The effectiveness of different neuroprotective agents in facial nerve injury: An experimental study
Gokce Tanyeri, Onur Celik, Oytun Erbas, Fatih Oltulu, Ozlem Yilmaz Dilsiz, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To examine and compare the neuroprotective effects of dexamethasone, oxytocin, and resveratrol administration on regeneration after facial nerve crush injury in a rat model.
Study Design
Prospective, randomized, controlled animal study.
Methods
A crush-type facial nerve injury was performed on the right side of all rats (injury group [IG]), whereas there was no injury on the left side (sham group [SG]). These main groups were divided into five subgroups: 1) no medicine (control); 2) physiological serum; 3) dexamethasone; 4) oxytocin; and 5) resveratrol (Res) administered (intraperitoneal injection) for 28 days. Functional recovery was evaluated by daily eye-blink reflex and facial electromyography. Nerve–muscle degeneration and regeneration, apoptosis, and intercellular connections were evaluated in histopathological and immunohistochemical examinations.
Results
Recovery time of the postinjury eye-blink reflex demonstrated faster recovery in IG + Res when compared with the other subgroups. In peak-to-peak amplitude values, a significant increase was observed in the dexamethasone (P = 0.007) and oxytocin subgroups (P = 0.004) and was even more apparent in the resveratrol subgroup (P < 0.001). Nerve regeneration is apparent in the resveratrol subgroup. Apoptotic changes were evaluated immunohistochemically with TUNEL and Caspase 3 and 6 antibodies staining. Caspase 3 and 6 immunoexpressions of resveratrol and oxytocin subgroups were moderate when compared with dexamethasone subgroup. Except for the resveratrol subgroup, which had an increase in expression, the majority of subgroups were similar to SG in terms of intercellular connections (Connexin 32 and 43).
Conclusion
Resveratrol leads to the best outcome after facial nerve crush injury in rats when compared with dexamethasone and oxytocin, even though these agents demonstrate a significant improvement in facial nerve regeneration.
Level of Evidence
N/A. Laryngoscope, 2015
Quantitative assessment of vestibular otopathology in otosclerosis: A temporal bone study
Ömer Hızlı, Serdar Kaya, Patricia A. Schachern, Geeyoun Kwon, Michael M. Paparella, Sebahattin Cureoglu, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To determine if peripheral vestibular otopathology is present in human temporal bones with otosclerosis.
Study Design
Comparative human temporal bone study.
Methods
Seventy-four human temporal bones from 46 subjects with otosclerosis (mean age of 61 ± 18 years) and 20 within histologically normal limits from 17 subjects (mean age of 59 ± 14 years) were included in this study. Temporal bones with otosclerosis were divided into those with and without endosteal involvement. Using differential interference contrast microscopy at 1008× magnification, type I and type II vestibular hair cell counts were performed on each vestibular sense organ in which the neuroepithelia was oriented perpendicular to the plane of section. The organ-specific cell densities (cells/0.01 mm2 surface area) were compared between the groups with and without endosteal involvement, and also compared to counts in the nonotosclerosis control group using Student's t-test.
Results
Mean type I and type II hair cell densities of all vestibular structures in the group with endosteal involvement were significantly lower compared to the group without endosteal involvement. Mean type I and type II hair cell densities of all vestibular structures in the group with endosteal involvement were also significantly lower compared to the control group, but they were not in the group without endosteal involvement compared to the control group.
Conclusion
Endosteal involvement of otosclerotic foci is associated with vestibular hair cell loss to be consistent with the conclusion section of the manuscript, change applied to the abstract that may contribute to the vestibular symptoms in otosclerosis.
Level of Evidence
N/A. Laryngoscope, 2015
Safety of cochlear implantation before 12 months of age: Medical University of South Carolina and Pediatric American College of Surgeons–National Surgical Quality improvement program outcomes
Brendan P. O'Connell, Meredith A. Holcomb, Daniel Morrison, Ted A. Meyer, David R. White, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
The primary objective of this study was to determine the safety profile of cochlear implantation (CI) in infants <12 months old.
