Endonasal Acoustic Doppler Sonography in Predicting the Survival of Nasoseptal Flap Following Previous Irradiation.

OBJECTIVE: Blood supply to the nasoseptal flap may be compromised in patients who had previous irradiation to the head and neck region, hence, affecting its viability. Here, we evaluate the role of an endonasal acoustic Doppler sonography in predicting the survival of the nasoseptal flap in this group of patients. STUDY DESIGN: Retrospective cohort. METHODS: Retrospective review of patients with previous irradiation to the head and neck region who had undergone endoscopic endonasal surgeries requiring nasoseptal flap as reconstruction. Survival rates of nasoseptal flap were compared between groups where endonasal Doppler was used. RESULTS: A total of 28 patients were identified with previous irradiation to the head and neck region who had undergone endoscopic endonasal surgeries requiring nasoseptal flap as reconstruction. The overall survival rate of nasoseptal flap is 67.8% (19 out of 28). Endonasal acoustic Doppler was used in 17 of these patients, of which 13 patients had a positive signal. The flap survival rate in the Doppler-positive group compared to the non-Doppler group was significantly better at 100% vs 45.4% (P = .003). Among those where the endonasal Doppler was used, the flap survival rate with a negative doppler signal was significantly worse at 25%, compared with 100% flap survival in those with positive doppler signal (P = .006). The positive predictive value of a positive endonasal Doppler signal with flap survival is 100%. CONCLUSION: The use of endonasal acoustic Doppler may be useful in predicting the viability of nasoseptal flap in postirradiated patients who need a local mucosal flap coverage. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:244-247, 2023.

Using Muscle Synergy to Evaluate the Neck Muscular Activities during Normal Swallowing.

Swallowing is an extremely complex motion controlled by multiple muscles on the front neck region. Normal swallowing is dependent on orderly activation and co-coordination of the associated neck muscles, known as muscle synergy. However, evidence for muscle synergy during normal swallowing is rarely investigated. In this study, we studied the muscle synergy associated with swallowing saliva based on high-density (HD) surface electromyography (sEMG) signals acquired from four healthy subjects. The non-negative matrix factorization algorithm was applied to reconstruct the muscle activation patterns, and the values of variance accounted for (VAF) coefficients were computed to determine the number of muscle synergies. The results showed that the VAF values raised with the increase in the number of synergies on both the left and right sides of the neck. And the variation tendency of the VAF values was almost similar between the left and right area with a significant correlation ($\text{r}=0.9902 \pm 0.0046$, $\mathrm {p}<0.05)$. Furthermore, it was observed that an average of 5 muscle synergies was the minimum number required to sufficiently reconstruct the spatial characteristics of the synergism between both sides of the neck. These results suggest that the muscle synergy approach could serve as a promising candidate to evaluate the muscular co-contractions during swallowing, and it might be a useful method for dysphagia monitoring and diagnoses.

Do Chinese speakers need a specialized cochlear implant system?

BACKGROUND: Cochlear implants are a standard treatment option for the profoundly deaf, but have only recently become a treatment option in China. Chinese is a tonal language, and a change in the lexical tone almost always changes the meaning of a word. METHODS: A critical review of the strategies for improving the outcome of cochlear implantation in Chinese speakers was made. RESULTS: The introduction of cochlear implantation in China has stimulated the development of new speech perception tests, which are specific to Chinese, for adults and children. Research undertaken over the last decade in Hong Kong has demonstrated the successful acquisition of tones in adults and children who have received cochlear implants. Surgical approaches have been developed to address specific issues, including post-irradiation and infected ears. New areas of research into the enhancement of speech understanding through signal processing have been established. CONCLUSIONS: The findings in these new areas will form the basis of a cochlear implant system for Chinese people in the near future.