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Biomedical subjects

E D Blom

Publications and source records attributed to E D Blom.

At least 19 recordsLinked to original sources
PubMed2000

Frontal sinus stents.

OBJECTIVES: The formation of scar tissue, synechiae, or osteogenesis in the narrow frontal outflow tract after instrumentation of the frontal sinus has led to attempts to enlarge the frontal duct or stenting. STUDY DESIGN: Prospective pilot study. RESULTS: Sixty-four Freeman frontal sinus stents were used to maintain patency in 46 patients. Stents were inserted using an endoscopic technique in 26 sinuses containing polyps, 20 with pansinusitis, and 18 cavities with stenosis of the frontal duct. External incisions with frontal sinusotomy were required to remove the stenosis and insert the stent in nine sinuses. Polypoid degeneration, granulation, purulent drainage, and lateralization of the middle turbinate were encountered infrequently. Frontal obliteration was subsequently required in six sinuses. CONCLUSION: The Freeman frontal sinus stent prevented blockage of the outflow tract in patients who had removal of disease in the sinus or duct or treatment of frontal stenosis.

Adult↗
PubMed2000

Current status of voice restoration following total laryngectomy.

Total laryngectomy is the surgical procedure traditionally used to treat patients with advanced-stage cancer of the larynx. The impairments resulting from removal of such a small organ are, indeed, profound. They include loss of voice and speech; altered respiration, necessitating a permanent breathing opening in the neck; and diminished sense of smell and taste. When one considers these factors, successful treatment of laryngeal cancer cannot be measured by survival rate alone. Rapid, effective restoration of voice and speech is one of the primary focuses of rehabilitation and is pivotal to the prevention of the potential psychosocial and economic consequences of total laryngectomy. This article focuses on the methods of voice restoration currently being employed to reestablish the ability to speak.

Esophagus↗
PubMed1997

An efficiency comparison of four heat and moisture exchangers used in the laryngectomized patient.

Bypassing the upper airway places the burden of humidification on the lower airway. For this reason passive heat and moisture exchangers (HMEs) are used in the laryngectomized patient in an attempt to minimize the effect of lost upper airway function. We measured efficiency and airflow resistance and calculated the costs of four HMEs used in the laryngectomized patient. The HMEs were measured according a modified International Standards Organization (ISO) 9360 standard. The airflow resistance was measured at flow rates of 15, 30, and 60 L/min. The measurements were repeated three times. Costs were calculated with two realistic scenarios. The study found that there are significant differences in moisture output and airflow resistance between the HMEs tested. There are major daily cost differences between these devices. This study shows that filter material and size influence the HME's moisture output efficiency and airflow resistance considerably. The construction differences and filter and housing type have great influence on the HME's daily costs. We believe that knowledge of the efficiency in combination with the average daily costs of the HMEs allows the clinician to make a balanced choice of which filter to use.

Costs and Cost Analysis↗
PubMed1995

Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part I: Speech characteristics.

The speech characteristics of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with drainage myotomy limited to the cricopharyngeus were studied. All patients used a Blom-Singer low-pressure voice prosthesis. Audio recordings of each patient speaking with both the Blom-Singer tracheostoma valve and manual occlusion of the tracheostoma were recorded at 3 weeks, 6 months, and 12 months after surgery. The three surgical variations were equally effective at preventing pharyngospasms; only 1 patient (10%) in each group had some loss of fluency during the 12-month study period. Neurectomized patients produced significantly higher fundamental frequencies during reading than did patients in the other groups. Residual resting tone in the neurectomized pharyngoesophageal segment may contribute to more favorable speaking frequencies in this group.

Analysis of Variance↗
PubMed1995

Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part II: Swallow characteristics.

The swallowing function of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with a small drainage myotomy limited to the cricopharyngeus was studied. Swallowing function data were collected on each patient at 3 weeks, 6 months, and 12 months after surgery using videofluoroscopy. Differences in swallowing function among the treatment groups were primarily the amounts and loci of oral and pharyngeal residues. The differing patterns of bolus residue may reflect the different mechanisms that were affected by the various procedures. Despite significant changes in some swallow measures, the patients did not complain of dysphagia. Oropharyngoesophageal swallow efficiency--a clinical measure that weighs the amount of bolus swallowed by total transit time--fell within normal limits for each patient group at each evaluation. This measure may be a better index of the patients' perceived normal swallow than the component variables of residue and transit times would suggest.

Deglutition↗
PubMed1990

Reconstructive and rehabilitative aspects of head and neck cancer in the elderly.

