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Biomedical subjects

Clark A Rosen

Publications and source records attributed to Clark A Rosen.

At least 19 recordsLinked to original sources
PubMed2007

Operating room versus office-based injection laryngoplasty: a comparative analysis of reimbursement.

BACKGROUND: Injection laryngoplasty (IL) continues to evolve as new indications, techniques, approaches, and injection materials are developed. Although historically performed under local or general anesthesia in the operating room suite, IL is now increasingly being performed in an office-based setting. This report presents the results of a reimbursement analysis comparing office-based versus operative IL. OBJECTIVE: The objective of this study was to compare the reimbursement of office-based injection laryngoplasty with the reimbursement of performing the same procedure in the operating room. DESIGN: The authors conducted reimbursement and outcome analysis through retrospective office chart and hospital record review. METHODS: A retrospective review was performed of the hospital records of patients having undergone injection laryngoplasty at the University of Pittsburgh Voice Center from July 1998 through March 2005. Group I included patients who underwent IL in the operating room, whereas group II included those who had office-based IL. A reimbursement analysis for both groups was then performed comparing surgeon fees, anesthesia, and hospital charges and reimbursement. The clinical efficacy of IL performed in either office versus operating room settings was measured by comparing the pre- and postintervention Voice Handicap Index-10 scores for all patients. A predictive model of potential cost savings is developed based on the results of the analysis. RESULTS: Average reimbursement was 2,505 dollars for group I (n = 108) and 496 dollars for group II (n = 50). This reimbursement differential was preserved across the various insurance types examined. There was no significant difference in Voice Handicap Index-10 change after surgery between group I and II. CONCLUSIONS: Office-based IL is both clinically and financially effective, providing patients with a convenient and flexible alternative to operating room-based intervention for glottal insufficiency.

Adolescent↗
PubMed2006

Influenza and the vocal performer: update on prevention and treatment.

SUMMARY: Upper respiratory tract infections (URIs) are a major cause of morbidity among vocal arts professionals, both from their acute impairment of the vocal mechanism and their predisposing influence for the development of serious vocal sequelae. In this review, we present some of the salient features of currently available treatments effective against influenza, the virus family responsible for the most serious form of URI. At present, these include an inactivated vaccine and four antiviral drugs, each approved in the United States and many other countries for the prevention and treatment of influenza. A live attenuated vaccine is also available, and other vaccines and antiviral drugs are under development. This review details the current options available for treating both influenza and noninfluenza related URIs in the professional voice user.

Antiviral Agents↗
PubMed2006

Dynamic biomechanical strain inhibits IL-1beta-induced inflammation in vocal fold fibroblasts.

Despite the fact that vocal folds are subjected to extensive mechanical forces, the role of mechanical strain in vocal fold wound healing has been overlooked. Recent studies on other tissues have demonstrated that low physiological levels of mechanical forces are beneficial to injured tissues, reduce inflammation, and induce synthesis of matrix-associated proteins essential for enhanced wound healing. In this study, we speculated that mechanical strain of low magnitudes also attenuates the production of inflammatory mediators and alters the extracellular matrix synthesis to augment wound healing in cultured vocal fold fibroblasts. To test this hypothesis, fibroblasts from rabbit vocal folds were isolated and exposed to various magnitudes of cyclic tensile strain (CTS) in the presence or absence of interleukin-1beta (IL-1beta). Results suggest that IL-1beta activates proinflammatory gene transcription in vocal fold fibroblasts. Furthermore, CTS abrogates the IL-1beta-induced proinflammatory gene induction in a magnitude-dependent manner. In addition, CTS blocks IL-1beta-mediated inhibition of collagen type I synthesis, and thereby upregulates collagen synthesis in the presence of IL-1beta. These findings are the first to reveal the potential utility of low levels of mechanical signals in vocal fold wound healing, and support the emerging on vivo data suggesting beneficial effects of vocal exercise on acute phonotrauma.

Animals↗
PubMed2006

Primed fibroblasts and exogenous decorin: potential treatments for subacute vocal fold scar.

