The Laryngoscope
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1) Develop a computerized technique to accurately compare acoustic neuroma size on routine computed tomography and magnetic resonance imaging (MRI) scans; 2) use this technique to determine the growth pattern in a large series of patients with acoustic neuroma who were conservatively managed; 3) describe the natural history of patients with acoustic neuromas who did not receive surgical intervention and those who underwent subtotal resection; 4) correlate the size and growth rate of acoustic neuromas to clinical presentation and auditory and vestibular testing; and 5) recommend guidelines for the management of patients with acoustic neuromas. ⋯ Measurement of the maximal tumor diameter on MRI scans is a reliable method for following acoustic neuroma growth. There is no need to perform a rigorous analysis of tumor size to determine whether the tumor is growing significantly. The vast majority of patients older than 65 years with acoustic neuromas do not require intervention. The indications for intervention should be based on a combination of rapid tumor growth with the development of symptoms.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia.
Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long-term care settings While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. ⋯ Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia-free interval are essentially the same.
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Comparative Study
An objective method of analyzing cochlear versus noncochlear patterns of distortion-product otoacoustic emissions in patients with acoustic neuromas.
To objectify the effects of retrocochlear disease on distortion-product otoacoustic emissions (DPOAEs) by developing a computer-based software strategy for classifying DPOAE patterns as cochlear or noncochlear and to evaluate the sensitivities of these techniques in a large series of patients with unilateral acoustic neuromas. ⋯ Subjective analysis of a large series patients with acoustic neuromas showed that the majority of ears with tumors demonstrated cochlear (57%), rather than non-cochlear (41%), patterns of DPOAEs. The computerized, software-based algorithm developed for differentiating cochlear from noncochlear patterns of DPOAEs in patients with retrocochlear disease had a maximum sensitivity of 59%. This value was significantly higher than that reported in previous studies.
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To evaluate the effect of increased of laryngeal mask airway (LMA) intracuff pressures on the laryngopharyngeal mucosa. ⋯ The increase in LMA intracuff pressure caused only mild alterations in the laryngopharyngeal mucosa of the dog.
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Case Reports Multicenter Study Comparative Study Clinical Trial
A pilot study of autofluorescent endoscopy for the in vivo detection of laryngeal cancer.
To determine the advantage of autofluorescent endoscopy for the identification of laryngeal cancer. ⋯ Autofluorescent endoscopy is advantageous only in the hands of an experienced ENT specialist. Although it does not replace the combination of white-light endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Autofluorescent endoscopy can help in determining whether microscopic laryngoscopy performed with general anesthesia should be recommended urgently to the patient. Microscopic laryngoscopy remains the best method for the identification of malignant lesions, if it is combined with obtaining taking multiple biopsy specimens. Confirmation of the results of this pilot study with a larger series of patients is desirable.