Mulberry Posterior Inferior Nasal Turbinate Is Associated with a Lower Pharyngeal pH Environment.

OBJECTIVES: Mulberry-like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction. Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute to sinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT formation. Therefore, this study is aimed to investigate the 24-h pharyngeal pH value in patients with MPINT. STUDY DESIGN: Prospective case-control multi-center study. METHODS: Fifty-five patients with chronic EER symptoms were included in the study. They filled in questionnaires aimed at reflux and sinonasal symptoms (RSI®, SNOT-22) and underwent video endoscopy evaluating the laryngeal findings (RFS®) and the presence or absence of the MPINT. And, 24-h oropharyngeal pH monitoring was used to detect the acidic pH environment in the pharynx. RESULTS: Out of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group 2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidic pH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p = 0.001). Moreover, in group 1, a significantly higher median total percentage of time spent below pH 5.5 (p = 0.005), as well as a higher median number of events lasting more than 5 min (p = 0.006), and higher median total number of events with pH drops (p = 0.017) were observed. CONCLUSION: In this study, the MPINT was significantly more often present in patients with acidic pH events detected by 24-h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:62-68, 2024.

The impact of acute weight loss following bariatric surgery on Eustachian tube function.

Obesity has emerged as a pressing concern in contemporary society, prompting an increase in bariatric surgery (BS) procedures for severe obesity management. Post-bariatric weight loss might cause complications, such as a reduction in the soft tissue surrounding the Eustachian tube, potentially affecting its function. This cohort prospective study, conducted between May and December 2022, aimed to assess the impact of post-bariatric acute weight loss on Eustachian tube function. A total of 54 cases of bariatric surgery and 157 control subjects were included in the study. Data on socio-demographics, weight, and the type of bariatric surgery were collected for the study group. ET function was assessed using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Approximately 55% of the participants fell within the age range of 18-25 years, with the majority (91.4%) having not undergone bariatric surgery. Conversely, participants who underwent BS were significantly more prevalent in the older age groups, specifically those over 50, between 40-50, and 31-40 years (p<0.001). Our sample consisted of 82.5% females and 17.5% males, with BS being significantly more common among male subjects (45.9%) compared to females (21.3%) (p=0.002). The mean total ETDQ-7 in control subjects was significantly higher (11.29±5.49) compared to those who had BS (9.11±4.09). Moreover, when comparing the ETDQ-7 between subjects who had BS and the control group, no statistically significant differences were observed in the total ETDQ-7 score and across all seven items within the ETDQ-7. Based on these findings, bariatric surgery did not have a major effect on ET function.

Association Between Oral Health and Swallowing Function in the Elderly.

Objective: Although the oral environment significantly affects the risk of pneumonia, there have been few studies regarding its relation with swallowing. There is no doubt that there is a significant link between the oral environment and the development of pneumonia; however, there have been few comparative studies of swallowing using video endoscopy (VE) and video fluorography (VF) as indicators to determine the actual availability of oral intake and the choice of food form. This study was performed to examine whether the oral environment or swallowing function contributes more to the development of pneumonia in the elderly. Methods: The study population consisted of 24 patients (7 men and 17 women; age range: 64-97 years; average age: 86 years) assessed using the Oral Health Assessment Tool (OHAT), VE and VF at Fukuoka Dental College Hospital. The most common disease was pneumonia (17 patients), followed by cerebral infarction (5 patients), pyelonephritis (4 patients), bronchitis (2 patients), Parkinson's disease (2 patients), scleroderma (1 patient), diabetes (1 patient), eosophageal cancer (1 patient) and Parkinson's syndrome> (1 patient). Some patients had multiple diseases. Oral intake was possible in 20 patients (80%), whereas tube feeding and gastric banding were required in 4 patients. Results: The OHAT score was not correlated with either the VE or VF score. Furthermore, the OHAT score was not significantly different between the multiple- and no/single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or only a single episode of pneumonia. Conclusion: Oral assessment, VE and VF are necessary to evaluate swallowing in patients with suspected dysphagia. Swallowing function, especially as assessed by VE and VF, is more important than examination of the oral environment for evaluating risk of recurrent aspiration pneumonia in the elderly. In addition, multiple factors contribute to recurrent pneumonia in patients with a good oral environment, including subclinical aspiration, pharyngeal clearance and delayed activation of the gag reflex.

