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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20090101_19_2756"
                     title="First Guidelines for Management of Hoarseness Released (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/15789?impressionId=1265798945938"
                     
      &lt;p&gt;Clinicians should tell patients diagnosed with dysphonia, or hoarseness, that voice therapy is an effective treatment, according to guidelines issued by the American Academy of Otolaryngology  --  Head and Neck Surgery.&lt;/p&gt;
&lt;p&gt;However, voice therapy should not be undertaken before confirming the diagnosis by visualizing the larynx with laryngoscopy and sending the results to a speech-language pathologist, the guideline authors, led by Seth Schwartz, MD, MPH, of Virginia Mason Medical Center in Seattle, cautioned.&lt;/p&gt;
&lt;p&gt;The guidance was published as a supplement to the September issue of &lt;em&gt;Otolaryngology  --  Head and Neck Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The authors also strongly recommended against routine use of antibiotics for hoarseness because of their ineffectiveness in the majority of patients.&lt;/p&gt;
&lt;p&gt;In most patients, hoarseness is caused by acute laryngitis or a viral upper respiratory infection.&lt;/p&gt;
&lt;p&gt;The guidelines are the first devoted to the clinical management of dysphonia, which is characterized by altered voice quality, pitch, loudness, or vocal effort that impairs communication and reduces voice-related quality of life.&lt;/p&gt;
&lt;p&gt;Often referred to as hoarseness, the condition can lead to depression, social isolation, missed work, and lost wages, the authors said.&lt;/p&gt;
&lt;p&gt;It will affect about 30% of people during their lifetime, but a 2005 study showed that only 5.9% of those with the condition sought treatment.&lt;/p&gt;
&lt;p&gt;&quot;Hoarseness is often caused by benign or self-limited conditions,&quot; the authors said, &quot;but may also be the presenting symptom of a more serious or progressive condition requiring prompt diagnosis and treatment.&quot;&lt;/p&gt;
&lt;p&gt;To develop the recommendations, experts assembled from several disciplines, including neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology - head and neck surgery, and pediatrics. Consumers were represented as well.&lt;/p&gt;
&lt;p&gt;Some of the recommendations: &lt;ul&gt; &lt;li&gt;Clinicians should diagnose dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life.&lt;/li&gt; &lt;li&gt;Patients with hoarseness should be assessed by history or physical exam for factors that modify management, such as recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or performer.&lt;/li&gt; &lt;li&gt;Laryngoscopy should be used to visualize the voice box and vocal cords if hoarseness persists for a maximum of three months, or immediately if a serious underlying cause is suspected.&lt;/li&gt; &lt;li&gt;CT and MRI should not be used for a primary complaint of hoarseness before using laryngoscopy.&lt;/li&gt; &lt;li&gt;Antireflux medications should not be prescribed for hoarseness unless there are signs or symptoms of gastroesophageal reflux disease or laryngeal inflammation.&lt;/li&gt; &lt;li&gt;Botulinum toxin injections should be prescribed for the treatment of hoarseness caused by adductor spasmodic dysphonia even though the treatment is not FDA approved for this indication.&lt;/li&gt; &lt;li&gt;The routine use of oral corticosteroids is not recommended.&lt;/li&gt; &lt;li&gt;Surgery should not be the primary treatment for hoarseness, but may be indicated for suspected laryngeal cancer, benign laryngeal lesions, glottic insufficiency, or laryngeal dystonia.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors included an option for counseling patients with hoarseness about preventive measures, including hydration, the avoidance of irritants, voice training, and the use of amplification during heavy voice use. However, they noted that the evidence for these is either weak or inconclusive in terms of which is better.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The cost of developing the guidelines, including travel expenses of all panel members, was covered in full by the AAO-HNS Foundation.&lt;/p&gt;&lt;p&gt;Schwartz did not make any financial disclosures. His co-authors reported conflicts of interest or relationships with TAP Pharmaceuticals, Bioform, Kramer Patient Education, Restore Medical (Medtronic), Alcon, Schering-Plough, Pfizer, Boehringer Ingelheim, Forest, Novartis, GlaxoSmithKline, Central Arkansas Veterans Healthcare System, the American Academy of Family Physicians, eDocAmerica, KayPentax, and Plural Publishing.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_191"
