Inner ear deficits in irradiated nasopharyngeal carcinoma survivors.

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Inner ear deficits in irradiated nasopharyngeal carcinoma survivors.

Laryngoscope. 2015 Nov;125(11):2565-71

Authors: Chi FH, Young YH

Abstract
OBJECTIVES/HYPOTHESIS: Despite the advancement of concurrent chemoradiotherapy, inner ear symptoms such as hearing loss, tinnitus, or vertigo/dizziness are still experienced in irradiated nasopharyngeal carcinoma (NPC) survivors. This study utilized an inner ear test battery to assess the causes and sequence of inner ear deficits in irradiated NPC survivors with a mean interval of 10 years after radiotherapy.
STUDY DESIGN: Retrospective study.
METHODS: Thirty-six irradiated NPC survivors were enrolled. Otoscopy and an inner ear test battery comprising audiometry were performed, as well as ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests.
RESULTS: Otoscopic examination revealed middle ear complications in 37 ears (51%), including radiation-induced otitis media in 32 ears and otitis media with effusion in five ears. Percentages of abnormal cVEMP test, oVEMP test, bone-conducted mean hearing level, and caloric test were 91%, 75%, 67%, and 39%, respectively, exhibiting a significantly declining sequence in inner ear deficits. Most (67%) NPC survivors had inner ear deficit originated from peripheral vestibular lesion, mainly due to sequela of otitis media. In contrast, 33% of them had inner ear deficit caused by central vestibular disorder.
CONCLUSIONS: A significant sequential decline in inner ear function of irradiated NPC survivors was observed from the saccule to the utricle, cochlea, and semicircular canals. Most of them were due to sequela of otitis media, followed by central vestibular disorder.
LEVEL OF EVIDENCE: 4.

PMID: 25945470 [PubMed - indexed for MEDLINE]

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Bilateral cervical ribs causing cerebellar stroke and arterial thoracic outlet syndrome: a case report and review of the literature.

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Bilateral cervical ribs causing cerebellar stroke and arterial thoracic outlet syndrome: a case report and review of the literature.

Ann Vasc Surg. 2015 May;29(4):840.e1-4

Authors: Palmer OP, Weaver FA

Abstract
Stroke is an exceedingly rare presentation of arterial thoracic outlet syndrome (aTOS). This report describes a case of cerebellar stroke secondary to aTOS and reviews the literature. A 56-year-old woman with no previous history of stroke or arm ischemia presented with vertigo. Computed tomography (CT) and magnetic resonance imaging confirmed a left cerebellar ischemic stroke. She subsequently developed ischemia of her left arm, which was treated by a thromboembolectomy. CT angiography revealed bilateral cervical ribs along with bilateral subclavian artery aneurysms. Staged resection of the cervical ribs and reconstruction of the subclavian arteries were performed. Symptomatic arterial thoracic outlet syndrome most commonly presents as arm ischemia because of embolization of intramural clot from a subclavian artery aneurysm or because of thrombosis of the subclavian artery aneurysm itself. In rare cases, the clot can propagate retrograde, resulting in stroke. In young patients presenting with ischemic stroke, arterial thoracic outlet syndrome should be considered as part of the differential diagnosis.

PMID: 25725278 [PubMed - indexed for MEDLINE]

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Oral health screening: feasibility and reliability of the oral health assessment tool as used by speech pathologists.

Oral health screening: feasibility and reliability of the oral health assessment tool as used by speech pathologists.

Int Dent J. 2016 Feb 8;

Authors: Simpelaere IS, Van Nuffelen G, Vanderwegen J, Wouters K, De Bodt M

Abstract
BACKGROUND: The aim of this study was to investigate the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech pathologists, to become part of a comprehensive clinical swallowing examination.
METHODS: A multicentre study in 132 elderly subjects was conducted by speech pathologists. The inter-rater, test-retest and intra-rater reliabilities of the OHAT were assessed in R statistics, version 3.0.1. Intraclass correlation coefficients (ICCs) were used for the total OHAT, and Kappa statistics were used for the individual categories.
RESULTS: Total OHAT scores showed good inter-rater (ICC = 0.96), intra-rater (ICC ≥ 0.95) and test-retest (ICC ≥ 0.78) agreement. The inter-rater Kappa statistics were almost perfect (κ ≥ 0.83) for seven of the eight individual categories of the OHAT and perfect for 'dental pain' (κ = 1.00). The test-retest Kappa statistics indicated excellent agreement for 'natural teeth' and 'dentures' (κ ≥ 0.86). The intra-rater per cent agreement was excellent for all categories except 'gums and tissues'.
CONCLUSIONS: This is the first study to examine the feasibility and reliability of the OHAT as used by speech pathologists. As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. However, future research investigating actual referral strategies and adaptation of care strategies following assessment with OHAT is needed.