A novel 3D-printed laryngoscope with integrated working channels for laryngeal surgery.

Background: For the surgical treatment of early-stage laryngeal cancer, the use of transoral laser microsurgery (TLM) has emerged as the gold standard. However, this procedure requires a straight line of sight to the operating field. Therefore, the patient's neck needs to be brought into a hyperextended position. In a considerable number of patients, this is not possible due to anomalies in the cervical spine anatomy or soft tissue scarring, e.g., after radiation. In these cases, adequate visualization of relevant laryngeal structures cannot be ensured using a conventional rigid operating laryngoscope, which may negatively affect the outcome of these patients. Methods: We present a system based on a 3D-printed prototype of a curved laryngoscope with three integrated working channels (sMAC). The curved profile of the sMAC-laryngoscope is specifically adapted to the nonlinear anatomy of the upper airway structures. The central working channel provides access for flexible video endoscope imaging of the operating field while the two remaining channels provide access for flexible instrumentation. In a user study (n = 11), visualization and reachability of relevant laryngeal landmarks as well as the feasibility of basic surgical procedures with the proposed system were examined in a patient simulator. In a second setup, the system was evaluated for its applicability in a human body donor. Results: All participants of the user study were able to visualize, reach and manipulate the relevant laryngeal landmarks. Reaching those took significantly less time in the second attempt compared to the first one (27.5 s ± 5.2 s vs. 39.7 s ± 16.5 s, p = 0.008) indicating a significant learning curve for handling the system. Instrument changes were performed quickly and reliably by all participants (10.9 s ± 1.7 s). All participants were able to bring the bimanual instruments into position for a vocal fold incision. Relevant laryngeal landmarks could be visualized and reached in the human body donor setup. Conclusion: Possibly, the proposed system may develop into an alternative treatment option for patients with early-stage laryngeal cancer and restricted mobility of the cervical spine in the future. Further improvements of the system could include finer end effectors and a flexible instrument with a laser cutting tool.

A Quantitative Analysis of Smartphone-Based Endoscopy and Video Tower Endoscopy.

OBJECTIVES: Examine the differences between traditional tower-based endoscopy (TBE) and smartphone-based endoscopy (SBE) using objective measures of cost, setup time, and image quality. METHODS: Cost analysis study and randomized single-blinded prospective trial was performed at a tertiary academic health center. Twenty-three healthcare providers, 2 PA-C, 9 residents, 2 fellows, 10 attendings varying in practice from 1 to 27 years were a part of the study. Actual cost analysis was used for purchase of the Karl Storz video tower system and the Save My Scope smartphone-based endoscopy system for cost analysis. For setup time, providers entered a room and were randomized to set up either an SBE or TBE system and timed from room entry to a visible on-screen image. A crossover was then performed so all providers performed both setups. For image discernment, standardized photos of a modified Snellen's test were sent via text message to providers who were blinded as to which photo represented which system. Practitioners were randomized as to which photo to receive first. RESULTS: Cost savings was 95.8% ($39,917 USD) per system. Setup time for the smartphone system was 46.7 seconds less than video tower system on average (61.5 vs 23.5 seconds; P < .001, 95% CI: 30.3-63.1 seconds). Level of visual discernment was slightly better for SBE over TBE, with reviewers able to identify Snellen test letters at a size of 4.2 mm with SBE versus 5.9 mm with TBE (P < .001). CONCLUSIONS: Smartphone-based endoscopy was found to be cheaper, quicker to set up, and to have marginally better image quality when transmitted via messaging than tower-based endoscopy, although the clinical significance of these visual differences are unknown. If appropriate for their needs, clinicians should consider smartphone-based endoscopy as a viable option for viewing and collaborating on endoscopic images from a fiberoptic endoscope.