Age should not be considered a contraindication to adequate head and neck oncologic surgery. Reconstructive efforts should be by the most direct means to attain restoration of form and function in one stage. The next significant breakthroughs in the battle against cancer may well come on the cellular or molecular level. We endorse the plea of Endicott for increased education and research directed at the problem of head and neck cancer and rehabilitation as they relate to the geriatric patient.

Aged↗
PubMed1989

Statistical differentiation of tracheoesophageal speech produced under four prosthetic/occlusion speaking conditions.

Twelve male and 12 female total laryngectomy patients who received the tracheoesophageal puncture (TEP) as a means of vocal rehabilitation served as subjects for this investigation. Recordings were made of these subjects' speech produced with four prosthetic/occlusion conditions: (1) duckbill prosthesis with tracheostoma valve; (2) duckbill prosthesis with digital occlusion of the tracheostoma; (3) low pressure prosthesis with tracheostoma valve; and (4) low pressure prosthesis with digital occlusion. Speech tasks consisted of three trials of maximum phonation time on /a/ and reading of a 98-word standard passage. Acoustic analysis of the recorded speech samples included a total of 34 frequency, intensity, temporal, and noise measures. Eight acoustic measures (words per minute, harmonics-to-noise ratio, percent jitter, intensity range during vowel phonation, percent periodic phonation, mean intensity during reading, directional jitter, and directional jitter, and directional shimmer) were chosen as dependent variables for a repeated measures MANOVA. The overall repeated measures MANOVA, a set of complex contrasts, and paired t tests revealed that TEP speech produced with the low pressure prosthesis was significantly different from that produced with the duckbill prosthesis on a weighted linear combination of the eight acoustic variables. Tracheoesophageal voice produced with a low pressure prosthesis had greater amounts of periodic phonation than tracheoesophageal voice produced with a duckbill prosthesis. The use of a tracheostoma valve did not have a significant impact on the subset of acoustic measures used in the repeated measures MANOVA.

Female↗
PubMed1989

Applications of the voice prosthesis during laryngectomy.

With the recent introduction of the voice prosthesis for alaryngeal speech rehabilitation, its application in the early postlaryngectomy period is gaining acceptance. One hundred twenty-eight patients received a tracheoesophageal puncture and adjunctive pharyngeal constrictor relaxation during laryngectomy. The voice prosthesis was applied as early as 10 days after surgery, and the results of a 9-year experience are presented. Eighty percent of the population achieved a durable voice, and the complications were infrequent. The results support the primary use of tracheoesophageal phonation as a relatively safe and reliable alternative to total laryngectomy alone.

Adult↗
PubMed1986

A prospective study of tracheoesophageal speech.

Gates et al suggested that commonly accepted statistics on esophageal speech acquisition may be inflated because they are compiled from retrospective observations that tend to exclude high-risk or poor-outcome patients who are unavailable or unwilling to be assessed. Using a multi-institution prospective study design, they demonstrated that at six months following laryngectomy only 12 (26%) of their 47 patients used esophageal speech. We prospectively assessed a group of 47 laryngectomees' pretracheoesophageal puncture and posttracheoesophageal puncture to determine the efficacy of this speech-rehabilitation method. Forty-four patients (94%) achieved good to superior tracheoesophageal speech, and, at one year, 39 patients (83%) continued to use their voice prosthesis. Results of this study reveal (1) preoperative speech intelligibility and acceptability, (2) predictive value of the preoperative esophageal insufflation test, (3) speech intelligibility and acceptability four days following initial voice prosthesis placement, (4) cost profiles, and (5) results and experiences at one year.

Adult↗
PubMed1986

Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation.

Pharyngeal constrictor and cricopharyngeal spasm have been implicated as deterrants to esophageal speech acquisition as well as tracheoesophageal phonation. Recent efforts to reduce the resultant hypertonicity include pharyngeal constrictor myotomies and modifications of pharyngeal reconstruction during laryngectomy. Investigation of the innervation of the muscular wall of the pharynx led to the development of a pharyngeal plexus neurectomy technique to alter the tonicity of the pharynx without myotomy. The resultant alaryngeal speech is fluent, and acoustic parameters compare favorably to esophageal speech.

Adult↗
PubMed1985

Primary voice restoration at laryngectomy.

The tracheoesophageal puncture techniques of secondary voice restoration have been applied to primary restoration at laryngectomy. Satisfactory speech resulted in 48 patients (69%). This figure was improved by revision surgery to 75% and case selection may produce even higher success rates.

Esophagus↗