PMID: 26853437 [PubMed - as supplied by publisher]

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Knowledge, Attitudes, and Practices of Pediatric Dentists Regarding Speech Evaluation of Patients: Implications for Dental Education.

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Knowledge, Attitudes, and Practices of Pediatric Dentists Regarding Speech Evaluation of Patients: Implications for Dental Education.

J Dent Educ. 2015 Nov;79(11):1279-85

Authors: Van Eyndhoven L, Chussid S, Yoon RK

Abstract
The aim of this cross-sectional study was to determine pediatric dentists' attitudes about speech evaluation in the dental setting and assess their knowledge of speech development and pathology. In October 2013, members of the American Academy of Pediatric Dentistry were invited to participate in an electronic questionnaire. Categories of questions were demographics, attitudes and confidence in speech pathology, and theoretical and practical knowledge of speech development and speech pathology. Theoretical knowledge was assessed using questions about phonetics and speech milestones. Practical knowledge was determined with three 30-second interview-style video clips. A total of 539 responses were received for a response rate of 10.4%. The majority of respondents reported feeling that speech evaluation should be part of the pediatric dental visit (72.8%) and felt confident in their ability to detect speech issues (73.2%). However, they did poorly on the theoretical knowledge questions (41.9%) as well as the practical knowledge questions (8.5%). There was a statistically significant difference in theoretical score between gender and type of occupation (p<0.05). This difference was not observed when examining practical knowledge. This study suggests that although pediatric dentists are in an ideal position to aid in the detection of speech issues, they currently have insufficient training and knowledge to do so.

PMID: 26522632 [PubMed - indexed for MEDLINE]

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Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

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Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

Dysphagia. 2014 Aug;29(4):450-8

Authors: Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV

Abstract
The implication of dysphagia for people treated nonsurgically for head and neck cancer (HNC) and its detrimental effects on functioning and quality of life has been well documented. To date, however, there has been a paucity of research on the effects of dysphagia following HNC on carers, independent of the consequences of a gastrostomy. The objective of this qualitative study was to report on the experiences of carers of people with dysphagia (non-gastrostomy dependent) following nonsurgical treatment for HNC and to identify the support needs of this group. A purposive, maximum-variation sampling technique was adopted to recruit 12 carers of people treated curatively for HNC since 2007. Each participated in an in-depth interview, detailing their experience of caring for someone with dysphagia and the associated impact on their life. Thematic analysis was adopted to search the transcripts for key phases and themes that emerged from the discussions. Analysis of the transcripts revealed four themes: (1) dysphagia disrupts daily life, (2) carers make adjustments to adapt to their partner's dysphagia, (3) the disconnect between carers' expectations and the reality of dysphagia, and (4) experiences of dysphagia-related services and informal supports. Carers generally felt ill-prepared for their role in dysphagia management. The qualitative methodology successfully described the impact of dysphagia on the everyday lives of carers, particularly in regard to meal preparation, social events, and family lifestyle. Clinicians should provide adequate and timely training and support to carers and view carers as copartners in dysphagia management.

PMID: 24844768 [PubMed - indexed for MEDLINE]

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Development of the Arabic Version of Dysphagia Handicap Index (DHI).

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Development of the Arabic Version of Dysphagia Handicap Index (DHI).

Dysphagia. 2014 Aug;29(4):459-67

Authors: Farahat M, Malki KH, Mesallam TA, Bukhari M, Alharethy S

Abstract
The Dysphagia Handicap Index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool for measuring the handicapping effect of dysphagia on the physical, functional, and emotional aspects of people's lives. The purposes of the present study were to develop an Arabic version of the DHI and to evaluate its validity, consistency, and reliability in the normal Arabic population with oropharyngeal dysphagia. This was a prospective study that was carried out at the Communication and Swallowing Disorders Unit, King Saud University. The generated Arabic DHI was administered to 94 patients with oropharyngeal dysphagia and 98 control subjects. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Arabic DHI showed excellent internal consistency (Cronbach's α = 0.95). Also, good test-retest reliability was found for the total scores of the Arabic DHI (r = 0.9, p = 0.001). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (p < 0.001). This study demonstrated that the Arabic DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on the physical, functional, and emotional aspects of patients and can be used by Arabic language speakers.