Study Design
Retrospective review of institutional (Medical University of South Carolina [MUSC]) and national data (Pediatric American College of Surgeons–National Surgical Quality Improvement Program [ACS-NSQIP]).
Methods
Cases were subdivided into two groups according to age at CI: <12 months and 12 to 18 months. The primary outcome measure of interest was occurrence of a postoperative medical or surgical complication. Operative time, anesthesia time, time in the postoperative anesthesia care unit, and length of stay were also assessed.
Results
In infants <12 months of age, the incidence of a 30-day postoperative surgical complication using the ACS-NSQIP database was 3.6%; this did not differ from the rate observed in the 12- to 18-month-old group (3.2%, P = 1.0). In the MUSC series, the occurrence of a 30-day postoperative complication in children <12 months old was comparable (2.7%). At longer-term follow-up (mean = 3.7 years), the incidence of a postoperative surgical complication in infants <12 months old using MUSC data was 13.5%. When compared to older children at longer-term follow-up, no difference was noted (12.7%, P = 1.0). The incidence of a postoperative medical or anesthetic complication in children <12 months of age was extremely rare in both MUSC and ACS-NSQIP series (0% and 1.3%, respectively).
Conclusions
Institutional and national data demonstrate that CI in children <12 months of age is a safe procedure. Although infants <12 months old are at risk for postoperative complications, the rates of surgical and medical complications were no different compared to children 12 to 18 months of age.
Level of Evidence
4 Laryngoscope, 2015
A newborn with three cochlear turns: Case report and literature review
Douglas M. Hildrew, Ashwin Ananth, Kimsey H. Rodriguez, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
The human cochlea is most commonly considered to have two and a half turns. Although the causes of cochlear hypoplasia are well described, cochlear hyperplasia is a rarer entity that is poorly understood. We describe rare anatomic cochlear malformations identified in a 4-month-old male originally referred for evaluation after a failed newborn hearing screening. The full diagnostic evaluation, imaging findings, treatment, and follow-up are described in detail. Cochleae with three turns are an uncommon malformation that is not included in current classifications schemes and may represent a distinct type of anomaly not caused by developmental arrest.Laryngoscope, 2015
Methylprednisolone use during radiotherapy extenuates hearing loss in patients with nasopharyngeal carcinoma
Junming Chen, Yuanxin Zhao, Xiaowei Zhou, Lingmei Tan, Zeying Ou, Youjun Yu, Yuejian Wang, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To investigate the hearing protective effects of methylprednisolone use during radiotherapy in patients with nasopharyngeal carcinoma.
Study Design
Prospective, controlled clinical study.
Methods
Fifty-three patients with nasopharyngeal carcinoma (106 ears). Twenty-five patients (50 ears) received radiotherapy with intravenous methylprednisolone for 14 days, and another 28 patients (56 ears) received radiotherapy alone. Pure tone audiometry, distortion product otoacoustic emission (DPOAE), and auditory brainstem responses (ABR) results were reviewed before and 1 year after radiotherapy.
Result
One year after radiotherapy, the air-and-bone conduction pure tone hearing thresholds increased, and the DPOAE levels decreased in the control group. There was no difference in the ABR wave I, III, and V latencies and the I to V interwave latencies before and 1 year after radiotherapy. The pure tone air conduction thresholds decreased, and the DPOAE levels increased in the treatment group compared with the control group.
Conclusion
Early sensorineural hearing loss after radiotherapy primarily affected the outer hair cells. The use of methylprednisolone during radiotherapy can extenuate early sensorineural hearing loss caused by irradiation.
Level of Evidence
4. Laryngoscope, 2015
Characteristics of patients treated for orbital cellulitis: An analysis of inpatient data
Emily Marchiano, Milap D. Raikundalia, Eric T. Carniol, Kristen A. Echanique, Evelyne Kalyoussef, Soly Baredes, Jean Anderson Eloy, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
Orbital cellulitis represents a spectrum of diseases, some of which may progress to potentially serious complications. The authors used the Nationwide Inpatient Sample (NIS) database to analyze the epidemiologic features of pediatric and adult patients admitted for the treatment of orbital cellulitis and to examine associations with surgical management.