                     title="Dissolving Implant Aids Nasal Surgery (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/PlasticSurgery/tb/18027?impressionId=1265798945938"
                     
      &lt;p&gt;A polymer-based, resorbable plate implanted in the nose as part of extracorporeal surgery to repair deviated septums appeared to improve outcomes, researchers said.&lt;/p&gt;
&lt;p&gt;Rhinomanometry confirmed that almost 82% of 396 patients receiving the polydioxanone implants at two centers achieved &quot;remarkably improved nasal flow&quot; according to Miriam Boenisch, MD, PhD, now of Medicent Linz in Linz, Austria, and Gilbert J. Nolst Trenit&amp;#233;, MD, PhD, of the University of Amsterdam in the Netherlands.&lt;/p&gt;
&lt;p&gt;No cases of perioperative complications such as bleeding, septal hematomas, inflammatory reactions, or necrosis were reported. &quot;Postoperative crusts disappeared after two weeks in almost all patients,&quot; Boenisch and Nolst Trenit&amp;#233; wrote in the January issue of the &lt;em&gt;Archives of Facial and Plastic Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Slight septal thickening, lasting some three weeks and disappearing over two months, occurred in 19 patients, they added.&lt;/p&gt;
&lt;p&gt;&quot;To date, we have encountered no short- or long-term complications as a consequence of the use of polydioxanone plate,&quot; the researchers wrote, adding that cosmetic results have been good as well, with up to 10 years of follow-up.&lt;/p&gt;
&lt;p&gt;&quot;The fundamental surgical goal, straightening of the nasal septum, was achieved in about 87% of patients. From the patients&apos; viewpoint, the success rate for improvement of nasal breathing was even higher and was supported by rhinomanometry results,&quot; according to the report.&lt;/p&gt;
&lt;p&gt;However, the study had no control group and reflected the experience of two centers in Austria, in Linz and Steyr.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; reported that the first patients were treated treated with the polydioxanone plates in 1996.&lt;/p&gt;
&lt;p&gt;The material is water soluble and is completely resorbed by the body over a period of weeks. Polydioxanone plates have a long history in restoration of bone discontinuities, the researchers noted.&lt;/p&gt;
&lt;p&gt;Physicians at the centers believed such plates could help make extracorporeal septum repair  --  in which the septum is removed from the nose, reshaped, and perhaps augmented for reimplantation  --  more feasible for patients with extensive defects not reparable with conventional methods.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; described a general procedure in which septal cartilage was removed and sutured to a custom-cut piece of polydioxanone for reimplantation.&lt;/p&gt;
&lt;p&gt;In patients with insufficient septal cartilage to create a full new septum, additional cartilage was harvested from their ears. In addition to the polydioxanone plate, foil made of the same material was used to stabilize the construction.&lt;/p&gt;
&lt;p&gt;A total of 47 patients required such compound grafts, including five in which the new septum was made entirely of ear cartilage.&lt;/p&gt;
&lt;p&gt;All but about 5% of the procedures, including those with compound grafts, could be completed in a single outpatient session, the researchers reported.&lt;/p&gt;
&lt;p&gt;The journal report included serial photographs of three patients before and after the procedures.&lt;/p&gt;
&lt;p&gt;One set showed a patient, six days after surgery, whose appearance was essentially normal, except for a scab at the base of the septum. Six months later, he appeared to be completely healed.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; reported that one patient in the series needed revision surgery due to a nasal trauma suffered a month after the reconstruction. The patient originally had a so-called saddle deformity because of trauma, and the new injury caused it to recur after the polydioxanone resorbed.&lt;/p&gt;
&lt;p&gt;The researchers said the revision, performed seven months after the first attempt, involved a compound graft including ear cartilage, and healed well.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported. The polydioxanone plates and foil were supplied by Johnson &amp;amp; Johnson.&lt;/p&gt;&lt;p&gt;The researchers reported no potential conflicts of interest.&lt;/p&gt;&lt;p&gt;Boenisch analyzed the data as part of a PhD dissertation at the University of Pecs, Hungary. Medicent Linz, where she currently works, is part of a chain of private clinics in Austria.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_182"
                     title="Kids with Bionic Ears Have Trouble Controlling Their Voices (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/18018?impressionId=1265798945938"
                     
