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The aim of this study was to assess the responsiveness to change of a range of different measures, following voice therapy and surgery.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215107007839_sec2\">\u003Cjats:title>Design:\u003C\u002Fjats:title>\u003Cjats:p>Longitudinal, cohort comparison study.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215107007839_sec3\">\u003Cjats:title>Setting:\u003C\u002Fjats:title>\u003Cjats:p>Two UK voice clinics.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215107007839_sec4\">\u003Cjats:title>Participants:\u003C\u002Fjats:title>\u003Cjats:p>One hundred and forty-four patients referred for treatment of benign voice disorders, 90 undergoing voice therapy and 54 undergoing laryngeal microsurgery.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215107007839_sec5\">\u003Cjats:title>Main outcome measures:\u003C\u002Fjats:title>\u003Cjats:p>Three measures of self-reported voice quality (the vocal performance questionnaire, the voice handicap index and the voice symptom scale), plus the short form 36 (SF 36) general health status measure and the hospital anxiety and depression score. Perceptual, observer-rated analysis of voice quality was performed using the grade–roughness–breathiness–asthenia–strain scale. We compared the effect sizes (i.e. responsiveness to change) of the principal subscales of all measures before and after voice therapy or phonosurgery.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215107007839_sec6\">\u003Cjats:title>Results:\u003C\u002Fjats:title>\u003Cjats:p>All three self-reported voice measures had large effect sizes following either voice therapy or surgery. Outcomes were similar in both treatment groups. The effect sizes for the observer-rated grade–roughness–breathiness–asthenia–strain scale scores were smaller, although still moderate. The roughness subscale in particular showed little change after therapy or surgery. Only small effects were observed in general health and mood measures.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215107007839_sec7\">\u003Cjats:title>Conclusion:\u003C\u002Fjats:title>\u003Cjats:p>The results suggest that the use of a voice-specific questionnaire is essential for assessing the effectiveness of voice interventions. All three self-reported measures tested were capable of detecting change, and scores were highly correlated. 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Congenital cholesteatoma develops behind a normal, intact tympanic membrane, whilst acquired cholesteatoma is associated with a defect in the tympanic membrane. The pathological substrate of cholesteatoma is keratinising stratified squamous epithelium, but the origin of this epidermal tissue in the middle ear is controversial. Here, we review the most relevant and recent evidence for the principal aetiopathogenic theories of both forms of cholesteatoma, in the light of recent otopathological findings.\u003C\u002Fjats:p>\u003Cjats:p>Congenital cholesteatoma is most plausibly explained by the persistence of fetal epidermoid formation. Conclusive ‘proof’ awaits the unambiguous demonstration of the metamorphosis of an epidermoid nidus into a lesion\u003Cjats:italic>in vivo\u003C\u002Fjats:italic>.\u003C\u002Fjats:p>\u003Cjats:p>Acquired cholesteatoma may develop by various mechanisms: immigration, basal hyperplasia, retraction pocket and\u002For trauma (iatrogenic or non-iatrogenic). However, squamous metaplasia of the normal cuboidal epithelium of the middle ear is a highly unlikely explanation. Chronic inflammation seems to play a fundamental role in multiple aetiopathogenic mechanisms of acquired cholesteatoma. Therefore early treatment of inflammatory conditions might reduce their sequelae, perhaps by preventing the development of hyperplastic papillary protrusions.\u003C\u002Fjats:p>\u003Cjats:p>Continued otopathological, cellular and molecular research would enhance our limited understanding of cholesteatoma and may lead to new therapeutic strategies for this erosive disease, which often defies surgical treatment.