JAMA Otolaryngology–Head & Neck Surgery: Neuro-otology Topic Collection

Carbon Dioxide Laser Endoscopic Posterior Cordotomy Technique for Bilateral Abductor Vocal Cord Paralysis A 15-Year Experience CO 2 Laser Endoscopic Posterior Cordotomy

Özdemir S, Tuncer Ü, Tarkan Ö, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Treatment of bilateral vocal cord paralysis is a considerable challenge for otolaryngologists. Many surgical techniques have been developed for the management of this entity to eliminate the need for tracheotomy.

Objective

To evaluate the success of the unilateral carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis.

Design

A retrospective study.

Setting

A university department of otolaryngology–head and neck surgery.

Participants

Sixty-six patients (58 women and 8 men) diagnosed as having bilateral abductor vocal cord paralysis.

Intervention

Endoscopic posterior cordotomy with the carbon dioxide laser.

Main Outcome Measures

Decannulation and postoperative voice quality and exercise tolerance.

Results

The most common etiologic factor was recurrent laryngeal nerve paralysis after thyroidectomy, observed in 61 patients (92%); an unknown cause was observed in 5 (8%). Unilateral cordotomy sufficed in 58 patients (88%). We performed revision procedures for vocal cord granuloma in 4 patients (6%). Bilateral cordotomy was required for 4 patients (6%) with an insufficient airway. Postoperative tracheotomy was needed for only 4 patients owing to the edema in the operation site. These patients underwent decannulation within a mean period of 7 days. No patient had poor postoperative exercise tolerance. We found no statistically significant difference between the preoperative and postoperative voice quality using the 10-item Turkish version of the Voice Handicap Index.

Conclusions and Relevance

Carbon dioxide laser endoscopic posterior cordotomy is a safe, minimally invasive, effective technique with a short operation time. A bilateral approach or a revision procedure is rarely required. Bilateral cordotomy should be reserved for patients with insufficient airway passage with unilateral cordotomy.

Treatment of Neural Anosmia by Topical Application of Basic Fibroblast Growth Factor–Gelatin Hydrogel in the Nasal Cavity An Experimental Study in Mice Treatment of Neural Anosmia

Nota J, Takahashi H, Hakuba N, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

A new treatment of neural anosmia.

Objective

To investigate the effects of basic fibroblast growth factor (bFGF)–gelatin hydrogel on recovery of neural anosmia in mice.

Design

Anosmia was induced by intraperitoneal injection of 3-methylindole, 200 mg/kg. One week later, the animals underwent 1 of the following 3 procedures bilaterally: (1) group A: single-shot intranasal drip infusion of phosphate-buffered saline, (2) group B: single-shot intranasal drip infusion of bFGF, and (3) group C: placement of bFGF–gelatin hydrogel in the nasal cavity. The olfactory function of the animal was evaluated by the odor-detection test (ODT) 2 and 4 weeks later. Following the testing, the animal was killed, the thickness of the olfactory epithelium was measured, and the number of olfactory marker protein (OMP)-positive cells was counted.

Setting

Research installation.

Participants

Mice.

Intervention

The placement of bFGF–gelatin hydrogel in the nasal cavity.

Main Outcomes and Measures

An ODT, thickness of olfactory epithelium, the number of OMP-positive cells

Results

The ODT proved that neural anosmia recovered in group C but not in groups A and B. Histologically, olfactory epithelium became thicker and the number of OMP-positive cells increased in group C, while such functional and histologic recovery was poor in groups A and B. These findings suggested that placement of bFGF–gelatin hydrogel in the nasal cavity was an efficient way to facilitate recovery of neural anosmia.

Conclusions and Relevance

As a gelatin hydrogel degrades slowly in the body, bFGF is gradually released around the site of the lesion; thus, it constantly exerts its effects on neural regeneration.

Low-Frequency Repetitive Transcranial Magnetic Stimulation to the Temporoparietal Junction for Tinnitus Four-Week Stimulation Trial Repetitive Transcranial Magnetic Stimulation

Piccirillo JF, Kallogjeri D, Nicklaus J, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

This research examines the impact of 4 weeks of repetitive transcranial magnetic stimulation (rTMS) stimulation to the temporoparietal junction and compares the results of this longer duration of treatment with a similar stimulus protocol of only 2 weeks' duration.

Objective

To examine the effectiveness and safety of 4 weeks of low-frequency rTMS to the left temporoparietal junction in a cohort of patients with bothersome tinnitus.

Design

Crossover, double-blind, randomized controlled trial.

Setting

Outpatient academic medical center.

Participants

The study population comprised 14 adults aged between 22 and 59 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of 6 months' duration or greater and a score of 34 or greater on the Tinnitus Handicap Inventory (THI).

Interventions

Low-frequency (1 Hz) 110% motor threshold rTMS or sham to the left temporoparietal junction for 4 weeks.

Main Outcome and Measure

The difference of the change in the THI score between active rTMS and sham rTMS.

Results

Active treatment was associated with a median reduction in THI score of 10 (range, −20 to +4) points, and sham treatment was associated with a median reduction of 6 (range, −24 to +12) points. The median difference in THI score between the change associated with active and sham rTMS was 4 (95% CI, −9 to 10; and range, −32 to +14) points.

Conclusions and Relevance

Daily low-frequency active rTMS to the left temporoparietal junction area for 4 weeks was no more effective than sham for patients with chronic bothersome tinnitus. Possible explanations for this negative study include the failure of rTMS to stimulate deeper parts of auditory cortex within the sylvian fissure and more widespread cortical network changes not amenable to localized rTMS effects.

Trial Registration

clinicaltrials.gov Identifier: NCT00567892