Publication date: Available online 19 February 2018
Source:Journal of Voice
Author(s): Sonya Marcus, Micah Timen, Gregory R. Dion, Mark A. Fritz, Ryan C. Branski, Milan R. Amin
ObjectiveGiven that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy.Study DesignRetrospective, financial analyses were performed.MethodsPatients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded.ResultsOf the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment.ConclusionIn-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy.
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Δευτέρα 19 Φεβρουαρίου 2018
The Effect of Parkinson Disease Tremor Phenotype on Cepstral Peak Prominence and Transglottal Airflow in Vowels and Speech
Publication date: Available online 19 February 2018
Source:Journal of Voice
Author(s): Brittany R. Burk, Christopher R. Watts
ObjectivesThe physiological manifestations of Parkinson disease are heterogeneous, as evidenced by disease subtypes. Dysphonia has been well documented as an early and progressively significant impairment associated with the disease. The purpose of this study was to investigate how acoustic and aerodynamic measures of vocal function were affected by Parkinson tremor subtype (phenotype) in an effort to better understand the heterogeneity of voice impairment severity in Parkinson disease.Study DesignThis is a prospective case-control study.MethodsThirty-two speakers with Parkinson disease assigned to tremor and nontremor phenotypes and 10 healthy controls were recruited. Sustained vowels and connected speech were recorded from each speaker. Acoustic measures of cepstral peak prominence (CPP) and aerodynamic measures of transglottal airflow (TAF) were calculated from the recorded acoustic and aerodynamic waveforms.ResultsSpeakers with a nontremor dominant phenotype exhibited significantly (P < 0.05) lower CPP and higher TAF in vowels compared with the tremor dominant phenotype and control speakers, who were not different from each other. No significant group differences were observed for CPP or TAF in connected speech.ConclusionsWhen producing vowels, participants with nontremor dominant phenotype exhibited reduced phonation periodicity and elevated TAF compared with tremor dominant and control participants. This finding is consistent with differential limb-motor and cognitive impairments between tremor and nontremor phenotypes reported in the extant literature. Results suggest that sustained vowel production may be sensitive to phonatory control as a function of Parkinson tremor phenotype in mild to moderate stages of the disease.
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Source:Journal of Voice
Author(s): Brittany R. Burk, Christopher R. Watts
ObjectivesThe physiological manifestations of Parkinson disease are heterogeneous, as evidenced by disease subtypes. Dysphonia has been well documented as an early and progressively significant impairment associated with the disease. The purpose of this study was to investigate how acoustic and aerodynamic measures of vocal function were affected by Parkinson tremor subtype (phenotype) in an effort to better understand the heterogeneity of voice impairment severity in Parkinson disease.Study DesignThis is a prospective case-control study.MethodsThirty-two speakers with Parkinson disease assigned to tremor and nontremor phenotypes and 10 healthy controls were recruited. Sustained vowels and connected speech were recorded from each speaker. Acoustic measures of cepstral peak prominence (CPP) and aerodynamic measures of transglottal airflow (TAF) were calculated from the recorded acoustic and aerodynamic waveforms.ResultsSpeakers with a nontremor dominant phenotype exhibited significantly (P < 0.05) lower CPP and higher TAF in vowels compared with the tremor dominant phenotype and control speakers, who were not different from each other. No significant group differences were observed for CPP or TAF in connected speech.ConclusionsWhen producing vowels, participants with nontremor dominant phenotype exhibited reduced phonation periodicity and elevated TAF compared with tremor dominant and control participants. This finding is consistent with differential limb-motor and cognitive impairments between tremor and nontremor phenotypes reported in the extant literature. Results suggest that sustained vowel production may be sensitive to phonatory control as a function of Parkinson tremor phenotype in mild to moderate stages of the disease.
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Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
Publication date: Available online 19 February 2018
Source:Gait & Posture
Author(s): Laura Comber, Jacob J. Sosnoff, Rose Galvin, Susan Coote
BackgroundMultiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.MethodsA systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.ResultsForty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).Resultsindicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.ConclusionsThe large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
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Source:Gait & Posture
Author(s): Laura Comber, Jacob J. Sosnoff, Rose Galvin, Susan Coote
BackgroundMultiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.MethodsA systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.ResultsForty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).Resultsindicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.ConclusionsThe large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
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Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
Publication date: Available online 19 February 2018
Source:Gait & Posture
Author(s): Laura Comber, Jacob J. Sosnoff, Rose Galvin, Susan Coote
BackgroundMultiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.MethodsA systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.ResultsForty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).Resultsindicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.ConclusionsThe large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
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Source:Gait & Posture
Author(s): Laura Comber, Jacob J. Sosnoff, Rose Galvin, Susan Coote
BackgroundMultiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.MethodsA systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.ResultsForty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).Resultsindicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.ConclusionsThe large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
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Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
Publication date: Available online 19 February 2018
Source:Gait & Posture
Author(s): Laura Comber, Jacob J. Sosnoff, Rose Galvin, Susan Coote
BackgroundMultiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.MethodsA systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.ResultsForty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).Resultsindicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.ConclusionsThe large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
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Source:Gait & Posture
Author(s): Laura Comber, Jacob J. Sosnoff, Rose Galvin, Susan Coote
BackgroundMultiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.MethodsA systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.ResultsForty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).Resultsindicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.ConclusionsThe large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.
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