Justin C. Wise

Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing

Objective To assess the relationship of gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR) with obstructive sleep apnea (OSA). Patients and Methods Thirty-seven sleep-disordered breathing (SDB) patients underwent polysomnography (PSG) and dual-channel pH probe testing. LPR was defined as greater than 6.9 proximal reflux episodes or reflux area index (RAI) greater than 6.3. GER was defined as greater than 4% of time below pH 4.0. Results OSA was present in 28 patients. Twenty-three patients had LPR (66.7% of snorers, 60.7% of OSA patients). Twenty-one patients had GER (33.3% of snorers, 64.3% of OSA patients). Body mass index (BMI) correlated positively with respiratory disturbance index (RDI) (r = 0.67, P < 0.001). BMI did not correlate with pH probe parameters. OSA presence/severity did not correlate with LPR or GER. Supine LPR and GER events did not correlate with OSA presence/severity. Conclusion Gastric acid reflux is prevalent in SDB patients. Direct correlations between reflux and PSG parameters were not identified. EBM rating: B-2b

Association of nasopharyngeal and laryngopharyngeal reflux with postnasal drip symptomatology in patients with and without rhinosinusitis.

Background Patients often report postnasal drip (PND), but objective rhinosinusitis and allergy findings are frequently absent. In this study, we evaluate the association between PND and pharyngeal reflux. Methods Sixty-eight participants underwent 24-hour pH testing, including chronic rhinosinusitis (CRS) patients persistently symptomatic after endoscopic sinus surgery, CRS patients successfully treated by endoscopic sinus surgery, and volunteers without a CRS history. The pH probes contained nasopharyngeal (NP), laryngopharyngeal (LP), and distal esophageal sensors. Participants completed the Sinonasal Outcome Test-20 (SNOT-20) and Modified Reflux Symptom Index (MRSI) questionnaires. Survey items addressing PND symptomatology were compared with NP reflux (NPR) below pH 4 and pH 5 (defined as ≥1 event), and LP reflux (LPR; defined as ≥7 events or reflux area index <6.3). Results Pearson analyses revealed a positive correlation of r = 0.87 between SNOT-20 and MRSI PND items. For NPR < pH 4, no significant difference existed between participants with and without reflux on the SNOT-20 or MRSI (p < 0.05). However, for NPR < pH 5, reflux-positive participants exhibited significantly more PND symptoms on the SNOT-20 (p = 0.030) and the MRSI (p = 0.018) compared with participants without reflux. Finally, participants with LPR had significantly more PND symptomatology on the SNOT-20 (p = 0.010) versus those without LPR. A borderline significant difference existed on the MRSI PND item between participants positive and negative for LPR (p = 0.055). Conclusion Objective evidence of NPR and LPR exists in patients reporting PND. Reflux treatment may reduce PND complaints.

The Relationship between Phonological Processing Skills and Word and Nonword Identification Performance in Children with Mild Intellectual Disabilities.

Word and nonword identification skills were examined in a sample of 80 elementary school age students with mild intellectual disabilities and mixed etiologies who were described as struggling to learn to read by their teachers. Performance on measures of receptive and expressive vocabulary, measures of phonological awareness, and measures of word and nonword identification were included for analyses. Hierarchical regression analyses indicated that, after controlling for chronological age and vocabulary knowledge, phonological processing accounted for a large and significant amount of unique variance of both word and nonword identification. In addition, the pattern of results found in this study is similar to that obtained with typically developing learners. As with typically developing children, measures of phonological awareness were significantly correlated with measures of both reading achievement and vocabulary knowledge.