PMID: 24842336 [PubMed - indexed for MEDLINE]

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Variation in the timing and frequency of sucking and swallowing over an entire feeding session in the infant pig Sus scrofa.

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Variation in the timing and frequency of sucking and swallowing over an entire feeding session in the infant pig Sus scrofa.

Dysphagia. 2014 Aug;29(4):475-82

Authors: Gierbolini-Norat EM, Holman SD, Ding P, Bakshi S, German RZ

Abstract
Feeding is a rhythmic behavior that consists of several component cycle types. How the timing of these cycles changes over a complete feeding sequence is not well known. To test the hypothesis that cycle frequency/duration changes as a function of time spent feeding, we examined complete feeding sequences in six infant pigs, using EMG of mylohyoid and thyrohyoid as cycle markers. We measured the instantaneous frequency of sucking and of swallowing cycles in 19 sequences. Each sequence contained three qualitatively distinctive phases of sucking frequency. Phase 1 started with cycles at a very high frequency and quickly dropped to a more constant level with low variation, which characterized phase 2. Phase 3 had a steady level of frequency but was interspersed with a number of high- or low-frequency cycles. Each phase differed from the others in patterns of within-phase variation and among-phase variation. Phase 2 had the least variation, and phase 3 had the largest range of frequencies. The number of sucks per swallow also differed among phases. These patterns, which characterize normative feeding, could indicate a physiologic basis in satiation. In human infant clinical studies, where data collection is often limited, these results indicated the utility of collecting data in different phases. Finally, these results can be used as a template or pattern with which to assess clinically compromised infants.

PMID: 24839189 [PubMed - indexed for MEDLINE]

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Differences in videofluoroscopic swallowing study (VFSS) findings according to the vascular territory involved in stroke.

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Differences in videofluoroscopic swallowing study (VFSS) findings according to the vascular territory involved in stroke.

Dysphagia. 2014 Aug;29(4):444-9

Authors: Kim SY, Kim TU, Hyun JK, Lee SJ

Abstract
Dysphagia affects up to half of stroke patients and increases the risk of pneumonia and fatal outcomes. In order to assess swallowing difficulty, videofluoroscopic swallowing study (VFSS) has traditionally been the gold standard. The purpose of this study was to compare the patterns of post-stroke swallowing difficulties according to the vascular territories involved in the stroke. One hundred and three patients who were diagnosed with first ischemic stroke by brain magnetic resonance imaging and had swallowing difficulty were included in this study. Location of the stroke was classified into three groups: territorial anterior infarcts (TAI) (n = 62), territorial posterior infarcts (TPI) (n = 19) and white matter disease (WMD) (n = 22). Oral cavity residue existed significantly in the TAI group more than in any other groups (P = 0.017). The WMD group showed more residue in the valleculae (P = 0.002) and the TPI group showed more residue in the pyriform sinuses (P = 0.001). The oral transit time, pharyngeal delay time and pharyngeal transit time did not show significant differences among the groups with swallowing of both thick and thin liquids. Penetration and aspiration were more frequent in the TPI group (P < 0.05) with swallowing of both thick and thin liquids. The results suggest that TAI is more related to oral phase dysfunction and TPI is more related to pharyngeal dysfunction. In ischemic stroke, patterns of swallowing difficulty may differ according to the vascular territory involved and this should be considered in the management of post-stroke dysphagia.

PMID: 24682308 [PubMed - indexed for MEDLINE]

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[Characterization of the Laryngeal Adductor Reflex by Stimulation with Microdroplets Impulses (Microdroplet Impulse Testing)].

[Characterization of the Laryngeal Adductor Reflex by Stimulation with Microdroplets Impulses (Microdroplet Impulse Testing)].

