PubMed Health⌕ Search

Biomedical subjects

Clark Rosen

Publications and source records attributed to Clark Rosen.

8 recordsLinked to original sources
PubMed2006

Development and validation of the vocal tremor scoring system.

BACKGROUND: Essential tremor (ET) occurs in approximately 4% of the population, and 25% of patients with ET have vocal tract involvement referred to as essential tremor of voice (ETV). Treatment of vocal tremor has a variable success rate most likely as a result of inaccurate identification of the affected area(s). A vocal tremor assessment system was developed to standardize the evaluation and scaling of vocal tremor. Applying this system clinically can help determine who will benefit most from botulinum toxin injection treatment. The Vocal Tremor Scoring System (VTSS) can also be used as a tool to determine treatment efficiency for all treatment modalities of ETV, including surgery, medications, and implantable devices. STUDY DESIGN: The authors studied instrument development and validation. METHODS: A clinical consensus conference was conducted to develop an assessment tool for standardized rating of vocal tremor location and severity. The assessment tool was then tested for reliability using video-perceptual analysis. Once validated, the assessment tool was applied to 10 examinations of patients with vocal tremor who had been treated with botulinum toxin A (BtxA) injections of the thyroarytenoid muscle(s) to determine the ability of the scoring instrument to predict treatment outcome. RESULTS: : The VTSS is based on severity scores for different anatomic sites within the vocal tract. The assessment areas of the VTSS are the palate, base of tongue, pharyngeal walls, larynx, supraglottis, and true vocal cords. Statistical analysis of the video-perceptual analysis results showed that the anatomic sites with the best interrater agreement were the true vocal folds, palate, base of tongue, and supraglottis. Overall, the VTSS demonstrated a level of interrater reliability of at least 0.914 at all sites. Intrarater reliability was excellent. The consensus group also analyzed 10 standardized examinations and the scores from both reviewer groups were then compared and found to have a reliability of at least 0.6 at each site. Pretreatment VTSS scores of 10 patients with ETV who underwent BtxA therapy were then compared with treatment response. The VTSS predicted the favorable treatment outcome 100% of the time when the score given to the true vocal folds was equal or greater to the mean of the scores given to the other sites. CONCLUSION: The VTSS represents the first standardized system for rating anatomic site(s) and severity of vocal tremor. This tool will allow improved communication between otolaryngologists, facilitate research in vocal tremor treatments, and establish a descriptive system for assessing vocal tremor. Using this assessment tool for patients with vocal tremor increases optimal patient selection and success rate for intralaryngeal botulinum toxin treatment.

Aged↗
PubMed2006

Nasal and paranasal sinus carcinoma: how can we continue to make progress?

PURPOSE OF REVIEW: New developments in the nasal and paranasal sinus cancers are reviewed. RECENT FINDINGS: In addition to woodworking, several risk factors for nasal and paranasal sinus cancers have been identified, most notably smoking. Progress in the differential diagnosis of small round cell nasal and paranasal sinus cancers allows the precise diagnosis of esthesioneuroblastoma. Despite recent improvements, T staging for ethmoid and nasal cavity needs refinement. An association of surgery and radiation therapy remains the best treatment modality. Major developments include endoscopic resection of nasal and paranasal sinus cancers, high-precision radiotherapy techniques such as intensity-modulated radiotherapy, and proton-beam radiotherapy. There is probably no role for chemotherapy in esthesioneuroblastoma. Although chemotherapy is important for aggressive neoplasms, its generalized use for nasal and paranasal sinus cancers awaits the application/development of newer drugs. These drugs might be applied locally since the majority of recurrences remain local. SUMMARY: Progress in the treatment of nasal and paranasal sinus cancers could be achieved through better prevention and the developments of more selective treatments such as endoscopic resection, high-precision radiotherapy, and new chemotherapy drugs.

Carcinoma↗
PubMed2004

Anatomy and fiber type composition of human interarytenoid muscle.

