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<recommendedContent xmlns="http://api.mspoke.com">
    <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=1265767199960"
                     
      &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="20090101_19_2584"
                     title="Corticosteroid Injections Improve Vocal Fold Polyps"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/15558?impressionId=1265767199960"
                     
      &lt;p&gt;Percutaneous corticosteroid injections successfully treated vocal fold polyps, requiring only local anesthesia and producing significant improvements in voice quality, a small study found.&lt;/p&gt;
&lt;p&gt;The overall response rate among 24 patients who underwent the procedure was 91%, and complete remission was achieved in 59%, according to Yen-Bin Hsu, MD, of National Yang-Ming University, Taipei, and colleagues.&lt;/p&gt;
&lt;p&gt;Writing in the August &lt;em&gt;Archives of Otolaryngology-Head and Neck Surgery,&lt;/em&gt; the researchers reported that the surgery typically took 20 minutes and was associated with minimal morbidity.&lt;/p&gt;
&lt;p&gt;Vocal fold polyps usually result from vocal misuse or overuse, with mechanical stress injuring the lamina propria of the vocal fold, resulting in inflammation that can have a significant impact on a patient&apos;s life.&lt;/p&gt;
&lt;p&gt;The standard treatment is surgical removal with direct microlaryngoscopy under general anesthesia.&lt;/p&gt;
&lt;p&gt;An alternative used by the researchers starting in 1995 was transoral laryngeal surgery performed with flexible laryngovideostroboscopy. That procedure does&lt;strong&gt; &lt;/strong&gt;not require general anesthesia or suspension of the larynx, but it can be hampered by the gag reflex and may lead to scarring and stiffness.&lt;/p&gt;
&lt;p&gt;Glucocorticoids have been used to treat some laryngeal lesions, but the intraoral injection technique can be difficult and the surgical view is poor.&lt;/p&gt;
&lt;p&gt;To overcome these difficulties, in 2007 the investigators developed a percutaneous technique for the injection of approximately 0.1 mL of triamcinolone acetonide via the cricothyroid membrane after topical anesthesia with lidocaine.&lt;/p&gt;
&lt;p&gt;Patients with a history of hoarseness for at least six months were diagnosed by laryngovideostroboscopic analysis, and the polyps classified as translucent, hemorrhagic, or fibrotic hyaline.&lt;/p&gt;
&lt;p&gt;The procedure involved passage of a flexible nasopharyngoscope into the laryngeal introitus and insertion of a 25-gauge needle into the lesion under video monitoring, followed by slow infusion of the glucocorticoid.&lt;/p&gt;
&lt;p&gt;The treatment was successful in 22 patients. Reasons for failure were the presence of thick soft tissue in the neck and hypersensitivity of the gag reflex.&lt;/p&gt;
&lt;p&gt;Researchers reported the following polyp status after one month: &lt;ul&gt; &lt;li&gt;Disappeared in 5 (23%)&lt;/li&gt; &lt;li&gt;Improved in 15 (68%)&lt;/li&gt; &lt;li&gt;Unaltered in 2 (9%)&lt;/li&gt; &lt;li&gt;Deteriorated in 0&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;And three months later: &lt;ul&gt; &lt;li&gt;Disappeared in 13 (59%)&lt;/li&gt; &lt;li&gt;Improved in 7 (32%)&lt;/li&gt; &lt;li&gt;Unaltered in 2 (9%)&lt;/li&gt; &lt;li&gt;Deteriorated in 0&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;No further improvements were seen at six months.&lt;/p&gt;
&lt;p&gt;Successful outcomes according to polyp type were:&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;	Translucent, 100% (1 of 1)&lt;/li&gt;
&lt;li&gt;	Hemorrhagic, 91% (10 of 11)&lt;/li&gt;
&lt;li&gt;	Fibrotic hyaline, 90% (9 of 10)&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;Before and after the procedure, patients were evaluated on measures of voice quality, with significant improvements being seen in grade (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), roughness (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), breathiness (&lt;em&gt;P&lt;/em&gt;=0.003), asthenicity (&lt;em&gt;P&lt;/em&gt;=0.001), and strain (&lt;em&gt;P&lt;/em&gt;=0.002).&lt;/p&gt;
&lt;p&gt;Significant improvements also appeared in phonatory measures. including mean maximum phonation time (&lt;em&gt;P&lt;/em&gt;=0.02), jitter (&lt;em&gt;P&lt;/em&gt;=0.006), shimmer (&lt;em&gt;P&lt;/em&gt;=0.001), and noise-to-harmonic ratio (&lt;em&gt;P&lt;/em&gt;=0.01).&lt;/p&gt;
&lt;p&gt;There were no complications such as infection, and bleeding was minor. Two patients had recurrences six and nine months later.&lt;/p&gt;
&lt;p&gt;The investigators wrote that the benefits of this approach included good patient tolerance, no systemic exposure to corticosteroids, and the avoidance of the expense and risk of general anesthesia. Nor do surgeons need special, direct microlaryngoscopic equipment.&lt;/p&gt;
&lt;p&gt;But they cautioned that familiarity with&lt;strong&gt; &lt;/strong&gt;three-dimensional&lt;strong&gt; &lt;/strong&gt;laryngeal anatomy is essential, and that topical anesthesia must be adequate. Follow-up voice therapy may be also needed.&lt;/p&gt;
&lt;p&gt;The investigators reported no absolute contraindications to the procedure, and found it suitable even for patients with poor medical status and surgical risks. The procedure avoids possible scar formation, and a second injection can be considered if necessary, they noted.&lt;/p&gt;
&lt;p&gt;The researchers concluded that percutaneous corticosteroid injection is a practical procedure with minimal morbidity, but noted that their findings are preliminary and longer duration of follow-up is needed.&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 investigators reported no financial disclosures.&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="-0.005"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/18018?impressionId=1265767199960"
                     
      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="-0.006"
                     href="