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Background: Inducible laryngeal obstruction (ILO, also called vocal cord dysfunction) can be difficult to distinguish clinically from asthma. Limited studies have explored the use of respiratory oscillometry to detect changes unique to ILO, but more study is needed to determine if routine oscillometry can differentiate these two clinical entities., Objective: Determine if impedance variables measured on routine oscillometry over tidal breathing vary between individuals with asthma and ILO., Methods: Subjects with asthma and ILO were recruited to participate in a single-center, observational study at the University of Rochester Medical Center. Oscillometry measurements were obtained over tidal breathing according to technical standards. Exploratory oscillometry variables were analyzed, as well as standard oscillometry variables including measures of peripheral airways dysfunction., Results: 25 subjects (12 with asthma and 13 with ILO) were recruited and included in the analysis. Measures of peripheral airways dysfunction including frequency dependence of resistance (R5-R20), area under the reactance curve (AX), and reactance at 5 Hz (X5) were significantly more abnormal in asthma subjects compared to ILO subjects (p = 0.039, p = 0.008, and p = 0.0327 respectively). Resistance at 5 Hz (R5) was not statistically different between asthma and ILO (p = 0.301). Exploratory variables, including inspiratory impedance and the standard deviation of impedance, were not significantly different between asthma and ILO., Conclusion: Measures of peripheral airways dysfunction by oscillometry were significantly different in subjects with asthma compared to ILO and more significant in subjects with poor asthma control. There were no exploratory oscillometry variables that were significantly different between ILO and asthma., Competing Interests: Declaration of competing interest Patrick Donohue MD, Margaret Connolly MD, Marcus D'Alfonso, Gerriann Jackson MS, Liane C Grasso MS, Xueya Cai PhD, Ashley P O'Connell Ferster MD, G Todd Schneider MD-MS, Sandhya Khurana MD, and Steve N Georas MD declare that they have no known competing financial interests or disclosures that may have influenced the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The North American Airway Collaborative (NoAAC) previously published a 3-year multi-institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re-enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision-making. Level of evidence: 2-prospective cohort study., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Objectives: To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients., Methods: Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence., Results: The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression., Conclusions: Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.

We describe a novel and safe use of existing instrumentation in the removal of select foreign bodies in the upper aerodigestive tract to minimize health-care costs. A retrospective review of 4 cases involving visualized upper aerodigestive tract foreign bodies were identified via flexible laryngoscopy and extracted under local anesthesia from 2016 to 2018. All 4 patients were not in any airway distress and underwent successful removal of the foreign body, which included 2 fishbones, a sewing pin, and a wire bristle with a maxillary Heuwieser or giraffe instrument under flexible laryngoscopy visualizing using local anesthesia without complications. No foreign bodies were dislodged. The use of a maxillary Heuwieser and flexible laryngoscopy visualization is safe, allows for removal of otherwise difficult to reach foreign bodies at the bedside, improving patient comfort, obviates the need for general anesthesia to the patient, and minimizes health-care costs.

Electrical stimulation of the mammalian efferent vestibular system (EVS) predominantly excites primary vestibular afferents along two distinct time scales. Although roles for acetylcholine (ACh) have been demonstrated in other vertebrates, synaptic mechanisms underlying mammalian EVS actions are not well-characterized. To determine if activation of ACh receptors account for efferent-mediated afferent excitation in mammals, we recorded afferent activity from the superior vestibular nerve of anesthetized C57BL/6 mice while stimulating EVS neurons in the brainstem, before and after administration of cholinergic antagonists. Using a normalized coefficient of variation (CV*), we broadly classified vestibular afferents as regularly- (CV* < 0.1) or irregularly-discharging (CV* > 0.1) and characterized their responses to midline or ipsilateral EVS stimulation. Afferent responses to efferent stimulation were predominantly excitatory, grew in amplitude with increasing CV*, and consisted of fast and slow components that could be identified by differences in rise time and post-stimulus duration. Both efferent-mediated excitatory components were larger in irregular afferents with ipsilateral EVS stimulation. Our pharmacological data show, for the first time in mammals, that muscarinic AChR antagonists block efferent-mediated slow excitation whereas the nicotinic AChR antagonist DHβE selectively blocks efferent-mediated fast excitation, while leaving the efferent-mediated slow component intact. These data confirm that mammalian EVS actions are predominantly cholinergic.