[Laparoscopic transhiatal resection of the lower third of the esophagus for late recurrence of achalasia cardia after laparoscopic esophagocardiomyotomy: a 12-year follow-up]. / Rezektsiya nizhnei treti pishchevoda laparoskopicheskim transkhiatal'nym dostupom po povodu pozdnego retsidiva akhalazii kardii posle laparoskopicheskoi ezofagokardiomiotomii: 12 let nablyudeniya.

The choice of treatment for recurrence after esophagocardiomyotomy is individual. Repeated esophagocardiomyotomy is appropriate in patients without malignancy and significant deposition of food masses in distal esophagus followed by severe pulmonary complications. Esophagectomy is desirable in case of unadvisable or failed repeated esophagocardiomyotomy. The authors presents laparoscopic transhiatal resection of the lower third of the esophagus (2019) in a patient with recurrent achalasia of the cardia stage 3-4 and cicatricial peptic stricture of the lower third of the esophagus after previous laparoscopic esophagocardiomyotomy with fundoplication (2009). The immediate results of redo surgery and physical status of the patient after 3 years (12-year follow-up) are described.

Evaluation of Eustachian Tube Function in Cases of Chronic Otitis Media by Dynamic Slow Motion Videoendoscopy and Impedance Audiometry.

Eustachian tube (ET) dysfunction is known to be a cause for various middle ear diseases. Dynamic slow motion videoendoscopy (DSVE) and impedance audiometry (IA) can both be employed to evaluate ET dysfunction. To assess the role of DSVE and IA for diagnosing ET dysfunction in cases of middle ear disorders. It is a prospective case control study. 102 ears with chronic otitis media were taken as cases and 102 healthy ears as controls. IA and DSVE were performed to assess ET function in both the groups. Sensitivity/ specificity of both the diagnostic tests were evaluated in case and control groups. Out of 102 ET of case group exposed to both tests, 87 were found to have ET dysfunction by DSVE and 80 by IA. Among 102 ET of control group 78 were identified as normal by DSVE while 87 by IA. On applying chi square test in both these groups, the associations were significant. (p value < 0.0001). Patients with grade 2B or higher on DSVE endoscopy had abnormal IA findings, indicating that higher the grade on DSVE, higher the chance of abnormal IA. DSVE and IA are potentially useful tools in evaluation of cases of COM and which provide information regarding functional and pathological factors responsible for ET dysfunction.

The role of NBI with flexible video-endoscope in the follow-up of head and neck cancer patients: a prospective study.

PURPOSE: Narrow band imaging (NBI) enhances mucosal vasculature and could help in the identification of recurrences. We assessed the effectiveness of NBI with flexible video-endoscope in the early detection of recurrence after treatment of head and neck squamous cell carcinoma, its diagnostic advantage over high-definition white-light (HD WL) endoscopy, also in relation to recurrence site, and the influence of previous radiotherapy (RT) or chemotherapy (CT). Moreover, we investigated the association between index tumor site and the risk of developing recurrence, and the relation between index tumor site and recurrence site. METHODS: From January 2018 to November 2020, 160 patients previously treated with surgery and/or RT ± CT were evaluated using NBI with flexible video-endoscope. Sensitivity, specificity, positive/negative predictive value, and accuracy were calculated for NBI and HD WL, and compared using the McNemar test. The Fisher exact test was used to compare the other associations investigated. RESULTS: The difference between NBI and HD WL sensitivity was statistically significant (p < 0.001). The NBI diagnostic advantage was 62.5%, highest in the hypopharynx (p = 0.05), and was not influenced by previous RT or CT (p = 0.49). Index tumor site statistically related with recurrence site (p < 0.001), but not with the risk of developing recurrence (p = 0.81). CONCLUSION: NBI with flexible video-endoscope could represent a valid option to detect recurrence early during the follow-up, especially in a difficult-to-visualize site such as the hypopharynx.

