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Mark S Courey

Publications and source records attributed to Mark S Courey.

12 recordsLinked to original sources
PubMed2006

Quality-of-life impact of non-neoplastic voice disorders: a meta-analysis.

OBJECTIVES: We undertook to explore the relationship between non-neoplastic voice disorders and patients' quality of life. METHODS: A PubMed search (1966 to 2003) for the terms Voice Handicap Index (VHI), Short Form-36 (SF-36), voice disorders, voice quality, treatment outcome, voice outcome, quality of life, and questionnaires was performed. Raw data were obtained whenever possible. Studies were analyzed by meta-analysis techniques. RESULTS: Of 54 VHI studies identified, 11 were excluded, and of 21 SF-36 studies, 7 were excluded for incomplete data, non-English language, measuring malignant disease, or duplicate publication. Patients with neurologic and inflammatory or traumatic laryngeal disease had worse VHI scores than controls, and those with neurologic laryngeal disease had the most severe impairment (p < .001, Kruskal-Wallis analysis of variance; p < .05, Dunn's method of multiple comparisons). Those with neurologic laryngeal disease had worse SF-36 subdomain scores than did controls in 6 of 8 subdomains (p < .03, Kruskal-Wallis analysis of variance; p < .05, Dunn's method of multiple comparisons). Both patients with neurologic disease and patients with inflammatory or traumatic laryngeal disorders had changes in SF-36 subdomains similar to those of patients with other chronic disease states. CONCLUSIONS: Non-neoplastic voice disorders adversely impact patients' voice-related and general quality of life, and neurologic voice disorders have the greatest impact.

Analysis of Variance↗
PubMed2006

Laryngoscopy in bilateral vocal fold immobility: can you make a diagnosis?

OBJECTIVES: This study explores whether videoendoscopic findings and patient history help make the diagnosis in bilateral vocal fold immobility (BVFI). METHODS: Medical records from 1995 to 2003 were searched to identify patients with posterior glottic stenosis (PGS) and bilateral vocal fold paralysis (BVFP) who also had videoendoscopic examinations. Videoendoscopic examination findings that could help differentiate PGS from BVFP were identified a priori. A weighted scoring index, based on the adjusted odds ratios of significant examination findings on multiple logistic regression, was derived. Associations between the weighted scoring index, patient history, and diagnosis were then evaluated. RESULTS: Twenty-six patients with BVFP and 28 patients with PGS were identified. Posterior glottic scar (weight = 2), medial arytenoid erosion with a widened posterior glottis (weight = 1), and appropriate vocal fold motion (weight = 1) were significant variables (p < or = .05, multiple logistic regression) and constituted the weighted scoring index. A weighted scoring index of > or = 2 and a history of prolonged intubation predicted PGS in 95.2% of cases. A weighted scoring index of < or = 1 and a history of neck surgery predicted BVFP in 95.0% of cases. CONCLUSIONS: The weighted scoring index with the patient history provides an objective tool for diagnosing BVFI.

Adult↗
PubMed2006

Voice-related quality of life in T1 glottic cancer: irradiation versus endoscopic excision.

OBJECTIVES: Several studies have explored posttreatment voice outcomes for early glottic cancer with varying results. To further clarify the voice-related quality of life (QOL) of T1 glottic cancer patients treated by external beam radiotherapy (EBRT) compared to endoscopic carbon dioxide laser excision (CLE), we performed a meta-analysis. METHODS: We performed a meta-analysis review for the years 1966 to 2005 for the Voice Handicap Index (VHI), laryngeal cancer, voice outcome, voice quality, and quality of life. Studies in which the VHI was assessed at least 3 months after treatment for T1 glottic cancer were identified and analyzed by meta-analysis techniques. RESULTS: Six studies with 208 patients (6 T1b and 202 T1a) treated with CLE and 91 patients (6 T1b and 85 T1a) treated with EBRT were identified. The posttreatment VHI scores were similar for the EBRT- and CLE-treated patients (p = .1, Wilcoxon rank sum test). CONCLUSIONS: We conclude that CLE and EBRT provide comparable levels of voice handicap for patients with T1 glottic cancer.

Endoscopy↗
PubMed2005

Acute histologic effects of extraesophageal reflux on vocal fold healing.

This study evaluates how extraesophageal reflux affects membranous vocal fold healing in a canine model. We created membranous vocal fold injuries in the animals and randomly assigned them to topical application of acid and pepsin at pH 2 or pH 6 or of normal saline solution every other day for 12 days. The experimental vocal folds were compared to uninjured, control vocal folds from animals painlessly sacrificed for other reasons. Hematoxylin and eosin, fibronectin, and procollagen I staining were performed for histologic analysis. The injured specimens had three times greater cellular infiltrate (p < or = .001, analysis of variance) and twice as much fibronectin and procollagen I (p < or = .001, analysis of variance) as did the specimens from the control animals. No significant differences or trends were identified for cellular infiltrate, fibronectin, or procollagen I within the injured groups (p > .05, Bonferroni t-test). Acute wound healing did not appear to be influenced by the presence of acid and pepsin at pH 2 or 6 as compared to saline solution.

