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Revision of GORE-TEX medialization laryngoplasty
Scientific Session—Sunday
time course showed no significant change in viability, suggesting that some immortalized cells were resistant to apoptosis. Morphological change: No obvious morphological change was observed for cells under physiological concentration of lead inducement. Apoptosis: 35% of the leadtreated cells exhibited nuclear condensation consistent with apoptosis. This indicates that the immortalized cells are not yet transformed. EMSA: Cells resistant to apoptosis were clonally isolated and exposed continuously to low-dose lead. EMSA using these resistant cells showed significant increase of AP-1 binding activity, indicating cellular proliferation. The clone was also assayed for transformation ability. Conclusions: These results suggest that lead may play a role in cell transformation.
11:46
AM
Revision of GORE-TEX Medialization Laryngoplasty Dwight David Bates MD (presenter); Jacob Cohen MD; Gregory N Postma MD Winston Salem NC; Winston-Salem NC; Winston Salem NC
Objectives: To evaluate the causes for revision of GoreTex medialization laryngoplasty (GML) and describe their management. Methods: A retrospective chart review of 16 patients who underwent revision surgery after initial GML between 1998 and 2002. Analysis was based on preoperative and postoperative video-laryngoscopy, Glottal Closure Index (GCI), and voice rating scale. Results: One hundred fifty-six GML procedures were performed at the Center for Voice Disorders at Wake Forest University Baptist Medical Center between January 1998 and October 2002. Of these, 16 patients have required revision procedures. The most common reason for revision was undercorrection (n ⫽ 11). Other reasons included anterior overcorrection (n ⫽ 1), persistent posterior glottic insufficiency (n ⫽ 2), extruded implant (n ⫽ 2), shifted implant (n ⫽ 1), and a posterior implant limiting cord abduction (n ⫽ 1). Revision procedures included GML (n ⫽ 9), injection augmentation (n ⫽ 9), implant removal (n ⫽ 2), and arytenoid adduction (n ⫽ 2). Video-laryngoscopic findings improved in 11 of 14 patients after revision. GCI improved in 11 of 14. The voice rating scale improved in 10 of 13. Conclusions: Causes for revision of GML are variable, with the most common being under-correction. A variety of safe, feasible revision techniques are available with a high success rate.
Room OCCC 202 •
Scientific Session: Laryngology Stanley E Thawley MD; William R LeMear MD (moderators)
10:30
AM
Wireless pH Testing As an Adjunct to Unsedated Transnasal Esophagoscopy Peter C Belafsky MD PhD MPH (presenter) Del Mar CA
Objectives: The introduction of transnasal esophagoscopy (TNE) has allowed the otolaryngologist to evaluate the esophagus in patients with laryngopharyngeal reflux (LPR), chronic cough, gastroesophageal reflux disease (GERD), and other esophageal disorders. The introduction of 48-hour wireless pH testing offers clinicians a new alternative for the objective documentation of reflux. The purpose of this investigation was to describe our preliminary experience with the transnasal placement of a wireless pH capsule. Methods: All patients undergoing TNE and transnasal placement of a wireless pH capsule between 10/01/02 and 12/31/02 were prospectively evaluated. The pH capsule was placed 6 cm above the endoscopic determination of the squamocolumnar junction. Data concerning patient tolerability, success of capsule placement and function, complications, endoscopic findings, and pH recordings were collected. Results: Sixteen patients were evaluated. The procedure was well tolerated by all patients. The mean age of the cohort was 39 (⫾ 13). Sixty-nine percent were male. Thirty-eight percent had endoscopic evidence of esophagitis. The indications for the procedure were chronic cough (9/16), GERD (3/16), atypical chest pain (2/16), LPR (1), and subglottic stenosis (1). There were no complications. The incidence of epistaxis was 0%. The capsule could not be placed in 1 person secondary to a tight nasal vault, and the capsule failed in 1 individual secondary to equipment malfunction. Two persons had previously undergone conventional pH testing with a hardwired transnasal pH catheter for 24 hours. Both preferred the 48-hour wireless capsule. Conclusions: The transnasal placement of a wireless pH capsule is a safe and effective diagnostic adjunct to unsedated transnasal esophagoscopy. 10:38
AM
Vocal Fold Augmentation with Calcium Hydroxylapatite Peter C Belafsky MD PhD MPH (presenter) Del Mar CA
Objectives: Voice disorders affect over 3% of the general population. Vocal fold atrophy is a part of the normal aging process with up to 60% of 60-year-old individuals displaying evidence of glottal insufficiency. A safe, effective, and durable substance for injection augmentation of the vocal folds is not currently available. The purpose of this investigation was to describe our preliminary experience with calcium hydroxylapatite (CaHA) for vocal fold augmentation.
