Aerodynamic Measurements in Medialization Thyroplasty

Objective --External vocal fold medialization thyroplasty is a standard technique for improving voice, swallowing and breathing impairments due to insufficient glottal closure caused by either unilateral vocal fold paralysis or deficit of vocal fold tissue (i.e. as a result of cordectomy, scarring processes or sulcus glottidis). However, only scant information is available concerning the effect of the medialization thyroplasty on aerodynamic parameters. The aim of this study was to investigate the effect of vocal fold medialization thyroplasty on the degree of laryngeal stenosis using selected aerodynamic parameters. Material and Methods --Thirty patients (12 female, 18 male) underwent external vocal fold medialization with a titanium vocal fold medialization implant under local anesthesia supplemented by i.v. sedation. Pulmonary function tests were performed pre- and postoperatively and selected parameters were analyzed statistically. Results --All patients reported improved self-control of breathing during speaking, laughing, coughing and physical activity. The postoperative values of the parameters tested showed no significant alteration in comparison to the preoperative data. Conclusions --The analysis of the aerodynamic findings indicated that the medialization procedure using an implant did not cause an increase in the laryngeal resistance.     

Validation of a clinical assessment tool for cicatrising conjunctivitis

PurposeThis study was designed to validate a semi-quantitative clinical assessment tool for cicatrising conjunctivitis (CC).MethodsFifty-five patients (109 eyes) with mucous membrane pemphigoid (MMP) and 31 patients (61 eyes) with Stevens-Johnson syndrome (SJS) were included. Three methods were used for validation: (1) comparison of inter- and intra-observer reproducibility for the components selected for the initial version of the tool, (2) quantitative measurement of the scarring component with a fornix depth measurer, compared with qualitative Tauber grading methodology, (3) the final version of the tool was compared with the published Sotozono SJS grading system. Main outcome measures included: inter- and intra-observer reproducibility, calculation of composite measures of scarring and morbidity, component redundancy, and correlation with other grading systems.ResultsInter- and intra-observer agreement was moderate-to-excellent for graded components of conjunctival hyperaemia, upper and lower symblepharon, upper and lower fornix depth, corneal vascularisation, and corneal opacity. There was poor-to-good agreement for limitation of motility which was rejected from inclusion in the final tool. Composite scores for scarring components and morbidity components showed good-to-excellent agreement and distribution of ocular disease severity. Analysis of the composite components showed no redundancy - all components contributed independently. Comparison with both Tauber and Sotozono grading methodologies showed good concordance.ConclusionsThis study has developed the first validated assessment tool applicable to causes of CC. The tool is concise and discriminates patients with varying disease severity. It measures both disease activity and severity and is suitable for clinical and research applications.     

Reliability of the Cervical Range of Motion Device in Measuring Upper Cervical Motion

Abstract

Limitations in upper cervical range of motion (occiput, Cl and C2) correlate highly with many pathological dysfunctions, including acute and chronic neck pain, headache, and temporomandibular joint (TMJ) pain. Although methods have been developed which provide valid and reliable measures of the middle and lower cervical spine, a quantitative method to evaluate upper cervical range of motion has not been documented in the literature thus far. The purpose of this study was to investigate the intra-tester and inter-tester reliability of the Cervical Range of Motion device (CROM) in measuring upper cervical flexion and extension. Thirty healthy volunteers, ages 23 to 37, were measured three times by three testers. Moderate to high reliability was observed for upper cervical measurements with ICC’s of .65 to .81 among testers and .89 to .97 between testers. Therefore, this method of evaluation can be used to obtain consistent quantitative measures in documenting changes in upper cervical range of motion.     

Nonlinear Methods to Assess Changes in Heart Rate Variability in Type 2 Diabetic Patients

Background

Heart rate variability (HRV) is an important indicator of autonomic modulation of cardiovascular function. Diabetes can alter cardiac autonomic modulation by damaging afferent inputs, thereby increasing the risk of cardiovascular disease. We applied nonlinear analytical methods to identify parameters associated with HRV that are indicative of changes in autonomic modulation of heart function in diabetic patients.

Objective

We analyzed differences in HRV patterns between diabetic and age-matched healthy control subjects using nonlinear methods.

Methods

Lagged Poincaré plot, autocorrelation, and detrended fluctuation analysis were applied to analyze HRV in electrocardiography (ECG) recordings.

Results

Lagged Poincare plot analysis revealed significant changes in some parameters, suggestive of decreased parasympathetic modulation. The detrended fluctuation exponent derived from long-term fitting was higher than the short-term one in the diabetic population, which was also consistent with decreased parasympathetic input. The autocorrelation function of the deviation of inter-beat intervals exhibited a highly correlated pattern in the diabetic group compared with the control group.

Conclusion

The HRV pattern significantly differs between diabetic patients and healthy subjects. All three statistical methods employed in the study may prove useful to detect the onset and extent of autonomic neuropathy in diabetic patients.     

Acoustic Impedance Study of Peritubal Myoclonus

An audible clicking sound coexistent with the contractions of the peritubal muscles is thought to be an isolated form of palatal myoclonus that presents with myoclonal contractions of the soft palate, larynx, pharynx and, sometimes, cervicofacial area. Acoustic impedance measurements, by demonstrating the relation between the muscle contractions and the clicking noise, represent one of the ways in which the diagnosis can be confirmed. This paper reports the impedance changes following various maneuvers and simultaneous electromyography recordings in four patients with peritubal myoclonus and confirms the accuracy and simplicity of these tests. The pathology of peritubal myoclonus and its treatment options are discussed.     

Histopathologic characteristics of chronic sinusitis with bronchial asthma

Although tympanic-membrane (TM) perforations are common sequelae of middle-ear disease, the hearing losses they cause have not been accurately determined, largely because additional pathological conditions occur in these ears. Our measurements of acoustic transmission before and after making controlled perforations in cadaver ears show that perforations cause frequency-dependent loss that: (1) is largest at low frequencies; (2) increases as perforation size increases; and (3) does not depend on perforation location. The dominant loss mechanism is the reduction in sound-pressure difference across the TM. Measurements of middle-ear air-space sound pressures show that transmission via direct acoustic stimulation of the oval and round windows is generally negligible. A quantitative model predicts the influence of middle-ear air-space volume on loss; with larger volumes, loss is smaller.