\u003C\u002Fjats:p>",{"EN":711},"Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma",{"VOID":713},"17697435",{"VOID":715},"10.1017\u002Fs0022215107000503",[182],"https:\u002F\u002Fwww.cambridge.org\u002Fcore\u002Fproduct\u002Fidentifier\u002FS0022215107000503\u002Ftype\u002Fjournal_article",[719,736,753,772,791,808,827,842],{"id":720,"sortIndex":25,"researcher":24,"roles":721,"affiliations":722,"properties":731,"displayName":733,"givenName":24,"familyName":24},"b985fbaf-e3f5-455a-8803-773d92b9097d",[],[723],{"id":724,"sortIndex":25,"affiliation":725,"properties":24},"4e38b5ed-306a-434e-9c7d-d980386a54f0",{"id":724,"createTime":24,"updateTime":24,"relativeEntities":726,"slug":24,"properties":727,"entityType":24,"verifyStatus":24,"verifyTime":24,"verifyNote":24,"languages":24,"translateLanguages":24,"viewCount":24,"url":24,"parentIds":730,"statistic":24},[],{"title":728},{"VI":729},"Department of Otolaryngology, Northwick Park Hospital, Harrow, UK",[],{"title":732,"openalex":734},{"EN":733},"Rajendra Persaud",{"VOID":735},"A5109098254",{"id":737,"sortIndex":98,"researcher":24,"roles":738,"affiliations":739,"properties":748,"displayName":750,"givenName":24,"familyName":24},"25adc19e-202f-4bf7-afec-c659ad79aa53",[],[740],{"id":741,"sortIndex":25,"affiliation":742,"properties":24},"885707ef-2474-41ee-8e3e-9c637d7a21b3",{"id":741,"createTime":24,"updateTime":24,"relativeEntities":743,"slug":24,"properties":744,"entityType":24,"verifyStatus":24,"verifyTime":24,"verifyNote":24,"languages":24,"translateLanguages":24,"viewCount":24,"url":24,"parentIds":747,"statistic":24},[],{"title":745},{"VI":746},"Department of Otolaryngology, Southmead Hospital, Bristol, UK",[],{"title":749,"openalex":751},{"EN":750},"Daniel Hajioff",{"VOID":752},"A5017631887",{"id":754,"sortIndex":101,"researcher":24,"roles":755,"affiliations":756,"properties":765,"displayName":769,"givenName":24,"familyName":24},"8c64d69d-afde-4020-8be4-1d5d9673446f",[],[757],{"id":758,"sortIndex":25,"affiliation":759,"properties":24},"cdce1645-badd-4066-bad5-9aaa7aefb27d",{"id":758,"createTime":24,"updateTime":24,"relativeEntities":760,"slug":24,"properties":761,"entityType":24,"verifyStatus":24,"verifyTime":24,"verifyNote":24,"languages":24,"translateLanguages":24,"viewCount":24,"url":24,"parentIds":764,"statistic":24},[],{"title":762},{"EN":763},"Department of Otolaryngology, Royal Free Hospital, London, UK",[],{"orcid":766,"title":768,"openalex":770},{"VOID":767},"https:\u002F\u002Forcid.org\u002F0000-0001-8365-8024",{"EN":769},"Aaron Trinidade",{"VOID":771},"A5080408250",{"id":773,"sortIndex":93,"researcher":24,"roles":774,"affiliations":775,"properties":784,"displayName":788,"givenName":24,"familyName":24},"7195c5ed-fe3d-4f0d-936d-e56094b4421e",[],[776],{"id":777,"sortIndex":25,"affiliation":778,"properties":24},"78f2d00b-f50f-440d-a9bf-548729f8ce1e",{"id":777,"createTime":24,"updateTime":24,"relativeEntities":779,"slug":24,"properties":780,"entityType":24,"verifyStatus":24,"verifyTime":24,"verifyNote":24,"languages":24,"translateLanguages":24,"viewCount":24,"url":24,"parentIds":783,"statistic":24},[],{"title":781},{"EN":782},"Department of Otolaryngology, Royal National Throat, Nose and Ear Hospital, London, UK",[],{"orcid":785,"title":787,"openalex":789},{"VOID":786},"https:\u002F\u002Forcid.org\u002F0000-0002-5836-0688",{"EN":788},"S. 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In: http:\u002F\u002Fwww.dh.gov.uk\u002Fprod_consum_dh\u002Fgroups\u002Fdh_digitalassets\u002F@dh\u002F@en\u002F@ps\u002Fdocuments\u002Fdigitalasset\u002Fdh_113900.xls [25 March 2012]",{},{"id":24,"text":1782,"url":24,"identifiers":1783},"10.1016\u002F0301-5629(96)00038-5",{"doi":1782},{"id":24,"text":1785,"url":24,"identifiers":1786},"10.1259\u002F0007-1285-68-807-266",{"doi":1785},{"id":24,"text":1788,"url":24,"identifiers":1789},"2004, Guidance on Cancer Services: Improving Outcomes in Head and Neck Cancers",{},{"id":24,"text":1791,"url":24,"identifiers":1792},"10.1017\u002FS0022215106004944",{"doi":1791},{"id":24,"text":1794,"url":24,"identifiers":1795},"10.1002\u002Fcncr.21715",{"doi":1794},{"id":24,"text":1797,"url":24,"identifiers":1798},"10.1016\u002Fj.ejrad.2007.05.016",{"doi":1797},{"id":24,"text":1800,"url":24,"identifiers":1801},"10.1309\u002FXLNDTE289WAQYK0Y",{"doi":1800},{"id":24,"text":1803,"url":24,"identifiers":1804},"Ganguly, 