Importance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research., Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease., Design, Setting, and Participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook., Main Outcomes and Measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications., Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk., Conclusions and Relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.

A trend of attributing abnormal voice changes to reflux has gained momentum among medical professionals over the last few decades. Evidence supporting the connection between reflux and voice and the use of anti-reflux medication in patients with dysphonia is conflicting and deserves careful examination. In the current health care environment, it is important that medical decisions be based on science rather than anecdote and practice patterns. The goal of this review is to investigate the evidence linking reflux and voice changes. Specifically, this association will be examined in the context of the Bradford-Hill criteria to determine what evidence exists for a causal relationship between this exposure (reflux) and outcome (voice change)., Competing Interests: None

This article aims to present the productivity of the assumptions of Philosophical Hermeneutics (Gadamer, 1996) and his discovery of the logical, ontological and structural model of the game that takes place during the experience that is the basis of comprehension. Thus, digital games are proposed as manners, methods and ways to improve the understanding, interpretation and application of the concepts of Sustainability and Environmental Principles. The attraction of the game as a pedagogic space lays in the fact that it takes over and allows the player to internalize ecological sensitivity, something that happens during the play. Finally, the results show an augment on students' motivation, when using the game versus the traditional process.

Hypothesis: The WaxVac ear cleaning device may be a useful adjunct for patients requiring aural toilet., Background: Cerumen removal and routine aural toilet is a common complaint that presents to the otolaryngology clinic. We tested this device to make an appropriate recommendation to our patients., Methods: We conducted in vitro testing of the WaxVac device on an artificial ear canal model and cadaveric temporal bones testing the strength of the suction, noise created by the device, and the ability of the device to remove foreign bodies from the external auditory canal. These foreign bodies included a PE tube, baby powder, a q-tip head, saline, and artificial cerumen., Results: The WaxVac created very little suction as compared with Frazier tip suctions used in clinic. The device produced very little noise in the canal, which was equivalent to a #3 Frazier tip suction. The WaxVac was unable to remove q-tip heads or artificial cerumen from the ear canal model or the cadaveric temporal bones. Very little of the saline could be removed by the WaxVac, and only 20% to 50% of trials demonstrated removal of a PE tube. However, a large amount of the powder was able to be removed by the device., Conclusion: Although the concept of this device is good, the actual product does not produce adequate suction to remove cerumen or most common foreign bodies from the external auditory canal. It is unlikely to be useful for aural toilet.

Objectives: To determine if the timing of tracheotomy in elderly patients results in less ventilator associated-pneumonia, mortality, and morbidity., Study Design: Historical cohort study., Subjects and Methods: This study included 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographics, outcomes, and ventilation data were collected and analyzed., Results: The early tracheotomy group (continuous intubation time <7 days) included 43 patients, and 115 patients were included in the late group. There were no statistically significant differences in the demographics of the two groups. A statistically significant difference in the rate of ventilator-associated pneumonia was noted in the early versus late tracheotomy group (-0.29% VAP, 95% CI: -0.46, -0.12). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (0.70 intubations, 95% CI: 0.41, 0.99). The early tracheotomy group has a lower total ICU admission time (-9.5 days, 95% CI: -21.81, -2.25) and total hospital admission time (-10 days, 95% CI: -33.69, -2.249). There was no difference in mortality, although there was a trend of lower mortality in the early tracheotomy group (-11.3% mortality, 95% CI: -0.27, -0.05)., Conclusion: Early tracheotomy in elderly patients is associated with less ventilator-associated pneumonia, more frequent intubations, less total admission time, and a trend toward lower mortality.