OBJECTIVE: To investigate hepatocyte growth factor (HGF) primed fibroblasts and decorin application on skin and vocal fold fibroblasts in vitro and in vivo in rabbit vocal fold scar model. STUDY DESIGN AND SETTING: Vocal fold and skin fibroblasts underwent five in vitro treatment conditions: control, epidermal growth factor, HGF, both decorin and HGF, and decorin alone. Hyaluronic acid and collagen enzyme-linked immunosorbent assays were performed. In vivo, 12 rabbits underwent unilateral vocal fold stripping. Injured vocal folds were then injected with skin fibroblasts, HGF, HGF-primed fibroblasts and decorin, or decorin. Outcomes included histologic and lamina propria height analyses. RESULTS: In vitro, HGF increased hyaluronic acid synthesis in vocal fold fibroblasts (P<0.001). HGF and decorin treatment diminished collagen secretion (P<0.01). In vivo, histologic findings indicated minimal difference in collagen amount between treatment groups. CONCLUSION: HGF and decorin together may decrease collagen production by skin and vocal fold fibroblasts. Fibroblast transplantation into scarred vocal folds has equivocal benefit.

Animals↗
PubMed2006

Office-based arytenoid palpation for diagnosis of disorders of bilateral vocal fold immobility.

Bilateral vocal fold immobility is an uncommon but serious condition with many causes. Accordingly, accurate diagnosis is essential in order to treat patients promptly and avoid long-term sequelae. Historically, diagnosis has been performed in the operating room with the patient under general anesthesia. We present the case of a patient who was diagnosed with bilateral vocal fold immobility by in-office arytenoid palpation that required only topical anesthesia of the larynx. The patient subsequently underwent appropriate treatment. In our opinion, office-based arytenoid palpation is a simple, safe, and accurate procedure for diagnosing bilateral vocal fold immobility.

Aged↗
PubMed2005

Vocal fold wound healing: a review for clinicians.

SUMMARY: The basic science of wound healing is largely omitted from the curriculum of many voice clinicians. This fact is relatively disheartening as most therapeutic manipulation in the realm of laryngology and voice disorders deals with injured tissue. Therefore, the selection of therapeutic tasks for persons with vocal injury should ideally be informed by basic science in wound healing. Recently, several investigators have initiated lines of research to determine the course of vocal fold wound healing and the potential role of therapeutic agents, including behavioral agents. The current review seeks to provide a foundation of basic wound healing science and present the most current data regarding the wound healing process in the vocal folds.

Extracellular Matrix↗
PubMed2005

Preliminary results of a new temporary vocal fold injection material.

Temporary vocal fold injection is a valuable procedure for vocal fold paralysis or paresis of uncertain permanency and as a trial augmentation to decide the value of vocal fold augmentation. A new material made from glycerin, carboxymethylcellulose, and water has recently been developed for temporary vocal fold augmentation. Eleven patients underwent vocal fold injection for the treatment of glottal incompetence with this material. The duration of effectiveness of this injection material was 2 to 3 months depending on the injection amount. This new material satisfies several requirements for an ideal temporary vocal fold injection material in terms of injectability, convenience, duration of effectiveness, and safety. The authors conclude that this new material is a good option for temporary vocal fold augmentation.

Adult↗
PubMed2005

Biochemical markers associated with acute vocal fold wound healing: a rabbit model.

This study seeks to determine the ability of enzyme-linked immunosorbent assays (ELISAs) of vocal fold secretions to detect and describe the acute tissue response to injury in a rabbit vocal fold model. Vocal fold secretions were collected before the induction of a unilateral surgical injury to the vocal fold and at 6 timepoints after injury (1, 5, 7, 10, 14, and 21 days). Secretions were then subjected to ELISAs to assess concentrations of interleukin-1 beta (IL-1beta) and prostaglandin-E2 (PGE-2). The results indicate that ELISAs may be useful in documenting fluctuations in these markers associated with the wound healing process in the rabbit model. The temporal expression of both IL-1beta and PGE-2 was consistent with their proposed roles in the wound healing cascade in other systems, pointing to the potential that surface secretions may be at least partial indicators of wound healing events within the tissue.

Animals↗
PubMed2005

Stroboscopy as a research instrument: development of a perceptual evaluation tool.

Laryngeal stroboscopy is arguably the most important clinical tool for the evaluation and treatment of patients with voice disorders. Unfortunately, at present, laryngeal stroboscopy is strictly a clinical tool and has no definitive use in the area of voice research. The limitation with laryngeal stroboscopy is the subjective nature of the interpretation of the video examination. A video stroboscopy research tool was developed using 10 stroboscopic parameters selected from the literature and clinical practice. The stroboscopy research tool was validated with the results of 18 reviewers using the instrument to rate 21 unique "cases" and 6 repeated "cases." The results of this video perceptual analysis study identified which parameters were the most robust and reliable across a wide range of reviewers and validated power analysis curves for future similar research. Furthermore, findings from this study revealed that a greater than 80% intra-rater reliability is the preferred method for the selection of a valid and reliable reviewer. Future research using this instrument will most likely increase the reliability and utility of the instrument with the use of prestudy reviewer training and/or the use of video examples to serve as anchors or external references.