Laryngorhinootologie. 2016 Feb 8;

Authors: Ptok M, Schroeter S

Abstract
Background: The larynx is considered a crossing point between breathing and swallowing pathways. During swallowing, the airway below the glottis must be protected against food components by an appropriate laryngeal closure mechanism. The laryngeal adductor reflex (LAR) with an early, probably di- or oligosynaptic interconnected ipsilateral LAR1- and a late ipsilateral and contralateral LAR2 polysynaptic component is believed to serve as such a mechanism. Here we aimed to measure and characterize the LAR in healthy volunteers and to compare the data obtained with previously published data. Methods: We designed a prospective pilot study. 10 healthy volunteers (22-57 years) participated. To elicit the LAR we used a newly designed microdroplet impulse testing (MIT) device: very small waterdroplets were shot onto the endolaryngeal mucosa. By simultaneously observing the anatomical structures with a high speed glottography system, the time between impact of the microdroplet on the mucosa and the beginning of the adduction movement and thus an approximate value for the reflex latency could be determined. Results: An early adduction movement corresponding to LAR1 could not be detected. The measured LAR2 latency time was higher than the EMG LAR2 data. No significant latency difference between right and left stimulation was found. Discussion: Since we were unable to demonstrate any LAR1 component it may be that muscle activity observable by EMG may not be sufficient to lead to a visible medial vocal cord movement. The longer LAR2 latency compared to EMG data may be explained by the fact that the visually vocal cord movement occurs after a delay although muscle activity already started as evidenced by EMG.Further studies on LAR are warranted, especially since our results also raise questions about the clinical significance of the LAR.

PMID: 26854534 [PubMed - as supplied by publisher]

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Multiportal combined transnasal transoral transpharyngeal endoscopic approach for selected skull base cancers.

Multiportal combined transnasal transoral transpharyngeal endoscopic approach for selected skull base cancers.

Head Neck. 2016 Feb 8;

Authors: Turri-Zanoni M, Battaglia P, Dallan I, Locatelli D, Castelnuovo P

Abstract
BACKGROUND: Minimally invasive endoscopic endonasal approaches to the ventral skull base have evolved considerably over the past several years. However, where there is a lateral extension of tumors as far as the parapharyngeal spaces with inferior extension below the level of the soft palate, limitations remain for an exclusive transnasal approach.
METHODS: A combined endoscopic-assisted transnasal-transoral-transpharyngeal multiportal approach was performed to resect selected skull base malignancies that could not be adequately managed using a single approach.
RESULTS: Three cases of skull base cancer (squamous cell carcinoma, polymorphous low-grade adenocarcinoma, and high-grade osteosarcoma) were suitable for such an approach. In all cases, a radical resection was obtained without major complications and with minimal morbidity for the patient.
CONCLUSION: The transnasal, transoral, and transpharyngeal surgical windows are complementary approaches that, when combined, provide excellent exposure for selected skull base malignancies that have extended too laterally and inferiorly to allow an exclusively transnasal approach. © 2016 Wiley Periodicals, Head Neck, 2016.

PMID: 26855345 [PubMed - as supplied by publisher]

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Is Patient Age Associated with Perioperative Outcomes Following Surgical Resection of Benign Cranial Nerve Neoplasms?

Is Patient Age Associated with Perioperative Outcomes Following Surgical Resection of Benign Cranial Nerve Neoplasms?

World Neurosurg. 2016 Feb 5;

Authors: McCutcheon BA, Grauberger J, Murphy M, Kerezoudis P, Rinaldo L, Shepherd D, Maloney P, Snyder K, Carter BS, Bydon M, Van Gompel JJ, Link MJ, Mayo Clinic Neuro-Informatics Laboratory

Abstract
OBJECTIVE: Prior literature has demonstrated that increasing age is associated with decreased rates of operative management and gross total resection in patients with vestibular schwannomas.
METHODS: The ACS-NSQIP data registry was used for this retrospective cohort analysis. Patients enrolled in the registry from 2007-2013 with a diagnosis of a benign neoplasm of a cranial nerve were included. The association between age and postoperative morbidity and mortality was evaluated using multivariable logistic regression analyses.
RESULTS: Of 565 patients included for analysis, the mean(median) age was 51(53) years. Three clusters were evaluated: <50, 50-69, and ≥70 years. Mortality(0% vs. 1.03% vs. 4.55%, p=0.012), stroke(0% vs. 0.69% vs. 6.82%, p<0.001), and ventilator weaning failure(0.43% vs. 2.41% vs. 6.82%, p=0.014) increased with age. Mean age was significantly greater among patients who suffered death(70.60 vs. 50.87 years, p=0.002), stroke(68.00 vs 50.89 years, p=0.006), cardiac arrest(71.50 vs 50.89 years, p=0.038), coma(74.00 vs 50.96 years, p=0.020), and those who failed ventilator weaning(62.55 vs. 50.82, p=0.006). Age as both a continuous(OR 1.10, 95% CI 1.03 to 1.18) and categorical variable(age 70+ years OR 78.88, 95% CI 3.41 to 1825.57) was associated with an increased odds of composite morbidity.
CONCLUSIONS: In patients undergoing surgery for benign cranial nerve neoplasms, increasing age is associated with increased mortality, stroke, coma, and ventilator weaning failure. Composite complication rates are significantly higher in patients ≥70 years, with a near 80 fold increased risk of complications.