Granular cell tumors are an uncommon neoplasm of neural origin. They occur throughout the body; only about 10% are found in the vulvar region. Granular cell tumors are most frequent in the third and fourth decade of life, the African-American race, and the female. Generally, they appear as small, firm, painless, slow-growing subcutaneous nodules. They are rarely encapsulated and recurrence is common. The malignant granular cell tumor is rare, representing 1% to 2% of cases. This form is highly aggressive, unresponsive to treatment, and ultimately fatal. A third type of granular cell tumor has been described which has benign pathologic characteristics but behaves in a clinically malignant manner. The treatment of choice for all types is wide, local surgical excision. A case is described which typifies the benign type granular cell tumor.

These studies use 24 cats under non-anesthetic states. Electrodes are implanted, under appropriate anesthetic and stereotoxic procedures in non-auditory neocortical areas, nucleus accumbens, and certain nuclei of the amygdala complex. Auditory stimulation was done using the free field method with periodic tones at 2.0 KHz to 3.0 KHz at 80db. The auditory stimulation and recording was performed with hard wire and telemetry methods. The analog data is collected on FM tape and processed with minicomputer. Digital filtering, cross, coherence, phase, spectral and cycle time analyses are used on the analog data. In these studies, we have looked at the electroencephalogram (EEG) and the auditory evoked potentials (AEP) of cortical and subcortical regions using frequency and time domain methods. The analyses of the interaction of spatially distributed neuronal networks during EEG and AEP activity may give insights to topographical relations in the brain.

These experiments try to exhibit the interactions of the electrical activity of the microenvironment of a neuronal population spatially distant from the microenvironment of a different neuronal population. These experiments involve 18 cats with chronic electrodes surgically implanted into cerebral cortex, septal nuclei and amygdala. The Fast Fourier Transform (FFT) algorithm is done to process frequency domain data. In order to compare the phase relations between two channels, x(t) and y(T), use is often made of the coherence function. Computing partial coherence implies first eliminating from each two signals, that part which can be considered as being determined by, or predictable, on the basis of a third signal. It is assumed that there are three stochastic signals Y1, Y2, Y3. These variables can be considered as spectral components for a particular frequency. We assume that the correlations can be interpreted as square root of the coherence. For simplicity we use, in the partial correlations analyses.

These studies concern the EEG rhythms of the sensory motor cortex in cats. The cat generates a 12H to 16Hz rhythm related to the MU (Rolandic) rhythm in man. The behavioral state required to generate the rhythm in man and the cat requires complete immobility and alertness. The MU rhythm in man centers around 9Hz and in the cat at 12Hz to 16Hz. This rhythm is used in the biofeedback training for the treatment of intractable seizures in man. It has also been used (12 Hz to 16 Hz) experimentally in animals. It is necessary to enhance the MU rhythm and simultaneously depress the seizure activity. Our interest has been to detect and enhance the SMR rhythm (12 H to 16 Hz) in the cat. We found that when it is enhanced it also enhances the amplitude of auditory evoked potentials in other brain regions.

Ambulatory 24-hour esophageal manometry was applied to analyze motility in 12 normal subjects and 9 patients with chest pain and dysphagia caused by diffuse esophageal spasm (DES). Pain episodes characterized by nonperistaltic activity occurred in 7 of 9 patients. A score based on 10 variables of the motility pattern differentiated patients from normal subjects and quantitated the severity of the disorder. Ambulatory motility monitoring was prospectively performed in 8 normal subjects and 37 patients: 8 with DES, 13 with hypertensive contractions, and 16 with a nonspecific disorder on standard manometry. The score was positive in 6 of 8 patients with DES and negative in all normal subjects (accuracy 87 percent). Nine of the 13 patients with hypertensive contractions (70 percent) and 6 of 16 with nonspecific disorders (38 percent) had a pathologic score reflecting a dysmotility as severe as DES. Ambulatory esophageal manometry is a more physiologic way to identify a motor disorder than standard manometry and has the potential to improve selection of patients for a surgical myotomy.

