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Biomedical subjects

J A Koufman

Publications and source records attributed to J A Koufman.

At least 19 recordsLinked to original sources
PubMed1992

Voice analysis of patients with endoscopically treated early laryngeal carcinoma.

Endoscopic laser resection of early (T1) laryngeal carcinoma has been advocated as an alternative to radiotherapy. Heretofore, the voice characteristics following this procedure have been addressed in only one review, which included patients treated by irradiation and laser resection. We present the first review of voice findings in 22 patients treated only by endoscopic laser resection of their vocal cord carcinomas. Laser resection of selected vocal cord carcinomas produced voice function results acceptable to the patients and was rated by them to be normal to almost normal. Speech pathologists rated the voices to be near-normal to mildly abnormal. Voices after laser resection of vocal carcinoma exhibited a slightly higher fundamental frequency, a decrease in intensity and phonatory duration, and markedly higher laryngeal airway resistance. The percentage of voicing showed little deviation from normal, as did mean percentage of perturbations.

Airway Resistance↗
PubMed1991

The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury.

Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order ot test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double-probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx. Two hundred twenty-five consecutive patients with otolaryngologic disorders having suspected GERD evaluated from 1985 through 1988 are reported. Ambulatory 24-hour intraesophageal pH monitoring was performed in 197; of those, 81% underwent double-probe pH monitoring, with the second pH probe being placed in the hypopharynx at the laryngeal inlet. Seventy percent of the patients also underwent barium esophagography with videofluoroscopy. The patient population was divided into seven diagnostic subgroups: carcinoma of the larynx (n = 31), laryngeal and tracheal stenosis (n = 33), reflux laryngitis (n = 61), globus pharyngeus (n = 27), dysphagia (n = 25), chronic cough (n = 30), and a group with miscellaneous disorders (n = 18). The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation). Thus, by traditional symptomatology, GER was occult or silent in the majority of the study population. Twenty-eight patients (12%) refused or could not tolerate pH monitoring. Of the patients undergoing diagnostic pH monitoring, 62% had abnormal esophageal pH studies, and 30% demonstrated reflux into the pharynx. The results of diagnostic pH monitoring for each of the subgroups were as follows (percentage with abnormal studies): carcinoma (71%), stenosis (78%), reflux laryngitis (60%), globus (58%), dysphagia (45%), chronic cough (52%), and miscellaneous (13%). The highest yield of abnormal pharyngeal reflux was in the carcinoma group and the stenosis group (58% and 56%, respectively). By comparison, the diagnostic barium esophagogram with videofluoroscopy was frequently negative. The results were as follows: esophagitis (18%), reflux (9%), esophageal dysmotility (12%), and stricture (3%). All of the study patients were treated with antireflux therapy. Follow-up was available on 68% of the patients and the mean follow-up period was 11.6 +/- 12.7 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Unusual auricular complications in cutaneous oncology.

The anatomic complexity of the pinna predisposes that structure to a variety of unique, site specific postoperative complications following management of skin cancer. We describe four unusual auricular complications: 1) radiochondronecrosis; 2) autonecrosis of skin during second intention healing; 3) hearing loss secondary to tragal retraction over the external auditory canal; and 4) extension of tumor through fenestrated cartilage. Well-known postoperative auricular complications are reviewed and anticipation and recognition of these unusual complications are emphasized.

Adult↗
PubMed1991

Functional voice disorders.

Functional voice disorders (FVDs) are common. The diagnostic criteria for six types of FVD and the results of treatment in a large series of patients are reported. Voice therapy was effective in 69% of the patients. Failure of voice therapy usually correlated with continued tobacco use, noncompliance with therapy, or premature termination of therapy.

Adult↗
PubMed1991

Laryngoplastic phonosurgery.

Laryngoplastic phonosurgery is a new term used to describe all forms of laryngeal framework surgery to improve the voice. One of the most important new surgical techniques is medialization laryngoplasty (ML) for the correction of unilateral vocal cord paralysis. This article focuses on ML techniques, results, complications and indications; the artenoid adduction procedure (AA) is described as a complementary technique. In addition, some of the more experimental laryngoplastic procedures are reviewed.

Female↗
PubMed1991

The spectrum of vocal dysfunction.

Levels of vocal use, types of vocal complaints, and the spectrum of vocal dysfunction are discussed in this article. Functional voice disorders account for 40% and organic conditions for 60% of patients presenting with voice disorders. Twelve percent of the patients are children.

Humans↗
PubMed1991

Approach to the patient with a voice disorder.

The author's approach to patients with voice disorders emphasizes the value of a multidisciplinary voice team, including an otolaryngologist, a speech pathologist, and a neurologist.

Humans↗
PubMed1990

Sarcoidosis of the upper respiratory tract in patients with nasal rim lesions: a pilot study.

Lupus pernio has been associated with sarcoidosis of the upper respiratory tract. The semantic differences in the use of the designation "lupus pernio" are such that American dermatologists may not consider patients with nasal rim papules of sarcoidosis to have lupus pernio. During a 12-month period, we referred each new patient with sarcoidosis and nasal rim lesions for direct and indirect laryngoscopy. Three of our four patients had sarcoidosis of the upper respiratory tract. We recommend a large prospective study to assess the incidence of this disorder in patients with nasal rim lesions of sarcoidosis. Until such a study is undertaken, however, we believe that consideration should be given to otolaryngologic examination of these patients, regardless of their symptoms.