2010, The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic, Ann R Coll Surg Engl, 92, 660",{},{"id":24,"text":1806,"url":24,"identifiers":1807},"10.1017\u002FS002221510014246X",{"doi":1806},{"id":1809,"createTime":1810,"updateTime":1810,"relativeEntities":1811,"slug":1812,"properties":1813,"entityType":177,"verifyStatus":178,"verifyTime":1826,"verifyNote":180,"languages":1827,"translateLanguages":24,"viewCount":25,"primaryUrl":1828,"fullTextUrl":24,"authors":1829,"publicationType":296,"publisherRelationship":1883,"citationCount":1937,"citationInfo":1938,"publishDate":1941,"publishYear":1939,"citationAnalyzeStatus":23,"lastCitationAnalyze":24,"indexDatabases":1942,"openAccess":24,"references":1943,"isForceReanalyzing":413},"56f30339-02ac-4761-b891-de009f16c78f","2025-01-03T00:42:02.577+00:00",[],"Top-cited-articles-of-the-last-30-years-1985-2014-in-otolaryngology-head-and-neck-surgery",{"openalex":1814,"mag":1816,"abstract":1818,"title":1820,"pm":1822,"doi":1824},{"VOID":1815},"W2212233792",{"VOID":1817},"2212233792",{"EN":1819},"\u003Cjats:title>Abstract\u003C\u002Fjats:title>\u003Cjats:sec id=\"S002221511500300X_sec_a1\">\u003Cjats:title>Background:\u003C\u002Fjats:title>\u003Cjats:p>The frequency with which a scientific article is cited by other studies is one way to measure its academic influence.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S002221511500300X_sec_a2\">\u003Cjats:title>Methods:\u003C\u002Fjats:title>\u003Cjats:p>A comprehensive search was performed to identify journal articles in the otorhinolaryngology subject category of the 2013 Journal Citation Report Science Edition over the last 30 years (1985–2014). The 100 most cited articles were reviewed and basic information including the publication year, country of origin, source journal, article type and research field was collected.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S002221511500300X_sec_a3\">\u003Cjats:title>Results:\u003C\u002Fjats:title>\u003Cjats:p>The 100 most cited articles were published in 15 of the 44 otorhinolaryngology journals. The number of citations per article ranged between 208 and 1559. The leading research field was otology and neurotology (\u003Cjats:italic>n\u003C\u002Fjats:italic> = 50), followed by rhinology (\u003Cjats:italic>n\u003C\u002Fjats:italic> = 23) and head and neck surgery (\u003Cjats:italic>n\u003C\u002Fjats:italic> = 11). Most papers originated in the USA (\u003Cjats:italic>n\u003C\u002Fjats:italic> = 64).\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S002221511500300X_sec_a4\">\u003Cjats:title>Conclusion:\u003C\u002Fjats:title>\u003Cjats:p>The possibility of an article being cited is influenced by the publication language, country of origin and source journal.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>",{"EN":1821},"Top-cited articles of the last 30 years (1985–2014) in otolaryngology – head and neck surgery",{"VOID":1823},"26584956",{"VOID":1825},"10.1017\u002Fs002221511500300x","2025-01-03T00:42:02.576+00:00",[182],"https:\u002F\u002Fwww.cambridge.org\u002Fcore\u002Fproduct\u002Fidentifier\u002FS002221511500300X\u002Ftype\u002Fjournal_article",[1830,1849,1868],{"id":1831,"sortIndex":25,"researcher":24,"roles":1832,"affiliations":1833,"properties":1842,"displayName":1846,"givenName":24,"familyName":24},"9d2db53b-c25b-4556-a949-20afadabeab6",[],[1834],{"id":1835,"sortIndex":25,"affiliation":1836,"properties":24},"cb9bc63d-2aba-4b76-ba5b-8ea59b7b8ea3",{"id":1835,"createTime":24,"updateTime":24,"relativeEntities":1837,"slug":24,"properties":1838,"entityType":24,"verifyStatus":24,"verifyTime":24,"verifyNote":24,"languages":24,"translateLanguages":24,"viewCount":24,"url":24,"parentIds":1841,"statistic":24},[],{"title":1839},{"EN":1840},"Division of Otorhinolaryngology, S.S. Giacomo e Cristoforo General Hospital, Massa, Italy",[],{"orcid":1843,"title":1845,"openalex":1847},{"VOID":1844},"https:\u002F\u002Forcid.org\u002F0000-0002-8273-415X",{"EN":1846},"Riccardo