- Email: [email protected]
The relationship between oral malodor and volatile sulfur compounds producing bacteria
Wednesday, September 22, 2004
6:30 AM to 7:45 AM Room JJCC Special Events Hall 1DMR •
Miniseminar: Current Controversies in Otitis Media Joseph E Kerschner, MD; James Christopher Post, MD PhD (moderator); Richard M Rosenfeld, MD MPH
Milwaukee WI; Pittsburgh PA; Brooklyn NY Otolaryngologists are viewed as the experts in diagnosing and treating otitis media (OM) both medically and surgically. As experts, otolaryngologists are also often asked to comment on controversial clinical topics related to OM. The miniseminar’s format will be that of an interactive panel of experts
8:00 AM to 9:30 AM Room JJCC 1A21 •
Scientific Sessions: General Moderators: Serge A. Martinez, Hotlel, MD
MD,
Michael R.
8:00 AM Combined Endoscopic Medial and External Lateral Orbital Decompression Robert D Silver, MD (presenter); George S Goding, Jr, Andrew R Harrison, MD Edina MN; Minneapolis MN; Minneapolis MN
MD;
Objectives: To compare the efficacy of endoscopic medial and external lateral orbital wall surgery to 3-wall decompression in patients with progressive thyroid eye disease. Methods: Patients underwent either endoscopic medial and external lateral orbital wall decompression or 3-wall decompression (including the orbital floor). This was performed in 32 orbits of 17 patients and 15 orbits of 8 patients, respectively. Patients diagnosed with thyroid eye disease demonstrating severe proptosis, exposure keratitis, or compressive optic neuropathy were included. Results: Mean reduction in proptosis as evaluated by Hertel exophthalmometry was 4.37 mm OU (range, 0.58 mm) in the 2-wall approach and 4.59 (range, 1– 8 mm) in the
P212 Otolaryngology–Head and Neck Surgery
who have contributed to the medical literature concerning current controversial topics as they relate to the selective use of antibiotics for acute otitis media, and the impact of OM on speech, language, and childhood development. A pointcounter point debate will center on the topic of withholding antibiotics to allow for spontaneous resolution of acute OM and will focus on the aspects of complications, speed of recovery, accuracy of diagnosis, costs, antimicrobial resistance, and medical/legal issues. A second point-counter point debate will center on the topic of the impact that chronic OM with effusion has on childhood development, specifically related to speech and language outcomes. The moderator will provide additional points of interest regarding each of these topics and audience participation will be encouraged through an interactive format. We plan a pre- and postpresentation audience survey to assess the program’s educational impact.
3-wall group. Seventy-five percent of patients in the 2-wall group demonstrated improved visual acquity, while 50% improved after surgical decompression in the 3-wall group. Palpebral fissures decreased by an average of 2.50 mm (range, 07 mm) in the 2-wall group and by 2.03 mm (range, 0 –3mm) in the 3-wall group. New onset diplopia was seen in 2 of 17 patients (11.8 %) in the 2-wall group and 1 of 8 (12.5%) patients following 3-wall orbital decompression. The mean time from diagnosis to intervention was 5.9 years in the 2-wall group and 19 years in the 3-wall group. Conclusions: This study supports the use of combined endoscopic medial with external lateral orbital wall decompression for patients with thyroid eye disease. Results compared favorably to those of 3-wall decompression. Additionally, the time interval from diagnosis to surgical intervention does not appear to predict the degree of improvement in patients with thyroid eye disease. 8:08 AM The Relationship between Oral Malodor and Volatile Sulfur Compounds Producing Bacteria Yosef P Krespi, MD (presenter); Mel Rosenberg, PhD New York NY; Tel Aviv Israel
Objectives: Halitosis can be a crippling social problem where the standard dental treatments and mouthwashes often
August 2004
WEDNESDAY
Foundation Annual Meeting Symposium (FAMS)
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
8:16 AM Vocal Quality of Life Improves with Treatment of Laryngopharyngeal Reflux Mary Es A Beaver, MD; Scott M Kaszuba, MD (presenter); Michael G Stewart, MD MPH; C Richard Stasney, MD Houston TX; Pearland TX; Houston TX; Houston TX
Objectives: To determine if vocal quality of life improves with treatment of laryngopharyngeal reflux disease (LPRD). Methods: A prospective case series study was performed on patients with a diagnosis of laryngopharyngeal reflux disease at a tertiary center of laryngology from 6/01 to 12/03. Pre- and posttreatment reflux symptoms, physical examination scores, and vocal quality of life scores were assessed using validated and standardized instruments (Voice Handicap Inventory-10 [VHI-10], Reflux Symptom Index [RSI], and Laryngopharyngeal Reflux Disease Index [LRDI]). Results: A significant improvement in posttreatment vocal quality of life as measured by the VHI-10 was noted (mean score, 8.3) as compared to pretreatment (mean score 13.48,
P ⬍ 0.001). This improvement correlated significantly with improvement in the RSI (posttreatment 12.56 vs pretreatment 18.10, P ⬍ 0.001, Pearson correlation coefficient 0.359). Physical examination score as measured by the LRDI improved with treatment but the degree of improvement did not correlate with improvement in the VHI-10 or the RSI. Conclusions: Treatment of LPRD significantly improves vocal quality of life. Laryngeal reflux symptoms improve with treatment and this improvement correlates with improvement in vocal quality of life.
