The Laryngoscope via MedWorm.com

Surgical anatomy of cartilaginous structures of the Asian nose: Clinical implications in rhinoplasty

The Laryngoscope — Sat, 13 Mar 2010 00:00:00 +0100

The morphologic features of upper and lower lateral cartilage and septal cartilage of the cadaveric nose were analyzed to provide practical anatomical knowledge for Asian rhinoplasty.Cadaveric dissection.A total of 21 Korean adult cadavers were dissected. External nasal morphology was observed, measured, photographed, and analyzed. Histologic features were observed with a light microscope in coronally-transected specimens stained with hematoxylin and eosin.The lengths of the upper and lower lateral cartilage of Korean cadaveric noses were similar to those of white noses. The widths of the upper and lower lateral cartilage were substantially smaller in Korean cadaveric noses than in those of whites. Upper lateral cartilage include substantial transverse portions near the keystone area that ...

Postoperative morbidity after different types of selective neck dissection

The Laryngoscope — Thu, 11 Mar 2010 00:00:00 +0100

Although selective neck dissection (SND) is an oncologically efficient procedure for the N0 neck, its functional results are discussed controversially. The aim of the present study was to analyze the frequency of morbidity related to SND.Retrospective single-institution series.The clinical data of 98 patients who had undergone unilateral SND of different dimensions and neck levels were analyzed. Radiotherapy was carried out in 37 (37.8%) patients. Functional and aesthetic results were evaluated in the context of aftercare consultation in 52 patients. The contralateral side of each patient served as the control. The mean follow-up period was 2.6 (0.5-9.1) years.SND-related complications arose in two out of 50 patients (4%) with dissection of level IV in terms of an injury of the thoracic du...

Differential diagnosis of muscle tension dysphonia and adductor spasmodic dysphonia using spectral moments of the long-term average spectrum

The Laryngoscope — Wed, 10 Mar 2010 00:00:00 +0100

Adductor spasmodic dysphonia (ADSD) can mimic the voice characteristics of muscle tension dysphonia (MTD) contributing to diagnostic confusion and inappropriate management. Elevated spectral noise has been reported in MTD, which may aid in differential diagnosis. The long-term average spectrum (LTAS) can be compared to a Gaussian bell curve using spectral moments analysis. Four moments describe features of the LTAS: spectral mean (moment 1), standard deviation (moment 2), skewness (moment 3), and kurtosis (moment 4). This investigation evaluated spectral moments analysis of the LTAS as an objective test to distinguish ADSD from MTD.Case-control comparison.Pretreatment voice samples from 59 subjects with MTD (10 males and 49 females) and 41 subjects with ADSD (19 males and 22 females) were ...

Continuous analysis and monitoring of snores and their relationship to the apnea-hypopnea index

The Laryngoscope — Wed, 10 Mar 2010 00:00:00 +0100

We used a new automatic snoring detection and analysis system to monitor snoring during full-night polysomnography to assess whether the acoustic characteristics of snores differ in relation to the apnea-hypopnea index (AHI) and to classify subjects according to their AHI.Individual Case-Control Study.Thirty-seven snorers (12 females and 25 males; ages 40-65 years; body mass index (BMI), 29.65 ± 4.7 kg/m2) participated. Subjects were divided into three groups: G1 (AHI (Source: The Laryngoscope)

The early postoperative course of surgical sleep apnea patients

The Laryngoscope — Wed, 10 Mar 2010 00:00:00 +0100

Recent guidelines from the American Society of Anesthesiologists recommended postoperative monitoring for most patients undergoing surgery for obstructive sleep apnea (OSA). These guidelines, however, are largely based on retrospective literature and expert opinion. The appropriate level of postoperative monitoring remains controversial. Our objective was to prospectively document the early postoperative course of patients undergoing OSA surgery.Prospective cohort study.One hundred twenty-one patients (age 43.9 ± 13.5 years, 79.8% male) with sleep-study proven OSA (apnea-hypopnea index 31.9 ± 22.7) who were undergoing surgery for OSA at our tertiary care center were recruited from 2007 to 2009. Outcome measures were: 1) incidence of respiratory complications requiring nursing interventio...

Miller fisher syndrome presents as an acute voice change to hypernasal speech

The Laryngoscope — Tue, 09 Mar 2010 00:00:00 +0100

The authors describe a 38-year-old man who presented with hypernasality, perioral and acroparesthesia, dyspnea, and dysphagia. Further evaluation revealed a diagnosis of Miller-Fisher syndrome (MFS). MFS is a variant of Guillain-Barré syndrome previously described in neurology and critical care journals; however, there is a paucity of work concerning this disease in the otolaryngology literature. An acute change in voice usually occurs secondary to inflammatory processes as seen after intubation and infection, but can occur as part of a more complex disease entity such as Guillain-Barré or Miller-Fisher syndrome. As such, clinicians should consider this in their evaluation of rhinolalia aperta. Laryngoscope, 2010 (Source: The Laryngoscope)

Effect of vascular endothelial growth factor on nasal vascular permeability

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

This study was designed to estimate the increased vascular permeability by VEGF in nasal mucosa and to discuss its possible role in allergic rhinitis.Prospective animal experiment.Hartley guinea pigs were used. Ethyl carbamate was injected into the abdomen for anesthesia, followed by intravenous injection of Evans blue into the femoral vein. Phosphate buffered saline, histamine, or VEGF was then applied to nasal cavities. Nasal mucosa was harvested after saline reflux from heart with phlebotomy by amputating the abdominal aorta. Tissue samples were soaked in formamide for 12 hours at 63°C to extract dye exudates from nasal mucosa. To analyze vascular permeability, dye was quantified by colorimetry.VEGF increased vascular permeability in nasal mucosa, and was more than 1 × 106 times more ...

Laryngeal mucosa: Its susceptibility to damage by acid and pepsin

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

This study aims to quantitate damage caused to laryngeal tissue by acid alone, and acid and pepsin, and also to determine if the extent of this damage depends on the tissue site.Prospective translational research study.An excised porcine laryngeal damage model in a small Ussing chamber was used to measure the effect of pepsin and acid on five sites (ventricles, vocal folds, posterior commissure, supraglottic, and subglottic mucosa). The tissue samples were incubated on the lumenal side for 1 hour with pH 2 and 4 HCl, pH 2 plus 1 mg/mL pepsin, and pH 4 plus 1 mg/mL pepsin. Damage was assessed by changes in absorbance of the bathing solution at optical density (OD) 260 nm and OD 280 nm and by measurement of released DNA compared to tissues bathed in pH 7.4 buffer. Damage was also assessed hi...

Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

To demonstrate that the osteocutaneous radial forearm free flap provides equivalent functional outcomes and improved morbidity compared to the fibular free flap in mandibular reconstruction.Retrospective review.There were 168 patients requiring free flap reconstruction of segmental mandibular defects between January 2001 and December 2008. Mean follow-up was 31 months for fibula free flap (FFF) (n = 117) and 20 months for osteocutaneous radial forearm free flaps (OCRFFF) (n = 51), reflecting an increasing use of forearms.OCRFFF were more commonly used in older patients (mean 63.7 years vs. 59 years, P = .03). The majority (96.2%) of reconstruction was for malignant pathology. Flap failure was 3.4% for the fibula group and 3.9% in the forearm group. Malunion was infrequent (2.0% OCRFFF, 6.0...

The management of thyroid carcinoma invading the larynx or trachea

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

To describe the controversies in the management of thyroid carcinoma invading the airway.Contemporary review of literature; level of evidence: 5.Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resec...

Association of the C677T polymorphism in the methylenetetrahydrofolate reductase gene with sudden sensorineural hearing loss

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

To investigate the recently reported association of the C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene with sudden sensorineural hearing loss (SSNHL), we analyzed data from a community-based Japanese population.Nested case-control study.Among 2,174 adults (1,096 males and 1,078 females) aged 40 to 79 years old who participated in the National Institute for Longevity Sciences-Longitudinal Study of Aging, we compared 33 cases of prevalent SSNHL, defined as a self-reported otolaryngologist diagnosis, with the other cases. Multiple logistic regression was used to obtain odds ratios (ORs) for SSNHL in subjects with the MTHFR C677T polymorphism, with adjustment for other possibly influential factors under additive, dominant, and recessive genetic models.The per-allele...

Viscoelastic properties of phonosurgical biomaterials at phonatory frequencies

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

The purpose of this study was to examine the functional biomechanical properties of several injectable biomaterials currently or potentially used for vocal fold augmentation.Rheometric investigation of phonosurgical materials in vitro.Linear viscoelastic shear properties of 3% bovine collagen (atelocollagen), micronized AlloDerm (Cymetra; LifeCell Corp., Branchburg, NJ), calcium hydroxylapatite (CaHA) (Radiesse; BioForm Medical, San Mateo, CA), and 2.4% cross-linked hyaluronic acid (HA) gel (Juvéderm; Allergan, Inc., Irvine, CA) were quantified as functions of frequency covering the phonatory range, and compared to those of the human vocal fold cover. Measurements of elastic shear modulus (G[prime]) and dynamic viscosity ([eta][prime]) were made at up to 250 Hz with a controlled-strain si...

Management of patients with acoustic neuromas: A Markov decision analysis

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

The management of patients with small ( (Source: The Laryngoscope)

Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

Review of clinical experience and results using botulinum toxin type A (BTX) for the management of adult patients with respiratory compromise due to new onset bilateral vocal fold motion impairment (BVFMI).Retrospective case series.The records of 11 patients from two institutions with respiratory compromise due to bilateral vocal fold motion impairment were reviewed. Age, sex, etiology of motion impairment, subjective response to BTX injections, changes in pulmonary function studies pre- and postinjection when available, the dosage of botulinum toxin required to achieve response, the number of injections per patient, and complications were reported.All patients were over 18 years old. There were three male and eight female subjects. The etiology of BVFMI was due to previous anterior cervic...

Quality of life following nasal surgery

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

This prospective study aimed to investigate changes in quality of life (QOL) after nasal surgery.Prospective study.A total of 788 patients (492 men and 296 women; age range, 9-81 years; mean age, 41 years) were included in this prospective study. Three hundred thirty-six patients received sinus surgery, 358 received septum surgery, and 94 additional patients received sinus surgery involving the septum. QOL was assessed with a standardized questionnaire for general health and well-being (36-Item Short Form Health Survey [SF-36]). Additionally, subjective sinunasal impairment was collected using the Rhinosinusitis Disability Index (RSBI). QOL and subjective sinunasal impairment were retested 4 months after surgery (63-339 days after surgery; mean, 128 days) in 361 patients.In the RSBI severi...

Correlates of chemosensory malingering

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

This study determined whether chemosensory test malingerers differ from nonmalingerers in terms of age, sex, education, and a range of self-reported behaviors and symptoms, potentially providing information of value for malingering detection.Case control.Twenty-two chemosensory malingerers were identified from a large clinical database and matched, randomly, to 66 nonmalingerers on the basis of etiology. Differences in demographics and responses to intake questionnaire items were statistically assessed. Logistic regression was used to identify variables that best predicted malingering behavior.Relative to nonmalingerers, malingerers reported significantly fewer allergies, dental problems, cigarettes smoked, surgical operations, nasal sinus problems, and use of medications, and significantl...

The effect of topical castellani solution on outer hair cell function of rats

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

To evaluate if Castellani solution, which is used for the treatment of mycotic infections of the ear, has any ototoxic potential. There are some studies about the toxic effect of some of the ingredients of the Castellani solution, but the ototoxic effect is not known. The current study was designed to investigate the ototoxicity experimentally.Prospective controlled animal study.Experiments were performed on 40 male Wistar albino rats. The animals were divided into four groups, each consisting of 10 rats. Under general anesthesia, the right tympanic membranes of the all of the rats were perforated and baseline distortion product otoacoustic emission (DPOAE) measurements were performed from the right ears before the use of solutions. The solutions were applied through the ear canal for 2 we...