PMID: 26855306 [PubMed - as supplied by publisher]

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Synovial chondromatosis of the right side temporomandibular joint extending to the middle cranial fossa: A case report with 7-year postoperative follow up and expression of a biomarker of cell proliferative activity.

Synovial chondromatosis of the right side temporomandibular joint extending to the middle cranial fossa: A case report with 7-year postoperative follow up and expression of a biomarker of cell proliferative activity.

Int J Surg Case Rep. 2016 Jan 25;20:133-137

Authors: Yoshitake H, Kayamori K, Wake S, Sato F, Kino K, Harada K

Abstract
INTRODUCTION: Synovial chondromatosis of the temporomandibular joint (TMJ) with cranial extension is rare. Here, we report 7-year follow-up of a case with immunohistochemical examination of cell proliferative activity.
PRESENTATION OF CASE: The patient was a 72-year-old man. Severe bone resorption of the glenoid fossa was apparent on CT images. Pathological findings by biopsy led to diagnosis of synovial chondromatosis of the right side TMJ. Extirpation of the tumor was performed via temporopreauricular incision under general anesthesia. PCNA expression was examined by immunohistochemical analysis. The lesion had penetrated into the middle cranial fossa, but the cranial dura mater was intact. Expression of PCNA was confirmed.
DISCUSSION: The PCNA expression suggested that growth activity caused expansion of the lesion to the skull base.
CONCLUSION: We were able to follow up this case for a long period without recurrence postoperatively.

PMID: 26855075 [PubMed - as supplied by publisher]

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Patient-centered decision making: the role of the baseline SNOT-22 in predicting outcomes for medical management of chronic rhinosinusitis.

Patient-centered decision making: the role of the baseline SNOT-22 in predicting outcomes for medical management of chronic rhinosinusitis.

Int Forum Allergy Rhinol. 2016 Feb 8;

Authors: Steele TO, Rudmik L, Mace JC, DeConde AS, Alt JA, Smith TL

Abstract
BACKGROUND: For patients with chronic rhinosinusitis (CRS), the decision to elect continued medical management vs surgery is complex and involves tradeoffs between benefits, risks, and overall effectiveness of each therapy. The purpose of this study is to investigate whether baseline disease-specific quality of life (QOL) can assist in predicting outcomes in patients with refractory CRS who elect continued medical management.
METHODS: CRS patients electing medical management were enrolled in a prospective, multi-institutional cohort study. Patients were stratified into pretreatment 22-item Sino-Nasal Outcome Test (SNOT-22) subgroups based on 10-point score increments (eg, 10 to 19, 20 to 29, 30 to 39, etc.) to capture potential outcome differences by baseline SNOT-22 disease burden. The proportion of patients achieving minimal clinically important difference (MCID≥9 points) and relative improvement (%) for each score category were calculated.
RESULTS: Seventy-five CRS patients with a mean ± standard deviation pretreatment SNOT-22 score of 45.2 ± 16.6 were followed for a mean of 14.9 months. The majority of participants electing medical therapy failed to improve 1 MCID (57%) with a mean relative score improvement of 16%. Overall, 37% of patients maintained baseline SNOT-22 QOL status, whereas 20% of patients deteriorated >1 MCID. When treatment crossover patients (to endoscopic sinus surgery [ESS]) were included (n = 117), approximately 1 in 4 (27%) patients achieved an MCID.
CONCLUSION: Results from this study suggest that the majority of CRS patients electing ongoing medical management with low baseline disease-specific QOL impairment maintain stable QOL with continued medical management. Furthermore, of CRS patients electing ongoing medical therapy, approximately 1 in 4 patients achieved MCID, whereas 1 in 5 experienced deterioration by >1 MCID.

PMID: 26852743 [PubMed - as supplied by publisher]

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Dialectal and gender differences in nasalance for a Mandarin population.

