Effects of compound betamethasone on vocal fold wound healing in rabbit model: A preliminary study.

Objectives: The compound betamethasone is widely used to prevent scarring in dermatology. This study aims to explore the effects of compound betamethasone on vocal fold (VF) wound healing. Study design: Prospective animal study in rabbits. Methods: Eighteen rabbits underwent bilateral VF stripping and three rabbits served as controls. 0.1 mL of compound betamethasone (1 mL: betamethasone sodium phosphate 5 mg and betamethasone dipropionate 2 mg) was injected into the right VF of each rabbit, and 0.1 mL 0.9% saline was injected into the contralateral VF. Endoscopy was performed for morphologic observation. Six larynges were harvested for histological analysis at 3 days, 7 days, and 1 month. The VFs were stained with hematoxylin and eosin (H&E), Alcian blue, and Masson' trichrome staining. Results: In morphological analysis, there was no visible difference between betamethasone-treated and saline-treated VFs at 3 and 7 days. After 1 month, more VF scars appeared on the saline-treated VFs than the VFs treated with betamethasone. Inflammatory cell number showed significant difference between both VFs at 3 days (p = .037) and 7 days (p = .045). No significant different was found in epithelial thickness at 1 month between the betamethasone and saline groups. The collagen in the saline-treated VFs was significantly denser than that of the betamethasone-treated group (p = .037). There was also a significant increase in the level of hyaluronic acid (HA) in betamethasone-injected VFs in comparison to the saline-injected VFs (p = .006). Conclusions: Based on this study, compound betamethasone can improve VF healing. Our findings suggest that VF injection with compound betamethasone helps to minimize scarring by increasing HA level and decreasing collagen density.

Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings.

The aim of this study was to determine the prevalence of facial nerve (FN) bifurcation in patients who undergo stapes surgery, and to ascertain the correlation between the intraoperative and radiographic findings in cases where an unexpected branch malformation for patients undergoing stapes surgery. Patients who underwent stapes surgery were retroactively examined for confirmed FN bifurcation. Among the 887 patients, 10 had a bifurcated FN confirmed during surgery and had a preoperative high-resolution computed tomography (HRCT) scan. The HRCT scans were examined by two radiologists who were blinded to the operational findings. The diagnostic accuracy of HRCT imaging was examined along with their preoperative audiometry. In total, 887 patients underwent stapes surgery and among them the prevalence of FN bifurcation was 1.13%. These 10 patients had a 1:1 male-female ratio with a mean age of 17.9 ± 7.0 years. From a surgical review, all cases had bifurcation at the horizontal segment of FN, including 1 case of FN trifurcation. The diagnostic difference between HRCT imaging and intraoperation observations for malformations in the middle ear varies widely depending on the location, ranging from 0% to 90%. The prevalence of incus and stapes malformations was high in both imaging and operation findings (≥60%). The detection rate of abnormal positioning and bifurcation of the FN during HRCT imaging was 30% and 0%, respectively. The mean air-bone gap hearing threshold for patients was significantly improved from 42.3 dB preoperatively to 15.6 dB postoperatively without any complications. These results showed that it is extremely difficult to predict the FN bifurcation prior to surgery with a detection rate of 0%. The diagnostic difference between HRCT imaging and intraoperation observations for malformations of different parts of the middle ear varies widely. These results highlight the importance of being vigilant in regard to FN anatomical variation during stapes surgery for any unexpected malformations that are not detected during HRCT evaluation. In addition, the surgical outcomes for these patients were optimal when treatment was performed by senior surgeons.

Do the Nonlinear Dynamic Acoustic Measurements, Nonlinear Energy Difference Ratio and Spectrum Convergence Ratio, Correlate with Perceptual Evaluation of Esophageal Voice Speakers?

BACKGROUND: The acoustic assessment of phonation after total laryngectomy is challenged by signal aperiodicity which makes frequency-based acoustic measures less reliable. This is important for patients who use esophageal voice since voice samples mostly include type III (highly aperiodic) and 4 (chaotic) signals. As such, using non-linear measures, which are better suited for aperiodic phonation, may be useful to investigate the relationship between acoustic signal characteristics and perception of esophageal voice quality. OBJECTIVES: This study aimed to investigate whether nonlinear dynamic acoustic methods, nonlinear energy difference Ratio (NEDR) and spectrum convergence ratio (SCR), were correlated with perceptual measures in subjects who used esophageal phonation. METHODS: Thirty-one subjects who had undergone total laryngectomy and use esophageal voice as a rehabilitation method were included in this study. Expert and non-expert raters listened to the esophageal voice samples from the subjects and rated vowels and connected speech samples on a scale from 1 to 7 on dysphonia severity and intelligibility. In addition, non-linear acoustic analysis was performed to calculate NEDR and SCR. Analysis from the raters was compared to the non-linear acoustic analysis to find the correlation between the variables. RESULTS: There were no significant correlations between any of the non-linear acoustic measures NEDR and SCR and the perceptual ratings at the significance level of 0.05. Correlations were calculated for each acoustic measure among the expert raters and among the non-expert raters in both connected speech samples and sustained vowel fragments. CONCLUSIONS: In conclusion, the nonlinear dynamic acoustic analyses of spectrum convergence ratio and nonlinear energy difference ratio do not have a significant correlation with perceptual measures of esophageal voice.

Stability of computed tomography densitometry in patients with otosclerosis:a two-year follow-up.

OBJECTIVES: To quantify the progression of otosclerosis in the unoperated ear between two stapedotomy procedures for patients with bilateral otosclerosis which can help to determine whether a HRCT scan should be re-performed before the second surgery for patients who already received HRCT imaging before the initial surgery. METHODS: 35 patients who underwent bilateral stapedotomy were included. Two rounds of HRCT examination and audiometry were performed at the time of the first surgery and second surgery on the ear that was not operated on during the initial surgery. The relationship between the changes in HRCT densitometry and audiometry over time was analyzed. RESULTS: The second round of HRCT did not add significant information about the changes to the otosclerosis lesions in either the imaging diagnosis or the HRCT density values except for small changes in the HRCT densitometry readings at the area anterior to the inner auditory (P = 0.01). While the changes in HRCT manifestation are small, changes near the fissula ante fenestram (FAF) were still positively correlated with the air bone gap (ABG) of patients (p = 0.031, r = 0.388). CONCLUSIONS: The progression of lesions in otosclerosis is slow resulting in small and insignificant changes to the HRCT features. Therefore, a repeat HRCT evaluations prior to surgery is not necessary for patients who have had a previous HRCT evaluation within 2 years of the operation. The small changes in HRCT manifestation near the FAF were still correlated with negative effects on the ABG which could cause worsened hearing thresholds over this timeframe.