Acids↗
PubMed2004

Injection laryngoplasty.

After a nearly a century of development, augmentation of laryngeal tissue through injection remains as complex a procedure as it was in the earlier part of the century. Initially, the number of surgeons performing injection laryngoplasty was limited since the technique of injection was thought to be difficult and the selection of cases was thought to require the judgment of an accomplished laryngologist. Performing successful injection laryngoplasty does in fact require an understanding of laryngeal anatomy and physiology, and the physical characteristics of the substance to be injected. In addition, the surgeon must be aware of potential host reactions to the injected material. Finally, the surgeon must have an understanding of the etiology and configuration of the glottic insufficiency, and keep in mind the goals of the procedure.

Collagen↗
PubMed2004

Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker's diverticulum.

OBJECTIVES/HYPOTHESIS: To compare open and CO2 laser-assisted endoscopic surgical management of Zenker's diverticulum. STUDY DESIGN: A retrospective review of 49 consecutive surgically treated patients with Zenker's diverticulum was conducted. METHODS: Patients' records were reviewed and analyzed for patient age and sex, size of diverticulum, incision time (time recorded from start of incision to surgical completion of case), length of hospital stay, complications, and follow-up management. A postoperative questionnaire inquiring about swallow function was conducted by mail or telephone. Swallow function was assessed on a four-point scale. RESULTS: Various procedures performed included endoscopic CO2 laser-assisted diverticulotomy (n = 24) and open diverticulectomy with cricopharyngeal myotomy (n = 28). The average incision time of laser endoscopic cases (47 min) was significantly shorter (P <.001) than that of open diverticulectomy cases (170 min). Length of hospital stay did not significantly vary between the two groups. Five patients (21%) initially treated with laser endoscopic diverticulotomy demonstrated symptomatic persistent Zenker's diverticulum; three underwent repeat operation. No open cases required repeat operation. One endoscopic case was aborted secondary to esophageal injury from placement of the endoscope. Postoperative fever was seen in two (8%) endoscopic cases and four (14%) open approach cases. No major complications (recurrent laryngeal nerve paralysis, mediastinitis, or death) were encountered. More than 90% of respondents in each treatment group reported normal or near-normal swallow function. CONCLUSION: Laser endoscopic management is a reasonable and safe method for surgical treatment of Zenker's diverticulum in comparison with the open technique. Employment of the endoscopic approach reduces operative time and the complexity of postoperative care. Practitioners should be aware that the endoscopic approach may result in a higher failure rate.

Aged↗
PubMed2004

Quality-of-life outcomes following laryngeal endoscopic surgery for non-neoplastic vocal fold lesions.

Preservation of the vocal fold cover during laryngeal surgery should optimize vocal outcomes for patients with benign glottal lesions. The aim of this study was to evaluate changes in the quality of life, perceptual voice evaluation, and acoustic and aerodynamic measures of patients before and after endoscopic laryngeal microsurgery for true vocal fold cysts, polyps, and scarring. Preoperative and postoperative Voice Handicap Index (VHI) scores, Short Form 36 scores, and perceptual, acoustic, and aerodynamic voice measures were obtained prospectively from 42 patients who underwent phonomicrosurgery from February 2000 through May 2003. The mean (+/-SD) preoperative VHI was 49.6 +/- 21. The mean postoperative VHI score at a minimum of 3 months after surgery decreased to 26.8 +/- 21 (p < .001). When divided by lesion type, VHI scores improved significantly after surgery for vocal fold polyps and cysts. Although patients with vocal fold scarring demonstrated improvement in VHI scores after surgery, statistical significance was not achieved. For the entire group, the Short Form 36 scores were not significantly different from US norms either before or after operation. The acoustic data showed statistically significant decreases in jitter (2.05% to 1.26%), shimmer (7.06% to 4.03%), and noise-to-harmonics ratio (0.18 to 0.13) after surgery (p < .05) in female patients. The upper pitch limit increased after surgery in women (495.3 Hz to 654.9 Hz, p < .001). These results indicate that the voice-related quality of life and some acoustic parameters improve significantly for patients who have undergone laryngeal microsurgery for vocal fold cysts and polyps. Vocal fold scarring remains a difficult clinical problem with less favorable outcomes following surgical treatment in this patient set.

Acoustics↗
PubMed2003

Reanimation of the paralyzed human larynx with an implantable electrical stimulation device.