Adult↗
PubMed1990

Radiation-induced squamous sialometaplasia.

We describe a patient with recurrent acantholytic squamous cell carcinoma following radiation therapy. Mohs micrographic sections revealed extensive squamous sialometaplasia showing striking histologic similarity to the patient's squamous cell carcinoma. Criteria necessary to differentiate squamous sialometaplasia from neoplasm are presented. This differentiation is important to ensure adequate tumor resection without unnecessary sacrifice of tumor-free tissue.

Aged↗
PubMed1989

Surgical correction of dysphonia due to bowing of the vocal cords.

This report reviews laryngoplastic techniques for correction of bowing of the vocal cords, with special consideration to the anatomic details of the anterior commissure. I present a new technique in which the glottic gap is closed by bilateral medialization. This technique may be superior to those described previously, since the correction achieved at the time of surgery is maintained by the placement of Silastic.

Adult↗
PubMed1989

Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring.

Gastroesophageal reflux (GER) has been implicated in otolaryngologic problems, particularly chronic hoarseness that cannot be attributed to other causes. To study this relationship, we used 24-h ambulatory intraesophageal or dual pharyngoesophageal pH monitoring in 33 patients with chronic hoarseness and laryngeal lesions suggestive of acid irritation. Twenty-six of the patients (78.8%) had pH evidence of severe GER, being at least three times greater than the upper limit of normal. In contrast to 19 patients with proven esophagitis, this GER was worse in the upright position. Of 15 patients with both pharyngeal and esophageal probes, three had esophagopharyngeal reflux, and two had atypical unexplained pharyngeal decreases in pH to below 4.0. Less than half of the 33 patients had the typical symptoms of GER, and standard esophageal tests usually yielded normal findings. Occult GER, predominantly in the upright position, appears to be common and severe in patients with chronic hoarseness, who have laryngeal lesions suggestive of GER. The causative mechanisms are not clear. The 24-h esophageal pH monitor is useful in screening this potentially treatable problem.

Adult↗
PubMed1988

Vocal fatigue and dysphonia in the professional voice user: Bogart-Bacall syndrome.

Over the past 5 years, the authors have treated 67 adult professional voice users with a musculoskeletal tension disorder involving the larynx and supporting structures and leading to vocal dysfunction. Common clinical features in both sexes were muscle tension in the neck, poor control of the breath stream, and an abnormally low-pitched speaking voice. Most of the men sounded like Humphrey Bogart and the women like Lauren Bacall. These cases represent a discrete clinical vocal fatigue syndrome, the treatment of which is patient education and voice therapy.

Adult↗
PubMed1988

A comparison of the carbon dioxide and neodymium: YAG lasers in a canine model of acquired subglottic stenosis.

In a previously defined canine model of subglottic stenosis, two different wavelength lasers--the carbon dioxide (CO2) and the neodymium-yttrium aluminum garnet (Nd:YAG)--were used as the principal surgical therapy, and the results were compared. Two lathyrogenic agents, colchicine and penicillamine, were also used in a subset of each treatment group in order to determine their effect as an adjunct to laser therapy in the treatment of subglottic stenosis. The CO2 laser treatment group showed an overall improvement; the Nd:YAG laser treatment group showed a worsening of subglottic stenosis. The dogs treated with the lathyrogenic agents had no added benefit from the use of these agents.

Aluminum↗
PubMed1987

Proximal large-bore jet ventilation for laryngeal laser surgery.

The carbon dioxide surgical laser has made many open upper airway operations obsolete. However, new laser-related hazards have been encountered, the most serious of which is fire in the airway. Venturi jet ventilation removes that risk and provides an unobstructed surgical field. Indications and techniques for the use of jet ventilation with carbon dioxide laser surgery remain controversial, particularly whether jet ventilation should be used in papillomatosis or in the severely obstructed airway, and whether proximal and distal catheter techniques are equally safe and effective. We report the successful use of proximal large-bore Venturi jet ventilation in 327 consecutive patients undergoing microlaryngeal laser surgery. The technique is ideal for pediatric patients with subglottic stenosis or recurrent respiratory papillomas and has not caused distal seeding in the latter group. We recommend the use of low-pressure ventilation, even in relatively obstructed airways. The experimental evidence reported here corroborates the clinical viewpoint expressed; the technique is safe, simple, and uncomplicated if used with care.

Adult↗
PubMed1987

Endoscopic laser surgery. An alternative in laryngeal cancer treatment.

Thirty-three patients with newly diagnosed laryngeal carcinoma underwent endoscopic treatment with the carbon dioxide laser under microscopic control and venturi jet ventilation. Ten of these patients underwent emergency tumor debulking to relieve airway obstruction and to avoid emergency tracheotomy for airway control, and 23 had definitive treatment of superficial or frankly invasive carcinoma. Among the first group, all had an adequate airway after tumor debulking and could be treated with elective laryngectomy with or without radical neck dissection once their metabolic conditions had improved and they had been appropriately evaluated. Among the second group, two died of lung carcinoma but were free of laryngeal disease and two were lost to follow-up at one year. With a minimal three-year follow-up, six of the remaining 19 patients underwent additional laser procedures. None have required external laryngeal surgery or radiation therapy. Endoscopic laser therapy appears preferable to a more radical approach for carcinoma in situ, microinvasive carcinoma, or superficially invasive carcinoma of the larynx.

Airway Obstruction↗