There is evidence that certain brain rhythms may signal the occurrence of different brain states. Support for this hypothesis may be provided by evidence that processing of information is changed during different brain states. The prestimulus period proceeding the auditory evoked potential (AEP) is converted to a power spectral estimate. These power spectra are used to sort for the AEP when certain power values for the (36-42Hz) and the (11-16Hz) are reached in the prestimulus period of the sensory motor cortex, nucleus accumbers and amygdala. Attempts are made to measure the performance of the 40Hz and SMR estimators. These studies are made in the cerebral cortical and subcortical regions in cats. In these studies D and L isomers of amphetamine are used to induce a chemical brain state changes. The AEP are selected in the amphetamine altered states based on the prestimulus auto spectra.

When antibodies specific to fast-twitch, slow-twitch, and slow-tonic myosins were used to stain the clasp muscle, m. sternoradialis, of Xenopus laevis, three predominant fiber types were identified in both males and females. Three fiber types can also be distinguished by the diameters and conduction velocities of their motor nerves. Significant differences in the numbers of slow-tonic fibers were identified between the genders and between control and castrated male animals. This finding suggests that these slow-tonic fibers, which probably dominate the clasp reflex during mating, may be under hormonal control.

Malignant disease of the female reproductive organs accounts for over 11,000 deaths annually in the United States in patients over 65 years of age. Hormonal treatment is being used in some cases in conjunction with more conventional methods of treatment. Synthetic progesterone is used in the palliation of patients with advanced adenocarcinoma of the endometrium. A significant increase in the incidence of ovarian cortical stromal hyperplasia, obesity, diabetes and hypertension is found in these patients. For treatment of carcinoma of the ovary, a massive dose of an experimental progesterone agent, dimethylprogesterone (NSC-123018) is being tested in a group study. The treatment is used only for patients for whom conventional therapy has been unsuccessful. Although a few patients have shown remission, it is too early for conclusive results. Patients with advanced breast cancer and estradiol receptors in their tissue may show a favorable clinical response to hormonal therapy in 40-60% of cases. Patients lacking estrogen receptors have only a minimal chance of responding to hormonal therapy.

The properties of ion channels in patches from the luminal membrane of cultured monolayers of type II alveolar epithelial cells from adult rat lung have been studied. In excised patches, prepared as described to yield the "outside-out" configuration (with cesium ions in the bathing solutions to suppress currents arising from potassium channels), we observed anion-selective channels with a conductance of 350-400 pS, and burst lengths lasting seconds. When patches were bathed in solutions with equal chloride concentrations, channels opened and closed spontaneously at membrane voltages close to zero, but tended to close when the potential was shifted by +/- 10 mV, particularly in the negative direction. Other anions could pass through these channels with a permeability sequence of I(1.5) greater than Br(1.02) = greater than Cl(1.00) greater than NO3(0.9) greater than gluconate(0.6) but there was a very low permeability for sodium (PNa/PCl = 0.015 +/- 0.006). Calcium ions reduced channel conductance. The channels probably have a role to play in salt absorption by this epithelium, but insufficient information is available about how sodium crosses it for the role of the anion channels in transport to be defined with confidence.

The specificity of gonadotropin binding was studied in fresh and frozen human corpora lutea. Ovine, bovine, and porcine luteinizing hormone (LH) competed with 125I-labeled human LH (125I-hLH) and 125I-labeled human chorionic gonadotropin (125I-hCG) for binding to tissue receptors in homogenates of human corpora lutea frozen for 3 to 12 months. In contrast, oLH, bLH, and pLH competed minimally for 125I-hLH and 125I-hCG binding sites in homogenates of fresh human corpora lutea. Ovine follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) did not compete in homogenates of fresh or frozen tissue. Competition of oLH and hCG for 125I-hCG binding sites at several dose levels in a homogenate of a fresh corpus luteum was studied. One hundred micrograms of oLH and ten nanograms of hCG gave an equivalent competition--a 10,000-fold difference in competitive potency. Only hCG competed with 125I-hCG for binding when the competition of oLH, bLH, pLH, oFSH, oTSH, hCG and hCG subunits, and hCG were compared at the 10-mug level in a homogenate of fresh human corpus luteum. The binding of 125I-labeled homologous human hormones by the corpus luteum was examined in a limited fashion. 125I-Prolactin did not bind to preparations of fresh stroma from a patient with polycystic ovaries nor did it bind to three separate preparations of fresh corpora luteum which did bind 125I-hCG. 125I-hTSH did not show significant binding to a fresh human corpus luteum preparation which did bind 125I-hCG. These studies indicate that the gonadotropin receptor of the fresh human corpus luteum possesses a unique species specificity and illustrate the importance of working with human corpora lutea in their most native state.