Methods
The NIS was queried for patients admitted for treatment of orbital cellulitis from 2002 to 2010. Patient demographics, length of stay, hospital charges, and concomitant diagnoses were analyzed.
Results
There were 14,149 cases of orbital cellulitis identified with 1,717 (12.1%) having undergone surgical management. Surgical patients were older (29.6 ± 23.4) and more commonly male (62.0%) (P = 0.004 and < 0.001, respectively). Patients who had surgical intervention had longer length of stay and higher hospital charges than nonsurgical patients (P < 0.001). Our study showed that the proportion of pediatric patients age 10 to 19 years (22.1%) undergoing surgery was four times that of patients < 5 years of age (5.1%) (P < 0.001). Patients with concomitant diagnoses of acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema had significantly increased odds ratio of surgical intervention. Frontal sinusitis was the site most commonly associated with surgical intervention among sinusitis patients.
Conclusion
This study describes the characteristics of pediatric and adult patients admitted for orbital cellulitis from a national perspective. Patients 10 to 19 years of age were most likely to undergo surgical management. Acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema were concomitant diagnoses associated with significantly increased odds ratio of surgical intervention.
Level of Evidence
2C. Laryngoscope, 2015
Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy
Stacey T. Gray, Peter M. Sadow, Derrick T. Lin, Ahmad R. Sedaghat, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
Patients with a history of sinonasal malignancy can develop chronic rhinosinusitis (CRS) as a consequence of their oncologic treatment. Some patients will fail medical management and require endoscopic sinus surgery (ESS). This study reviews the use of ESS in the management of CRS in patients previously treated for sinonasal malignancy.
Study Design
Retrospective review.
Methods
All patients with a history of sinonasal malignancy who developed CRS and underwent ESS were reviewed. Preoperative and postoperative imaging and symptoms were collected. Major complications (bleeding, orbital injury, and cerebrospinal fluid leak) and minor complications (adhesion formation) and postoperative healing were reviewed.
Results
Eighteen patients were identified. All patients presented with symptoms of CRS and sinonasal crusting. Additionally, five patients presented with recurrent facial cellulitis, and six patients had mucoceles. No major complications were encountered. Postoperatively, all patients reported a subjective improvement in their sinonasal symptoms. Comparison of pre- and post-ESS imaging revealed a significant improvement in Lund-Mackay scores after ESS (P < 0.001) from 12.8 (range 5–22) to 7 (range). Despite symptomatic improvement, all patients continued to have nasal crusting. All patients who initially presented with recurrent facial cellulitis had no further episodes after ESS. None of the endoscopically drained mucoceles recurred.
Conclusion
For patients previously treated for sinonasal malignancy with refractory CRS, ESS appears to be a safe and effective treatment option. ESS in these patients results in subjective improvement in sinonasal symptoms as well as objective improvement in radiographic CRS disease burden, although sinonasal crusting will likely not resolve.
Level of Evidence
4. Laryngoscope, 2015
Otolaryngology utilization of speech-language pathology services for voice disorders
Seth M. Cohen, Michaela A. Dinan, Jaewhan Kim, Nelson Roy, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outpatients with laryngeal/voice disorders.
Study Design
Retrospective analysis of a large, national, administrative US claims database.
Methods
The study population included patients with a laryngeal/voice disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist as an outpatient, and 12 months of follow-up. Data were collected on SLP evaluation and treatment and patient factors including age, gender, geographic region, employment status, initial laryngeal diagnosis, and laryngeal diagnosis change over 12 months. Multivariable logistic regression analysis was used to investigate factors associated with receipt of SLP evaluation and treatment.
