Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.

OBJECTIVE: To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. METHODS: We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. RESULTS: At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). CONCLUSION: Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Sudden sensorineural hearing loss.

Approximately 4000 new cases of sudden hearing loss (SHL) occur annually in the United States, and 15,000 annually worldwide, accounting for approximately 1% of all cases of SHL. Although prevalence studies do not necessarily distinguish between idiopathic and acquired SHL, most cases of spontaneous SHL have no identifiable cause. In this article, the authors assess the cause, history, diagnosis, and treatment of SHL.

Vocal fold medialization using autologous cartilage in a canine model: a preliminary study.

Unilateral vocal fold paralysis can alter phonation. Medialization of the vocal fold using cartilage augmentation dates to the early 1950s. Improved phonation after cartilage chordal augmentation has been reported, but no study has as yet documented cartilage viability or size in this setting over time. The authors of this study evaluated thyroid alar cartilage as a medializing material in three mongrel dogs. Grafts were inserted lateral to the inner thyroid perichondrium at the vocal fold level via a window in the thyroid cartilage. Changes in weight, size, and volume were assessed 6 months after implantation. The average graft weight declined by 15%, and the average square area declined by 3%. Importantly, the average volume maintained was 87%. The grafts remained rigidly fixed to the thyroid cartilage in their placement positions. Histologic examination documented minimal resorption. The data suggest that thyroid alar cartilage is a viable filler in type I thyroplasty procedures.

Long-term flap tracheostomy in a pediatric animal model.

OBJECTIVE: To investigate the short- and long-term complications of pediatric tracheostomy, emphasizing posttracheostomy tracheal stenosis in an animal model. DESIGN: Twenty-five New Zealand white rabbits were randomly assigned to three groups: flap tracheostomy, traditional vertical tracheostomy, and control. Interactive image analysis was used to compare the tracheal cross-section area and circumference between groups 16 weeks after surgery. The incidence of peristomal infections and accidental decannulations was also compared. RESULTS: The vertical tracheostomy group had a smaller circumference (P = .01) and smaller cross-sectional area (P = .006) than the control or flap tracheostomy groups. A 30% decrease in tracheal cross-sectional area occurred in the vertical tracheostomy group. The flap tracheostomy group had fewer problems with accidental decannulation and peristomal infection compared with the vertical tracheostomy group. CONCLUSIONS: We found no significant risk of tracheal stenosis or adverse effects on tracheal growth for the flap tracheostomy in a developing animal model. This tracheostomy technique may be useful in the management of pediatric patients who require long-term bypass of the upper airway.

Tonsillar carcinoma.

Carcinoma of the tonsil is the second most common malignancy of the head and neck. Various studies have attempted to define the presentation, diagnosis, treatment, and prognosis of these tumors. This report reviews the currently available information on tonsillar carcinoma and discusses treatment options.

Radiocarpal articular contact characteristics with scaphoid instability.

The relative importance of the three major periscaphoid ligament complexes in maintaining the normal radiocarpal articulation was assessed. Pressure-sensitive film recorded the changes in radioscaphoid and radiolunate articular contact that occurred with sequential ligament sectioning in 12 cadaver wrists. Alterations in the radiocarpal articular contact as a result of ligament disruption are evident in the absence of the recognizable static x-ray changes of carpal instability. The scapholunate interosseous ligament is essential in preventing scapholunate diastasis and dorsoradial subluxation of the proximal scaphoid. Rotatory subluxation of the scaphoid occurs when disruption of the scapholunate interosseous ligament is coupled with disruption of either the palmar intracapsular radiocarpal ligaments or the scaphotrapezial ligament complex. These data help explain the development of degenerative arthritis caused by carpal ligamentous instability.