Intrinsic laryngeal muscle investigations, especially those of the interarytenoid (IA) muscle, have been primarily teleologically based. We determined IA muscle anatomy and histochemical and immunohistochemical classification of extrafusal and intrafusal (muscle spindle) fibers in 5 patients. Extrafusal fibers were oxidative type I and glycolytic types IIA and IIX. Intrafusal fibers of muscle spindles were identified by the presence of tonic and neonatal myosin. The results demonstrate that the IA muscle has a phenotype similar to that of limb skeletal muscle. Myosin coexpression, the absence of intrafusal fibers, and fiber type grouping were unusual features found previously in the thyroarytenoid and posterior cricoarytenoid muscles, but they were not present in the IA muscle. These findings lead to the conclusion that the IA muscle has functional significance beyond its assumed importance in maintaining vocal fold position during phonation. The presence of spindles demonstrates differences in motor control as compared to the thyroarytenoid and posterior cricoarytenoid muscles. Further, extrafusal fiber characteristics implicate IA muscle involvement in muscle tension dysphonia and adductor spasmodic dysphonia. Given the unique physiologic characteristics of the human IA muscle, further research into the role of the IA muscle in voice disorders is warranted.

Adenosine Triphosphate↗
PubMed2003

Staining of human thyroarytenoid muscle with myosin antibodies reveals some unique extrafusal fibers, but no muscle spindles.

This study describes the myosin composition of extrafusal and intrafusal muscle fibers found in the human thyroarytenoid (TA) and sternohyoid (control) muscles. We sought to determine the presence of muscle spindles in the TA muscle, and to identify unusual extrafusal fiber types, using the commonly accepted approach of tissue staining with myosin isoform specific antibodies. Extrafusal fibers are organized into motor units, which subsequently produce muscle movement, whereas intrafusal fibers compose muscle spindles, the primary stretch receptor that provides afferent (feed back) information to the nervous system for regulation of motor unit length and tonicity. Immunohistochemical identification of muscle spindles was confirmed in sternohyoid, but not in TA samples; however, some extrafusal fibers contained tonic myosin. These results indicate that human TA muscle functions similar to some mammalian extraocular muscle, performing unloaded (non-weight bearing) contractions without afferent information from native muscle spindles.

Aged↗
PubMed2003

Muscle fiber type composition and effects of vocal fold immobilization on the two compartments of the human posterior cricoarytenoid: a case study of four patients.

The human posterior cricoarytenoid (PCA) muscle is divided into two compartments, the vertical and horizontal bellies, which contain differences in their myosin heavy chain (MyHC) composition. Using immunohistochemical techniques on whole PCA samples, this study provides a more thorough description of the fiber type composition of entire bellies of the PCA. Four patients provided complete PCA samples containing both compartments of their right and left sides; two with unilaterally immobilized vocal folds. The horizontal belly had 80% slow (type I) fibers and 20% fast (type II) fibers. The vertical belly contained equal amounts of slow and fast fibers (approximately 55%:45%); clearly distinguishing between two compartments. Atrophy of muscle fibers and fiber type grouping were also present in both normal and affected subjects; providing no clear confirmation of the clinical findings of vocal fold immobilization. Further study of the PCA muscle from patients with unilaterally immobilized vocal folds is needed.

Aged↗
PubMed2002

Unloaded shortening velocity and myosin heavy chain variations in human laryngeal muscle fibers.

Myosin description in human laryngeal muscles is incomplete, but evidence suggests the presence of type I, IIA, IIX, and tonic myosin heavy chain (MHC) fibers. This study describes the unloaded shortening velocity (V0) of chemically skinned laryngeal muscle fibers measured by the slack test method in relation to MHC content. Skeletal fibers from human laryngeal and limb muscle biopsy specimens were obtained for determination of V0, and subsequently, glycerol-sodium dodecyl sulfate-polyacrylamide gel electrophoresis was used to determine the MHC isoform content. The fibers from human limb muscle had shortening speeds similar to those in previous reports on human skeletal fibers. Type I, IIA, and IIX fibers of laryngeal muscle had shortening speeds similar to those of fibers from limb muscle, but laryngeal fibers with heterogeneous MHC expression had a wide range of shortening speeds, some being nearly twice as fast as limb fibers. In addition, MHC isoform bands from human extraocular muscle comigrated with some bands from laryngeal muscle--a finding suggesting that extraocular myosin may also be expressed.

Adult↗