High Speed Video Observations of Vocal Fold Kinematics While Playing a Clarinet.

INTRODUCTION: In this pilot study, flexible high-speed video (HSV) technology with synchronized audio is used to visualize vocal fold behavior in a wind instrumentalist. Specifically, this study aims to contribute to describing the vocal fold behavior of a professional clarinet musician playing varying tones and melodies. METHOD: Vocal folds of a healthy 26-year-old professional clarinet musician were recorded utilizing a HSV camera coupled to a flexible endoscope, which allowed the synchronous recording of audio with vocal fold movement at the onset, playing, and offset of playing. Two raters experienced with analyzing vocal folds described vocal fold motion of each sample. Samples were processed through a software model to determine the vocal fold movement relative to their position at rest. Digital kymograms (DKGs) were additionally obtained to visualize vocal fold micromovements throughout each sample. RESULTS: At the onset of playing, the raters observed the vocal folds moving to a paramedian position. Vocal fold adduction varied according to the task performed and ranged from 58% to 77% of the original resting glottis width. The calculated changes in glottis width and DKGs were consistent with the descriptions by the raters. CONCLUSION: This study demonstrates the utility of flexible HSV in observing vocal fold motion before, during, and after events other than sustained phonation. The incomplete adducted vocal fold postures observed while playing the clarinet not only differ from phonation but also differ depending on task. These various postures may contribute to voice fatigue in wind instrumentalists or to various disorders experienced during their careers.

A deep learning framework for quality assessment and restoration in video endoscopy.

Endoscopy is a routine imaging technique used for both diagnosis and minimally invasive surgical treatment. Artifacts such as motion blur, bubbles, specular reflections, floating objects and pixel saturation impede the visual interpretation and the automated analysis of endoscopy videos. Given the widespread use of endoscopy in different clinical applications, robust and reliable identification of such artifacts and the automated restoration of corrupted video frames is a fundamental medical imaging problem. Existing state-of-the-art methods only deal with the detection and restoration of selected artifacts. However, typically endoscopy videos contain numerous artifacts which motivates to establish a comprehensive solution. In this paper, a fully automatic framework is proposed that can: 1) detect and classify six different artifacts, 2) segment artifact instances that have indefinable shapes, 3) provide a quality score for each frame, and 4) restore partially corrupted frames. To detect and classify different artifacts, the proposed framework exploits fast, multi-scale and single stage convolution neural network detector. In addition, we use an encoder-decoder model for pixel-wise segmentation of irregular shaped artifacts. A quality score is introduced to assess video frame quality and to predict image restoration success. Generative adversarial networks with carefully chosen regularization and training strategies for discriminator-generator networks are finally used to restore corrupted frames. The detector yields the highest mean average precision (mAP) of 45.7 and 34.7, respectively for 25% and 50% IoU thresholds, and the lowest computational time of 88 ms allowing for near real-time processing. The restoration models for blind deblurring, saturation correction and inpainting demonstrate significant improvements over previous methods. On a set of 10 test videos, an average of 68.7% of video frames successfully passed the quality score (≥0.9) after applying the proposed restoration framework thereby retaining 25% more frames compared to the raw videos. The importance of artifacts detection and their restoration on improved robustness of image analysis methods is also demonstrated in this work.

Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders.

Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition.

Gliding Brow Lift (GBL): A New Concept.

