. Conclusions: Vocal fold injection augmentation induced passive movement of the arytenoid that has not been described previously. This movement does not reproduce the trajectory of physiologic adduction. This finding has implications for the treatment of unilateral vocal fold paralysis without arytenoid repositioning maneuvers. Laryngoscope, 2010 [source] Simulated reflux decreases vocal fold epithelial barrier resistance,,THE LARYNGOSCOPE, Issue 8 2010CF-SLP, Elizabeth Erickson MS Abstract Objectives/Hypothesis: The vocal fold epithelium provides a barrier to the entry of inhaled and systemic challenges. However, the location of the epithelium makes it vulnerable to damage. Past research suggests, but does not directly demonstrate, that exposure to gastric reflux adversely affects the function of the epithelial barrier. Understanding the nature of reflux-induced epithelial barrier dysfunction is necessary to better recognize the mechanisms for vocal fold susceptibility to this disease. Therefore, we examined the effects of physiologically relevant reflux challenges on vocal fold transepithelial resistance and gross epithelial and subepithelial appearance. Study Design: Ex vivo, mixed design with between-group and repeated-measures analyses. Methods: Healthy, native porcine vocal folds (N = 52) were exposed to physiologically relevant acidic pepsin, acid-only, or pepsin-only challenges and examined with electrophysiology and light microscopy. For all challenges, vocal folds exposed to a neutral pH served as control. Results: Acidic pepsin and acid-only challenges, but not pepsin-only or control challenges significantly reduced transepithelial resistance within 30 minutes. Reductions in transepithelial resistance were irreversible. Challenge exposure produced minimal gross changes in vocal fold epithelial or subepithelial appearance as evidenced by light microscopy. Conclusions: These findings demonstrate that acidic environments characteristic of gastric reflux compromise epithelial barrier function without gross structural changes. In healthy, native vocal folds, reductions in transepithelial resistance could reflect reflux-related epithelial disruption. These results might guide the development of pharmacologic and therapeutic recommendations for patients with reflux, such as continued acid-suppression therapy and patient antireflux behavioral education. Laryngoscope, 2010 [source] Laryngeal sensory deficits in patients with chronic cough and paradoxical vocal fold movement disorder,THE LARYNGOSCOPE, Issue 8 2010Thomas Murry PhD Abstract Objectives/Hypothesis: Although the diagnostic accuracy of paradoxical vocal fold movement disorder and chronic cough has improved, the underlying pathophysiology remains relatively unknown. We hypothesize that one potential etiological factor in these patients is an aberrant laryngeal sensory response and sought to determine if respiratory retraining in addition to antireflux therapy alters this aberrant response. Study Design: Retrospective, outcomes. Methods: Sixteen patients who had been on at least 3 months of twice-daily proton pump inhibitors with no subjective improvement in their primary complaint of cough, self-reported symptoms of gastroesophageal and laryngopharyngeal reflux, and concurrent paradoxical vocal fold movement (PVFM) were included in the current study. In addition to continuing twice daily pharmacological therapy, subjects underwent a course of respiratory retraining. Outcome measures including the Reflux Symptom Index (RSI), transnasal flexible laryngoscopy, and laryngopharyngeal sensory discrimination thresholds were obtained prior to and following a course of respiratory retraining. Results: Mean bilateral laryngeal sensory response improved significantly after combined respiratory retraining and aggressive proton pump inhibitor therapy (P = .01). In addition, mean RSI score decreased significantly following treatment (P = .02). Specifically, 13 of 16 patients experienced improved sensory response, corresponding with patient reports of improved PVFM symptoms following treatment. Conclusions: Aberrant laryngeal sensation was identified in patients with PVFM and chronic cough. This response, however, normalized following a limited course of respiratory retraining, corresponding with improved patient symptoms. Laryngoscope, 2010 [source] Cigarette smoke condensate induces nuclear factor kappa-b activity and proangiogenic growth factors in aerodigestive cells,THE LARYNGOSCOPE, Issue 8 2010Joseph Rohrer MD Abstract Objectives/Hypothesis: Aerodigestive cancer risk of both lung and head and neck cancers has been linked to the genotoxic effects of tobacco use. These effects include upregulation of nuclear factor kappa-B (NF,B) and its downstream products associated with both lung and head and neck cancer malignant progression. Study Design: Bench Research. Methods: In the present study we examined the effects of cigarette smoke condensate on functional activation of NF,B in human papillomavirus (HPV)-transformed oral cavity cells (HOK 16B cells) and transformed bronchial epithelium (Beas2B cells) using the head and neck squamous cancer cell line, UMSCC 38, as a comparison. Luciferase reporter gene assays with two types of transiently transfected NF,B reporter genes were employed and downstream NF,B-dependent products, interleukin-6, interleukin-8, and vascular endothelial growth factor, were assayed by enzyme-linked immunosorbent assay. Results: All cell lines were able to dose dependently activate NF,B reporter genes after exposure to cigarette smoke condensate (P < .05). However, the HPV premalignant, transformed cell line had a much more robust NF,B response (3.45-fold) versus the squamous cancer cell line (1.62-fold) and SV40 transformed Beas2B (1.83). Both NF,B reporter genes had similar response curves. Conclusions: This study demonstrates cigarette smoke products might be more potent promoters of an NF,B-dependent progression from HPV+ premalignancy to cancer rather than after tumors are established. Future studies should focus on abrogating NF,B increases during malignant progression and premalignancy. This might be even more relevant in the HPV+ patient with premalignancy. Laryngoscope, 2010 [source] Familial aggregation of olfactory impairment and odor identification in older adults,THE LARYNGOSCOPE, Issue 8 2010Laura A. Raynor MS Abstract Objectives/Hypothesis: The objective of this analysis was to estimate the genetic contributions to olfactory impairment. Study Design: Population based. Methods: Olfactory impairment was measured using the San Diego Odor Identification Test at the 5-year follow-up examination for the population-based Epidemiology of Hearing Loss study. Subjects were classified as impaired if they correctly identified fewer than six out of eight odorants. To reduce confounding by age, analysis was restricted to subjects who were 60 to 79 years of age. Familial aggregation was evaluated by heritability estimates, tetrachoric correlations, and odds ratios in 207 sibling pairs from 135 sibships. Results: The prevalence of olfactory impairment was 20.2% overall and was higher in men. After adjustment for sex, age, and smoking, heritability of olfactory impairment was moderate (h2 = 0.55), although not statistically significantly different from 0 (P = .09). By contrast, the adjusted heritability estimate for bubble gum, one of the individual odorants, was significant (h2 = 0.51; P = .01). Conclusions: Genetic factors might contribute to general olfactory impairment in older adults, but the strength of familial aggregation differs for individual odorants, a finding consistent with prior research. Laryngoscope, 2010 [source] Prevalence of laryngomalacia in children presenting with sleep-disordered breathing,,§¶THE LARYNGOSCOPE, Issue 8 2010Mahilravi Thevasagayam FRCS(Ed) FRCS (ORL-HNS) Abstract Objective: To determine the prevalence of laryngomalacia among children presenting with symptoms of sleep-disordered breathing (SDB). Method: A retrospective observational study was conducted at a tertiary care paediatric hospital. All children presenting with SDB during a 55-month period were investigated using sleep nasopharyngoscopy (SNP). Patients who had laryngomalacia were identified. Patients who did not present primarily with SDB, or were not examined with SNP were excluded. Data for analysis was collected from a prospectively kept surgical database and medical records. This included patients' demographics, symptoms (including symptoms in infancy), diagnoses, SNP findings, overnight pulse oximetry findings, and treatment. Results: We identified 358 patients with documented primary diagnosis of SDB and who had undergone SNP. Fourteen of these also had a documented diagnosis of laryngomalacia, giving a prevalence rate of 3.9%. Three children were syndromic, and one had cerebral palsy in addition to SDB and laryngomalacia. Three children were obese, and three children had gastroesophageal reflux disease. Seven cases (50%) had symptoms of snoring and/or swallowing dysfunction and/or stridor in infancy. Twelve patients had adenotonsillar surgery. In eight cases symptoms resolved completely with adenotonsillar surgery only. In total, six patients had a supraglottoplasty. There were three failures to supraglottoplasty. Conclusion: The prevalence of laryngomalacia within children presenting with SDB is 3.9%. Our findings support full evaluation of the airway to identify the site of pathology mediating SDB symptoms. Laryngoscope, 2010 [source] Surgery for chronic rhinosinusitis may improve sleep and sexual function,THE LARYNGOSCOPE, Issue 8 2010Michael S. Benninger MD Abstract Objectives/Hypothesis: This study was designed to evaluate the impact of surgery on the sexual function and sleep function of patients with chronic rhinosinusitis (CRS). Study Design: A retrospective review of a cohort of prospectively enrolled patients with chronic rhinosinusitis who have undergone endoscopic sinus surgery. Methods: Each patient