8:30 AM The Efficacy of Injection Laryngoplasty in Managing Unilateral Vocal Fold Paralysis Siew Shuen Chao, FRCS (presenter); Scott M Graham, MD; Lucy Karnell, PhD; Alexander PM Jay, MD; Henry T Hoffman, MD Singapore Singapore; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA
Objectives: To determine the efficacy of injection laryngoplasty with collagen, autologous fat, and gelfoam in patients with unilateral vocal fold paralysis using vocal and swallowing outcome measures. Methods: This retrospective study investigated patients who received injection laryngoplasty for their unilateral vocal fold paralysis. The outcome measures included the GRBAS voice assessment scale (0 ⫽ normal, 3 ⫽ severely abnormal) and patient-reported impact of disease on life (0 ⫽ none, 6 ⫽ severe) and improvement in swallowing function (yes, no). Results: Forty-seven patients (average age, 59.5 years; 28 male) received 58 injections that had pretreatment and posttreatment vocal assessments (with 1 through 5 injections received by 42, 12, 2, 1, and 1, respectively). The first injection was collagen for 74%, fat for 19%, and gelfoam for 7%. The median duration between treatment and follow-up assessment was 42 days. The mean scores of all parameters improved after treatment, with greatest improvement in grade (2.19 ⫾ 0.63 to 0.98 ⫾ 0.68, P ⫽ 0.02), breathiness (1.78 ⫾ 0.91 to 0.49 ⫾ 0.68, P ⫽ 0.03) and asthenia (1.46 ⫾ 0.94 to 0.44 ⫾ 0.60, P ⫽ 0.08). Scores improved in 86% of patients for grade, 45% for roughness, 76% for breathiness, 64% for asthenia, and 73% for impact. Among the 26 patients (55%) who presented with swallowing problems, 70% improved after treatment. Statistical analysis suggested no significant differences in outcome between the various materials injected. Conclusions: This study provides evidence that injection laryngoplasty is an effective treatment for patients with unilateral vocal fold paralysis. Improvements were demonstrated in all 5 vocal parameters and in swallowing following treatment, with the changes in grade and breathiness being significant.
WEDNESDAY
recommended provide only temporary relief. Oral malodor is primarily the result of microbial metabolism. The mouth is home to hundreds of bacterial species with various nutritional preferences. These organisms enjoy proteins, as they digest proteins several fetid substances arise. The role of volatile sulfur compounds (VSC) producing bacteria colonizing over the tongue as a main cause for halitosis was recently understood. Detection of VSC such as methylmercaptan and hydrogen sulfite by utilizing organoleptic and objective methods, one can identify the source. Methods: We developed a rational effective approach to the care of the patient with oral malodor. Following comprehensive evaluation for possible cause for halitosis, most patients seen in an ENT practice were found to have the tongue as the origin. Oral malodor from the overgrowth of proteolytic, anaerobic gram negative bacteria on the crevices of the tongue dorsum can be successfully diagnosed and treated. Results: Bacteriologic analysis from the biofilm and scraped specimens obtained from the tongue dorsum or other oral sites can identify the VSC producing bacteria. Porphyromonas, Prevotella, Actinobacillus and Fusobacterium species were the most common organisms identified from cultures. These sites were primarily the tongue dorsum, gingival pockets, and tonsil crypts. Conclusions: Halitosis is an oral phenomenon, research suggests that almost no cases originate below the tonsils. Halitosis arising from the tongue dorsum from overpopulated VSC producing bacteria can be successfully managed with combination of mechanical cleansing using tongue brushes or scrapes and various chemical solutions. Various chemicals containing essential oils, zinc chloride, and cetylpyridium chloride were found effective in reducing VSC.