Dialectal and gender differences in nasalance for a Mandarin population.

Clin Linguist Phon. 2016 Feb 6;:1-12

Authors: Kim HK, Yu XM, Cao YJ, Liu XM, Huang ZM

Abstract
The purpose of this study was to determine whether there are dialectal and gender related differences in nasalance of main Mandarin vowels and three sentences in 400 Chinese normal adults. The mean nasalance score difference for dialect and gender was significant (p < .001) in all speech materials. For different dialects, the average nasalance scores show that Chongqing > Beijing > Shanghai > Guangzhou for the nasal sentence, oro-nasal sentence, /a/, /i/ and /u/. In addition, the average nasalance scores of females were higher than those of males for all speech materials in all dialects. The clinical significance of this study can be helpful in making nasalance clinical decisions for Chinese people with cleft palate, hearing disorders and dysarthria with resonance disorders. It also shows the theoretical and socio-cultural features for linguists considering dialects and gender.

PMID: 26853731 [PubMed - as supplied by publisher]

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Tongue displacement and durational characteristics of normal and disordered Brazilian Portuguese liquids.

Tongue displacement and durational characteristics of normal and disordered Brazilian Portuguese liquids.

Clin Linguist Phon. 2016 Feb 6;:1-19

Authors: Berti L, Boer G, Bressmann T

Abstract
The goal of the present study was to characterize normal and disordered Brazilian Portuguese liquids. The research hypotheses were that disordered liquid sounds would be characterized by (1) longer syllable and segment durations, (2) larger and more undifferentiated displacement of the tongue and (3) that the speech errors would show sub-phonemic differences depending on the target sound. The participants of this study were 11 children with phonological disorders and 9 control participants matched for age and educational background. The children's tongue movement in the sagittal plane was recorded with ultrasound. The speech stimuli consisted of 3 repetitions of 5 words representing the four Brazilian Portuguese liquids /l/, /ʎ/, /ɾ/ and /ʀ/ in the context of the vowel /a/. A panel of four listeners transcribed each of the productions and classified them as correct or incorrect. The outcome measures were based on duration (syllable duration, ratio L/V) and tongue displacement (percentage average displacement, anterior displacement, posterior displacement). Based on mixed model analyses of variance, the first research hypothesis was confirmed for the /l/ and /ɾ/ targets, but not for the /ʀ/ and /ʎ/ targets. The second hypothesis was partially confirmed. The third hypothesis was confirmed. The research serves to illustrate the effects of phonological disorder on the phonetic realisation of Brazilian Portuguese liquid sounds.

PMID: 26853548 [PubMed - as supplied by publisher]

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Computerized Tomography Measures During and After Artificial Lengthening of the Vocal Tract in Subjects With Voice Disorders.

Computerized Tomography Measures During and After Artificial Lengthening of the Vocal Tract in Subjects With Voice Disorders.

J Voice. 2016 Feb 4;

Authors: Guzman M, Miranda G, Olavarria C, Madrid S, Muñoz D, Leiva M, Lopez L, Bortnem C

Abstract
PURPOSE: The present study aimed to observe the effect of two types of tubes on vocal tract bidimensional and tridimensional images.
METHODS: Ten participants with hyperfunctional dysphonia were included. Computerized tomography was performed during production of sustained [a:], followed by sustained phonation into a drinking straw, and then repetition of sustained [a:]. A similar procedure was performed with a stirring straw after 15 minutes of vocal rest. Anatomic distances and area measures were obtained from computerized tomography midsagittal and transversal images. Vocal tract total volume was also calculated.
RESULTS: During tube phonation, increases were measured in the vertical length of the vocal tract, oropharyngeal area, hypopharyngeal area, outlet of the epilaryngeal tube, and inlet to the lower pharynx. Also, the larynx was lower, and more closure was noted between the velum and the nasal passage.
CONCLUSION: Tube phonation causes an increased total vocal tract volume, mostly because of the increased cross-sectional areas in the pharyngeal region. This change is more prominent when the tube offers more airflow resistance (stirring straw) compared with less airflow resistance (drinking straw). Based on our data and previous studies, it seems that vocal tract changes are not dependent on the voice condition (vocally trained, untrained, or disordered voices), but on the exercise itself and the type of instructions given to subjects. Tube phonation is a good option to reach therapeutic goals (eg, wide pharynx and low larynx) without giving biomechanical instructions, but only asking patients to feel easy voice and vibratory sensations.