Ambulatory pediatric otolaryngologic procedures in the United States: Characteristics and perioperative safety

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

Determine the prevalence and safety of pediatric ambulatory otolaryngologic procedures in the United States.Historical cohort study.All cases of pediatric otolaryngologic surgery were extracted from the National Survey of Ambulatory Surgery 2006 release. The population was characterized according to age, sex, and individual procedures performed. Rates of immediate perioperative complications were determined for arrest, malignant hyperthermia, hemorrhage, blood transfusion, and postoperative nausea/vomiting. Discharge status and unexpected medical return visits were tabulated. Complication rates for patients younger than 3 years were compared to the remaining cohort.An estimated 1,410,546 ± 246,009 (± standard error) children underwent one or more pediatric otolaryngologic procedures in 2...

In response to electromyographic facial nerve monitoring during parotidectomy for benign lesions does not improve the outcome of postoperative facial nerve function: A prospective two-center trial

The Laryngoscope — Mon, 08 Mar 2010 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Angiogenesis in vestibular schwannomas: Expression of extracellular matrix factors MMP-2, MMP-9, and TIMP-1

The Laryngoscope — Fri, 05 Mar 2010 00:00:00 +0100

This study targets the angiogenic process by investigation of tumor expression of MMP-2, MMP-9, and tissue inhibitors of metalloproteinase (TIMP)-1. A possible correlation with gender, patient age, symptom duration, tumor size, and the absolute and relative growth rate is explored.Prospective vestibular schwannoma tissue sampling for ELISA and immunohistochemical determination of MMP-2, MMP-9 and TIMP-1.Thirty-four patients with a sporadic, noncystic, vestibular schwannoma were selected prospectively. Repeated, preoperative magnetic resonance imaging determined the tumor growth pattern. Following translabyrinthine resection, an enzyme-linked immunosorbent assay was used for determination of the MMP-2, MMP-9, and TIMP-1 concentration in tumor sample homogenates. Immunohistochemical labeling...

Degrees of dysplasia and the use of cidofovir in patients with recurrent respiratory papillomatosis

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

This study aims to explore the association between increasing degree of papilloma dysplasia and the use of cidofovir in the context of the natural progression of dysplasia in RRP.Retrospective case series.Demographic data and surgical history were obtained through chart reviews for this retrospective case series of 13 patients with RRP who had histopathologic biopsies done before and after exposure to cidofovir. Pathologic data collected over 10 years from serial excisions at the University of Iowa Hospitals were reviewed by a single pathologist, and the highest degree of dysplasia was noted per excision time.Of the 176 specimens collected in these 13 patients with serial papilloma biopsies, 5.7% had no dysplasia, 57.4% had mild dysplasia (grade 1), 28.4% had moderate dysplasia (grade 2), ...

Peripheral olfactory sensitivity in rodents after treatment with docetaxel

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

Clinical studies have documented that cytotoxic chemotherapy is often associated with body weight loss and decreased enjoyment of food. Besides taste, olfaction plays a role in food intake. We assessed whether systemic chemotherapeutic cancer treatment compromises olfactory function in rats and mice treated with docetaxel (Taxotere; Sanofi-Aventis, Paris, France).Randomized, controlled trials on mice and rats.Male mice received a single and male rats either a single, two, or three docetaxel administrations. Olfactory function was tested by means of electroolfactograms (EOGs) from the chemosensory epithelium of the nasal septum and the endoturbinates. We evaluated and compared the magnitude of EOG responses evoked by different odorants recorded at different time points after treatment.In bo...

Suprathreshold gustatory stimuli cause biphasic respiratory responses during resting respiration in humans

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

Until now there has been no standardized and internationally accepted method available to objectify taste perception. Such a method would be useful for expert opinions in the assessment of gustatory disorders. The aim of our study was to develop and evaluate an analogous method for the gustatory sense.Nonrandomized, controlled clinical trial.A continuous flow of water was presented to the tongues of 34 healthy adult subjects (15 men, 19 women). In this stream, suprathreshold gustatory stimuli were applied during regular resting respiration. Nasal respiration was measured unilaterally with a differential pressure transducer.No significant differences were measured between the different tastants but were between tastants and blanks. Gustatory-evoked changes in the breathing pattern resulted ...

Office-based injection laryngoplasty in the irradiated larynx

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

To review the clinical results of office-based injection laryngoplasty with two different therapeutic materials in patients with vocal fold paralysis and history of radiation therapy to the larynx.Retrospective study.Chart review of 11 patients who underwent office-based injection laryngoplasty with calcium hydroxylapatite or micronized Alloderm. All patients had a history of radiation therapy to the neck, with the larynx included in the radiation field. Voice analyses, clinical outcomes, and complications were reviewed. Efficacy of the procedure was evaluated by comparing pre- and postinjection mean phonation time (MPT) results from voice analysis data.A total of 15 injections were performed in 11 patients with vocal fold paralysis (one females, 10 males, mean age 62 years). Data from voi...

Middle ear aneurysm treated with an innovative, vessel-preserving, aneurysm-occluding stent

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

Middle ear aneurysms are rare and difficult to treat. An innovative, parent vessel-preserving, aneurysm occlusion stent is a treatment alternative. It redirects blood flow away from the aneurysm, resulting in stasis within, and ultimate aneurysm thrombosis. Concurrent coiling is not needed with this stent, eliminating the risk of coils extruding or migrating, or acting as a nidus for infection in the middle ear. We review a successful treatment using this device. Laryngoscope, 2010 (Source: The Laryngoscope)

Modified vertical dome division technique for rhinoplasty in Asian patients

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

This study examined results following application of our modified VDD approach in Asian patients requiring nasal tip surgery.A retrospective clinical chart review.We retrospectively studied 37 patients who underwent rhinoplasty using our modified VDD procedure. The indications were thick tip skin and relatively strong and well-developed lower lateral cartilages. Outcome measurements were made using preoperative and postoperative photographs. Doctors and patients separately indicated satisfaction using a visual analogue scale (from 1 = satisfied, to 4 = dissatisfied).Following surgery, the mean tip projection increment across the population was 15.8%, and the nasofrontal and nasolabial angle increments were 1.4° and 5.5°, respectively. Doctor and patient satisfaction scores were 1.54 ± 0...

Pulp necrosis during septorhinoplasty

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

Bony manipulation near the nasal spine or maxillary crest trimming can predispose teeth to injury during septorhinoplasty, especially when there is an aberrant vascular supply or a highly situated root apex in the premaxilla.Prospective cross-sectional study.A prospective cross-sectional study was carried out on 438 teeth (maxillary incisors and canines) that were supposedly affected and 73 control teeth (mandibular lateral incisors) in 73 candidates of septorhinoplasty before and after surgery to determine the frequency of pulp necrosis using electrical, heat, and cold pulpal tests. Those with difficult intubation, history of root canals or orthodontic procedures, history of dental trauma, or a positive preoperative test were excluded from the study. Patients were followed up 2 weeks, 3 m...

Long-term results of morbidity after parotid gland surgery in benign disease

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

To determine the incidence of major and minor complications and their impact on patients' comfort after parotid surgery in benign disease.Retrospective.Four hundred ninety-two patients were included. Total parotidectomy (TP) was performed in 65.8%, superficial parotidectomy (SP) in 27.2%, and partial superficial parotidectomy (PSP) in 7.0%. Patients were interviewed using a self-designed questionnaire. Incidence of complications was evaluated depending on the extent of surgery and intensity of complaints. To ascertain the impact of morbidity on their daily lives, patients were asked to estimate it according to a visual analog scale.Frey's syndrome occurred in 63.4%, and temporary facial nerve palsy in 32.7% of all cases. Both rates were significantly reduced after PSP. Permanent facial ner...

The history of pediatric airway reconstruction

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

To review the history of pediatric laryngotracheal reconstruction and to highlight those who made major contributions in the field.Retrospective literature review.A literature search using the PubMed database from 1950 to the present. Earlier references were obtained from the Adams Center, the National Library of Medicine, and Virginia Commonwealth University Library.A total of 20 articles were identified. The articles reported 274 airway reconstructions of which 79% were in children. Pre-1935 infection was the leading cause of laryngotracheal stenosis. Laryngostomy, pioneered by Chevalier Jackson, was the most common method of reconstruction. Between 1935 and 1970, trauma was the predominant cause of laryngotracheal stenosis. The most common procedure was the anterior/posterior cricoid sp...

What makes a good flap go bad?: A critical analysis of the literature of intraoperative factors related to free flap failure

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

The purpose of this article is to discuss the various factors related to poor outcome in free flap reconstructions of the head and neck (H&N). Free tissue transfer has become the standard reconstruction technique for complex H&N defects. With the evolution of free flap use in H&N surgery, numerous factors have been proposed that adversely affect flap outcome, many with the support of only anecdotal experience. We seek to critically review the literature to assess what evidence exists for the relation of various intraoperative factors to free flap complications.Literature review.A review of the contemporary literature (1995 to present) on free flap reconstruction of the H&N was undertaken. A PubMed search using the terms head and neck, reconstruction, free flap, microvascular, failure, comp...

Adjustable laterofixation of the vocal fold in bilateral vocal fold paralysis

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

To describe a modification of VF laterofixation in patients with bilateral vocal fold paralysis (VFP), which allows adjusting the sutures tension according to voice and airway patency in the first postoperative day.Prospective case study.Twenty-one patients with recent bilateral VFP were treated by the modified laterofixation technique in Ain-Shams University hospitals between May 2007 and February 2009. Eight male patients and 13 females were included. The median age of the group was 36 years. The standard laterofixation procedure was performed; the Prolene sutures were inserted through the thyroid ala cartilage and looped around the paralyzed VF just anterior to the vocal process. The ultimate tension of the suture was adjusted later in the first postoperative day to gain feedback from t...

Clinical behavior of follicular variant of papillary thyroid carcinoma: Presentation and survival

The Laryngoscope — Thu, 04 Mar 2010 00:00:00 +0100

To determine the prevalence and extent of disease characteristics of the follicular variant of papillary thyroid carcinoma (FV-PTC) and the survival impact of this histopathological diagnosis compared to classical papillary thyroid carcinoma (C-PTC).Cross-sectional population analysis of a national cancer database.Cases of C-PTC and FV-PTC were extracted from the Surveillance, Epidemiology and End Results database for 1988 to 2006 and staged. Surgical extent and radioactive iodine (RAI) use were determined. Demographic and staging parameters were statistically compared according to tumor histology. Survival differences according to histology were determined with a Cox proportional hazards model, adjusting for age, sex, T stage, N stage, surgical therapy, and RAI.A total of 46,699 patients ...

In reference to Reformation of Concha Bullosa Following Treatment by Crushing Surgical Technique: Implication for Balloon Sinuplasty

The Laryngoscope — Thu, 18 Feb 2010 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Evaluation of velopharyngeal function after relocation pharyngoplasty for obstructive sleep apnea

The Laryngoscope — Sat, 13 Feb 2010 00:00:00 +0100

To assess if relocation pharyngoplasty (RP) causes velopharyngeal dysfunction in patients with obstructive sleep apnea (OSA) by evaluating perioperative nasalance, nasality, voice, and articulation.Prospective, comparative study.Twenty-four OSA patients selected for RP (two women and 22 men; mean age, 35 years) were enrolled for the study of velopharyngeal function in speech. The RP procedure involved removal of supratonsillar adipose tissue, preservation of all palatal muscular structure, splinting the lateral pharyngeal wall, and anterior advancing of the soft palate. Measurements of nasalance (vowel /a/, /i/, consonant /m/, oronasal, oral, and nasal texts), nasality (mirror-fogging test, degree of nasality, Gutzmann test and Bzoch hypernasality test), voice (acoustic analysis), and arti...