Ion channels have generally been found to have two predominant conductance levels thought to be associated with 'open' and 'closed' states, but intermediate (subconductance) states have also been reported. We have now found that a large conductance, anion-selective channel in pulmonary alveolar epithelial cells can adopt any of six open levels of conductance that are integer multiples of 60-70 pS. The channel is usually either fully open or fully closed. The frequencies of the different conductance levels are inconsistent with the notion that there are six independent channels. We suggest that the channel consists of six conducting pathways in parallel, 'co-channels', with a shared gating mechanism that can synchronously render all of them non-conducting. Other channels with lower maximum conductance may operate in a similar way but multiple conductance levels would not easily be detected because of a less favourable signal-to-noise ratio.

Vaginal infection occurs at some time in the majority of women. Most such infections are caused by Candida albicans, Trichomonas vaginalis, and Gardnerella (Hemophilus) vaginalis. Some less common--but in many cases increasingly prevalent--causes include herpes-virus type 2, papillomavirus, Chlamydia trachomatis, Mycoplasma T strains, and toxic shock syndrome.

1. The post-synaptic effects of the aliphatic alcohols, ethanol to hexanol, were investigated at the neuromuscular junctions of toads, with particular emphasis on the effects of ethanol. 2. The alcohols increased the amplitude and duration of miniature end-plate potentials. It is shown that this effect was due to the prolongation of the decay phase of miniature end-plate currents (m.e.p.c.s). There was no effect of alcohols on the growth phase of m.e.p.c.s. 3. The prolonged decay of m.e.p.c.s in ethanol remained exponential and was normally sensitive to membrane potential. Prolonged m.e.p.c.s were associated with an equivalent prolongation of the mean duration of elementary events, as determined from power spectra of acetylcholine noise in 0-5 M ethanol. 4. The relationship betweeen the time constant of decay of m.e.p.c.s (tau) and the concentration of an alcohol of carbon chain length N (C-N) was exponential, conforming to the equation tau equals tau-s exp (B-N-C-N), in which tau-s is the decay time constant in standard solution and B-N is a constant, different for each alcohol. 5. There was also an exponential relationship between B-N and N, which closely followed the relationship between membrane-buffer partition coefficient and carbon chain length for the different alcohols, indicating that the alcohols are active in the lipid phase of the post-synaptic membrane. 6. It is suggested that the alcohols act by causing a change in the dielectric constant of the post-synaptic membrane which forms the environment of the rate-limiting reaction responsible for the decay of the end-plate conductance. On the assumption that this reaction involves dipoles, it is shown that the small changes in dielectric constant, calculated from the partition coefficients of the alcohols and by assuming an initial lipid dielectric constant of 3, would give an exponential relationship between the time constant of decay of m.e.p.c.s and alcohol concentration. 7. The results support the hypothesis that the decay (but not the onset) of acetylcholine-induced conductance changes is rate-limited by a first-order reaction which involves dipoles and occurs in the lipid environment of the post-synaptic membrane.

Infections of the reproductive tract in women of childbearing age menace not only the mother but also the offspring. Syphilis and gonorrhea may be lethal to the fetus. Candidiasis, trichomoniasis, and condylomata acuminata have less drastic effects on the fetus but if untreated are often troublesome to both the mother and child.