Laryngoscope
1531-4995
0023-852X
Mỹ
Cơ quản chủ quản: WILEY , Wiley-Blackwell
Lĩnh vực:
Otorhinolaryngology
Các bài báo tiêu biểu
Development and Validation of the Voice Handicap Index‐10 Abstract Objectives/Hypothesis: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI).Study Design: Item analysis of the VHI in individuals without voice disorders and patients with voice disorders and creation and validation of the abbreviated VHI.Methods: Clinical consensus review of the VHI items was held to prioritize the clinical value of each of the VHI items (30 items in all). Item analysis of the VHI was performed using the VHI responses of 100 patients with voice problems and 159 control subjects. The 10 most robust VHI items were selected using the item analysis and clinical consensus results to form the Voice Handicap Index‐10 (VHI‐10). Statistical analysis comparing the validity of the VHI‐10 with the VHI was performed with 819 patients representing a wide spectrum of voice disorders.Results: Statistical analysis of the VHI and VHI‐10 scores from the study group showed no statistically significant differences between the VHI and the VHI‐10. Irrespective of diagnosis, the correlation between the VHI and the VHI‐10 was greater than .90 (P = .01). The ratios of the VHI‐10 to VHI scores for a variety of voice disorder categories were analyzed and found to be consistently greater than the expected value (33%). This suggests that the VHI‐10 may be a more robust instrument than the VHI.Conclusion: The VHI‐10 is a powerful representation of the VHI that takes less time for the patient to complete without loss of validity. Thus, the VHI‐10 can replace the VHI as an instrument to quantify patients' perception of their voice handicap.
Tập 114 Số 9 - Trang 1549-1556 - 2004
A New Classification for Cochleovestibular Malformations Abstract Objective The report proposes a new classification system for inner ear malformations, based on radiological features of inner ear malformations reviewed in 23 patients.Study Design The investigation took the form of a retrospective review of computerized tomography findings relating to the temporal bone in 23 patients (13 male and 10 female patients) with inner ear malformations. The subjects were patients with profound bilateral sensorineural hearing loss who had all had high‐resolution computed tomography (CT) with contiguous 1‐mm‐thick images obtained through the petrous bone in axial sections.Methods The CT results were reviewed for malformations of bony otic capsule under the following subgroups: cochlear, vestibular, semicircular canal, internal auditory canal (IAC), and vestibular and cochlear aqueduct malformations. Cochlear malformations were classified as Michel deformity, common cavity deformity, cochlear aplasia, hypoplastic cochlea, incomplete partition types I (IP‐I) and II (IP‐II) (Mondini deformity). Incomplete partition type I (cystic cochleovestibular malformation) is defined as a malformation in which the cochlea lacks the entire modiolus and cribriform area, resulting in a cystic appearance, and there is an accompanying large cystic vestibule. In IP‐II (the Mondini deformity), there is a cochlea consisting of 1.5 turns (in which the middle and apical turns coalesce to form a cystic apex) accompanied by a dilated vestibule and enlarged vestibular aqueduct.Results Four patients demonstrated anomalies involving only one inner ear component. All the remaining patients had diseases or conditions affecting more than one inner ear component. Eight ears had IP‐I, and 10 patients had IP‐II. Ears with IP‐I had large cystic vestibules, whereas the amount of dilation was minimal in patients with IP‐II. The majority of the semicircular canals (67%) were normal. Semicircular canal aplasia accompanied cases of Michel deformity, cochlear hypoplasia, and common cavity. In 14 ears, the IAC had a defective fundus at the lateral end. In two ears the IAC was absent. In all seven cases of common cavity malformations, there was a bony defect at the lateral end of the IAC. In five of them the IAC was enlarged, whereas in two the IAC was narrow. All patients with IP‐I had an enlarged IAC, whereas in patients with type II disease, four had a normal IAC and 10 had an enlarged IAC. All cases of IP‐II had an enlarged vestibular aqueduct, whereas this finding was not present in any of the cases of IP‐I. In all cases, the vestibular aqueduct findings were symmetrical on both sides (simultaneously normal or enlarged). No patient demonstrated enlargement or any other abnormalities involving the cochlear aqueduct.Conclusions Radiological findings of congenital malformations in the present study suggested two different types of incomplete partition. Cystic cochleovestibular malformation (IP‐I) and the classic Mondini deformity (IP‐II). The type I malformation is less differentiated than the type II malformation. Classic Mondini deformity has three components (a cystic apex, dilated vestibule, and large vestibular aqueduct), whereas type I malformation has an empty, cystic cochlea and vestibule without an enlarged vestibular aqueduct. Mondini deformity represents a later malformation, so the amount of dysplasia is much less than in type II. Therefore, it is more accurate and useful for clinical purposes to classify these malformations (in descending order of severity) as follows: Michel deformity, cochlear aplasia, common cavity, IP‐I (cystic cochleovestibular malformation), cochlear hypoplasia, and IP‐II (Mondini deformity). Only in this way can these complex malformations be grouped precisely and the results of cochlear implantation compared.