Humans↗
PubMed2005

Oropharyngeal complications of suspension laryngoscopy: a prospective study.

OBJECTIVE: This study was designed to evaluate the oropharyngeal complications of suspension laryngoscopy (SL). METHODS: We prospectively analyzed 56 consecutive SLs for intervention-related complications. Oropharyngeal symptoms and physical examination abnormalities were recorded before and after SL. SL-related problems were graded in severity and followed over time (weekly) until resolution was achieved. All patients had SL with either a gallows suspension or a manual technique and not a rotation-oriented (fulcrum) laryngoscope holding device. RESULTS: Oropharyngeal minor complications after SL occurred at a rate of 37.5%, and all these were temporary. No dental injuries occurred in the study cohort. There were no major complications after SL. Minor alterations related to taste occurred in 18% of the patients, 16% of patients had subjective swallowing complaints, and 12.5% had partial tongue numbness. Average duration of the post-SL complaints was 11 (6-34) days. A correlation between duration of suspension, size of laryngoscope, and risk of developing a minor oropharyngeal complication was present. CONCLUSION: SL carries a higher risk for lingual and glossopharyngeal nerve injuries than previously recognized. All of these complications were temporary. On the basis of comparison with historic data, SL by gallows suspension technique may pose a lower risk of dental injuries. This information should be used to improve preoperative SL patient education and informed consent.

Female↗
PubMed2005

Acute vocal fold wound healing in a rabbit model.

Several authors have eloquently described the characteristics of vocal fold scar, a long-term consequence of vocal fold injury. However, events in the acute stage of mucosal injury, which lead up to fibrosis, have been largely overlooked. The current study describes acute events with regard to mucosal re-formation in a rabbit model. Vocal fold injury was induced surgically. A fibrinous clot was present 1 day after injury. Massive cellular infiltration was noted on day 3, and complete epithelial coverage was achieved by day 5. Also, neo-matrix deposition was noted as early as 5 days after injury, and more mature collagen was seen by day 7. The general timetable described in the current study can contribute to the experimental foundation for the development of regenerative models of healing in the vocal folds. Most notably, the proliferation phase of wound healing appears to occur approximately 3 days after injury, indicating a critical time for intervention. Manipulation and/or alteration of naturally occurring neo-matrix deposition and organization may yield improved biophysical function of the injured vocal fold.

Animals↗
PubMed2005

Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis.

OBJECTIVES: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared. METHODS: The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained. RESULTS: Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively. CONCLUSIONS: Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.

Adult↗
PubMed2004

Intralesional cidofovir for pediatric recurrent respiratory papillomatosis.

OBJECTIVE: To compare disease response among children with recurrent respiratory papillomatosis (RRP) who underwent combined surgical debulking and intralesional cidofovir injections vs repeated surgical debulking only. DESIGN: Retrospective medical record review; follow-up range: 16 to 56 months. SETTING: Tertiary care children's hospital. PATIENTS: Seven children with RRP, including 4 subjects treated with cidofovir and 3 controls matched for age and initial papilloma staging score. INTERVENTIONS: Subjects treated with cidofovir underwent combined surgical debulking and intralesional cidofovir injection every 2 months until disease remission. Control subjects underwent repeated surgical debulking at individually determined intervals. MAIN OUTCOME MEASURES: Intraoperative endoscopic photographs were retrospectively assigned papilloma staging scores. Cidofovir and control group comparisons were made using nonparametric 2-sample Wilcoxon rank-sum (Mann-Whitney) testing, and comparisons of initial and final papilloma staging scores were made using nonparametric matched-pair Wilcoxon signed-rank testing. RESULTS: The final cidofovir group scores were significantly lower than the control group scores (P < .05). Within-group differences between initial and final scores were not significant (cidofovir group, P = .07; control group, P = .29). CONCLUSIONS: Four children with RRP were safely and successfully treated with intralesional cidofovir injection. Consideration should be given to using cidofovir more widely for treatment of pediatric RRP. Larger numbers in the cidofovir and control groups are needed in future studies to determine the true impact of cidofovir on management of this disease.

Antineoplastic Agents↗
PubMed2004

Bilateral vocal fold paralysis: an unusual treatment with botulinum toxin.

We presented a patient with bilateral vocal fold paralysis treated with intralaryngeal Botox injection to improve the glottal airway. The use of Botox in this manner has not been previously reported and highlights the value and role of intralaryngeal Botox in changing the configuration of the glottis. The concept and various approaches for using Botox to alter pathologic vocal fold position is reviewed and discussed.