Lenzi",{"VOID":1848},"A5067101445",{"id":1850,"sortIndex":98,"researcher":24,"roles":1851,"affiliations":1852,"properties":1861,"displayName":1865,"givenName":24,"familyName":24},"859814fe-82ee-46b0-bba4-e489c5603cc4",[],[1853],{"id":1854,"sortIndex":25,"affiliation":1855,"properties":24},"e628ff1b-3a3f-4189-8f90-92291c53f320",{"id":1854,"createTime":24,"updateTime":24,"relativeEntities":1856,"slug":24,"properties":1857,"entityType":24,"verifyStatus":24,"verifyTime":24,"verifyNote":24,"languages":24,"translateLanguages":24,"viewCount":24,"url":24,"parentIds":1860,"statistic":24},[],{"title":1858},{"EN":1859},"Division of Otolaryngology-Audiology and Phoniatrics, University of Pisa, 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1977, Introducing citations classics: the human side of scientific reports, Curr Contents, 1, 5",{},{"id":24,"text":1972,"url":24,"identifiers":1973},"10.1136\u002Fbmj.314.7079.497",{"doi":1972},{"id":24,"text":1975,"url":24,"identifiers":1976},"10.1542\u002Fpeds.2013-0283",{"doi":1975},{"id":24,"text":1978,"url":24,"identifiers":1979},"10.1258\u002F002221502760132557",{"doi":1978},{"id":24,"text":1981,"url":24,"identifiers":1982},"10.1067\u002Fmem.2001.114318",{"doi":1981},{"id":24,"text":1984,"url":24,"identifiers":1985},"10.1097\u002FPRS.0b013e31816b13a9",{"doi":1984},{"id":24,"text":1987,"url":24,"identifiers":1988},"10.1097\u002FBOT.0b013e3181aa2182",{"doi":1987},{"id":1990,"createTime":1991,"updateTime":1991,"relativeEntities":1992,"slug":1993,"properties":1994,"entityType":177,"verifyStatus":178,"verifyTime":1991,"verifyNote":180,"languages":2007,"translateLanguages":24,"viewCount":25,"primaryUrl":2008,"fullTextUrl":24,"authors":2009,"publicationType":296,"publisherRelationship":2133,"citationCount":146,"citationInfo":2187,"publishDate":2189,"publishYear":1764,"citationAnalyzeStatus":23,"lastCitationAnalyze":24,"indexDatabases":2190,"openAccess":24,"references":2191,"isForceReanalyzing":413},"8bc1a1e6-9cce-4292-86a4-8d2f4091e969","2024-12-30T22:27:39.393+00:00",[],"Prognostic-factors-for-secondary-recurrence-of-pleomorphic-adenoma-a-20-year-retrospective-study",{"openalex":1995,"mag":1997,"abstract":1999,"title":2001,"pm":2003,"doi":2005},{"VOID":1996},"W1996605189",{"VOID":1998},"1996605189",{"EN":2000},"\u003Cjats:title>Abstract\u003C\u002Fjats:title>\u003Cjats:sec id=\"S0022215113001801_sec1\">\u003Cjats:title>Purpose:\u003C\u002Fjats:title>\u003Cjats:p>To evaluate the results of treatment of parotid pleomorphic adenoma, and the risk factors for secondary recurrence.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215113001801_sec2\">\u003Cjats:title>Materials and methods:\u003C\u002Fjats:title>\u003Cjats:p>Single-centre, retrospective study of 32 patients with pleomorphic adenoma recurrence managed between 1988 and 2008.\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215113001801_sec3\">\u003Cjats:title>Results:\u003C\u002Fjats:title>\u003Cjats:p>The mean age at diagnosis of primary pleomorphic adenoma recurrence was 43.4 years. Twenty-eight per cent of patients had secondary recurrence; 32 per cent had undergone two or more surgical resections and external adjuvant radiotherapy. An age of less than 25 years was significantly associated with an earlier primary recurrence (\u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.008). The most significant histopathological risk factor for secondary recurrence was the presence of a multifocal tumour (\u003Cjats:italic>p\u003C\u002Fjats:italic> = 0.019). Other histopathological criteria (i.e. cellularity and capsule rupture) were not significant. Radiotherapy was not associated with a decrease in recurrence. Nine per cent of patients progressed to malignancy. The main surgical complication was definitive facial palsy (14 per cent).\u003C\u002Fjats:p>\u003C\u002Fjats:sec>\u003Cjats:sec id=\"S0022215113001801_sec4\">\u003Cjats:title>Conclusion:\u003C\u002Fjats:title>\u003Cjats:p>Pleomorphic adenoma recurrence requires surgery, with greatly increased risk to the facial nerve. Resection with clear surgical margins is required, especially in young patients with multifocal tumours. 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