Scientific Session—Wednesday P213
6:30 AM to 7:45 AM Room JJCC Special Events Hall 1DMR •
Miniseminar: Current Controversies in Otitis Media Joseph E Kerschner, MD; James Christopher Post, MD PhD (moderator); Richard M Rosenfeld, MD MPH
Milwaukee WI; Pittsburgh PA; Brooklyn NY Otolaryngologists are viewed as the experts in diagnosing and treating otitis media (OM) both medically and surgically. As experts, otolaryngologists are also often asked to comment on controversial clinical topics related to OM. The miniseminar’s format will be that of an interactive panel of experts
8:00 AM to 9:30 AM Room JJCC 1A21 •
Scientific Sessions: General Moderators: Serge A. Martinez, Hotlel, MD
MD,
Michael R.
8:00 AM Combined Endoscopic Medial and External Lateral Orbital Decompression Robert D Silver, MD (presenter); George S Goding, Jr, Andrew R Harrison, MD Edina MN; Minneapolis MN; Minneapolis MN
MD;
Objectives: To compare the efficacy of endoscopic medial and external lateral orbital wall surgery to 3-wall decompression in patients with progressive thyroid eye disease. Methods: Patients underwent either endoscopic medial and external lateral orbital wall decompression or 3-wall decompression (including the orbital floor). This was performed in 32 orbits of 17 patients and 15 orbits of 8 patients, respectively. Patients diagnosed with thyroid eye disease demonstrating severe proptosis, exposure keratitis, or compressive optic neuropathy were included. Results: Mean reduction in proptosis as evaluated by Hertel exophthalmometry was 4.37 mm OU (range, 0.58 mm) in the 2-wall approach and 4.59 (range, 1– 8 mm) in the
P212 Otolaryngology–Head and Neck Surgery
who have contributed to the medical literature concerning current controversial topics as they relate to the selective use of antibiotics for acute otitis media, and the impact of OM on speech, language, and childhood development. A pointcounter point debate will center on the topic of withholding antibiotics to allow for spontaneous resolution of acute OM and will focus on the aspects of complications, speed of recovery, accuracy of diagnosis, costs, antimicrobial resistance, and medical/legal issues. A second point-counter point debate will center on the topic of the impact that chronic OM with effusion has on childhood development, specifically related to speech and language outcomes. The moderator will provide additional points of interest regarding each of these topics and audience participation will be encouraged through an interactive format. We plan a pre- and postpresentation audience survey to assess the program’s educational impact.
3-wall group. Seventy-five percent of patients in the 2-wall group demonstrated improved visual acquity, while 50% improved after surgical decompression in the 3-wall group. Palpebral fissures decreased by an average of 2.50 mm (range, 07 mm) in the 2-wall group and by 2.03 mm (range, 0 –3mm) in the 3-wall group. New onset diplopia was seen in 2 of 17 patients (11.8 %) in the 2-wall group and 1 of 8 (12.5%) patients following 3-wall orbital decompression. The mean time from diagnosis to intervention was 5.9 years in the 2-wall group and 19 years in the 3-wall group. Conclusions: This study supports the use of combined endoscopic medial with external lateral orbital wall decompression for patients with thyroid eye disease. Results compared favorably to those of 3-wall decompression. Additionally, the time interval from diagnosis to surgical intervention does not appear to predict the degree of improvement in patients with thyroid eye disease. 8:08 AM The Relationship between Oral Malodor and Volatile Sulfur Compounds Producing Bacteria Yosef P Krespi, MD (presenter); Mel Rosenberg, PhD New York NY; Tel Aviv Israel
Objectives: Halitosis can be a crippling social problem where the standard dental treatments and mouthwashes often
August 2004
WEDNESDAY
Foundation Annual Meeting Symposium (FAMS)
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
8:16 AM Vocal Quality of Life Improves with Treatment of Laryngopharyngeal Reflux Mary Es A Beaver, MD; Scott M Kaszuba, MD (presenter); Michael G Stewart, MD MPH; C Richard Stasney, MD Houston TX; Pearland TX; Houston TX; Houston TX
Objectives: To determine if vocal quality of life improves with treatment of laryngopharyngeal reflux disease (LPRD). Methods: A prospective case series study was performed on patients with a diagnosis of laryngopharyngeal reflux disease at a tertiary center of laryngology from 6/01 to 12/03. Pre- and posttreatment reflux symptoms, physical examination scores, and vocal quality of life scores were assessed using validated and standardized instruments (Voice Handicap Inventory-10 [VHI-10], Reflux Symptom Index [RSI], and Laryngopharyngeal Reflux Disease Index [LRDI]). Results: A significant improvement in posttreatment vocal quality of life as measured by the VHI-10 was noted (mean score, 8.3) as compared to pretreatment (mean score 13.48,
P ⬍ 0.001). This improvement correlated significantly with improvement in the RSI (posttreatment 12.56 vs pretreatment 18.10, P ⬍ 0.001, Pearson correlation coefficient 0.359). Physical examination score as measured by the LRDI improved with treatment but the degree of improvement did not correlate with improvement in the VHI-10 or the RSI. Conclusions: Treatment of LPRD significantly improves vocal quality of life. Laryngeal reflux symptoms improve with treatment and this improvement correlates with improvement in vocal quality of life.