Hydroxychloroquine for subglottic stenosis: A novel therapy in the battle for air

The Laryngoscope — Fri, 12 Feb 2010 00:00:00 +0100

Upper airway obstruction due to subglottic edema and granulation tissue proliferation may cause severe morbidity and may be life threatening. Hydroxychloroquine interferes with antigen processing by means of raising lysosomal pH and immune response modulation. Herein, we present the outcome of a steroid-sparing treatment using hydroxychloroquine in an 80-year-old man with acquired subglottic stenosis and steroid dependency. Twice daily oral hydroxychloroquine at 2 mg/kg/day allowed cessation of systemic steroids without recurrence of the stenosis. Successful weaning of the hydroxychloroquine took place over a 5-month period. Laryngoscope, 2010 (Source: The Laryngoscope)

In reference to Electromyographic facial nerve monitoring during parotidectomy for benign lesions does not improve the outcome of postoperative facial nerve function: A prospective two-center trial

The Laryngoscope — Wed, 10 Feb 2010 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

An assessment of sinonasal anatomic variants potentially associated with recurrent acute rhinosinusitis

The Laryngoscope — Thu, 04 Feb 2010 00:00:00 +0100

To examine sinonasal anatomic variants that may predispose toward recurrent acute rhinosinusitis (RARS).Retrospective case-control.Sinus computed tomography (CT) scans from a consecutive series of adult patients meeting strict diagnostic criteria for RARS were retrospectively reviewed. A control group was assembled from patients who underwent pituitary or temporal bone CT for a nonrhinosinusitis indication. CT scans were scored for the presence of Haller cells, concha bullosa, and impinging septal spurs. Maximal septal deviation (degrees), infundibular widths, and Lund staging were also assessed. The prevalence of these anatomic variants was statistically compared between the RARS and control groups.Thirty-six patients met diagnostic criteria for RARS (mean age, 47.2 years; 2:1 female prep...

The effect of AlloDerm on the initiation and growth of human neovessels

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

AlloDerm (LifeCell Corp., Branchburg, NJ) is commonly employed for reconstruction of ablative soft tissue and mucosal defects following surgical resections. Although devoid of growth factors, AlloDerm may serve as an adhesive matrix for binding of growth factors, increasing local angiogenesis, and wound healing. We hypothesized that AlloDerm would enhance angiogenesis and might be altered with autologous blood products to enhance initiation of the angiogenic response.We used a human placental vein in a fibrin-thrombin clot-based angiogenesis model. Four groups, human placental vein (HPVM), HPVM with AlloDerm, HPVM with AlloDerm plus platelet-poor plasma, and HPVM with AlloDerm plus platelet-rich plasma were evaluated. Endothelial cell growth was evaluated visually (40×). Hematoxylin and e...

Tissue regeneration of the vocal fold using bone marrow mesenchymal stem cells and synthetic extracellular matrix injections in rats

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

To determine the effectiveness of bone marrow mesenchymal stem cell (BM-MSC) transplantation in isolation or within a synthetic extracellular matrix (sECM) for tissue regeneration of the scarred vocal fold lamina propria.In vitro stability and compatibility of mouse BM-MSC embedded in sECM was assessed by flow cytometry detection of BM-MSC marker expression and proliferation. Eighteen rats were subjected to vocal fold injury bilaterally, followed by 1 month post-treatment with unilateral injections of saline or sECM hydrogel (Extracel; Glycosan BioSystems, Inc., Salt Lake City, UT), green fluorescence protein (GFP)-mouse BM-MSC, or BM-MSC suspended in sECM. Outcomes measured 1 month after treatment included procollagen-III, fibronectin, hyaluronan synthase-III (HAS3), hyaluronidase (HYAL3)...

Hypopharyngeal pharyngoplasty for the management of piriform fossa sinus

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Analysis of hearing preservation after endolymphatic mastoid sac surgery for Meniere's disease

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

Comparison of audiometric outcomes between patients with definite Meniere's disease who underwent endolymphatic mastoid sac surgery (EMSS) following failed medical therapy and patients who underwent medical therapy only.Retrospective chart review of 456 consecutive patients between 1997 and 2006.Outcome measures were changes in pure-tone average (PTA), word recognition score (WRS), and speech reception threshold (SRT).Of 58 qualified patients, 29 who underwent EMSS after failing medical therapy showed a 4 dB decrease in PTA, a 2% increase in WRS, and a 2 dB decrease in SRT. Twenty-nine patients treated with medical therapy only demonstrated a 1 dB PTA increase, 2% WRS improvement, and 2 dB SRT improvement. No significant difference was noted between the medically and surgically managed pat...

Gorham-Stout disease of the temporal bone

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

Gorham-Stout (GS) disease is a rare disease of the bone and is also known as massive osteolysis. Less than 200 cases have been reported in the world literature. A 29-year-old female with a diagnosis of GS disease was identified. She complained of aural fullness and tinnitus bilaterally. Demineralization and moth-eaten changes of the osseous structures of the skull base and posterior fossa were prominent. The left mastoid air cells were opacified and erosion extended to the left jugular foramen, left hypoglossal canal, left stylomastoid process, and left eustachian tube. The radiographic findings and brief literature review are presented. Laryngoscope, 2010 (Source: The Laryngoscope)

Outcomes of static and dynamic facial nerve repair in head and neck cancer

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

Determine outcomes associated with nerve grafting versus static repair following facial nerve resection.Retrospective chart review.Charts from 105 patients who underwent facial nerve reconstruction between January 1999 and January 2009 were reviewed. The majority had parotid malignancy (78.1%), most commonly squamous cell carcinoma (50.5%). Patients underwent static (n = 72) or dynamic (n = 33) reconstruction with nerve grafting. Facial nerve function was measured using the House-Brackmann (H-B) scale.Patients receiving static reconstruction were on average 10.3 years older (P = .002). Mean overall survival for tumor cases was 61.9 months; parotid squamous cell carcinoma was associated with worse prognosis (P = .10). Median follow-up was 16.1 months (range, 4-96.1 months). Most (97%) patie...

Characterization of mesenchymal stem cells from human vocal fold fibroblasts

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

Mesenchymal stem cells (MSCs) originally isolated from bone marrow (BM), are fibroblast-looking cells that are now assumed to be present in the stromal component of many tissues. MSCs are characterized by a certain set of criteria, including their growth culture characteristics, a combination of cell surface markers, and the ability to differentiate along multiple mesenchymal tissue lineages. We hypothesized that human vocal fold fibroblasts (hVFF) isolated from the lamina propria meet the criteria established to define MSCs and are functionally similar to MSCs derived from BM and adipose tissue.In vitro study.hVFF were previously derived from human vocal fold tissues. MSCs were derived from adipose tissue (AT), and BM of healthy donors based on their attachment to culture dishes and their...

Tonsillectomy in post-transplant lymphoproliferative disease in children

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

To review the role of tonsillectomy in diagnosis and management of post-transplant lymphoproliferative disorder (PTLD).Case series using a retrospective chart review.A retrospective review of post-transplant lymphoproliferative disease at a tertiary academic medical center from January 2004 to April 2008. Data extracted includes patients' gender, age at transplantation, year of transplantation and tonsillectomy, type of transplant, presenting symptoms, type of immunosuppression, and outcome.Six out of 25 (24%) patients who underwent tonsillectomy were found to have PTLD. The patient's characteristics, gender, age at transplantation, year of transplantation and tonsillectomy, type of transplant, presenting symptoms, type of immunosuppression, and outcomes are discussed.In our series, tonsil...

Bone-anchored hearing aid subjective benefit for unilateral deafness

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

Determine the benefit of the bone-anchored hearing aid (BAHA) in patients with unilateral deafness.Retrospective case series and prospective questionnaire study at a tertiary referral center.Patients with unilateral deafness of various etiologies who were implanted with a BAHA (n = 126) or not implanted with a BAHA after a translabyrinthine craniotomy (n = 126) were mailed questionnaires. A total of 139 patients (55%) responded to the questionnaires. Patients who were implanted with a BAHA received a general questionnaire concerning BAHA usage, the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Speech, Spatial, and Qualities of Hearing Questionnaire (SSQ). Patients not implanted with a BAHA received only the SSQ hearing questionnaire.Patients with unilateral deafness demonstra...

Evaluating the safety of frontal sinus trephination

The Laryngoscope — Wed, 03 Feb 2010 00:00:00 +0100

The depth of the frontal sinus was measured using axial computed tomography (CT) images to examine the safety of frontal sinus trephination at selected distances from the midline.Review of 200 sinus CT scans.Two hundred sinus CT scans (400 frontal sinuses) were reviewed to measure the frontal sinus depth at 5 mm, 10 mm, and 15 mm from midline.Males had a significantly deeper frontal sinus than females at all measurements points (P < .001). The measurements revealed a considerable number of small but nonhypoplastic frontal sinuses, which were shallower than the length of standard frontal trephine instruments (7 mm) and would risk penetration of the posterior table of the sinus. Of all frontal sinuses studied, 9.54% were (Source: The Laryngoscope)

Propranolol for infantile hemangiomas: Early experience at a tertiary vascular anomalies center

The Laryngoscope — Fri, 29 Jan 2010 00:00:00 +0100

This study explores the impact of propranolol on both proliferative and involuting hemangiomas at a tertiary vascular anomalies center.Retrospective single institution review.We reviewed children treated with propranolol for problematic hemangiomas followed by a blinded prospective analysis of serial photographs taken during the course of their therapy. Parental questionnaires were obtained to evaluate perceived therapeutic response and complications to oral propranolol.Thirty-two children with complete photo documentation were treated with oral propranolol for infantile hemangiomas between September 2008 and June 2009. Twenty-seven patients began therapy during the proliferative phase of their lesions (mean age, 4.9 months), whereas five patients began during the involutional phase (mean ...

Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function

The Laryngoscope — Thu, 28 Jan 2010 00:00:00 +0100

The desirable extent of surgical intervention for benign parotid tumors remains a matter of controversy. Superficial or total parotidectomy as a standard procedure is often said to be the gold standard; however, with it the risk of intraoperative damage to the facial nerve cannot be ignored. For some time now, extracapsular dissection without exposure of the main trunk of the facial nerve has been favored as an alternative for the treatment of discrete parotid tumors. Data on the incidence of facial nerve lesions and other acute postoperative complications of extracapsular dissection have been lacking until now.Retrospective analysis.We performed a retrospective analysis of the data from patients in whom extracapsular dissection of a benign parotid tumor had been performed under facial ner...

In Reference to Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: An alternative minimally invasive approach

The Laryngoscope — Wed, 27 Jan 2010 00:00:00 +0100

No Abstract. (Source: The Laryngoscope)

Positron emission tomography-computed tomography adds to the management of salivary gland malignancies

The Laryngoscope — Tue, 26 Jan 2010 00:00:00 +0100

To evaluate the efficacy of combined positron emission tomography-computed tomography (PET-CT) in identifying salivary gland malignancies and to examine the role of PET-CT in the management of these patients.Retrospective chart review.Fifty-five patients with diagnosed salivary gland cancer who had undergone PET-CT scanning were retrospectively reviewed from January 2000 to October 2008. PET-CT scans using intravenous contrast were correlated with clinicopathological information to determine diagnostic accuracy of disease extent. The impact of PET-CT findings on therapeutic management was analyzed. All histopathologic grades were included in the study.Overall, PET-CT demonstrated a sensitivity of 74.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value o...

Multiparameter comparison of injection laryngoplasty, medialization laryngoplasty, and arytenoid adduction in an excised larynx model

The Laryngoscope — Tue, 26 Jan 2010 00:00:00 +0100

This study provides objective support for the combined ML-AA procedure in tolerant patients. Laryngoscope, 2010 (Source: The Laryngoscope)

Treatment with HELP-apheresis in patients suffering from sudden sensorineural hearing loss: A prospective, randomized, controlled study

The Laryngoscope — Tue, 26 Jan 2010 00:00:00 +0100

This study's aim was to verify whether, in patients affected by sudden sensorineural hearing loss (SSHL) with high plasmatic levels of low-density-lipoprotein (LDL) cholesterol and/or fibrinogen, the therapeutic approach with a single selective plasmapheresis (HELP-apheresis) followed by 10 days of standard treatment (glycerol and dexamethazone) is more effective than 10 days of standard treatment.Randomized, superiority study (difference [ge]30%).One hundred thirty-two patients were admitted to the trial and randomly allocated to two different arms; 60 were given standard treatment and 72 were treated with HELP-apheresis plus standard treatment. Patients showed a value of LDL cholesterol >120 mg/dL and/or fibrinogen >320 mg/dL.In the HELP-apheresis plus standard therapy group, we observed...

