Faculty Bibliography

The purpose of this systematic review was to examine the evidence for the use of the Iowa Oral Performance Instrument (IOPI) to measure strength and endurance of the tongue and hand in healthy populations and those with medical conditions. A systematic search of the scientific literature published since 1991 yielded 38 studies that addressed this purpose. The IOPI was used primarily for tongue strength (38 studies) and endurance (15 studies) measurement; relatively few studies measured hand strength (9 studies) or endurance (6 studies). The majority of the studies identified used the IOPI as an evaluation tool, although four used it as an intervention tool. Half the studies were conducted in healthy people, primarily adults. Most of the other participants had disorders with dysphagia, primarily Parkinson's disease or head or neck cancer. Age and gender, as well as a number of medical conditions, influence the values of tongue and hand strength. There is sufficient evidence to support the use of the IOPI as a suitable tool for measuring tongue strength and endurance and as an assessment tool for intervention studies, and there is growing support for its use to assess hand strength and endurance in healthy and clinical populations.

IMPORTANCE: Functional recovery for patients who undergo maxillomandibular reconstruction with vascularized bone free flaps (VBFFs) is potentially more attainable with computer-assisted implant rehabilitation. This prosthodontic-driven approach uses software planning and surgical templates for implant placement supporting fixed dental prostheses (FDP). Implant success with immediate load (IL) provisional and definitive FDP restorations in VBFFs is reported for the first time in a patient cohort. OBJECTIVES: To determine implant success for FDP restorations and IL restorations. To determine factors that may influence success and predictability to provide FDP restorations in VBFFs. DESIGN: A retrospective medical chart review was conducted of patients who underwent VBFF reconstruction and computer-assisted planning (CP) for FDP implant rehabilitation. This study was conducted with approval from the institutional review board at Beth Israel Medical Center, New York, New York. SETTING: Clinical procedures were conducted in operating room and outpatient facilities in a tertiary referral medical center. PARTICIPANTS: Twenty-eight consecutive patient treatments were reviewed. Inclusion criteria for all patients were VBFF reconstruction and CP for FDP restoration prior to stage 1 implant surgery. Patients were evaluated for implant success, surgical templates, IL provisional restorations, and prosthodontic framework design. A comparison is made between patients with IL provisional restorations and those patients who did not receive an immediate restoration. MAIN OUTCOMES AND MEASURES: Implants that achieved osseointegration and used for prosthetic reconstruction determined success. Prosthodontic design considerations included whether the patient received an IL provisional restoration and 3 categories of FDP metal framework design. RESULTS Ninety-nine implants of 116 implants placed were used for prosthetic restorations, achieving an 85.4% success rate. Twenty-five of 28 patients received FDP restorations. Thirteen of 28 patients received IL provisional restorations at stage 1 implant surgery. Fifty of 56 implants were successful (89.3%) in the IL group. CONCLUSIONS: Computer-assisted implant rehabilitation of reconstructed defects can achieve superior results to provide FDP and IL provisional restorations. This prosthodontic-driven approach also uses unique framework design to account for mandible height discrepancy after fibula free flap reconstruction. Patient management for FDP rehabilitation is also dependent on radiation status, soft-tissue modification, and patient selection.

OBJECTIVES: Surgical resection of oral cancer can result in altered speech, swallowing, and quality of life (QOL). To date, the oral outcome variables of tongue strength, tongue and jaw range of motion, and saliva production have not been extensively assessed. This pilot study was done to assess tongue strength along with other oral outcomes and their relationship to performance status for speech, swallowing, and QOL after partial glossectomy. Our aim was to create a norm for what should be considered a normal tongue strength value in this population. We hypothesized that patients with tongue strength of 30 kPa or greater would perform better on the performance status scale and various QOL measures than do patients with tongue strength of less than 30 kPa. METHODS: We used a cross-sectional design in this study. The postoperative assessment included 1) Performance Status Scale and Karnofsky Performance Status Scale; 2) oral outcome variables of tongue strength, jaw range of motion. and saliva production; and 3) patient-rated QOL ratings via Eating Assessment Tool, M. D. Anderson Dysphagia Inventory, EORTC-H&N35, and Speech Handicap Index. RESULTS: Patients with tongue strength of at least 30 kPa performed better on the performance status scales and various QOL measures. The cutoff score of 30 kPa for tongue strength measures revealed a trend in predicting performance on the scales and QOL measures. CONCLUSIONS: The oral outcome variables correlated with performance status for speech, swallowing, and QOL. We propose a norm for tongue strength in this population, based on the trend seen in this group of patients, as none previously existed. Future studies are under way that incorporate a larger sample size to further validate this norm. Future studies will also examine oral functional outcome measures in a larger population by inclu'ding other oral and oropharyngeal sites to help predict speech and swallow performance status and QOL.