A Randomized Control Study of Instructional Approaches for Struggling Adult Readers

Abstract This study measured the effectiveness of various instructional approaches on the reading outcomes of 198 adults who read single words at the 3.0 through 5.9 grade equivalency levels. The students were randomly assigned to one of the following interventions: Decoding and Fluency; Decoding, Comprehension, and Fluency; Decoding, Comprehension, Fluency, and Extensive Reading; Extensive Reading; and a Control/Comparison approach. The Control/Comparison approach employed a curriculum common to community-based adult literacy programs, and the Extensive Reading approach focused on wide exposure to literature. The Fluency component was a guided repeated oral reading approach, and the Decoding/Comprehension components were SRA/McGraw-Hill Direct Instruction Corrective Reading Programs. Results indicated continued weaknesses in and poor integration of participants’ skills. Although students made significant gains independent of reading instruction group, all improvements were associated with small effect sizes. When reading instruction group was considered, only one significant finding was detected, with the Comparison/Control group, the Decoding and Fluency group, and the Decoding, Comprehension, Extensive Reading, and Fluency group showing stronger word attack outcomes than the Extensive Reading group.

Differences in Temporal Variables Between Voice Therapy Completers and Dropouts

OBJECTIVES The aim of this study was to examine temporal variables thought to be associated with voice therapy completion. STUDY DESIGN Retrospective chart review of 197 cases (120 dropouts and 77 completers) seen at two voice centers. METHODS Cases included males and females aged 15-90 years presenting with a chief complaint of dysphonia who were referred by an otolaryngologist to a speech-language pathologist for voice therapy. Cases were analyzed from the date of physician referral through the final therapy session. The dependent variable was completion of voice therapy. Independent variables included selected temporal variables related to the timing, frequency, and duration of voice therapy. A binary logistic regression was performed to evaluate the relationship between the dependent variable and the temporal variables. Differences between groups were assessed with independent t tests and post hoc analysis. RESULTS There were significant differences between groups for the number of sessions attended and the wait time between otolaryngology referral and speech-language pathology evaluation, which were also the strongest predictors of therapy completion. CONCLUSIONS There was a strong relationship found between selected temporal variables and therapy completion. Future research directions will examine methods to use these findings to effect a reduction in voice therapy dropout.

Ethnic and gender differences in bone erosion in allergic fungal sinusitis.

Background Erosion of the bony sinus walls in allergic fungal sinusitis (AFS) is an established phenomenon. Reports of the incidence of bone erosion in AFS vary widely, and definitions of bone erosion lack uniformity. Differences in bone erosion among ethnic and gender groups have not been examined previously in the literature. Methods At our institution we reviewed 47 cases of AFS for ethnic and gender differences in presentation and presence of bone erosion. Results Caucasians presented at a mean 12 years later than African-Americans (p = 0.002); however, this difference was largely carried by Caucasian females. African-Americans presented with a greater incidence of bone erosion than Caucasians (p = 0.028). In addition, there are statistically significant differences in the individual paranasal sinuses affected by bone erosion in AFS. Conclusions We examine the potential implications of ethnic and gender differences in presentation and bone erosion in AFS.

Results of a Large-Scale Head and Neck Cancer Screening of an At-Risk Population

OBJECTIVE/HYPOTHESIS To determine whether a community-based head and neck cancer screening could be an effective method to detect positive findings of head and neck cancer in at-risk populations. STUDY DESIGN Survey-based study with a nonexperimental intervention component. METHODS Five hundred sixty-eight adults were screened for oral and laryngeal cancers by otolaryngologists and oral and maxillofacial surgeons during three National Association of Stock Car Auto Racing race weekend events. A prescreening survey collected demographic information, relevant medical history, and information regarding risk factors for head and neck cancers, including current or past tobacco use, alcohol consumption, and chemical exposures. Signs and symptoms of head and neck cancer were documented during the screening. RESULTS Forty-three percent of participants with a history of smoking had abnormal findings. A Pearson chi-square indicated that the proportion of males who evidenced positive findings was significantly (P<0.05) higher than the proportion of females who evidenced positive findings. For every pack of cigarettes smoked per day, an individual was 1.95 times more likely to evidence abnormal findings even after controlling for alcohol use, family history of cancer, personal history of head and neck cancers, sex, age, and occupation. CONCLUSIONS This study is the first to document the results of a large-scale head and neck cancer screening of a population of people known to be at risk of head and neck cancers. The study demonstrates the feasibility of developing and implementing large-scale community-based head and neck cancer screenings, as are often seen in the early diagnosis and education of signs, symptoms, and risks for other cancers.