The tracheotomy punch for urgent tracheotomy

The Laryngoscope — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

In Response to Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: An alternative minimally invasive approach

The Laryngoscope — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Photodynamic therapy of cottontail rabbit papillomavirus-induced papillomas in a severe combined immunodeficient mouse xenograft system

The Laryngoscope — Thu, 21 Jan 2010 00:00:00 +0100

To evaluate the efficacy of photodynamic therapy (PDT) with the phthalocyanine photosensitizer Pc 4 for treating an animal model of recurrent respiratory papillomatosis (RRP).Rabbit skin was grafted onto the dorsum of severe combined immunodeficient mice, two xenografts per animal. After the graft healed, it was inoculated with cottontail rabbit papillomavirus (CRPV). When papillomas developed, Pc 4 (0.6 or 1.0 mg/kg) was administered systemically, and 48 hours later, one papilloma of the two on each animal was exposed to 675-nm photoactivating light at either 100 or 150 J/cm2. In addition to the contralateral tumors, which received Pc 4 but no light, other controls included animals receiving light only or neither agent. Response was assessed by measuring papilloma size with a caliper. Som...

An epistaxis severity score for hereditary hemorrhagic telangiectasia

The Laryngoscope — Wed, 20 Jan 2010 00:00:00 +0100

Hereditary hemorrhagic telangiectasia (HHT)-related epistaxis leads to alterations in social functioning and quality of life. Although more than 95% experience epistaxis, there is considerable variability of severity. Because no standardized method exists to measure epistaxis severity, the purpose of this study was to determine factors associated with patient-reported severity to develop a severity score.Prospective, survey-based study.HHT care providers and a focus group of patients were interviewed to determine epistaxis-associated factors. From this, an electronic survey was developed and administered to patients with HHT. Descriptive analyses were performed with calculations of means and medians for continuous and proportions for categorical variables. Multiple ordinal logistic and lin...

Exostoses of the external auditory canal in white-water kayakers

The Laryngoscope — Tue, 12 Jan 2010 00:00:00 +0100

This study aimed to characterize the prevalence of exostoses in white-water kayakers and identify associated risk factors and protective measures.Cross-sectional.Six hundred eleven white-water kayakers from across the United States were included in the study. Percent occlusion was graded as minimal (75%). Subjects completed a survey of risk factors and protective measures. Kruskal-Wallis and [chi]2 tests were performed to determine significant associations with percent occlusion. A multivariate proportional odds regression model was fit to adjust for confounding between the variables.The prevalence of exostoses in kayakers was 79% (482/611); 13% (78/611) had [ge]75% occlusion. Percent occlusion was associated with total years kayaked (P < .001), frequency [ge]1 day/week (P < .001), male ge...

Clinical characteristics of essential voice tremor: A study of 34 cases

The Laryngoscope — Mon, 11 Jan 2010 00:00:00 +0100

To describe and characterize essential voice tremor, including signs, symptoms, and severity, and its relation to other manifestations of essential tremor. Description of aspects of treatment is a secondary goal.Descriptive clinical cohort study.Thirty-four patients with essential voice tremor were identified over 40 months. Historical information regarding duration, family history, ethanol effect, arm tremor, and prior diagnosis was collected and examination was performed. Laryngeal and pharyngeal signs were graded using the Vocal Tremor Scoring System (VTSS); arm tremor was scored using the Washington Heights Inwood Genetic Study of Essential Tremor Rating Scale (WHIGET). Patients rated vocal disability using the Voice Handicap Index (VHI). Information regarding treatment was collected b...

Selective reinnervation of the posterior cricoarytenoid and interarytenoid muscles: An anatomical study

The Laryngoscope — Mon, 11 Jan 2010 00:00:00 +0100

This study provides new insight into laryngeal anatomy and further data for developing a reliable surgical approach. Laryngoscope, 2010 (Source: The Laryngoscope)

Spray cryotherapy for the treatment of glottic and subglottic stenosis

The Laryngoscope — Fri, 08 Jan 2010 00:00:00 +0100

We report here the first three human cases of glottic and subglottic narrowing treated with spray cryotherapy alone or in combination with balloon dilation.Institutional review board-approved clinical human trial.A 42-year-old female with idiopathic subglottic strictures, a 74-year-old female with glottic strictures and vocal cord stenosis following neck radiation, and a 33-year-old female with strictures from a previous tracheal stent were treated by four cycles of a 5-second cryotherapy spray alone or with balloon dilation. The effects of treatment were observed up to 6 months, 12 weeks, and 9 months, respectively.In all cases, patency of the stenosed areas was achieved with minimal bleeding and at least some degree of normalization of the glottic and subglottic mucosa. Airway patency an...

Scaffold-free tissue-engineered cartilage implants for laryngotracheal reconstruction

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

This study investigated the feasibility of using autologous chondrocytes to tissue-engineer scaffold-free cartilage grafts for LTR in rabbits to avoid degradation that often arises from an inflammatory reaction to scaffold carrier matrix.Animal study.Auricular cartilage was harvested from seven New Zealand white rabbits, the chondrocytes expanded and loaded onto a custom-made bioreactor for 7 to 8 weeks to fabricate autologous scaffold-free cartilage sheets. The sheets were cut to size and used for LTR, and the rabbits were sacrificed 4, 8, and 12 weeks after the LTR and prepared for histology.None of the seven rabbits showed signs of respiratory distress. A smooth, noninflammatory scar was visible intraluminally; the remainder of the tracheal lumen was unremarkable. Histologically, the gr...

Laryngeal mucous membrane pemphigoid: A systematic review and pooled-data analysis

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

To perform a systematic pooled-data analysis of literature data involving laryngeal mucous membrane pemphigoid (MMP).A systematic review and pooled-data analysis.We conducted a systematic literature search of MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the National Guideline Clearinghouse databases without language restriction for studies including combinations of relevant terms. All authors independently screened the abstracts of the search results, identified articles eligible for review, and critically appraised the full-text studies. Pooled-data analyses and Kaplan-Meier survival analyses were conducted using SPSS version 16.0 software (SPSS Inc., Chicago, IL).Of the 2,524 citations reviewed, the includ...

Factors associated with developing cholesteatoma: A study of 45,980 children with middle ear disease

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

To identify factors associated with the rate of developing cholesteatoma following ventilation tube insertion (VTI).A population-based retrospective cohort study.Administrative health data from all private and public hospitals in Western Australia for children who had at least one VTI from 1980 to 2004 was used to identify subsequent hospital admissions for cholesteatoma. Main outcome measures were time to cholesteatoma (survival) outcomes, including hazard ratios, log-rank tests, and Kaplan-Meier failure functions.There were 45,980 children who underwent at least one VTI from 1980 to 2004 with 460 subsequently developing cholesteatoma. The cumulative percentage of children who developed cholesteatoma within 15 years after one VTI procedure was 0.9% (95% confidence interval [CI], 0.8-1.0),...

Septoplasty retards midfacial growth in a rabbit model

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

This study uses a validated rabbit snout model to determine if septoplasty results in midfacial growth retardation, and if the retardation can be averted by replacing resected cartilage with a porous polyethylene implant.Prospective controlled animal study.Sixteen 9-week-old New Zealand white rabbits were divided into four groups: two control and two experimental. The experimental groups both underwent conservative submucoperichondrial surgical excision of a portion of their septum, leaving a generous dorsal and caudal septal strut for nasal support similar to what would be done clinically in humans. One of the experimental groups had replacement of the resected area by a rigid porous polyethylene graft, and in the other experimental group the resected area was left empty. Cephalometric me...

A nonrandomized comparison of potassium titanyl phosphate and CO2 laser fiber stapedotomy for primary otosclerosis with the otology-neurotology database

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

To compare short-term hearing results in patients undergoing laser stapedotomy for primary otosclerosis using either the flexible potassium titanyl phosphate (KTP) or CO2 laser fiber.Prospective nonrandomized clinical study at a tertiary referral center.Two hundred fourteen patients undergoing 214 stapedotomies for otosclerotic stapes fixation were enrolled in this study from January 2008 to January 2010. Comparative analyses were made between a group of 107 patients who underwent stapedotomy with the flexible KTP laser fiber and 107 patients who underwent stapedotomy with the flexible CO2 laser fiber. Preoperative and postoperative audiometric evaluation at 3 months using conventional audiometry, namely, air-bone gap (ABG), bone-conduction thresholds, and air-conduction thresholds, were a...

Transplantation of bone marrow-derived neurospheres into guinea pig cochlea

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

To investigate the potential of neurally induced bone marrow stromal cells (BMSCs) as transplants for replacement of spiral ganglion neurons.BMSCs were harvested from the femurs and tibias of adult guinea pigs. BMSCs were cultured with neural induction media and formed spheres. The capacity of BMSC-derived spheres for neural differentiation was examined by immunocytochemistry in vitro. BMSC-derived spheres were injected into the modiolus of the intact cochleae or those locally damaged by ouabain, followed by histological and functional analyses.In vitro analysis revealed a high capacity of BMSC-derived spheres for neural differentiation. After transplantation into the cochlear modiolus, the survival and neural differentiation of BMSC-derived spheres was observed in both the intact and dama...

Ambulatory sinus and nasal surgery in the United States: Demographics and perioperative outcomes

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

Determine the prevalence of ambulatory sinonasal surgical procedures and perioperative outcomes in the United States.The National Survey of Ambulatory Surgery 2006 release was examined, extracting all cases of nasal or sinus surgery. Sinonasal surgical procedures were grouped according to septoplasty and/or turbinate surgery, sinus surgery, facial plastic surgery, and other procedures. Overall and group population-based sinonasal procedure prevalences were estimated from the sample. Frequency of general anesthesia, discharge status, and unexpected emergency room visit estimates were obtained. Perioperative complication rates for cardiac arrest, malignant hyperthermia, postoperative emesis, and blood transfusion were determined as well.Overall, an estimated 600,000 patients underwent ambula...

Parotidotomy approach for a midcheek mass: A new surgical strategy

The Laryngoscope — Thu, 07 Jan 2010 00:00:00 +0100

To report the feasibility and the results of a new surgical strategy for midcheek masses we called the parotidotomy approach.Retrospective consecutive case series.Characteristics, surgical outcome, and cosmetic result of cases managed using the parotidotomy approach were collected by retrospectively reviewing medical records. The standard superficial parotidectomy approach was modified to dissect facial nerve branches selectively to obtain a symmetric facial contour. The parotid gland was fully bisected along the course of the zygomatic and buccal branches of the facial nerve to provide access to the midcheek mass. The bisected parotid gland was repositioned after mass excision.Seven patients (3 males and 4 females) were included in this study. The parotidotomy approach was accomplished in...

Response to the effect of study design and analysis methods on recovery rates in Bell's palsy

The Laryngoscope — Sat, 19 Dec 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Insular thyroid carcinoma in a patient with Cowden syndrome

The Laryngoscope — Fri, 18 Dec 2009 00:00:00 +0100

We present a patient with clinically relevant manifestations of Cowden syndrome, with genetic verification, impacting by way of airway compromise due to hamartomas, urinary tract abnormalities, and insular thyroid cancer. This case illustrates the value of recognizing Cowden syndrome at an earlier stage when the patient could have received appropriate management to decrease the morbidity of untreated hamartomatous growths, and an elective thyroidectomy would have been a viable option to manage his malignancy. Through this case report, we provide further insight into management of this disorder. Laryngoscope, 2010 (Source: The Laryngoscope)

Reconstruction of significant saddle nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts

The Laryngoscope — Fri, 18 Dec 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Characterization of human papillomavirus type 11-specific immune responses in a preclinical model

The Laryngoscope — Fri, 18 Dec 2009 00:00:00 +0100

Human papillomavirus (HPV) types 6 and 11 are associated with recurrent respiratory papillomatosis (RRP). Although a prophylactic vaccine has been developed that protects against HPV infection, a therapeutic vaccine is still needed for those patients infected with and/or suffering from persistent disease. Therefore, we developed a novel, therapeutic DNA vaccine targeting HPV-11 and characterized the in vivo immunologic responses generated against HPV-11 E6 and E7 after DNA vaccination in a preclinical model.We generated a DNA vaccine that encodes the HPV-11 E6 and E7 genes in a pcDNA3 backbone plasmid. We then vaccinated C57BL/6 mice with the pcDNA3-HPV11-E6E7 DNA plasmid. Splenocytes were harvested from these vaccinated animals and were incubated with overlapping peptides spanning either ...