BACKGROUND: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients. METHODS: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects. All were randomized to receive sour, sweet, or salty bolus flavor. Patients were evaluated at 7-10 days, 1 month, and 3 months after completion of tumor treatment. Control subjects received 1 assessment. RESULTS: All bolus flavors affected oropharyngeal swallow; sour flavor significantly shortened pharyngeal transit time across all evaluations. CONCLUSIONS: Sour flavor influenced the swallow of patients treated for head and neck cancer, as well as that of control subjects in a manner similar to those with neurologic impairment observed in an earlier study. Sour flavor may improve the speed of pharyngeal transit regardless of whether a patient has suffered peripheral or central sensory damage. (c) 2012 Wiley Periodicals, Inc. Head Neck, 2013.

OBJECTIVES:: The purpose of this study was to determine how the bandwidth of the hearing aid (HA) fitting affects bimodal speech recognition of listeners with a cochlear implant (CI) in one ear and severe-to-profound hearing loss in the unimplanted ear (but with residual hearing sufficient for wideband amplification using National Acoustic Laboratories Revised, Profound [NAL-RP] prescriptive guidelines; unaided thresholds no poorer than 95 dB HL through 2000 Hz). DESIGN:: Recognition of sentence material in quiet and in noise was measured with the CI alone and with CI plus HA as the amplification provided by the HA in the high and mid-frequency regions was systematically reduced from the wideband condition (NAL-RP prescription). Modified bandwidths included upper frequency cutoffs of 2000, 1000, or 500 Hz. RESULTS:: On average, significant bimodal benefit was obtained when the HA provided amplification at all frequencies with aidable residual hearing. Limiting the HA bandwidth to only low-frequency amplification (below 1000 Hz) did not yield significant improvements in performance over listening with the CI alone. CONCLUSIONS:: These data suggest the importance of providing amplification across as wide a frequency region as permitted by audiometric thresholds in the HA used by bimodal users.

Neurobiological correlates of adaptation to spectrally degraded speech were investigated with fMRI before and after exposure to a portable real-time speech processor that implements an acoustic simulation model of a cochlear implant (CI). The speech processor, in conjunction with isolating insert earphones and a microphone to capture environment sounds, was worn by participants over a two week chronic exposure period. fMRI and behavioral speech comprehension testing were conducted before and after this two week period. After using the simulator each day for 2h, participants significantly improved in word and sentence recognition scores. fMRI shows that these improvements came accompanied by changes in patterns of neuronal activation. In particular, we found additional recruitment of visual, motor, and working memory areas after the perceptual training period. These findings suggest that the human brain is able to adapt in a short period of time to a degraded auditory signal under a natural learning environment, and gives insight on how a CI might interact with the central nervous system. This paradigm can be furthered to investigate neural correlates of new rehabilitation, training, and signal processing strategies non-invasively in normal hearing listeners to improve CI patient outcomes.