Tập 112 Số 12 - Trang 2230-2241 - 2002
Clinical Manifestations of Superior Semicircular Canal Dehiscence
Tập 115 Số 10 - Trang 1717-1727 - 2005
Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): A 12‐year experience in more than 900 patients Abstract Objectives: This paper reviews a 12‐year experience in more than 900 patients with spasmodic dysphonia who have been treated with botulinum toxin. Study Design: This is a retrospective analysis of patients with adductor spasmodic dysphonia (strainstrangled voice), abductor spasmodic dysphonia (whispering voice), and adductor breathing dystonia (paradoxical vocal fold motion), all of whom have been treated with botulinum toxin injections for relief of symptom. Methods: All of the patients were studied with a complete head and neck and neurologic examination; fiberoptic laryngostroboscopy; acoustic and aerodynamic measures; and a speech evaluation including the Universal spasmodic dysphonia rating scale. Some were given electromyography. All patients received botulinum toxin injections into the affected muscles under electromyographic guidance. Results: The adductor patients had an average benefit of 90% of normal function lasting an average of 15.1 weeks. The abductor patients had an average benefit of 66.7% of normal function lasting an average of 10.5 weeks. Adverse effects included mild breathiness and coughing on fluids in the adductor patients, and mild stridor in a few of the abductor patients. Conclusion: Botulinum toxin A injection of the laryngeal hyperfunctional muscles has been found over the past 12 years to be the treatment of choice to control the dystonic symptoms in most patients with spasmodic dysphonia. Laryngoscope , 108:1435–1441, 1998
Tập 108 Số 10 - Trang 1435-1441 - 1998
Complications of endoscopic sinus surgery: Analysis of 2108 patients—incidence and prevention Abstract The incidence of complications of endoscopic sinus surgery (ESS) in a combined experience with 2108 total patients is compared to complications in 11 other series of patients (2583 total) who underwent ESS and 6 series of patients (2110 total) who underwent traditional endonasal sinus surgery. The incidence of major perioperative complications was 0.85%, with cerebrospinal fluid (CSF) leak being the most common. The most common minor complications of ESS were those related to orbital penetration and middle turbinate adhesions; minor complications occurred in 6.9% of the 2108 patients. There were no statistically significant differences in the overall incidences of major complications between this series and the other two groups. Recommendations are made for the prevention of complications during ESS.
Tập 104 Số 9 - Trang 1080-1083 - 1994
Complications of endoscopic intranasal ethmoidectomy Abstract A consecutive series of 90 patients undergoing endoscopic intranasal ethmoidectomy was reviewed. There were 26 complications (29%) in 19 patients in this group. Eight complications (8%) including CSF leak, temporary blindness, and hemorrhage were considered major with the latter occurring most commonly. Synechiae were the most commonly occurring minor complications. Endoscopic nasal sinus surgery performed by inexperienced operators carries with it the same risks and complications as traditional intranasal sinus surgery. Any surgeon who does not routinely perform traditional intranasal ethmoidectomy should accrue endoscopic experience through appropriate didactic training and multiple cadaver dissections (akin to otologic training).
Tập 97 Số 11 - Trang 1270-1273 - 1987
Management of tumors arising in the parapharyngeal space Abstract Tumors originating in the parapharyngeal space are rare. During the period of January 1977 to July 1989, 51 patients underwent surgery for parapharyngeal space tumors at the University of Pittsburgh's Eye and Ear Hospital. Eighty percent of the parapharyngeal space neoplasms were benign; 20% were malignant. Fifty‐seven percent (31/54) were of neurogenic origin, 30% (16/54) were of salivary origin, and 13% (7/54) were of miscellaneous origin. The use of computed tomography scan and magnetic resonance imaging, and selective use of angiography, allowed us to ascertain the location, size, vascularity, and relation of parapharyngeal space tumors to surrounding anatomical structures. Imaging techniques established the site of origin of these tumors with 96% accuracy. This information was essential in planning surgical approaches and predicting prognoses. Details of the surgery, morbidity, and outcome of these patients are presented.
Tập 100 Số 6 - Trang 583-589 - 1990
A Prospective Study of Quality of Life in Head and Neck Cancer Patients. Part II: Longitudinal Data Abstract Objectives To evaluate the health‐related quality of life (HRQL) of patients with head and neck cancer during and after treatment with radiotherapy, surgery, and chemotherapy.Study Design Prospective, descriptive study.Methods All new patients in four institutions in Norway and Sweden were asked to participate. Health‐related quality of life was assessed at baseline and at 1, 2, 3, 6, and 12 months after start of treatment by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC head and neck cancer–specific questionnaire. Baseline results are described elsewhere; longitudinal results are presented in the current article. Three hundred fifty‐seven patients with cancer in the oral cavity, pharynx, larynx, nose, sinuses, and salivary glands and neck node metastases from unknown primaries filled in the questionnaires at baseline.Results Seventy‐eight percent of the patients who were alive after 12 months filled in all questionnaires (218/280). The general trend was that HRQL deteriorated significantly during treatment, followed by a slow recovery until the 12‐month follow‐up with few exceptions (senses, dry mouth, and sexuality). Patients who later died reported worse HRQL at each assessment point compared with patients who filled in all six questionnaires, whereas those who dropped out of the study for other reasons were quite similar to patients who filled in all questionnaires. The patients with pharyngeal cancer in general reported worse HRQL compared with the other groups and did not reach pretreatment values in several domains. Stage was also an important factor for HRQL in patients with head and neck cancer.Conclusion Detailed knowledge about the differences between groups and changes over time may aid us in the communication with patients and in the design of intervention studies focusing on improvement of the support and rehabilitation of patients with head and neck cancer.
Tập 111 Số 8 - Trang 1440-1452 - 2001