Results
There were 91,898 unique patients who met study criteria. A total of 4,485 (4.9%) patients had an SLP evaluation, of whom 2,216 (49.4%) had at least one voice therapy session. Patient age, gender, geographic region, and laryngeal diagnosis were associated with increased likelihood of receiving SLP services. Patients whose final laryngeal diagnosis changed from their initial diagnosis had greater odds of having an SLP evaluation (odds ratio = 1.18, 95% confidence interval = 1.06-1.31) compared to patients without laryngeal diagnosis change.
Conclusions
SLP evaluation and treatment occurred in a minority of laryngeal/voice-disordered patients. Further study is needed to assess the impact of SLP services on the healthcare utilization of patients with laryngeal/voice disorders.
Level of Evidence
2C. Laryngoscope, 2015
Onabotulinum toxin A dosage trends over time for adductor spasmodic dysphonia: A 15-year experience
Christopher G. Tang, Daniel Novakovic, Niv Mor, Andrew Blitzer, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
Although onabotulinum neurotoxin A (BoNTA) has been used for over three decades for the treatment of adductor spasmodic dysphonia, no study has been performed to look at the trend of BoNTA dosages across time. The goal of this study is to evaluate the dosage trends to determine if the dosage necessary for voice improvement in patients increases over time.
Study Design
Charts were reviewed for patients with 15 years or more of experience.
Methods
Linear regression analysis was performed to determine correlation coefficients and trends.
Results
Fifty-five patients receiving BoNTA injections by the senior author (c.g.t) for over 15 years were evaluated. Thirty-nine patients (82% female) met inclusion criteria. Patients received injections over an average of 18.6 years ± 1.36 years, with the longest follow-up of 21.5 years. Of 39 patients, 16 (41%) had a negative correlation coefficient (Pearson's r) suggesting a decrease over time, whereas 23 (59%) had a positive correlation coefficient suggesting an increase over time. The mean correlation coefficient was 0.139 ± 0.534 and P < 0.05 in 19 patients and P > 0.05 in 20 patients. R2 for all patients were less than 0.75.
Conclusions
Onabotulinum neurotoxin A injection dosage trends vary depending on the individual over time. Overall, the dose range appears to be stable in the majority of patients, suggesting that tolerance does not play a significant part in dose variation over time.
Level of Evidence
4. Laryngoscope, 2015
Otolaryngology–head and neck surgery at Johns Hopkins: The first 100 years (1914–2014)
Howard W. Francis, Ira Papel, Ioan Lina, Wayne Koch, David Tunkel, Paul Fuchs, Sandra Lin, David Kennedy, Robert Ruben, Fred Linthicum, Bernard Marsh, Simon Best, John Carey, Andrew Lane, Patrick Byrne, Paul Flint, David W. Eisele, 2015-08-27 08:56:37 AM
Otolaryngological manifestations of Measles (Rubeola): A case report and brief review
Jay M. Bhatt, Kevin C. Huoh, 2015-08-27 08:56:37 AM
Measles is an acute viral respiratory illness caused by a virus of the Paramyxoviridae family. Despite being eliminated from the United States, small outbreaks across the country continue to occur. The United States experienced a record number of cases in 2014, with 668 cases seen across the country, a record since its elimination in 2000. Here, we present a case of an acute presentation of measles illness and discuss the otolaryngologic manifestation of the disease.
Level of Evidence
NA Laryngoscope, 2015
2014 Ogura Lecture
David Eibling, 2015-08-27 08:56:37 AM
Proliferative laryngitis with airway obstruction in an adult: Consider herpes
Carla V. Valenzuela, Colin P. Newbill, Christine Johnston, Tanya K. Meyer, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
Few cases of herpes simplex virus (HSV) affecting the larynx have been reported in the literature. Although HSV laryngitis appears to present with nonspecific symptoms, this is a potentially serious condition that can rapidly progress to unnecessary morbidity and mortality if not identified and treated accordingly. We report a case of HSV laryngitis in an individual with well controlled human immunodeficiency virus infection and perform a comprehensive literature review of HSV laryngitis in adults. From this case report and review of the literature, we advocate early diagnostic biopsy of unusual or poorly responsive laryngeal lesions for pathology, culture, and virology studies. Laryngoscope, 2015
Endoscopic surgery of the orbital apex: Outcomes and emerging techniques
Janalee Stokken, Divya Gumber, Jastin Antisdel, Raj Sindwani, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To review our experience with endoscopic orbital apex surgery.