SUNDAY
P58
Otolaryngology– Head and Neck Surgery August 2003
time course showed no significant change in viability, suggesting that some immortalized cells were resistant to apoptosis. Morphological change: No obvious morphological change was observed for cells under physiological concentration of lead inducement. Apoptosis: 35% of the leadtreated cells exhibited nuclear condensation consistent with apoptosis. This indicates that the immortalized cells are not yet transformed. EMSA: Cells resistant to apoptosis were clonally isolated and exposed continuously to low-dose lead. EMSA using these resistant cells showed significant increase of AP-1 binding activity, indicating cellular proliferation. The clone was also assayed for transformation ability. Conclusions: These results suggest that lead may play a role in cell transformation.
11:46
AM
Revision of GORE-TEX Medialization Laryngoplasty Dwight David Bates MD (presenter); Jacob Cohen MD; Gregory N Postma MD Winston Salem NC; Winston-Salem NC; Winston Salem NC
Objectives: To evaluate the causes for revision of GoreTex medialization laryngoplasty (GML) and describe their management. Methods: A retrospective chart review of 16 patients who underwent revision surgery after initial GML between 1998 and 2002. Analysis was based on preoperative and postoperative video-laryngoscopy, Glottal Closure Index (GCI), and voice rating scale. Results: One hundred fifty-six GML procedures were performed at the Center for Voice Disorders at Wake Forest University Baptist Medical Center between January 1998 and October 2002. Of these, 16 patients have required revision procedures. The most common reason for revision was undercorrection (n ⫽ 11). Other reasons included anterior overcorrection (n ⫽ 1), persistent posterior glottic insufficiency (n ⫽ 2), extruded implant (n ⫽ 2), shifted implant (n ⫽ 1), and a posterior implant limiting cord abduction (n ⫽ 1). Revision procedures included GML (n ⫽ 9), injection augmentation (n ⫽ 9), implant removal (n ⫽ 2), and arytenoid adduction (n ⫽ 2). Video-laryngoscopic findings improved in 11 of 14 patients after revision. GCI improved in 11 of 14. The voice rating scale improved in 10 of 13. Conclusions: Causes for revision of GML are variable, with the most common being under-correction. A variety of safe, feasible revision techniques are available with a high success rate.
Room OCCC 202 •
Scientific Session: Laryngology Stanley E Thawley MD; William R LeMear MD (moderators)
10:30
AM
Wireless pH Testing As an Adjunct to Unsedated Transnasal Esophagoscopy Peter C Belafsky MD PhD MPH (presenter) Del Mar CA
Objectives: The introduction of transnasal esophagoscopy (TNE) has allowed the otolaryngologist to evaluate the esophagus in patients with laryngopharyngeal reflux (LPR), chronic cough, gastroesophageal reflux disease (GERD), and other esophageal disorders. The introduction of 48-hour wireless pH testing offers clinicians a new alternative for the objective documentation of reflux. The purpose of this investigation was to describe our preliminary experience with the transnasal placement of a wireless pH capsule. Methods: All patients undergoing TNE and transnasal placement of a wireless pH capsule between 10/01/02 and 12/31/02 were prospectively evaluated. The pH capsule was placed 6 cm above the endoscopic determination of the squamocolumnar junction. Data concerning patient tolerability, success of capsule placement and function, complications, endoscopic findings, and pH recordings were collected. Results: Sixteen patients were evaluated. The procedure was well tolerated by all patients. The mean age of the cohort was 39 (⫾ 13). Sixty-nine percent were male. Thirty-eight percent had endoscopic evidence of esophagitis. The indications for the procedure were chronic cough (9/16), GERD (3/16), atypical chest pain (2/16), LPR (1), and subglottic stenosis (1). There were no complications. The incidence of epistaxis was 0%. The capsule could not be placed in 1 person secondary to a tight nasal vault, and the capsule failed in 1 individual secondary to equipment malfunction. Two persons had previously undergone conventional pH testing with a hardwired transnasal pH catheter for 24 hours. Both preferred the 48-hour wireless capsule. Conclusions: The transnasal placement of a wireless pH capsule is a safe and effective diagnostic adjunct to unsedated transnasal esophagoscopy. 10:38
AM
Vocal Fold Augmentation with Calcium Hydroxylapatite Peter C Belafsky MD PhD MPH (presenter) Del Mar CA
Objectives: Voice disorders affect over 3% of the general population. Vocal fold atrophy is a part of the normal aging process with up to 60% of 60-year-old individuals displaying evidence of glottal insufficiency. A safe, effective, and durable substance for injection augmentation of the vocal folds is not currently available. The purpose of this investigation was to describe our preliminary experience with calcium hydroxylapatite (CaHA) for vocal fold augmentation.
SUNDAY
P58
Otolaryngology– Head and Neck Surgery August 2003