PMID: 26852823 [PubMed - as supplied by publisher]

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Voice outcomes following reoperative central neck dissection for recurrent/persistent thyroid cancer.

Related Articles

Voice outcomes following reoperative central neck dissection for recurrent/persistent thyroid cancer.

Laryngoscope. 2015 Nov;125(11):2621-5

Authors: Starmer H, Noureldine SI, Ozgursoy OB, Tufano RP

Abstract
OBJECTIVES/HYPOTHESIS: We aimed to assess voice outcomes following reoperative central neck dissection (RCND) to characterize postoperative voice difficulties experienced, determine the natural progression of vocal recovery, and identify risk factors for the development of voice disorders postoperatively.
STUDY DESIGN: Prospective cohort study.
METHODS: Consecutive patients with recurrent/persistent thyroid cancer who were deemed appropriate candidates for RCND were eligible for participation in this study. A battery of voice evaluation measures was administered both preoperatively and 2 to 4 weeks postoperatively.
RESULTS: Twenty consecutive patients were included. Postoperatively, six (30%) new incidents of vocal fold motion impairment (VFMI) were identified, with two (10%) being due to intentional recurrent laryngeal nerve (RLN) transection. On 1-year follow-up, two patients had full restoration of vocal fold mobility and four had persistent VFMI. No preoperative voice/laryngeal exam factors were predictive of postoperative VFMI. Clinically relevant change in postoperative Voice Handicap Index score was absent in all patients without VFMI and present in five of six patients with VFMI (P=.0004). Patients with VFMI had significantly poorer overall dysphonia grade, less glottic closure, and elevated jitter in contrast to those individuals without VFMI. Patients with malignant tissue in the remnant thyroid were four times more likely to develop VFMI than those with central neck lymph node metastases alone (P=.06).
CONCLUSION: Patients undergoing RCND are at risk for postoperative VFMI, even when the RLN is anatomically preserved, with subsequent impact on quality of life. Presence of malignant disease in the remnant thyroid appears to be the best predictor for postoperative VFMI.
LEVEL OF EVIDENCE: 2b.

PMID: 26153252 [PubMed - indexed for MEDLINE]

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Localization of histamine (H1, H2, H3 and H4) receptors in mouse inner ear.

Localization of histamine (H1, H2, H3 and H4) receptors in mouse inner ear.

Acta Otolaryngol. 2016 Feb 6;:1-8

Authors: Takumida M, Takumida H, Anniko M

Abstract
Conclusion The present findings show that all four types of histamine receptors (H1R, H2R, H3R, and H4R) are present in the inner ear, thus supporting the hypothesis that histamine plays a physiological role in the inner ear. Objective To analyse the presence of histamine receptors in the normal mouse inner ear. Methods CBA/J mice were used in this study. The localization of H1R, H2R, H3R, and H4R in the inner ear, i.e. cochlea, vestibular end organs, vestibular ganglion, and endolymphatic sac, was studied by real-time PCR and immunohistochemistry. Results The mRNA for each receptor sub-type was detected in the inner ear. In the immunohistochemical study, the organ of Corti, spiral ganglion, vestibular ganglion, vestibular sensory epithelium, and endolymphatic sac cells showed an immunofluorescent reaction to all histamine receptors.

PMID: 26854127 [PubMed - as supplied by publisher]

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A novel combination of drug therapy to protect residual hearing post cochlear implant surgery.

A novel combination of drug therapy to protect residual hearing post cochlear implant surgery.

Acta Otolaryngol. 2016 Feb 6;:1-5

Authors: Eshraghi AA, Roell J, Shaikh N, Telischi FF, Bauer B, Guardiola M, Bas E, Van De Water T, Rivera I, Mittal J