8:30 AM The Efficacy of Injection Laryngoplasty in Managing Unilateral Vocal Fold Paralysis Siew Shuen Chao, FRCS (presenter); Scott M Graham, MD; Lucy Karnell, PhD; Alexander PM Jay, MD; Henry T Hoffman, MD Singapore Singapore; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA
Objectives: To determine the efficacy of injection laryngoplasty with collagen, autologous fat, and gelfoam in patients with unilateral vocal fold paralysis using vocal and swallowing outcome measures. Methods: This retrospective study investigated patients who received injection laryngoplasty for their unilateral vocal fold paralysis. The outcome measures included the GRBAS voice assessment scale (0 ⫽ normal, 3 ⫽ severely abnormal) and patient-reported impact of disease on life (0 ⫽ none, 6 ⫽ severe) and improvement in swallowing function (yes, no). Results: Forty-seven patients (average age, 59.5 years; 28 male) received 58 injections that had pretreatment and posttreatment vocal assessments (with 1 through 5 injections received by 42, 12, 2, 1, and 1, respectively). The first injection was collagen for 74%, fat for 19%, and gelfoam for 7%. The median duration between treatment and follow-up assessment was 42 days. The mean scores of all parameters improved after treatment, with greatest improvement in grade (2.19 ⫾ 0.63 to 0.98 ⫾ 0.68, P ⫽ 0.02), breathiness (1.78 ⫾ 0.91 to 0.49 ⫾ 0.68, P ⫽ 0.03) and asthenia (1.46 ⫾ 0.94 to 0.44 ⫾ 0.60, P ⫽ 0.08). Scores improved in 86% of patients for grade, 45% for roughness, 76% for breathiness, 64% for asthenia, and 73% for impact. Among the 26 patients (55%) who presented with swallowing problems, 70% improved after treatment. Statistical analysis suggested no significant differences in outcome between the various materials injected. Conclusions: This study provides evidence that injection laryngoplasty is an effective treatment for patients with unilateral vocal fold paralysis. Improvements were demonstrated in all 5 vocal parameters and in swallowing following treatment, with the changes in grade and breathiness being significant.
WEDNESDAY
recommended provide only temporary relief. Oral malodor is primarily the result of microbial metabolism. The mouth is home to hundreds of bacterial species with various nutritional preferences. These organisms enjoy proteins, as they digest proteins several fetid substances arise. The role of volatile sulfur compounds (VSC) producing bacteria colonizing over the tongue as a main cause for halitosis was recently understood. Detection of VSC such as methylmercaptan and hydrogen sulfite by utilizing organoleptic and objective methods, one can identify the source. Methods: We developed a rational effective approach to the care of the patient with oral malodor. Following comprehensive evaluation for possible cause for halitosis, most patients seen in an ENT practice were found to have the tongue as the origin. Oral malodor from the overgrowth of proteolytic, anaerobic gram negative bacteria on the crevices of the tongue dorsum can be successfully diagnosed and treated. Results: Bacteriologic analysis from the biofilm and scraped specimens obtained from the tongue dorsum or other oral sites can identify the VSC producing bacteria. Porphyromonas, Prevotella, Actinobacillus and Fusobacterium species were the most common organisms identified from cultures. These sites were primarily the tongue dorsum, gingival pockets, and tonsil crypts. Conclusions: Halitosis is an oral phenomenon, research suggests that almost no cases originate below the tonsils. Halitosis arising from the tongue dorsum from overpopulated VSC producing bacteria can be successfully managed with combination of mechanical cleansing using tongue brushes or scrapes and various chemical solutions. Various chemicals containing essential oils, zinc chloride, and cetylpyridium chloride were found effective in reducing VSC.
Scientific Session—Wednesday P213