Study Design
Retrospective review.
Methods
All cases with Current Procedural Terminology codes for endoscopic orbital decompression between 2002 and 2011 at two institutions were reviewed. Patients with a diagnosis of Graves orbitopathy or an orbital complication of sinusitis were excluded. Presenting symptoms, lesion location, pathology, surgical outcomes, and complications were examined.
Results
A total of 27 patients were identified. Seventeen (63%) of the patients were men, and the average age was 56 (range = 14–82) years. Eighteen patients had primary orbital apex lesions, and nine patients had sinonasal lesions that predominantly involved the medial orbital apex. The lesions were found to be on the right in 59% of cases. The etiologies include benign (40.7%), malignant (44%), infectious (7.4%), and metastatic (7.4%) lesions. Obtaining a pathologic diagnosis was successful endoscopically in all but two (7.4%) patients, both with lateral lesions. The two-surgeon, four-handed technique and intraoperative image guidance employing fused computed tomography/magnetic resonance imaging were used in the majority of intraconal cases. Complications occurred in three patients (11%) and included myocardial infarction, deep venous thrombosis, and vision loss. There were no cerebrospinal fluid leaks or postoperative hemorrhages. Notably, vision remained stable or improved in all but one patient (3.7% risk of vision decline). Average follow-up was 4 years (range = 1 month–8 years).
Conclusions
The endoscopic approach to the orbit apex offers significant advantages over traditional external approaches, and should be the preferred approach for all medial and inferior lesions. A two-surgeon multihanded technique can help facilitate difficult cases.
Level of Evidence
4. Laryngoscope, 2015
A multisensor approach to improve manometric analysis of the upper esophageal sphincter
Corinne A. Jones, Michelle R. Ciucci, Michael J. Hammer, Timothy M. McCulloch, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
High-resolution manometry (HRM) improves on previous manometric systems by including a greater number of sensors that are more densely placed. Due to deglutitive movement of the HRM catheter and upper esophageal sphincter (UES), it is unclear which HRM sensors capture pressure in the UES. To address this issue, we present two complementary studies to describe UES pressure patterns using HRM + videofluoroscopy and HRM + electromyography (EMG).
Study Design
Case series involving a new analysis method.
Methods
Study 1: Simultaneous HRM + videofluoroscopy were performed in 11 healthy subjects swallowing five 10-mL thin-liquid boluses. HRM catheter and UES movement were tracked to identify UES pressure patterns over multiple HRM sensors. Study 2: Simultaneous HRM + cricopharyngeal EMGs were performed in six healthy subjects swallowing five 10-mL water boluses. HRM and EMG outputs were correlated over individual and multiple HRM sensors.
Results
HRM sensors move prior to UES movement (P < .001) and to a lesser extent in rostral and ventral directions (P ≤ .01) than the UES. UES closure pressure is captured with two distinct patterns: 1) a rostral UES pattern with short durations and fast rate of pressure release, depicting UES descent along the catheter as it closes; and 2) a caudal UES pattern with tonic pressures at baseline and a deglutitive nadir. The HRM + EMG multisensor correlation (r = 0.88) was significantly stronger than the single-sensor correlation (r = 0.80; P = .02).
Conclusions
During deglutition, the HRM catheter and the UES rise above baseline positions and create a distinctive, multisensor manometric trace. Accurate deglutitive UES pressure evaluation must include multiple manometric sensors.
Level of Evidence
4 Laryngoscope, 2015
Squamous cell carcinoma of the nasal cavity: A population-based analysis
Aykut A. Unsal, Pariket M. Dubal, Tapan D. Patel, Alejandro Vazquez, Soly Baredes, James K. Liu, Jean Anderson Eloy, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
Squamous cell carcinoma of the nasal cavity (NCSCC) is an infrequent malignancy that has been historically difficult to characterize. This study provides new insight into NCSCC utilizing a population-based database. We analyze the propensity for cervical and distant metastasis from NCSCC, as well as survival outcomes.