Short-Term Effects of Patellar Kinesio Taping on Pain and Hop Function in Patients With Patellofemoral Pain Syndrome:

Background: Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have become increasingly popular; however, there has been scant research supporting its use on patients with PFPS. Hypothesis: The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-term pain and single-leg hop measures as compared with sham placement of KT. Study Design: Nonrandomized controlled clinical trial with repeated-measures design. Level of Evidence: Level 3. Methods: Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing 4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired t tests to measure improvement on a numeric pain rating scale. A 2-way, 2 × 2 analysis of variance was used to analyze the relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores. Results: Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect for side was not significant. The interaction between taping condition and side was significant. This showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects’ STJT distances were significantly greater for the experimental KT application than the sham application for the involved side. Conclusion: Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg hop function in patients with PFPS when compared with a sham application. However, improvement in STJT scores did not surpass the minimally detectable change value, and therefore, the clinical effectiveness of KT for improving single-leg hop function was not established in the current study. Clinical Relevance: Kinesio Tape provides a viable, short-term method to control pain.

Voice Outcomes from Subligamentous Cordectomy for Early Glottic Cancer

Objectives: We evaluated the voice and vocal fold pliability outcomes of European Laryngological Society (ELS) deep type I (subepithelial) and type II (subligamentous) cordectomies for early glottic cancer. Methods: We reviewed the medical records of patients with glottic carcinoma at a tertiary care medical center between 2005 and 2011. Their procedures were stratified into ELS type I and ELS type II cordectomies. The data recorded included age, gender, tumor stage, recurrence, patient-assessed voice-related quality of life, perceptual voice evaluation, and stroboscopy. Results: Four patients were identified as having subepithelial cordectomy, and 13 as having subligamentous cordectomy. The average preoperative and postoperative voice-related quality of life scores were 65 and 74 for the ELS I cohort and 64 and 95 for the ELS II group. The preoperative and postoperative perceptual voice evaluation scores were 56 and 35 for the ELS I cohort and 45 and 21 for the ELS II cohort. The ELS I cohort had a moderately to severely reduced mucosal wave, with 75% of patients demonstrating glottic insufficiency, whereas the ELS II cohort had a mildly to moderately reduced mucosal wave, with 8% of patients demonstrating glottic insufficiency. The survival outcomes were the same. Conclusions: Patients who underwent subligamentous excision of early glottic cancer had significantly improved postoperative voice and stroboscopy scores. This finding suggests that if tumor resection reaches the vocal ligament, and minimal superficial lamina propria can be preserved, subligamentous cordectomy should be performed.

The Growth of Phonological Awareness by Children with Reading Disabilities: A Result of Semantic Knowledge or Knowledge of Grapheme-Phoneme Correspondences?.

According to the Lexical Restructuring Model (Metsala & Walley, 1998), children move from holistic representations of words, to syllabic representations, and finally to phonemic representations through a restructuring process driven by their developing lexical base. In contrast, the psycholinguistic grain size theory put forth by Ziegler and Goswami (2005) suggests that the awareness of individual phonemes is not possible without direct literacy instruction. The purpose of this study was to examine whether semantic knowledge and/or knowledge of grapheme/phoneme correspondences influenced the acquisition of word-blending skills by a sample of children with a reading disability. Participants were 211 second-grade and third-grade students from public elementary schools who were assigned to a reading intervention. Hierarchical Linear Modeling techniques were used to model individual growth curves of word-blending skills. Overall, findings support the psycholinguistic grain size theory of reading and suggest that instruction in the relationship between orthographic patterns and their corresponding sounds is necessary for the development of phonological awareness.