      Although children who are deaf may be able to hear when fitted with cochlear implants in both ears, they have a more difficult time controlling their voices than kids with normal hearing, a single-center study showed.&lt;br&gt;
&lt;br&gt;Children with bilateral implants had deficits in controlling both the pitch and loudness of their voices when making a sustained &quot;ahh&quot; sound (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), according to Karen Gordon, PhD, of the Hospital for Sick Children in Toronto, and colleagues.&lt;br&gt;
&lt;br&gt;Pitch control, however, improved significantly the longer the implants were used (&lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the January issue of &lt;em&gt;Archives of Otolaryngology  --  Head &amp;amp; Neck Surgery.&lt;/em&gt;&lt;br&gt;
&lt;br&gt;&quot;The more experience one has with hearing, the better able to produce voice they have,&quot; Gordon said in an interview.&lt;br&gt;
&lt;br&gt;The number of children who receive cochlear implants for deafness has been increasing steadily over the past two decades, and it is now common, she said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The implants directly stimulate the auditory nerve to compensate for a nonfunctioning cochlea, regardless of the reason for the deafness.&lt;/p&gt;
&lt;p&gt;At the Hospital for Sick Children, a multidisciplinary team  --  including an audiologist, otolaryngologist, social worker, speech language pathologist, and auditory verbal therapist  --  assesses each child&apos;s suitability for the implants.&lt;/p&gt;
&lt;p&gt;&quot;We really look at the child, their candidacy from a hearing point of view, their expectations for what the implant can do for them, whether they&apos;re up for the surgery, and whether they&apos;re up for the therapy that&apos;s involved afterward,&quot; Gordon said.&lt;/p&gt;
&lt;p&gt;Although children with cochlear implants are able to hear, it&apos;s unclear exactly what their perception of sound is, she said. All must go through therapy lasting about two years to be able to interpret what they&apos;re hearing.&lt;/p&gt;
&lt;p&gt;However, the voicing of children with the implants compared with that of kids with normal hearing has not been extensively studied.&lt;/p&gt;
&lt;p&gt;So Gordon and her colleagues evaluated how 27 children with bilateral implants  --  ages 3 to 15  --  were able to control their voices, finding poorer control of long-term frequency perturbation (pitch) and long-term amplitude perturbation (loudness) compared with those with normal hearing.&lt;/p&gt;
&lt;p&gt;&quot;Despite the incredible opportunities that cochlear implants provide for auditory and linguistic development, abnormalities in acoustic voice outcomes persist,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;However, through a four-month follow-up, pitch control  --  but not loudness control  --  improved significantly with increased implant use.&lt;/p&gt;
&lt;p&gt;&quot;This result underlines the importance of early recognition and treatment of children with hearing loss to provide auditory experience as soon as possible,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;However, the use of cochlear implants is not free of complications, according to another study in the same issue of the journal by Natalie Loundon, MD, of the H&amp;#244;pital d&apos;Enfants Armand-Trousseau in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;Among 434 children younger than 16 who received the devices, 9.9% had complications, nearly two-thirds of which occurred more than eight days after implantation (mean 2.2 years).&lt;/p&gt;
&lt;p&gt;Major complications included severe cutaneous infections or hematoma, magnet displacement, meningitis, cholesteatoma, cerebrospinal fluid leak, and electrode misplacement.&lt;/p&gt;
&lt;p&gt;Minor complications included vertigo, soft-tissue infection, persistent otitis media, and facial nerve palsy.&lt;/p&gt;
&lt;p&gt;A large minority of those with complications (30.2%) required reimplantation.&lt;/p&gt;
&lt;p&gt;Trauma to the mastoid area and inner ear malformations were risk factors for delayed major complications and early minor complications, respectively (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both).&lt;/p&gt;
&lt;p&gt;Age at implantation was not associated with complication risk.&lt;/p&gt;
&lt;p&gt;&quot;The finding of complications several years after surgery highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family,&quot; Loundon and colleagues wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the authors of either of the studies made any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_189"
                     title="TRI: Erectile Dysfunction Drug Linked to Throat Problem"
                     score="-0.007"
                     href="