Study Design
Retrospective database analysis.
Methods
The Surveillance, Epidemiology, and End Results (SEER) database (2004–2012) was queried for NCSCC cases. Data were analyzed with respect to various demographic and clinicopathologic factors. The results were further examined for regional and distant metastasis. Survival was analyzed using the Kaplan-Meier model.
Results
A total of 1,180 cases of NCSCC were identified in the SEER database between 2004 and 2012. The mean age at diagnosis was 65.8 years. American Joint Committee on Cancer stage was known in 1,050 cases, of which 53.4% were stage I, 13.3% were stage II, 10.2% were stage III, and 23.0% were stage IV. By tumor (T) stage classification, T1 was the most common (56.6%), followed by T4 (19.3%). Most cases had no nodal (N) involvement at diagnosis (90.8%). Cervical nodal involvement was present in 9.1% of cases, while distant metastasis was seen in 1.9%. Five-year disease-specific survival was 69.5% overall, 39.6% in cases with neck involvement and 0.0% for metastatic cases.
Conclusions
This study represents the only known population-based investigation of NCSCC. Metastasis to cervical nodes or distant sites, especially with T1 tumors, is rare. However, any cervical involvement or distant metastasis discovered on presentation is a poor prognostic indicator.
Level of Evidence
4. Laryngoscope, 2015
Does septoplasty performed at the same time as oropharyngeal surgery increase complication rates?
Francis X. Creighton, Neil Bhattacharyya, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To determine whether septoplasty when combined with ambulatory oropharyngeal surgery increases postoperative complications.
Study Design
Cross-sectional analysis of multistate ambulatory surgery and hospital databases.
Methods
Ambulatory adult septoplasty and oropharyngeal surgical procedures (tonsillectomy and uvulopalatoplasty [UPPP]) were extracted from the state ambulatory surgery databases for New York, Florida, Iowa, and California for 2010–2011. Cases with concurrent sinus surgery were excluded. Cases were linked to the state emergency department databases and the state inpatient databases to identify revisits within 14 days. The rates of unplanned revisits and postoperative bleeding were determined and compared among groups undergoing solely oropharyngeal surgery versus groups undergoing oropharyngeal surgery combined with septoplasty.
Results
Among 26,280 tonsillectomies alone versus 1,002 tonsillectomies + septoplasty, rates for unplanned revisits and hemorrhage were 13.2% and 12.8% (P = .66) and 4.9% and 7.0% (P = .003), respectively. Among 2,598 UPPPs alone versus 1,343 UPPPs + septoplasty, rates for revisits and hemorrhage were 11.4% versus 10.1% (P = .242) and 3.5% versus 3.8% (P = 0.683), respectively. Among 389 UPPP/tonsillectomies versus 164 UPPP/tonsillectomies + septoplasty, rates for revisits and hemorrhage were 11.8% versus 8.5% (P = .256) and 3.9% versus 6.1% (P = .247), respectively. Among all cases and groups, there were mortalities only in the UPPP alone group.
Conclusions
The addition of septoplasty to oropharyngeal ambulatory surgical procedures does not significantly increase the rate of unplanned revisits or postoperative hemorrhage except in the case of septoplasty added to tonsillectomy, with a small percentage increase in hemorrhage rate. Combining septoplasty with ambulatory oropharyngeal surgery is clinically reasonable in adults.
Level of Evidence
2b Laryngoscope, 2015
Voice disorders in the elderly: A national database study
Nelson Roy, Jaewhan Kim, Mark Courey, Seth M. Cohen, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To determine the type, frequency, and factors associated with voice disorders in the elderly.
Study Design
Retrospective analysis of data from a large national administrative US claims database.
Methods
Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses.