OBJECTIVES:: Perception of spectrally degraded speech is particularly difficult when the signal is also distorted along the frequency axis. This might be particularly important for post-lingually deafened recipients of cochlear implants (CIs), who must adapt to a signal where there may be a mismatch between the frequencies of an input signal and the characteristic frequencies of the neurons stimulated by the CI. However, there is a lack of tools that can be used to identify whether an individual has adapted fully to a mismatch in the frequency-to-place relationship and if so, to find a frequency table that ameliorates any negative effects of an unadapted mismatch. The goal of the proposed investigation is to test the feasibility of whether real-time selection of frequency tables can be used to identify cases in which listeners have not fully adapted to a frequency mismatch. The assumption underlying this approach is that listeners who have not adapted to a frequency mismatch will select a frequency table that minimizes any such mismatches, even at the expense of reducing the information provided by this frequency table. DESIGN:: Thirty-four normal-hearing adults listened to a noise-vocoded acoustic simulation of a CI and adjusted the frequency table in real time until they obtained a frequency table that sounded "most intelligible" to them. The use of an acoustic simulation was essential to this study because it allowed the authors to explicitly control the degree of frequency mismatch present in the simulation. None of the listeners had any previous experience with vocoded speech, in order to test the hypothesis that the real-time selection procedure could be used to identify cases in which a listener has not adapted to a frequency mismatch. After obtaining a self-selected table, the authors measured consonant nucleus consonant word-recognition scores with that self-selected table and two other frequency tables: a "frequency-matched" table that matched the analysis filters with the noisebands of the noise-vocoder simulation, and a "right information" table that is similar to that used in most CI speech processors, but in this simulation results in a frequency shift equivalent to 6.5 mm of cochlear space. RESULTS:: Listeners tended to select a table that was very close to, but shifted slightly lower in frequency from the frequency-matched table. The real-time selection process took on average 2 to 3 min for each trial, and the between-trial variability was comparable with that previously observed with closely related procedures. The word-recognition scores with the self-selected table were clearly higher than with the right-information table and slightly higher than with the frequency-matched table. CONCLUSIONS:: Real-time self-selection of frequency tables may be a viable tool for identifying listeners who have not adapted to a mismatch in the frequency-to-place relationship, and to find a frequency table that is more appropriate for them. Moreover, the small but significant improvements in word-recognition ability observed with the self-selected table suggest that these listeners based their selections on intelligibility rather than some other factor. The within-subject variability in the real-time selection procedure was comparable with that of a genetic algorithm, and the speed of the real-time procedure appeared to be faster than either a genetic algorithm or a simplex procedure.

OBJECTIVES/HYPOTHESIS: The aims of the study were to identify trends in surgical management of laryngotracheal stenosis (LTS) based on lesion location, as well as to recognize factors associated with recurrence and repeat surgical intervention. STUDY DESIGN: The study is a retrospective review of all adult patients cared for at a tertiary care laryngology practice with a diagnosis of laryngotracheal stenosis between October 2001 and July 2010, following Institutional Review Board approval. METHODS: This study collectively measured demographics, comorbidities, etiologies, sites of stenoses, treatment modalities, and recurrences. RESULTS: Incisions made with the carbon dioxide (CO2 ) laser were the most common modality of treatment; patients with multilevel tracheal stenosis were most likely to have undergone at least one operation in which the CO2 laser was used to make incisions (78.7%). Balloon dilation was most commonly employed in patients with multilevel tracheal stenosis (66.0%). Lowest rates of decannulation were identified in patients with a pure tracheal stenosis (23.1%). Patients presenting with multilevel tracheal stenosis underwent the most procedures (6.7). Supraglottic, glottic, and multilevel laryngeal stenosis recurred at the lowest rates. Patients suffering from diabetes mellitus recurred in an average period of 3.9 months, a shorter time frame than those without diabetes, who recurred every 10.5 months. CONCLUSIONS: Laser incision and/or balloon dilation are most effective in treatment of pure glottic, subglottic, and tracheal stenosis. Multilevel tracheal stenosis warrants closer follow-up, and is more likely to require multiple procedures. Worsening stenosis despite endoscopic management warrants an open procedure. Diabetes is associated with an earlier recurrence of stenosis. LEVEL OF EVIDENCE: Level 2b (Individual retrospective cohort study). Laryngoscope, 2013.