Translational systems biology and voice pathophysiology

The Laryngoscope — Fri, 18 Dec 2009 00:00:00 +0100

Personalized medicine has been called upon to tailor healthcare to an individual's needs. Evidence-based medicine (EBM) has advocated using randomized clinical trials with large populations to evaluate treatment effects. However, due to large variations across patients, the results are likely not to apply to an individual patient. We suggest that a complementary, systems biology approach using computational modeling may help tackle biological complexity in order to improve ultimate patient care. The purpose of the article is: 1) to review the pros and cons of EBM, and 2) to discuss the alternative systems biology method and present its utility in clinical voice research.Tutorial.Literature review and discussion.We propose that translational systems biology can address many of the limitatio...

The current status of audiologic rehabilitation for profound unilateral sensorineural hearing loss

The Laryngoscope — Tue, 15 Dec 2009 00:00:00 +0100

Audiologic rehabilitation of individuals with profound unilateral sensorineural hearing loss (USNHL) has traditionally been limited to the use of air-conduction contralateral routing of sound (CROS) hearing aids. Treatment for these individuals has expanded with new applications of the bone-anchored hearing aid (BAHA), transcranial hearing aid (t-CROS), and the cochlear implant. In this article, the authors review the literature that addresses these various treatment options.Contemporary reviewHistorical information is available that describes the limited efficacy of air-conduction CROS hearing aids in lifting hearing handicap associated with USNHL. Current investigations on providing cross hearing are generally focused on use of the BAHA. Little is known at present whether new development...

Microbiology of third and fourth branchial pouch cysts

The Laryngoscope — Mon, 14 Dec 2009 00:00:00 +0100

To identify the most common pathogens involved in infections of third and fourth branchial pouch cysts. Third and fourth branchial pouch cyst infections are an uncommon cause of anterior neck abscesses often confused with other entities, such as thyroglossal duct cysts and thyroid abscesses leading to misdiagnosis, recurrence, and increased morbidity related to a delay in diagnosis and appropriate treatment.Retrospective chart and literature review.Retrospective chart review case series of patients presenting to the Bobby R. Alford Department of Otolaryngology at Texas Children's Hospital from July 2004 to July 2008 with third and fourth branchial pouch cysts.A total of 11 patients were identified. All patients had left-sided lesions. Eikenella corrodens was found in 60% of cultures and wa...

In reference to squamous cell carcinoma associated with intralesional injection of cidofovir for recurrent respiratory papillomatosis

The Laryngoscope — Thu, 10 Dec 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Virtual reality: A new paranasal sinus surgery simulator

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

Virtual surgical training systems are of growing value. Current prototypes for endonasal sinus surgery simulation are very expensive or lack running stability. No reliable system is available to a notable number of users yet. The purpose of this work was to develop a dependable simulator running on standard PC hardware including a detailed anatomic model, realistic tools and handling, stereoscopic view, and force feedback.Descriptive.A three-dimensional voxel model was created based on a high-resolution computed tomography study of a human skull, from which the bony structures were segmented. The mucosa and organs at risk were added manually. The model may be manipulated with virtual surgical tools controlled with a low-cost haptic device, which is also used to adjust microscopic or endosc...

Transoral laser ventricular fold resection and thyroarytenoid myoneurectomy for adductor spasmodic dysphonia: Long-term outcome

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

In this study, a long-term surgical outcome of this technique is investigated.A prospective clinical series.Fifty-two patients with ASD underwent transoral laryngomicrosurgery with a CO2 laser to resect the ventricular folds followed by myoneurectomy of the thyroarytenoid muscles. The nerve fibers of recurrent laryngeal nerve terminating at the thyroarytenoid muscle, which were frequently found branching deeply among the posterior belly of this muscle, were vaporized. Care was taken not to damage the vocal ligaments, lateral cricoarytenoid muscles, or arytenoid cartilages. Pre- and postoperative subjective voice assessments, and acoustic and aerodynamic measurements, were performed and statistically analyzed.Twenty-nine of the 52 patients who were followed up for more than 12 months (range...

Diagnosis and management of pediatric cervicofacial venous malformations: Retrospective review from a vascular anomalies center

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

In this study, we analyzed a cohort of pediatric patients with cervicofacial venous malformations (CFVM), with the goal of developing a treatment algorithm for these complex lesions.Eleven-year retrospective chart review. The setting was a vascular anomalies center at a pediatric tertiary hospital. Nineteen patients (10 male, 9 female), aged 11 months to 17 years, presented with CFVM.Patient charts were reviewed for demographics, signs and symptoms, timing of first and subsequent interventions, total number and type of interventions performed, and procedural complications. A family questionnaire supplemented outcome measures by determining the perception of disease control.Presenting symptoms for CFVM include growth (100%), disfigurement (63%), pain (58%), respiratory compromise (42%), and...

Role of the otolaryngologist in the treatment of struma ovarii

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

Struma ovarii, a rare germ cell tumor of the ovary composed of >50% thyroid tissue, is traditionally managed by gynecologic surgeons. Although struma ovarii is typically cured by simple excision, otolaryngology-head and neck surgeons may play a critical role in caring for these patients. In this article, we present two cases of struma ovarii and discuss the role of the otolaryngologist. Laryngoscope, 2010 (Source: The Laryngoscope)

Modified laser-assisted stapedotomy

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Outcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

To evaluate outcomes of salvage surgery with free flap reconstruction for recurrent squamous cell carcinoma of the oropharynx and oral cavity with increased use of chemoradiotherapy.Retrospective patient review.All patients undergoing salvage surgery with free flap reconstruction for oropharynx (n = 36) and oral cavity (n = 36) squamous cell carcinomas between January 2001 and January 2008 were obtained. Mean follow-up was 14 months. Previous chemoradiotherapy was used in 40% and radiotherapy alone in 60%.Complications were more frequent in oropharynx than oral cavity tumors (36% and 14%, respectively; P = .05) requiring more secondary procedures (15 for oropharynx vs. six for oral cavity). Few patients returned to a normal diet (8%), and a majority retained an enterogastric feeding tube (...

Pyramidal eminence and subpyramidal space: An endoscopic anatomical study

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces.This was an anatomical study on a prospective case series.The anatomy of the retrotympanum was studied by endoscopy in nine patients affected by cholesteatoma who underwent tympanomastoid surgery and in six temporal bone dissections.Pneumatization of the sinus tympani and posterior tympanic sinus or both, noted in 12 ears out of 15, may give rise to a recess beneath the pyramidal eminence, which we have called the subpyramidal space. This space can manifest with a variable degree of depth, shape, or extent depending on the shape and dimensions of the pyramidal eminence.Endoscopic exploration of the middle ear may guarantee a very good exposure of retrotympanic structures, allowing detailed...

Modulation of vocal fold scar fibroblasts by adipose-derived stem/stromal cells

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

To explore whether adipose-derived stem/stromal cells (ASCs) have therapeutic potential for treating scarred superficial lamina propria through the effects of secreted hepatocyte growth factor (HGF) on scar fibroblasts.In vitro study using coculture system.Scar fibroblasts (SFs) were isolated from ferret vocal folds electrocauterized 2 weeks previously. ASCs were isolated from ferret lipoaspirated subcutaneous abdominal fat. For coculture experiments, the two cell types were combined in Transwell plates for 6 days, followed by 1 or 3 days of monoculture after removing the upper chamber. Assays were then performed on cells and media from the bottom chamber. We measured: 1) the production of hyaluronic acid (HA), collagen and HGF via enzyme-linked immunosorbent assays, 2) the expression of [...

Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: An objective multiparameter approach

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

The main purpose of this study was to determine the impact of thyroidectomy on the subjective and objective vocal quality using the Dysphonia Severity Index. It was hypothesized that objective measures of vocal function and other vocal characteristics would change (temporarily or permanently) from the presurgical to the postsurgical conditions, even with the entire preservation of the laryngeal nerve, due to the surgical approach and other influencing factors.Prospective study in which 44 subjects were studied before (1 week) and three times post-thyroidectomy.Subjective (auditory perceptual evaluation and videolaryngostroboscopy) and objective (aerodynamic, vocal range, acoustic, and Dysphonia Severity Index measurements) assessment techniques were used.Paired samples t test indicated a s...

Rhinovirus infection-induced alteration of tight junction and adherens junction components in human nasal epithelial cells

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

The objective of this study was to investigate changes in the components of TJs (ZO-1, occluding, and claudin-1) and AJs (E-cadherin) after RV infection in cultured nasal epithelial cells.Primary human nasal epithelial cells grown at an air-liquid interface were infected apically with RV. RV-induced changes in the expression of epithelial TJ and AJ proteins were determined using real-time reverse transcriptase-polymerase chain reaction, confocal microscopy, and Western blot analyses. Functional changes in the integrity of junctional proteins were assessed by measuring transepithelial resistance (TER) using a voltmeter.RV infection decreased mRNA levels of ZO-1, occludin, claudin-1, and E-cadherin to 64.2%, 51.8%, 56.2%, and 56.3%, respectively, of those in controls (P < .05). Decreases in ...

The shelf life of antimicrobial ear drops

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

The advice given to patients regarding the shelf life of antimicrobial ear drops is based on little or no evidence. We aimed to determine appropriate recommendations for the shelf life of common antibiotic-containing topical otic solutions.Prospective experimental design.Ear drops containing gentamicin and ciprofloxacin were analyzed. Their effectiveness was assessed on agar plates inoculated with both Staphylococcus aureus and Pseudomonas aeruginosa. Bottles were also assessed for contamination once opened. In addition, drops used for 1 week on patients with culture-positive otorrhea were analyzed for contamination of both the bottle teat and the drop solution.Neither antibiotic showed deterioration in effectiveness against either microorganism over a 4-month period, as assessed by the si...

Hereditary hemorrhagic telangiectasia/avastin

The Laryngoscope — Wed, 09 Dec 2009 00:00:00 +0100

This is the first scientific report of hereditary hemorrhagic telangiectasia (HHT) epistaxis treatment by intranasal spraying of the vascular endothelial growth factor (VEGF) inhibitor bevacizumab (Avastin). Epistaxis in patients with HHT is a morbid, mortal condition that is difficult and unpleasant to manage. Nasal telangiectasia growth is modulated by VEGF, which is elevated in HHT patients. Bevacizumab is a VEGF inhibitor that diminishes epistaxis when administered intravenously or injected locally, or as reported here when sprayed topically onto the nasal mucosa. Laryngoscope, 2010 (Source: The Laryngoscope)

Septal button insertion - The screw technique

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

SLC26A4 genotype, but not cochlear radiologic structure, is correlated with hearing loss in ears with an enlarged vestibular aqueduct

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

Identify correlations among SLC26A4 genotype, cochlear structural anomalies, and hearing loss associated with enlargement of the vestibular aqueduct (EVA).Prospective cohort survey, National Institutes of Health, Clinical Center, a federal biomedical research facility.Eighty-three individuals, 11 months to 59 years of age, with EVA in at least one ear were studied. Correlations among pure-tone hearing thresholds, number of mutant SLC26A4 alleles, and the presence of cochlear anomalies detected by computed tomography or magnetic resonance imaging were examined.Linear mixed-effects model indicated significantly poorer hearing in ears with EVA in individuals with two mutant alleles of SLC26A4 than in those with EVA and a single mutant allele (P = .012) or no mutant alleles (P = .007) in this ...

Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management.Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008.Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed.Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80...

Head and neck sequelae of torture

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

To increase awareness of torture among otolaryngologists, and to describe methods and complications of head and neck torture.Retrospective review.Five cases of survivors of torture were evaluated in an otolaryngology practice in an urban hospital setting.The subjects presented with widely variable symptoms and physical manifestations related to the head and neck as a result of torture, in addition to psychiatric disease. Documentation of head and neck findings were essential to the asylum claim.Otolaryngologists serving immigrant and refugee populations must be familiar with methods and manifestations of torture involving the head and neck. Laryngoscope, 2010 (Source: The Laryngoscope)

Contact endoscopy for the evaluation of the pharyngeal and laryngeal mucosa

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

Contact endoscopy is a noninvasive tool that allows in vivo and in situ examination of superficial mucosa. Its use for early diagnosis of cancerous lesions of the oropharynx and larynx has not been evaluated. The aim of the study was to validate contact endoscopy for the examination of pharyngeal and laryngeal mucosa.Prospective clinical study.Superficial cells of the mucosa were stained with methylene blue and examined with contact endoscopes. The documented images were assessed by a cytopathologist and by an otolaryngologist independently for each patient. Biopsies for histopathological examination of the area were performed and correlated with contact endoscopic findings of both examiners.Of the 42 examined specimen, 32 (76.2%) showed benign changes in the histological analysis. Squamou...

Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

To identify contemporary indications, treatment principles, technique, injection materials, complications, and success rates of vocal fold injection augmentation.Multi-institutional retrospective review.Records of patients undergoing injection augmentation at seven university medical centers from July 2007 through June 2008 were reviewed for information regarding diagnosis, unilateral or bilateral injection, route of injection, anesthesia, treatment site (office or operating room), material used, reason for technique selected, and technical success.In 12 months, 460 injections were performed, 236 (51%) in awake, unsedated patients, and 224 (49%) under general anesthesia. Indications included vocal fold paralysis (248; 54%), paresis (97; 21%), atrophy (68; 15%) and scar (47; 10%). Scar was ...

Calcium hydroxylapatite injection laryngoplasty for the treatment of presbylaryngis: Long-term results

The Laryngoscope — Tue, 08 Dec 2009 00:00:00 +0100

Presbylaryngis is a normal part of the aging process, but many people visit hospitals with communication difficulties. The authors evaluated the efficacy of calcium hydroxylapatite (CaHA) injection laryngoplasty in patients with presbylaryngis.Retrospective review.Thirty-three patients with diagnosed presbylaryngis were administered a CaHA injection, and 17 of these patients without other vocal pathologies were included in the analysis. All 17 were male (mean age 65.9 years), mean follow-up duration was 335 days, and all injections were performed through the cricothyroid membrane under local anesthesia in a clinic.Subjective ratings, perceptual ratings, maximum phonation time, and closed quotients significantly improved after injection, and these improvements persisted without significant ...

Functional modulation of satellite cells in long-term denervated human laryngeal muscle

The Laryngoscope — Thu, 03 Dec 2009 00:00:00 +0100

To evaluate the effects of long-term denervation on satellite cells (SCs) as myogenic stem cells in human posterior cricoarytenoid (PCA) muscle.Histological investigation of SCs and quantitative assessment of myoD and myogenin, which are two key myogenic regulatory factors.According to the course of denervation, denervated PCA muscles of 58 patients who suffered from traumatic unilateral vocal cord paralysis were divided into four groups: group A (6-12 months, 15 cases), group B (13-24 months, 17 cases), group C (25-36 months, 14 cases), and group D (more than 36 months, 12 cases). Normal PCA muscles (12 cases) were used as a control group. Immunofluorescence labeling was used to visualize the SCs. Transcription and protein expression levels of myoD and myogenin were assessed using real-ti...

In response to Squamous cell carcinoma associated with intralesional injection of cidofovir for recurrent respiratory papillomatosis

The Laryngoscope — Wed, 02 Dec 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia

The Laryngoscope — Wed, 02 Dec 2009 00:00:00 +0100

This article describes the prevalence of laryngeal pathology in a treatment-seeking population with dysphonia in the Flemish part of Belgium.Retrospective investigation.During a period of 5 years (2004-2008), data were collected from 882 patients who consulted with dysphonia at the ear, nose, and throat department of the University Hospital in Ghent (Belgium). Laryngeal pathology was diagnosed using videostroboscopy. Ages ranged from 4 years to 90 years.Functional voice disorders were most frequently diagnosed (30%), followed by vocal fold nodule (15%), and pharyngolaryngeal reflux (9%). The role of age, gender, and occupation was investigated. Pathologies were significantly more common in females than in males, representing 63.8% and 36.2% of the population, respectively. Professional voi...

Targeted imaging modality selection for bacterial biofilms in chronic rhinosinusitis

The Laryngoscope — Tue, 01 Dec 2009 00:00:00 +0100

This study compares LIVE/DEAD BacLight (Invitrogen Corp., Carlsbad, CA) staining and fluorescence in situ hybridization (FISH), both utilizing the confocal scanning laser microscope (CSLM) for biofilm determination and characterization in CRS patients.Prospective study.Twenty CRS patients undergoing endoscopic sinus surgery were recruited for the study. Sinus mucosal tissue harvested at the time of surgery underwent both the BacLight/CSLM and FISH/CSLM protocols for biofilm determination and characterization.Combining the results of both protocols, 18/20 (90%) patients had bacterial biofilms demonstrable on at least one modality. The high biofilm detection rate combining the two techniques suggests the prevalence of biofilms in CRS may be greater than previously reported. The protocols had...

In reference to The Effect of Study Design and Analysis Methods on Recovery Rates in Bell's Palsy

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Parathyroidectomy in the elderly population: Does age really matter?

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

Compare parathyroidectomy patients based on age, including demographics, outcomes, and complications.Retrospective review.Prospective parathyroidectomy database covering 1998 to 2007 was reviewed retrospectively.A total of 687 patients underwent parathyroidectomy, including 247 (36%) >65 years old. Discharge was more often on day of surgery in younger patients (42.5% vs. 29.2%, P = .007) and >23 hours for older patients (24.7% vs. 12.3%, P < .0001). Older patients stayed longer in the recovery room (134 vs. 107 minutes, P = .005). Despite postoperative normocalcemia, older patients tended to have persistently elevated parathyroid hormone (PTH) (10.5% vs. 6.4%, P = .07), whereas younger patients had normal PTH (81.6% vs. 70%, P = .0007). PTH levels were low-abnormal (56-110) in younger pati...

Transnasal endoscopic surgery of the cavernous sinus for tissue diagnosis

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Sustained delivery of lidocaine into the cochlea using poly lactic/glycolic acid microparticles

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

Lidocaine is a local anesthetic that is known to suppress tinnitus via systemic or local application; however, this effect has only limited duration. The current study aimed to establish a method for the sustained delivery of lidocaine into the cochlea using poly lactic/glycolic acid (PLGA) microparticles.Experimental study.Lidocaine-loaded PLGA microparticles were produced and their in vitro-release profiles were examined. The lidocaine concentrations in the perilymph were measured at different time points following the application of the lidocaine-loaded PLGA microparticles to the round-window membranes of guinea pigs. The possible adverse effects of the local application of lidocaine-loaded PLGA microparticles were also examined.The in vitro analyses revealed that the microparticles wer...

Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

In reference to parathyroid surgery and methylene blue: A review with guidelines for safe intraoperative use

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Language performance in children with cochlear implants and additional disabilities

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

Quantify post-cochlear implant (CI) language among children with disabilities and determine the role of nonverbal cognitive quotients (NVCQ) in predicting language.Small cohort study in pediatric tertiary care center.Children (n = 20) with CIs and developmental disabilities were enrolled. Receptive and expressive language was reported as language quotients (LQs). Pre- and post-CI LQs were compared using the signed-rank test. Multiple regression models analyzed language while controlling for possible confounders.Five subjects had symptomatic cytomegalovirus, and four subjects had CHARGE syndrome with hearing loss etiology. Seventy-five percent had cognitive deficits, and 55% had motor delays. Median age of CI was 24 months; median CI duration was 27.7 months. The range of NVCQs for the stud...

Low-dose weekly platinum-based chemoradiation for advanced head and neck cancer

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

The optimal concurrent chemoradiotherapy regimen for definitive treatment of locoregionally advanced head and neck cancer remains to be determined. The present investigation reports toxicities, disease control, patterns of failure, and survival outcomes in a large mature cohort of patients treated with low-dose weekly platinum-based concurrent chemoradiotherapy.Retrospective single-institution series.Toxicity and outcome data for locoregionally advanced head and neck cancer patients treated with low-dose weekly platinum-based chemotherapy concurrent with standard fractionation radiotherapy were retrospectively collected and analyzed from a clinical database. Survival analysis methods, including Kaplan-Meier estimation and competing risks analysis, were used to assess locoregional disease c...

Intralesional bleomycin injections in the treatment of benign lymphoepithelial cysts of the parotid gland in HIV-positive patients: Case reports

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

We report successful treatment of three adults with bleomycin. All three patients presented with bilateral parotid enlargements. They received a total dose of between 180 U and 270 U of bleomycin over a period of 6 to 10 weeks. They all responded completely without morbidity or recurrence. Bleomycin is effective in the treatment of BLCs of the parotid glands in HIV-positive patients. Laryngoscope, 2010 (Source: The Laryngoscope)

Electromyographic laryngeal synkinesis alters prognosis in vocal fold paralysis

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

Synkinesis, or misdirected reinnervation, is likely a confounder when predicting return of function of an immobile vocal fold. Currently, no information exists on the incidence of synkinesis in unilateral vocal fold immobility (UVFI) or the effect synkinesis has on prognosis and treatment. Our objective was to examine a vocal fold adductor synkinesis screening protocol using diagnostic laryngeal electromyography (LEMG). We aim to determine the effect of synkinesis on prognosis of recovery of purposeful vocal fold motion.Retrospective review of LEMG data and patient charts from laryngology practice.A standardized LEMG analysis method to diagnose vocal fold adductory synkinesis was performed in 124 consecutive laryngeal electromyographic exams.Synkinesis testing was positive in 12/124 patien...

Characteristics of malfunctioning channels in pediatric cochlear implants

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

To examine the characteristics of pediatric cochlear implant channel malfunction preceding device failure.Retrospective review.All pediatric patients who underwent cochlear implantation at a tertiary academic medical center were reviewed regarding device type, reason for replacement, time to replacement, and timing and pattern of channel faults in failed versus nonfailed devices.Between 1993 and 2008, 264 pediatric cochlear implantations were performed. With an average 894-day follow-up, the replacement rate was 9.5% (25/264). Reasons for replacement were device failure (6.4%), medical/surgical failure (2.3%), and obsolescence (0.8%). Replacement rates were comparable among Advanced Bionics (13.3%), Cochlear Corporation (6.3%), and MED-EL (10.3%) devices. Fifty-two cochlear implants develo...

Laryngeal neuropathy of Charcot-Marie-Tooth disease: Further observations and novel mutations associated with vocal fold paresis

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

To describe and define laryngeal neuropathy in Charcot-Marie-Tooth (CMT) disease.Retrospective record review from a university laryngology practice.Four adult CMT patients presented with laryngeal symptoms. Three patients exhibited bilateral vocal fold palsy, in each case with more severe hypomobility on the left. One case exhibited an isolated left vocal fold palsy. All patients complained of hoarseness and stridor, three had dyspnea, two patients had dysphagia, and one had obstructive sleep apnea (OSA). One patient has required airway surgery to date. Genetic testing revealed known sequence alterations in one case and sequence alterations previously not associated with laryngeal dysfunction in two cases. One case was familial and two were sporadic; information is not available in a fourt...

