Biomedical subjects

Joseph R Spiegel

Publications and source records attributed to Joseph R Spiegel.

7 recordsLinked to original sources

PubMed2006

Treatment of chronic posterior laryngitis with esomeprazole.

OBJECTIVE: To evaluate the efficacy of acid-suppressive therapy with the proton pump inhibitor esomeprazole on the signs and symptoms of chronic posterior laryngitis (CPL) in patients with suspected reflux laryngitis. STUDY DESIGN: Prospective, multicenter, randomized, parallel-group trial that compared twice-daily esomeprazole 40 mg with placebo for 16 weeks. METHODS: Eligible patients had a history of one or more CPL symptoms (throat clearing, cough, globus, sore throat, or hoarseness) and laryngoscopic signs indicating reflux laryngitis based on CPL index (CPLI) scores measured during a screening laryngoscopy. Patients were randomized to treatment if their 7-day screening diary-card recordings showed a cumulative primary symptom score of 9 or higher and they had 3 or more days with moderately severe symptoms based on a 7-point scale. Efficacy was assessed by changes in symptoms as recorded by patients and investigators and by changes in CPLI scores based on laryngoscopic examinations. RESULTS: The patients' primary CPL symptom at final visit (primary efficacy end point) was resolved in 14.7% (14/95) and 16.0% (8/50) of patients in the esomeprazole and placebo groups, respectively (P=.799). Esomeprazole and placebo were not significantly different for change from baseline to the final visit in mean total CPLI (-1.66+/-2.13 vs. -2.0+/-2.55, respectively; P=.446) or any other secondary efficacy end points based on patient diary card or investigator assessments. CONCLUSION: This study provides no evidence of a therapeutic benefit of treatment with esomeprazole 40 mg twice daily for 16 weeks compared with placebo for signs and symptoms associated with CPL.

Adult↗

PubMed2006

A third branchial pouch cyst presenting as a lateral neck mass in an adult.

Anomalies of the branchial apparatus occur with some frequency in the adult and pediatric populations. Branchial anomalies are most often derivatives of the first or second pouch. Branchial anomalies involving the third pouch may present as cysts, sinuses, fistulas, and ectopic glands. They are relatively rare, and they respond well to surgical removal. We report the case of a 53-year-old woman who was referred to us for evaluation of a persistent left upper neck mass. The patient had no history of a cervical mass as a child or young adult. The mass was excised uneventfully, and the final pathology revealed a normocellular parathyroid gland and thymic tissue.

Branchial Region↗

PubMed2005

Increased incidence of carcinoma of the tongue in patients with systemic sclerosis.

OBJECTIVE: To describe the incidence of carcinoma of the tongue in a large cohort of patients with systemic sclerosis (SSc). METHODS: In total, 769 patients with SSc were prospectively followed over 16 years for the development of cancer. Patients with a diagnosis of carcinoma of the tongue were identified to determine the incidence of this cancer in SSc. The results were compared to the incidence of tongue cancer in the SEER cancer registries. RESULTS: A total of 3775 patient-years of followup of 769 patients with SSc (392 diffuse cutaneous, 377 limited cutaneous) prospectively evaluated for the occurrence of cancer disclosed 9 patients who were diagnosed with oral cavity and pharyngeal carcinomas. Six of these patients had squamous cell carcinoma of the tongue. One of these had both pharyngeal and tongue squamous cell carcinomas within a 4-year period, and another had 3 separate squamous cell carcinomas of the tongue. The standardized incidence ratio of squamous cell carcinoma of the tongue observed in this cohort of patients with SSc was 25-fold higher than that expected in an age adjusted population from the SEER cancer registries. All patients with SSc identified within this cohort with oral cavity carcinomas had the diffuse subset of the disease. CONCLUSION: There is a highly significant increase in the incidence of squamous cell carcinoma of the tongue in patients with SSc. A remarkable observation was that all patients within this cohort who developed oral cancer had the diffuse subset of SSc. This suggests a relationship between the etiology or pathogenesis of the diffuse form of SSc and development of squamous cell carcinoma of the tongue in this group of patients.

Aged↗

PubMed2003

Thyroplasty revisions: frequency and predictive factors.

UNLABELLED: Thyroplasty is the most commonly performed type of laryngeal framework surgery, and the surgical indications are gradually being expanded. Although many reports have described thyroplasty results and rates of success, no study has attempted to determine predictors of the need for revisions or other secondary surgical procedures. METHODS: Retrospective review of 118 primary thyroplasty procedures performed on 96 patients. Secondary surgical procedures were divided into planned second-stage procedures (all fat implantation due to scarring), touchup procedures (primarily fat or collagen injections to close localized glottic gaps), and thyroplasty revisions (for implant extrusion or slippage). Statistical analysis was performed via the chi-squared technique with p < 0.05 considered significant. RESULTS: 96 patients underwent thyroplasty, 58 for vocal fold paresis or paralysis and 38 for other indications. Thirty-two (33%) patients underwent secondary surgical procedures, including 4 planned second stage procedures, and 6 patients with progression of their underlying disease. Thirty-two secondary procedures were performed in the other 22 patients. Professional singers were found to be more likely to require touchup or planned second-stage procedures (p = 0.029). Patients with abnormal preoperative noise-toharmonic ratios were more likely to undergo secondary surgeries (p = 0.039). Maximum phonation time was not associated with need for secondary surgery. Implant material did not influence revision rates. CONCLUSIONS: Professional singers and those patients with severe voice disorders (as measured by more abnormal noise-to-harmonic ratios) are more likely to undergo secondary surgical procedures. The choice of implant material does not affect need for secondary surgical procedures.

Adolescent↗

PubMed2002

Vocal tremor reduction with deep brain stimulation: a preliminary report.

Vocal tremor has been a challenging problem for patients and their physicians. In some cases, it has been possible to lesson the symptom's tremor through medications and/or voice therapy. However, in most cases no good treatment has been available. Chronic stimulation of the thalamus has been successful in controlling tremors of the upper limb and other portions of the body. Our preliminary experience suggests that it may also be helpful in controlling vocal tremor.

Aged↗

PubMed2002

Prolonged ulcerative laryngitis.

Acute and prolonged laryngitis commonly are diagnosed and treated by primary care physicians. These ailments come to the attention of the otolaryngologist when symptoms are prolonged despite treatment. Since the beginning of 1991, the senior authors (RTS, JRS) have recognized a clinical syndrome defined by prolonged hoarseness, prolonged laryngeal inflammation, and vocal fold ulceration. Patients are frequently young, nonsmokers, and nondrinkers who have had an upper respiratory infection prior to, or associated with, the onset of laryngeal symptomatology. Patients may be affected for up to 1 year despite aggressive medical therapy. This review of 14 patients highlights the features of this previously undescribed entity.

Adult↗

PubMed2002

Chondrosarcoma of the skull base.

OBJECTIVES: Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base. STUDY DESIGN: Single case report and literature review. RESULTS: Extensive skull base resection for chondrosarcoma can be performed successfully and may be curative. CONCLUSION: There is a role for en bloc resection of large areas of the skull base for treatment of chondrosarcoma. It appears that treatment combining surgery and radiation therapy is most likely to be effective.

Adult↗