Abstract
Conclusions A cocktail combining NAC, Mannitol, and Dexamethasone may be used to prevent loss of residual hearing post-implantation. There is a window of opportunity to treat the cochlea before the onset of cell death in HCs. Objective Inner ear trauma caused by cochlear implant electrode insertion trauma (EIT) initiates multiple molecular mechanisms in hair cells (HCs) or support cells (SCs), resulting in initiation of programmed cell death within the damaged tissues of the cochlea, which leads to loss of residual hearing. In earlier studies L-N-acetylcysteine (L-NAC), Mannitol, and dexamethasone have been shown independently to protect the HCs loss against different types of inner ear trauma. These three molecules have different otoprotective effects. The goal of this preliminary study is to test the efficacy of a combination of these molecules to enhance the otoprotection of HCs against EIT. Methods OC explants were dissected from P-3 rats and placed in serum-free media. Explants were divided into control and experimental groups.
CONTROL GROUP: (1) untreated controls; (2) EIT. Experimental group: (1) EIT + L-NAC (5, 2, or 1 mM); (2) EIT + Mannitol (100, 50, or 10 mM); (3) EIT + Dex (20, 10, or 5 μg/mL); (4) EIT + L-NAC + Mannitol + Dex. After EIT was caused in an in-vitro model of CI, explants were cultured in media containing L-NAC alone, Mannitol alone, or Dex alone at decreasing concentrations. Concentrations of L-NAC, Mannitol, and Dex that showed 50% protection of hair cell loss individually were used as a combination in experimental group 4. Results There was an increase of total hair cell (THC) loss in the EIT OC explants when compared with control group HC counts or the tri-therapy cochlea. This study defined the dosage of L-NAC, Mannitol, and Dex for the survival of 50% protection of hair cells in vitro. Their combination provided close to 96% protection, demonstrating an additive effect.

PMID: 26854005 [PubMed - as supplied by publisher]

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Use of modified barium swallow study to measure posterior airway space in obstructive sleep apnea.

Use of modified barium swallow study to measure posterior airway space in obstructive sleep apnea.

Acta Otolaryngol. 2016 Feb 6;:1-6

Authors: Crosby T, Phillips J, Carbo A, Babcock K, Nathan CA

Abstract
Conclusion Measurement of the posterior airway space (PAS) using modified barium swallow (MBS) appears to correlate well with CT imaging. This data suggests MBS may be a low-cost alternative imaging modality to assess obstructive sleep apnea patients. Objectives Obstructive sleep apnea research has focused on imaging modalities that supplement polysomnography in evaluation of potential sites of airway obstruction. While several techniques have been used to assess the PAS, many incur significant costs and risks to the patient. This study proposes use of MBS as a simple modality to measure PAS. Advantages include its simplicity, lower radiation, and dynamic tongue base visualization, which may help predict surgical outcomes. It is hypothesized that cephalometric measurements obtained using MBS will correlate well with CT. Methods Thirty-six adult patients who underwent both CT imaging and MBS for head and neck cancer were included. Cephalometric measurements of the PAS were obtained using each imaging modality. Statistical analysis focused on correlating measurements taken using CT and MBS. Results The average PAS measurements were 12.53 ± 1.81 mm and 12.80 ± 1.75 mm by MBS and CT imaging, respectively. In comparing the two modalities, Pearson correlation between CT and MBS measurements revealed significant positive correlations between r = 0.769 and 0.937.

PMID: 26852777 [PubMed - as supplied by publisher]

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Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations.

Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations.

Acta Otolaryngol. 2016 Feb 6;:1-6

Authors: Hulterström AK, Sellin M, Monsen T, Widerström M, Gurram BK, Berggren D

Abstract
Conclusions Patients with symptomatic perforations of the nasal septum had a high prevalence of S. aureus in the nasal mucosa. Pulsed field gel electrophoresis (PFGE) analysis revealed a high genetic heterogeneity of S. aureus among both patients and controls. This indicates that presence of different strains of S. aureus can maintain a chronic inflammation in symptomatic nasal septal perforations. Objective The purpose of this study was to investigate the microbial flora around nasal septal perforations in patients having severe symptoms regarding bleeding, obstruction, and crustation associated with their perforation. Methods Twenty-five patients with untreated symptomatic nasal septal perforations were included. For culture, swabs around the perforations were collected. Bacteria were identified with standard laboratory techniques including a MALDI-TOF mass spectrometer. Epidemiological analysis was done using PFGE protocols. Bacteriological data were compared with data from a healthy control group. Results Staphylococcus aureus was present in the mucosa surrounding the nasal perforation significantly more often (p < 0.0001) in the patients (88%) compared to a control group (13%). Corynebacterium spp. and Propionibacterium spp. were significantly more frequently identified in the control group. The PFGE analysis of S. aureus strains revealed a high genetic heterogeneity and no specific S. aureus genotypes were associated with septal perforation.

PMID: 26852671 [PubMed - as supplied by publisher]

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