BACKGROUND: Creating the ideal aesthetic eyebrow shape and position is an important goal in facial rejuvenation. One challenge of an eyebrow lift is to find a predictable procedure that balances the advantages and disadvantages of the available strategies. The gliding brow lifting (GBL) is a technique that provides minimal incisions, an effective and stable eyebrow lift, and offers the advantage of precise reshaping of the eyebrow. METHODS: In a retrospective review, 124 patients, who underwent GBL technique from November 2015 through April 2016, were evaluated. With minimal incisions and tumescent infiltration, the subcutaneous plane of the forehead, eyebrows and temporal face is undermined releasing the skin from the underlying frontalis muscle, orbicularis oculi muscle, corrugator muscle and temporal parietal fascia. Fixation of the repositioned and reshaped eyebrow is achieved with the use of a hemostatic net for temporary cutaneous fixation. RESULTS: The average follow-up period was 17 months. Adequate brow repositioning and/or reshaping was achieved in 118 patients. Six patients had bilateral or unilateral recurrence of ptosis. Of these patients with recurrence, four patients had the same procedure re-performed within 1 month postoperatively with successful repositioning and/or reshaping of their brow. There was no incidence of hematoma, seroma, infection, permanent sensory changes, motor dysfunction, skin flap necrosis or alopecia. CONCLUSION: The "gliding brow lifting" (GBL), which combines subcutaneous frontal undermining with minimal incisions, elevation and reshaping of eyebrow and use of a temporary cutaneous fixation with hemostatic net (Net), allows effective, long-lasting results with low rates of complications and satisfactory results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Upper Airway Video Endoscopy: Assessment of the response to positive pressure ventilation and mechanical in-exsufflation.

Upper airways (UA) include the nasal cavities, pharynx, and larynx, and its main function is to warm and filter the inspired air. UA dysfunction is in the pathogenesis of various disorders, such as obstructive sleep apnea syndrome (OSAS) and vocal cord dysfunction. In addition, in some neurodegenerative diseases (e.g. Amyotrophic Lateral Sclerosis - ALS), UA dysfunction may also compromise the effective use of ventilatory support (VS). In this context, the endoscopic evaluation of UA may be useful in understanding the OSAS mechanisms, in determining the causes for treatment-induced airway obstruction and even in helping to titrate noninvasive ventilation (NIV) in ALS patients with bulbar or pseudo-bulbar (spastic) dysfunction. Specifically, in OSAS patients, when residual obstructive events persist, although an optimal ventilatory mode has been apparently achieved, along with interface and equipment, the endoscopic evaluation of UA seems to be a valuable tool in understanding its mechanisms, even assisting adjustments to NIV parameters. In addition, it has also been described as being useful in laryngeal response to mechanical in-exsufflation (MI-E) and Exercise-Induced Laryngeal Obstruction (EILO). However, no protocol has yet been published or validated for this. For this reason, a literature review was conducted on UA function and its response to positive pressure and MI-E. Special emphasis has also been given to the current indication for video endoscopy in chronically ventilated patients.

Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Abstract Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by themost complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia. (AU)

Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.

Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas (AU).

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas (AU).

Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies.

Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by the most complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia.

Dependencies and Ill-designed Parameters Within High-speed Videoendoscopy and Acoustic Signal Analysis.

OBJECTIVE: The phonatory process is often judged during sustained phonation by analyzing the acoustic voice signal and the vocal fold vibrations. Many formulas and parameters have been suggested for qualifying the characteristics of the acoustic signal and the vocal fold vibrations during sustained phonation. These parameters are directly computed from the acoustic signal and the endoscopic glottal area waveform (GAW). The GAW is calculated from laryngeal high-speed videoendoscopy (HSV) recordings and describes the increase and decrease of the glottal area during the phonation process, that is, the opening and closing of the two oscillating vocal folds over time. However, some of the parameters have strong mathematical dependencies with one another and some are ill-defined. The purpose of this study is to identify mathematical dependencies between parameters with the aim of reducing their numbers and suggesting which parameters may best describe the properties of the GAW and the acoustical signal. METHODS: In this preliminary investigation, 20 frequently used parameters are examined: 10 GAW only and 10 both GAW and acoustic parameters. RESULTS: In total 13 parameters can be neglected because of mathematical dependencies. In addition, nine of these parameters show problematic features that range from unexpected behavior to ill definition. CONCLUSIONS: Reducing the number of parameters appears to be necessary to standardize vocal fold function analysis. This may lead to better comparability of research results from different studies.

Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function

Abstract Introduction Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment. Objective To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases. Methods Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive ofmiddle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology. Results A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ2) test, showed a significant association between the 2 tests (p = 0.017). Conclusion There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.