OBJECTIVES/HYPOTHESIS: Electrical stimulation of the posterior cricoarytenoid muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment. STUDY DESIGN: A prospective study of six patients. METHODS: The patients were successfully implanted with an Itrel II stimulator (Medtronic, Inc). In postoperative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared with preoperative values. RESULTS: The optimum stimulus paradigm was a 1- to 2-second train of 1-millisecond pulses delivered at a frequency of 30 to 40 Hz and amplitude of 2 to 7 V. Posterior cricoarytenoid stimulation produced a large dynamic abduction (3.5-7 mm) in three patients and moderate abduction (3 mm) in a fourth patient. The fifth patient showed a large but delayed response of 4 mm to stimulation with some lateralization of the vocal fold. In the sixth patient, stimulated abduction was noted on device implantation but was lost postoperatively. All five patients with stimulated abduction postoperatively met the ventilatory criteria for decannulation, and three patients subsequently had decannulation. Long-term stimulation of the posterior cricoarytenoid muscle had no appreciable effect on voice quality. CONCLUSIONS: Electrical stimulation of the posterior cricoarytenoid muscle shows potential as an improved therapy for bilateral vocal fold paralysis.

Adult↗
PubMed2002

Risk factors and demographics in patients with spasmodic dysphonia.

OBJECTIVES: Spasmodic dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic dysphonia. STUDY DESIGN: Retrospective patient survey of 168 patients with a known diagnosis of spasmodic dysphonia who completed questionnaires at the time of interval botulinum toxin injection. METHODS: Patients completed questionnaires on demographics, education level, work history, significant life events, medical, social, and family history. The results were compared with those of first-degree relatives as a control group with similar demographics. Data were analyzed using percentages calculated on the total number of responses and distribution of frequency of each. Statistical significance was estimated on t tests of chi2 values. RESULTS: In the series of 168 patients, there was a female predominance of 79%. Age range at onset was 13 to 71 years with an average of age of 45 years. Sixty-five percent of patients had previously had the measles or mumps compared with the national average of 15% in a similar age group (P =.0001). Thirty percent of patients directly associated onset of spasmodic dysphonia symptoms to an upper respiratory tract infection, and 21% to a major life stress. There was no significant incidence of any other medical or neurological condition or symptomatology. There was no family history of spasmodic dysphonia. Twenty-six percent of patients had an essential tremor compared with 4% of first-degree relatives (P =.0001), and 11% had associated writer's cramp compared with 2% of relatives (P =.02). Less than 1% of patients described a history of toxic exposure or electrical injury. CONCLUSIONS: The majority of patients with spasmodic dysphonia are girls and women. A significantly higher incidence of childhood viral illness was found in the patients with spasmodic dysphonia. Patients with spasmodic dysphonia had a significant incidence of both essential tremor and writer's cramp but no history of major illness or other neurological disorder. There appear to be no significant environmental or hereditary patterns in the etiology of spasmodic dysphonia. Stress or viral infection may induce the onset of symptoms of spasmodic dysphonia. Many features of the disorder are common to other movement disorders, and this knowledge may direct future research efforts.

Adolescent↗
PubMed2002

Effect of chronic electrical stimulation of laryngeal muscle on voice.

Conventional surgical therapies for bilateral laryngeal paralysis sacrifice voice to enlarge the airway. Electrical pacing of the posterior cricoarytenoid (PCA) muscle to restore glottal opening and allow ventilation offers a new treatment approach. The purpose of this investigation was to determine whether long-term stimulation of the PCA muscle altered perceptual, acoustic, and aerodynamic parameters of voice. Two patients underwent implantation of a Medtronic Itrel II laryngeal pacemaker. Voice evaluation was performed before surgery and at monthly postoperative sessions with the pacemaker off. Months of PCA stimulation did not change perceptual descriptors of voice quality. Measures of fundamental frequency and intensity, upper and lower limits of the dynamic frequency and intensity range, and phonatory flow rates were largely unaltered. The results indicated that there was no effect of laryngeal pacing on voice.

Botulinum Toxins, Type A↗
PubMed2002

Electrically stimulated glottal opening combined with adductor muscle botox blockade restores both ventilation and voice in a patient with bilateral laryngeal paralysis.

The purpose of this study was to determine whether paced electrical stimulation of the posterior cricoarytenoid muscle with an implantable device could restore ventilation in a patient with bilateral vocal fold paralysis without disturbing voice. In the first US case of a multi-institutional study, this patient was implanted with an Itrel II stimulator (Medtronic, Inc). In monthly postoperative sessions over an 18-month period, an effective stimulus paradigm was derived, the magnitude of stimulated vocal fold abduction and ventilation was measured, and perceptual judgments of voice quality were made. After identification of optimum parameters, posterior cricoarytenoid muscle stimulation produced a moderately large vocal fold abduction of 4 mm, but only marginal improvement in mouth ventilation, with no change in voice quality. After adductor muscle blockade with botulinum toxin, the patient's voice improved with increased phonatory airflow, but ventilation through the passive airway was still inadequate. However, by combining these two therapeutic strategies, dynamic abduction increased to 7 mm, ventilation through the mouth surpassed that through the tracheotomy (allowing decannulation), and voice quality was restored to normal.

Botulinum Toxins, Type A↗