Results
Of the almost 55 million individuals in the database, 60,773 unique patients (mean age = 74.9 years, standard deviation = 6.6 years, range = 65–105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosis. The most frequent diagnoses overall were acute and chronic laryngitis, nonspecific dysphonia, and benign vocal fold lesions. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific dysphonia and laryngeal changes/lesions. In the otolaryngology group, odds of nonspecific dysphonia and vocal fold paralysis/paresis diagnoses increased with advancing age, whereas benign laryngeal pathology, and acute and chronic laryngitis decreased. As compared to men, women had lower odds of paralysis/paresis and laryngeal cancer but higher odds of acute laryngitis and nonspecific dysphonia. Odds of specific LVDs also varied depending upon comorbid conditions and geographic location.
Conclusions
Age, gender, comorbid conditions, geographic location, and physician type were significantly associated with specific LVD diagnoses within the elderly.
Level of Evidence
4 Laryngoscope, 2015
Endonasal identification of the orbital apex
Miguel S. Tepedino, Carlos D. Pinheiro-Neto, Thiago F. P. Bezerra, Paul A. Gardner, Carl H. Snyderman, Richard L. Voegels, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To describe anatomical landmarks for endoscopic endonasal approaches to the orbital apex and to measure the distances between those landmarks.
Methods
In this anatomic study, the nasal fossae of 30 adult fresh cadavers were dissected (n = 60 half-skulls). One double-injected orbit was carefully dissected, mainly focusing on the neurovascular structures. The orbital apex was dissected under endoscopic endonasal visualization in all cases. The distances between the ethmoidal crest and choanal arch to the optic canal (OC) and superior orbital fissure (SOF) were measured and recorded.
Results
The sample was predominantly male (63.3%, 19/30 cadavers). The following correlations between measurements according to side were observed: ethmoidal crest to OC, r = 0.748 (P = 0.0001); ethmoidal crest to SOF, r = 0.785 (P = 0.0001); choanal arch to OC, r = 0.835 (P = 0.0001); choanal arch to SOF, r = 0.820 (P = 0.0001).
Conclusions
In the cadavers studied in this sample, the ethmoidal crest and choanal arch were relevant structures and exhibited consistent measurements. Spearman correlation coefficients were greater than 0.7, which is indicative of good correlation between measurements obtained in the skull halves of each cadaver. Comparison of the measurements obtained in different sides showed similar values, with no statistically significant differences in the distances between any of the proposed anatomic landmarks.
Level of Evidence
N/A. Laryngoscope, 2015
Effect of three different chin-down maneuvers on Swallowing pressure in healthy young adults
Keigo Matsubara, Yoshihiko Kumai, Yuta Kamenosono, Yasuhiro Samejima, Eiji Yumoto, 2015-08-27 08:56:37 AM
Objectives/Hypothesis
To determine the effects of three different chin-down maneuvers on swallowing pressure (SP) in healthy young adults using high-resolution manometry (HRM).
Study Design
Repeated measures with subjects serving as their own controls.
Methods
Twenty-six healthy subjects (average age 26.4 [range 21–35] years) swallowed 5 mL of cold water to examine the maximum swallowing pressure (MSP) at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES), and to determine the duration of lowered SP at the UES using HRM. The subjects swallowed in the neutral position as a control and in the following three chin-down positions: 1) head flexion (HF); 2) neck flexion (NF); and 3) combined head and neck flexion (HFNF).
Results
The MSP at the velopharynx and meso-hypopharynx did not significantly differ among the three chin-down positions. Upon swallowing in the NF posture, the MSP was significantly lower (P < 0.0001) at the UES, and the duration of the lowered SP at the UES was significantly prolonged (P = 0.0010) compared to the neutral position. In comparison, the duration of lowered SP at the UES was significantly (P = 0.0001) shorter in the HF position than in the neutral position. Moreover, the HFNF position significantly (P = 0.0276) lowered the MSP at the UES compared to the control position.
Conclusion
In young healthy adults, NF maneuver resulted in significantly lower MSP and longer duration of the lowered swallowing pressure at the UES, which might assist bolus passage through the UES.
Level of Evidence
3b. Laryngoscope, 2015
Τετάρτη 26 Αυγούστου 2015
The Laryngoscope
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