completed the Rhinosinusitis Disability Index (RSDI) prior to surgery and at least nine months following endoscopic sinus surgery, and the preoperative and postoperative scores for the questions related to sleep and sexual activity were evaluated. Wilcoxon signed-rank test was used to assess the magnitude and direction of change between observation points. Results: Mean response scores regarding sexual activity between preoperative (1.1 ± 1.0) and postoperative scores (0.7 ± 0.8) are significantly different (P < .001). Mean response scores regarding sleep dysfunction between preoperative (2.4 ± 1.0) and postoperative scores (1.5 ± 1.1) are also significantly different (P < .001). For both questions, a higher frequency of subjects responded "never" and "almost never" in the postoperative period compared with preoperative measures. Conclusions: Using the questions from the RSDI, there is an improvement in scores of sexual function and sleep after surgery for patients with chronic rhinosinusitis. Further, more in-depth evaluations of these potential benefits are needed. Laryngoscope, 2010 [source] This Month in LaryngoscopeTHE LARYNGOSCOPE, Issue 7 2010This Month in Laryngoscope No abstract is available for this article. [source] An electron microscopic study,Correlation of gastroesophageal reflux disease and laryngopharyngeal reflux,THE LARYNGOSCOPE, Issue 7 2010Sanghoon Park MD Abstract Objectives/Hypothesis: Laryngopharyngeal reflux (LPR) originates from regurgitation of gastric contents, a mechanism seemingly identical to gastroesophageal reflux disease (GERD). Some researchers postulate a connection between LPR and GERD, whereas some assert LPR is a disease apart from GERD. We examined symptoms of GERD from LPR patients, and performed gastrointestinal endoscopy and transmission electron microscopy (TEM) to evaluate GERD findings from these patients. Study Design: Prospective study at an academic tertiary care center. Methods: Control subjects had no symptoms or signs of LPR/GERD. LPR was diagnosed with a Reflux Symptom Index >13 and Reflux Finding Score >7, and were questioned for GERD-related symptoms and examined with esophagogastroduodenoscopy, then allocated into either an LPR without GERD or LPR with GERD group. Esophageal tissues were obtained from the squamocolumnar junction and managed for TEM, and the intercellular space (IS) was measured to find dilatation, a characteristic GERD finding. Results: About 30% (8/26) of LPR patients showed GERD-related symptoms, connecting LPR with the GERD group. Most of the LPR patients showed grossly normal endoscopic findings. On TEM, IS of control group (n = 15) was measured as 0.35 ± 0.27 ,m, whereas the LPR without GERD group (n = 18) and LPR with GERD group (n = 8) revealed a dilated IS of 0.61 ± 0.47 ,m and 0.95 ± 0.44 ,m, respectively. This difference was statistically significant compared to the control group (P < .05). Conclusions: The mean IS of LPR was significantly increased, suggesting common pathogenesis between LPR and GERD. Laryngoscope, 2010 [source] An easy method for fitting conventional endoscopes for pneumatic video Otoscopy,THE LARYNGOSCOPE, Issue 7 2010Hans Wilhelm Pau MD Abstract Laryngoscope, 2010 [source] Audiological outcome of the pull-back technique in cochlear implantees,THE LARYNGOSCOPE, Issue 7 2010Dietmar Basta PhD Abstract Objectives/Hypothesis: The distance of the cochlear implant electrode contacts to the modiolus can be reduced by a surgical technique called "pull-back." This procedure changes the location of the fully inserted electrode array by moving the electrode out of the cochlea until the first silicon ring is visible in the cochleostomy. This leads to a more focused stimulation, which in turn could possibly improve hearing performance. The objective of the present study was to investigate the influence of the pull-back technique on frequency difference limens (FDL) and speech perception. Study Design: Double-blind trial. Methods: Twelve pull-back and 12 matched controls (matched by age, gender, duration of deafness, and duration of implant use) were used. Twenty-four patients were implanted with the Nucleus-24 Contour Advance array. In 12 patients the pull-back technique was used and in 12 matched controls a standard insertion technique was applied. Twelve months after the initial stimulation speech perception, spread of neuronal excitation (SOE) at electrodes 5, 10, and 15; and FDLs at 1, 2, and 4 kHz were measured. Results: There was no significant difference of speech perception performance between the two groups. However, the mean FDL for the 4 kHz reference tone was significantly lower in the pull-back group compared to the controls. The SOE was significantly reduced at basal, middle, and apical electrodes in the electrode pull-back group. Conclusions: The pull-back technique seems to have its greatest effect on perimodiolar position in the basal regions of the cochlea. Therefore, it is most likely to observe improved FDL in the 4 kHz region. Current speech