Anti-Dyskinesia Agents↗
PubMed2004

Indole-3-carbinol for recurrent respiratory papillomatosis: long-term results.

We report the results of a clinical study using Indole-3-Carbinol (I3C) for the treatment of recurrent respiratory papillomatosis (RRP). I3C is abundant in cruciferous vegetables and has been shown to decrease papillomatous growth in cell cultures and be effective in an animal model of RRP. This is a prospective, open-label study design. Patients with RRP were enrolled from September 1996 to August 2001 and treated with I3C (adult dose of 200 mg PO BID). All patients underwent complete surgical removal and then started I3C. Further surgery was performed on an as-needed basis. Patients were categorized as having a complete, partial, or no response to I3C. Thirty-three patients treated with I3C were available for long-term follow-up (mean=4.8 years), whereas 12 patients were lost to follow-up. Eleven (33%) patients experienced remission of papillomatous growth and did not require surgery while on I3C. Ten (30%) patients had a reduction in papillomatous growth that resulted in less frequent surgery. Twelve patients (36%) had no clinical response. No patients experienced a worsening of their RRP. Of the 9 pediatric patients available, 1 experienced a complete response, 3 a partial response, and 5 had no response to I3C. Twelve patients with a positive response (partial or complete) to I3C are still taking I3C. Seven positive responders discontinued I3C, 3 of which have remained disease-free, whereas 4 continue to have RRP. No immediate or long-term side effects related to I3C were found. I3C has been found to be a successful treatment option for RRP. I3C's efficacy in pediatric patients merits further study.

Adolescent↗
PubMed2004

Efficacy of cidofovir injection for the treatment of recurrent respiratory papillomatosis.

To evaluate the efficacy of intralesional cidofovir injection for the treatment of recurrent respiratory papillomatosis (RRP). It is a prospective, open-label study design. This prospective study included 16 RRP patients, ages 9 to 68 years, who were treated with intralesional injections of cidofovir combined with surgical excision of RRP. The disease states of the patients pretreatment and posttreatment were assessed by assigning RRP severity scores, examining the need for any surgical excision of RRP, and evaluating the presence of RRP upon long-term follow-up. Sixteen patients were treated with cidofovir; however, three were lost to follow-up. Thirteen patients are the subjects of this report. This study group included three pediatric patients. Ten of thirteen patients (76.9%) responded to the treatment and are presently in remission. One patient did not respond, and two patients relapsed after initial success or had a partial response. The responders consisted of eight adults and two children. The mean number of injections the responders received was 3.5, and the average follow-up period of the responders was 25.4 months. No immediate complication of cidofovir treatment was evident. However, three patients were found to have significant vocal fold scarring after long-term follow-up. Cidofovir has been found to be efficacious in treating RRP. Further study regarding long-term follow-up and the assessment of possible side effects after cidofovir intralesional injection for RRP is required.

Adolescent↗
PubMed2004

Vocal fold augmentation with injectable calcium hydroxylapatite: short-term results.

Symptoms of unilateral vocal fold paralysis are improved significantly by augmenting the paralyzed vocal fold via vocal fold injection. In this trial, augmentation with a new calcium hydroxylapatite implant was evaluated. In addition, two different phonosurgical injection techniques were used, and these procedures were compared for accuracy and reliability. A total of 11 terminal patients with unilateral vocal fold paralysis underwent vocal fold injection with calcium hydroxylapatite. Efficacy of the implant was evaluated by comparing results from the Voice Handicap Index (VHI) and mean airflow measurements before and 6 months after injection. Surgeon evaluations determined the comparative benefits of either endoscopic direct vocal fold injection or percutaneous vocal fold injection. Six-month data were obtained for a cohort of five patients. VHI scores improved for all five patients available for full evaluation and four of the five achieved improvements in mean airflow rates. Of the remaining patients, one later had a medialization laryngoplasty, two died from their terminal diseases before the 6-month follow-up, and two of the remaining three reported satisfaction with the results via telephone follow-up. Vocal fold injection via endoscopic, direct laryngoscopy was found to be a more reliable procedure for vocal fold injection than percutaneous injection. Slight overinjection (10% to 15%) was found to provide optimum results. Vocal fold injection of calcium hydroxylapatite for unilateral vocal fold paralysis improved voice quality and reduced mean airflow rates in this patient group with short-term results. Long-term studies are needed to confirm the durability of these findings.

Aged↗