Ergonomic analysis of microlaryngoscopy

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

To apply ergonomic principles in analysis of three different operative positions used in laryngeal microsurgery.Prospective case-control study.Laryngologists were studied in three different microlaryngeal operative positions: a supported position in a chair with articulated arm supports, a supported position with arms resting on a Mayo stand, and a position with arms unsupported. Operative positions were uniformly photographed in three dimensions. Full body postural data was collected and analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to calculate a risk score indicative of potential musculoskeletal misuse in each position. Joint forces were calculated for the neck and shoulder, and compression forces were calculated for the L5/S1 disc space.Higher-risk postures were ...

Two new approaches in intrauterine tracheal occlusion using an ultrathin fetoscope

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

To introduce and establish a new approach in minimal invasive fetoscopic surgery in order to reduce access trauma and the iatrogenic preterm premature rupture of the membranes (PPROM) as a major complication of intrauterine treatment of congenital diaphragmatic hernia.In total, 27 pregnant sheep were operated on using fetoscopes with 1.2 and 1.0 mm optics. We used an elliptic sheath alone with a maximum diameter of 2.6/1.3 mm; in these cases the balloon was placed under ultrasound control. In comparison, we placed the balloon under fetoscopic control using the fetoscopic sheath and a 7F (2.3 mm) introducer. Therefore, the maximum access trauma was not bigger than the diameter of sheath of introducer.With this technique we successfully operated on 22 sheep. The use of real time three-dimens...

A FGF3 mutation associated with differential inner ear malformation, microtia, and microdontia

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

Analysis of association between genotype and phenotype.Prospective genetic study in a family.Auditory investigations, computer tomography, and genetic sequencing of the fibroblast growth factor 3 (FGF3) gene were performed on a Somali family presenting with autosomal recessive, hearing impairment, microdontia, and outer ear morphologies ranging from normal auricle development to microtia assessed as type 1 Weerda dysplasia in affected individuals.Computed tomography imaging identified differential inter- and intraindividual malformations of the inner ear including labyrinth aplasia, development of a common cavity to the presence of a cochlear with 1.5 windings (Mondini malformation) in affected individuals, symptoms similar to those described as labyrinth aplasia, microtia, and microdontia...

Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

To assess the contribution of laryngopharyngeal sensory deficits and impaired pharyngeal motor function to aspiration in patients irradiated for nasopharyngeal carcinoma.A retrospective study at a tertiary referral university teaching hospital.One hundred consecutive patients who underwent radiotherapy for nasopharyngeal carcinoma referred to a dysphagia clinic underwent sensory testing of their laryngopharynx and endoscopic evaluation of their swallowing. The sensory threshold of the laryngopharynx was determined, the pharyngeal contraction assessed, and the status of the larynx and hypopharynx documented before and after swallowing. The presence of laryngeal penetration and aspiration was noted.The average time from radiation therapy to assessment was 10.2 years, and the mean duration of...

Effect of cochleostomy size on perilymph fistula control

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

Although the overall incidence of perilymphatic gushers is approximately 1%, patients with inner ear anomalies are at an increased risk for development of perilymphatic gushers. As cochlear implantation becomes more common in patients with inner ear anomalies (e.g., Mondini defect or common cavity defect), the ability to successfully seal such leaks becomes of paramount importance to reduce the risk of subsequent meningitis.A 1.0-mm and a 1.5-mm cochleostomy were placed superior to the round window in two respective temporal bones. Cochlear implant electrodes (Cochlear [Lane Cove NSW, Australia], Med-El [Insbruck, Austria] and Advanced Bionics [Valencia, CA]) were placed in the cochleostomy and sealed with porcine periosteum. A fixed amount of pressure was applied to the inner ear, and the...

Severe obstructive sleep apnea: Sleepy versus nonsleepy patients

The Laryngoscope — Thu, 26 Nov 2009 00:00:00 +0100

To compare demographic and polysomnographic data of sleepy versus nonsleepy severe obstructive sleep apnea (OSA) patients according to the Epworth Sleepiness Scale (ESS).Retrospective cohort.Six hundred forty-four consecutive severe (apnea-hypopnea index [AHI] [ge] 30) adult OSA patients who underwent a polysomnographic evaluation in our sleep disorders unit. ESS data were available in 569 (88.3%). Three hundred twenty-seven (57.5%) patients had ESS > 10.Sleepy severe OSA patients are slightly younger and more obese than nonsleepy patients. These sleepy patients have shorter sleep latency and lower percentage of slow wave sleep. They consistently show a higher AHI, both supine and lateral AHI, have a higher number of short arousals, and a higher arousal index. They also have higher snoring...

Superior semicircular canal dehiscence associated with external, middle, and inner ear abnormalities

The Laryngoscope — Wed, 25 Nov 2009 00:00:00 +0100

We report a case of bilateral superior semicircular canal dehiscence (SSCD) in a 38-year-old man who presented with congenital hearing loss without vestibular symptoms. This case is unusual due to the association of SSCD with multiple congenital anomalies of the external, middle, and inner ears, but without any other craniofacial or systemic developmental anomalies. Findings of multiple malformations of temporal bone structures in this case lend support to the theory that SSCD may have an underlying developmental or congenital etiology. Laryngoscope, 2010 (Source: The Laryngoscope)

Multimodality bronchoscopic imaging of recurrent respiratory papillomatosis

The Laryngoscope — Thu, 19 Nov 2009 00:00:00 +0100

Recurrent respiratory papillomatosis (RRP) of the central airways requires removal to potentially reduce recurrence and risk for malignant transformation. Analogous to the principles of treatment for early lung cancer, a precise determination of the extent of cartilage invasion could help guide therapeutic decisions and monitor response to treatment. The purpose of this study was to determine whether a bronchoscopy platform comprised of white light bronchoscopy (WLB), endobronchial ultrasound (EBUS), and optical coherence tomography (OCT) could identify layered microstructure of RRP and underlying cartilage.Case study.A bronchoscopy platform consisting of commercially available WLB, EBUS using a 7.5 MHz convex probe (BF-UC 160F; Olympus Optical Co. Ltd, Tokyo, Japan), and a time-domain OCT...

Clinical spectrum of patients with erosion of the inner ear by jugular bulb abnormalities

The Laryngoscope — Wed, 18 Nov 2009 00:00:00 +0100

Anatomic variants of the jugular bulb (JB) are common; however, abnormalities such as large high riding JB and JB diverticulum (JBD) are uncommon. Rarely, the abnormal JB may erode into the inner ear. The goal of our study is to report a large series of patients with symptomatic JB erosion into the inner ear.Retrospective review in an academic medical center.Eleven patients with JB abnormality eroding into the inner ear were identified on computed tomography (CT) scan of the temporal bone.Age at presentation was from 5 years to 82 years with six males and five females. The large JB or JBD eroded into the vestibular aqueduct (n = 9) or the posterior semicircular canal (n = 4). The official radiology report usually identified the JB abnormality; however, erosion into these structures by the ...

In reference to effect of the tympanostomy tube on postoperative retraction of the soft posterior meatal wall caused by habitual sniffing

The Laryngoscope — Tue, 17 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

In response to transcricothyroid electromyographic monitoring of the recurrent laryngeal nerve (Laryngoscope 2009;119:1918-1921)

The Laryngoscope — Wed, 11 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Diabetes-related changes in auditory brainstem responses

The Laryngoscope — Tue, 10 Nov 2009 00:00:00 +0100

Determine effects on auditory brainstem response (ABR) of diabetes mellitus (DM) severity.A cross-sectional study investigating DM severity and ABR in military Veteran subjects with (166) and without (138) DM and with no more than moderate hearing loss.Subjects were classified by three age tertiles ( (Source: The Laryngoscope)

In reference to transcricothyroid electromyographic monitoring of the recurrent laryngeal nerve (Laryngoscope 2009;119:1918-1921)

The Laryngoscope — Tue, 10 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Bilateral cochlear implantation: Current concepts, indications, and results

The Laryngoscope — Fri, 06 Nov 2009 00:00:00 +0100

The optimal treatment for bilateral hearing loss continues to evolve as cochlear implant (CI) and hearing aid technologies advance, as does our understanding of the central auditory system. Ongoing discussions continue on the validity and feasibility of bilateral CI in terms of performance, justification of need, medical/surgical safety concerns, and economics. The purpose of this review article is to provide an update on the advantages and disadvantages of bilateral CI and to provide a discussion on timing (simultaneous vs. sequential), technology (bimodal vs. binaural) and feasibility. Binaural advantages are found in both adult and pediatric bilateral CI recipients, the greatest being the head shadow effect and improvements in localization and loudness summation. This theoretically offe...

Supraglottic swelling may not correlate with tongue swelling in angiotensin converting enzyme inhibitor-induced angioedema

The Laryngoscope — Thu, 05 Nov 2009 00:00:00 +0100

We present a representative case. This observation suggests that all patients with ACEI-induced angioedema should undergo laryngeal fiberoptic examination and appropriate airway management. Laryngoscope, 2009 (Source: The Laryngoscope)

In reference to Lemierre's Syndrome: A Systematic Review (Laryngoscope 2009;119:1552-1559)

The Laryngoscope — Wed, 04 Nov 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Pilot testing of an assessment tool for competency in mastoidectomy

The Laryngoscope — Tue, 03 Nov 2009 00:00:00 +0100

This study tests the hypothesis that residents of dissimilar training levels differ in their technical performance as measured by this tool.Cross-sectional validation study.Two or more faculty otolaryngologists evaluated each resident performing a cortical mastoidectomy on a cadaveric temporal bone. Performance was rated using global and checklist components of a mastoidectomy assessment tool.Fifteen internal and external faculty members evaluated 23 residents over 3 years resulting in 118 evaluations. Construct validity was observed as scores increased with clinical training year. These differences were greater for more complex tasks. There was a percentage agreement of 78.5% between evaluator pairs in the determination of pass (score 3-5) versus fail (score 1-2) for the checklist instrum...

Additional heterozygous 2507A>C mutation of WFS1 in progressive hearing loss at lower frequencies

The Laryngoscope — Fri, 30 Oct 2009 00:00:00 +0100

To describe the audiological profiles in a Japanese family with autosomal dominant hereditary sensorineural hearing loss (SNHL) and to identify the causative gene.A family study at an academic tertiary referral center.A family with autosomal dominant hereditary SNHL was enrolled. Hearing loss (HL) of affected members showed mid-frequency SNHL in childhood and progressed at lower frequencies with age, resulting in low-frequency SNHL. To understand the pathology of HL of this family, we performed a genetic analysis of WFS1, TECTA, and GJB2 by direct sequencing, and further audiovestibular examinations, including speech audiometry, distortion product otoacoustic emissions, electrocochleography, auditory brainstem responses, and electronystagmography for some affected members.A heterozygous A-...

Eco-conservation and healthcare ethics: A call to action

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

No abstract. (Source: The Laryngoscope)

Management of the N0 neck in recurrent laryngeal squamous cell carcinoma

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

To evaluate the utility of neck dissections in patients undergoing salvage laryngectomy with a clinically negative neck.Retrospective cohort study.This retrospective review identified 71 patients with N0 necks who underwent salvage laryngectomy from 2001 to 2007. The standard practice of surgeons within our institution was different, thus neck dissections were performed on approximately one half of the patients, creating two groups for comparison. The number of neck dissections with positive metastasis were examined. Postoperative complications, overall survival, and site of recurrence were compared between patients with neck dissection and no neck dissection.Thirty-eight patients underwent 71 neck dissections concurrently with salvage laryngectomy. A total of 33 patients had salvage laryn...