recognition tests do not reflect the lower FDL. Laryngoscope, 2010 [source] Management and outcomes of facial paralysis from intratemporal blunt trauma: A systematic review,,THE LARYNGOSCOPE, Issue 7 2010John J. Nash MD Abstract Objectives/Hypothesis: To systematically review the existing literature on outcomes and management of facial paralysis resulting from intratemporal blunt trauma. Study Design: Systematic review of the literature. Methods: Thirty-five articles met our inclusion criteria. Outcome variables analyzed included severity of paralysis, time of onset of paralysis, surgical or nonsurgical management, steroid use, and final facial nerve function. Results: All studies were classified as level 4 evidence as defined by the Oxford Centre for Evidence-Based Medicine. There was marked variation in the quality of the studies with inconsistent outcome measures, diagnostic testing, and follow-up, thus ruling out a formal meta-analysis. In an exploratory pooling of data, 612 cases had sufficient follow-up and facial movement grading for some evaluation of trends. In 189 patients who were followed observationally, 66% achieved an outcome equivalent to House-Brackmann (HB) I, 25% achieving HB II-V, and two patients an HB VI score. Among 83 patients treated with steroids, 67% achieved HB I, 30% HB II-V, and no patients with HB VI. In 340 patients treated surgically, 23% achieved HB I postoperatively, 58% were graded as HB II-V, and 9% with HB grade VI postoperatively. No patient presenting with partial paralysis had an HB VI outcome. Conclusions: The role of surgery versus nonsurgical interventions for this clinical entity remains inconclusive. Level 4 evidence studies predominate and are further hindered by poor description of outcome measures and incomplete data reporting. Exploratory pooling of data without formal meta-analysis suggests the need to compare any intervention to the natural course of healing, which overall appears to be favorable. Laryngoscope, 2010 [source] The effect of topical sodium thiosulfate in experimentally induced myringosclerosis,THE LARYNGOSCOPE, Issue 7 2010Yong Ho Park MD Abstract Objectives/Hypothesis: The purpose of this study was to investigate the effect of topical sodium thiosulfate (STS) in experimentally induced myringosclerosis (MS). Study Design: A prospective experimental animal study. Methods: Thirty Wistar albino rats were bilaterally myringotomized. The right ears were treated with STS or saline daily, and the left ears were left untreated and used as controls. The tympanic membranes were observed by otoendoscopy weekly, and tympanometric measurements were performed. All animals were histopathologically examined for myringosclerotic plaques. Results: Under otoendoscopy, myringosclerosis were observed around the handle of the malleus and near the annular region. The numbers of myringosclerotic ears were significantly more frequent in control and saline groups compared with the STS group (P < .05), and the formation of MS was more severe in control and saline groups compared with STS group (P < .05). Using tympanometric measurement, significantly reduced magnitudes of maximum admittance were observed in control and saline groups compared to normal and STS groups (P < .05). Under histopathologic examination, the tympanic membrane of the STS group appeared thinner than the control group (P < .05), with reduced calcium deposition than control and saline groups. Conclusions: Our results show that sodium thiosulfate has a preventive role in the development of myringosclerosis in the experimental animal model. Laryngoscope, 2010 [source] Influence of topical antifungal drugs on ciliary beat frequency of human nasal mucosa,THE LARYNGOSCOPE, Issue 7 2010An In Vitro Study Abstract Objectives/Hypothesis: Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions. Study Design: Case series of in vitro experiments and in vitro study of cultured ciliated cells of human nasal mucosa. Methods: Human nasal mucosa was acquired during routine endoscopic sinus surgery. Cells were cultivated on object slides and exposed to different antifungal drugs in a newly developed test system. This system allowed continuous and reproducible exposure to different drugs at constant temperature, pH value, and osmolarity. The drugs were amphotericin B in two different concentrations and itraconazole. Results: Rinsing with higher concentrations of amphotericin B led to an immediate decrease of CBF, with a total stop after 15 minutes. A different result was seen in the group with lower concentrations; CBF decreased again quickly after rinsing with the test drug, but all of them recovered after rinsing with neutral solution. When using itraconazole a decline in CBF was observed again; one half of the samples returned to activity. Conclusions: Our in vitro results demonstrate a dose-dependent effect of the antifungal drugs amphotericin B and itraconazole on ciliary beat frequency of human nose epithelium. Laryngoscope, 2010 [source] | ||||||||||