Outcomes of minimally invasive endoscopic resection of anterior skull base neoplasms

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

This study validated technical feasibility of MIER for diversity of benign and malignant ASB histopathology. Majority of patients were able to avoid adjunct craniotomy, whereas lumbar drainage was utilized in selective cases. This surgical strategy resulted in low complication rate and acceptable disease-free survival in patients with advanced T3 and T4 malignant lesions. Future studies should focus on multicenter trials to facilitate more robust survival analysis and comparison to open surgical approaches. Laryngoscope, 2009 (Source: The Laryngoscope)

Multifactorial dysphagia: Diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Swallowing is a complex, multistage event with oral, pharyngeal, and esophageal phases. A thorough clinical examination for swallowing complaints begins to differentiate whether the problem is due to anatomic, mechanical, or neurologic etiologies. Based on the clinical suspicion, additional tests may be beneficial, including fluoroscopic and direct imaging methods, and electrophysiologic measurements. A multidisciplinary approach may also be advantageous, as in this case of dysphagia from diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis, which incorporated care from otolaryngology, speech pathology, orthopedic surgery, and gastroenterology. Laryngoscope, 2009 (Source: The Laryngoscope)

Patterns of recurrence and survival of head and neck adenoid cystic carcinoma after definitive resection

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

To determine factors impacting recurrence and long-term survival of adenoid cystic carcinoma (ACC) of the head and neck after definitive resection.Retrospective cohort study at an academic tertiary care hospital.Patients with ACC of the head and neck treated at our institution were reviewed. Those not receiving surgery, or with metastatic disease were excluded. Clinicopathological data on each patient was collected.Of 113 patients identified with ACC, 99 were studied. The overall median survival for the cohort was 71 months (mean ± standard deviation, 94 ± 79 months). American Joint Committee on Cancer (AJCC) tumor stage and N stage were independent predictors of survival on multivariate analysis. Mean overall survival (P = .001) and time to recurrence (P = .006) were lower for patients ...

Primary middle ear Epstein-Barr virus-related lymphoepithelial carcinoma: Case reports and systematic review

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

To report two cases of primary lymphoepithelial carcinoma in the middle ear and to determine the optimal treatment for such lesions.Case reports and a systematic review of the literature.Primary lymphoepithelial carcinoma in the middle ear is an exceptionally rare condition with only two other cases reported in the literature. There appears to be an association with Epstein-Barr virus infection and in those patients originating from the Guangdong province of China, much as is the case for similar lesions found in the nasopharynx. Piecemeal rather than en bloc excision, in combination with adjuvant radiotherapy, appears to adequately control the disease.Primary lymphoepithelial carcinoma of the middle ear is a rare lesion, which when treated has a good prognosis. Laryngoscope, 2009 (Source:...

Is severe epistaxis associated with acetylsalicylic acid intake?

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Epistaxis represents a very common emergency in any ear, nose, and throat (ENT) department around the world. Despite other risk factors, acetylsalicylic acid (ASA) contributes to nosebleeds by its intrinsic ability to impair thrombocyte aggregation. The aim of this study was to investigate the influence of ASA on the severity of epistaxis and to compare it with other potential risk factors.A prospective cohort study was performed at the ENT department of University Hospital Zurich.A total of 591 events were evaluated concerning surgical interventions and the length of in-hospital stay. Further analyses regarding recurrences and number of treatments and a specially designed severity score, as well as other outcome parameters, were performed.Ninety-nine patients needed to stay in-hospital fo...

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G-tube).We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G-tubes were placed as needed. The timing and duration of G-tube placement and treatment-related complications and risk factors for long-term G-tube use were analyzed.A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy-nine percent of patients received platinum-based therapy during CRT. Severe mucositis occurred in 40% of ...

Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

To determine whether respiratory compromise from bilateral vocal fold impairment (paralysis) can be objectively alleviated by reinnervation and pacing.A patient with paramedian vocal folds and synkinesis had a tracheotomy for stridor after bilateral laryngeal nerve injury and Miller Fisher syndrome. One posterior cricoarytenoideus (PCA) received a nerve-muscle pedicle fitted with a perineural electrode for pacemaker stimulation. The airway was evaluated endoscopically and by spirometry for up to 1 year.Bilateral vocal fold patency during quiet breathing was reversed to active vocal fold adduction during tracheal occlusion. Peak inspiratory flows (PIFs) were significantly higher (P < .001) after reinnervation. PIFs and glottic apertures increased further under stimulation (42 Hz, 1-4 mA, 42...

Chronic vocal fold scar restoration with hepatocyte growth factor hydrogel

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Therapeutic challenges exist in the management of vocal fold scarring. We have previously demonstrated the therapeutic potential of hepatocyte growth factor (HGF) in the management of acute phase vocal fold scarring using a novel hydrogel-based HGF drug delivery system (DDS). However, the effect of HGF on matured vocal fold scarring remains unclear. The current study aims to investigate the effect of HGF-DDS on chronic vocal fold scarring using a canine model.Animal model.Vocal folds from eight beagles were unilaterally scarred by stripping the entire layer of the lamina propria; contralateral vocal folds were kept intact as normal controls. Six months after the procedures, hydrogels (0.5 mL) containing 1 [mu]g of HGF were injected into the scarred vocal folds of four dogs (HGF-treated gro...

Pediatric cholesteatoma and variants in the gene encoding connexin 26

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Connexin 26 is a gap junction protein encoded by the GJB2 gene. It is expressed in cholesteatoma, and mutations cause proliferative skin disorders and sensorineural hearing loss (SNHL). Deletions of GJB6, which encodes connexin 30, cause SNHL in a digenic manner with a heterozygous GJB2 mutation. We hypothesize that GJB2 and GJB6 mutations might influence the development of cholesteatoma.Prospective observational study to identify GJB mutations in pediatric cholesteatoma.Peripheral blood samples from 98 children with cholesteatoma were screened for mutations in the GJB2 gene by direct sequencing of the coding region (exon 2 and the intron/exon boundary). Deletions of the GJB6 gene were tested using multiple ligation probe amplification methods. GJB status was compared with other population...

Vocal process granuloma and glottal insufficiency: An overlooked etiology?

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Vocal process granuloma has been attributed to intubation, laryngopharyngeal reflux, and phonotraumatic/hyperfunctional vocal behaviors. Vocal process granuloma has recurrence rates following surgical excision approaching 92%. We hypothesize that a portion of persistent or idiopathic cases of vocal process granuloma result from underlying glottal insufficiency (GI) caused by paresis, scar, or atrophy. Our goal was to examine our vocal process granuloma population and determine the incidence of GI, treatment interventions, and outcomes.Retrospective chart review.Thirty-four patients with vocal process granuloma were divided into surgically or conservatively managed groups. Patients were identified if they carried a diagnosis of GI. The time to resolution and number of recurrences within the...

Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: An alternative minimally invasive approach

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Transoral treatment of cricopharyngeal bar and small Zenker's diverticulum remains a challenge. We propose a new transoral approach for transoral cricopharyngeal myotomy (TOCPM) for patients with cricopharyngeal spasm and pharyngeal bar, and for transoral resection of diverticula (TORD) with cricopharyngeal myotomy in the patient with small ( (Source: The Laryngoscope)

A new mouse laryngeal transplantation rejection grading system

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

Development of a rat laryngeal transplantation model allowed for the first total human laryngeal transplantation by the senior author in 1998. In an effort to further our knowledge of the immune system's role in laryngeal rejection, a change to the mouse model was required. Prior to initiating immunosuppressive research protocols, a reliable mouse larynx rejection classification had to be established.Animal study.Thirty-one mouse laryngeal transplants (C57 BL/6 donors to C3H recipients) were performed and allowed to reject. Six time points were evaluated histologically: 1, 3, 5, 7, 9, and 15 days post-transplant. Eight anatomic sites were evaluated and assigned a point value. A linear regression model was constructed using the group number as the response and the scores from the eight hist...

Patient reported voice outcome in recurrent respiratory papillomatosis

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

In this study cohort, 68% scored above the VHI cutoff point, and 18% had an increased risk for depression or anxiety disorders (HADS). VHI scores were related to age, time between consecutive surgeries, time since last surgery, and passive coping. They were not related to gender, onset of RRP, or location. VHI scores were related to the SF-36 subscales social functioning (r = -0.43) and mental health (r = -0.43).Patients with RRP often report voice problems in daily life, and this is related to (a passive) coping style, social functioning, and mental health. Psychosocial intervention targeting an adaptive coping style may be beneficial in selected cases. Laryngoscope, 2009 (Source: The Laryngoscope)

Decoy NF-[kappa]B fortified immature dendritic cells maintain laryngeal allograft integrity and provide enhancement of regulatory T cells

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

The increased risk of malignancy associated with post-transplant immunosuppression limits the potential of laryngeal transplantation as a reconstructive option. This risk may be mitigated by utilizing decoy nuclear factor kappa B (NF-[kappa]B) immature dendritic cells (iDC) to provide donor-specific tolerance. The purpose of this study was to explore whether tolerogenic properties of iDC can be applied to composite tissue transplantation.Animal study.Five iDC-injected mice were euthanized at 15, 30, and 60 days post-laryngeal transplant. Control groups included five transplanted mice without immunosuppression, one iDC-injected mouse euthanized prior to transplantation, one mouse without injection or transplantation, and one mouse administered mature DC to serve as an accelerated rejection ...

Clarithromycin inhibits rhinovirus-induced bacterial adhesions to nasal epithelial cells

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

We investigated the inhibitory effects of clarithromycin (CM) on the rhinovirus (RV)-induced expression of fibronectin (Fn) and carcinoembryonic antigen-related cell adhesion molecules (CEACAMs), which act as major receptors for Staphylococcus aureus and Haemophilus influenzae, respectively. We further investigated the effects of CM on secondary S. aureus and H. influenzae adhesions to RV-infected primary human nasal epithelial cells (HNECs).Cells were pretreated with 10 [mu]M CM 24 hours before RV-16 infection and for 48 hours thereafter. The expression levels of Fn and CEACAMs were assayed by reverse transcriptase-polymerase chain reaction and Western blotting. Bacterial adhesion to cells was assessed by confocal microscopy and the fluorescence intensity of adherent bacteria was analyzed...

Bone chip-induced rhinosinusitis

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

This case report describes both the pathophysiology and management of chronic rhinosinusitis (CRS). Specifically, we report a case of chronic maxillary rhinosinusitis with a free-floating maxillary sinus calcification (bone chip). After obtaining the computed tomography scan, the patient underwent endoscopic sinus surgery, with removal of the uncinate, enlargement of the diseased natural ostium of the maxillary sinus, and removal of the diseased bone chip. This eliminated the nidus for infection, ultimately restoring mucociliary flow. Laryngoscope, 2009 (Source: The Laryngoscope)

Trends in the management of vestibular schwannomas at Johns Hopkins 1997-2007

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

To assess trends in the management of unilateral vestibular schwannomas over an 11-year period and to identify disease- and provider-related influences.Retrospective chart review.Subjects presented to the Department of Otolaryngology-Head and Neck Surgery and the Department of Neurosurgery for management of unilateral vestibular schwannoma from 1997 through 2007, with at least two visits within the first year of presentation. The proportion of patients for whom initial management consisted of observation, surgical resection, or radiation therapy was determined, and the relative influence of study year, patient age, hearing status, and tumor size was analyzed.Over the study period there was an increase in the proportion of cases that were observed with follow-up scanning (10.5% to 28.0%) an...

Spiral ganglion loss outpaces inner hair cell loss in endolymphatic hydrops

The Laryngoscope — Thu, 29 Oct 2009 00:00:00 +0100

This study quantifies the relationship between neuronal degeneration and hair cell degeneration in ELH to evaluate the hypothesis that a primary neural insult would yield greater loss in the spiral ganglion than at the inner hair cell level.Following induction and histopathologic confirmation of endolymphatic hydrops in guinea pigs, the degree of hydrops, spiral ganglion loss, and hair cell degeneration were quantified and compared.Guinea pigs with surgically induced unilateral hydrops were sacrificed and their cochleas preserved. Hydrops severity and spiral ganglion density were quantified using automated methods. Hair cells were counted manually. Values were normalized against the contralateral ear to create loss indexes.Inner hair cell (IHC) loss at the apex is significantly lower than ...