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Introduction: Singers have unique vocal demands, and if the voice is impaired there can be a negative impact on their quality of life. While a variety of options exist to assess vocal health, the utilization of cepstral peak prominence (CPP) has increased due to his reliability in some situations. However, it has not been utilized commonly in the singing population. This study sought to assess vocal health in singing students using noninvasive measures such as singing voice handicap index (SVHI) and consensus auditory perceptual evaluation of voice (CAPE-V) as well as CPP to provide preliminary information on this measure., Methods: A prospective longitudinal study of singing students independent of year of training enrolled in a 2-credit voice lesson at an undergraduate School of Music was conducted. Non-invasive measures were used to evaluate the voice. All participants recorded the same spoken sentence at four equally spaced intervals throughout the semester using a ZOOM H4n Pro (two cardioid input microphone, Hauppauge, New Year). Participants completed SVHI at the time of each recording, and CAPE-V conducted by two speech language pathologists trained in voice. CPP was determined using running speech samples., Results: A total of 23 singers completed the study (11 male, 12 female). There was a significant difference in SVHI at the first recording compared to the final recording (10.6 ± 4.6 vs 9.3 ± 5.9, P= 0.008). Similarly, there was a significant difference in CPP at the first recording compared to the final recording (9 ± 3 vs 9.4 ± 1.1, P < 0.001). However, no significant difference was seen with CAPE-V., Conclusion: Our results are similar to previous studies. There was no evidence in decline in objective and subjective vocal quality utilizing the measure included in our study., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Previous studies have identified abnormal findings in up to 86.1% of singers on initial screening strobovideolaryngoscopy (SVL) examinations. No studies have compared the prevalence of abnormalities in singers on their subsequent follow-up SVL. Our study evaluates the frequency of these findings in both the initial and subsequent examinations., Methods: Retrospective charts and SVL reports were reviewed on students from an opera conservatory from 1993 to 2014. All students had initial screening SVL, but only students who later returned with acute voice complaints were included in the study (n = 51, 137 follow-up visits). Normal SVL was defined as an examination without structural or functional abnormalities and reflux finding score ≤7. Data were analyzed using the chi-square test., Results: For initial examinations, 90.2% (including reflux) and 88.2% (excluding reflux) were abnormal. In follow-up examinations, 94.9% (including reflux) and 94.2% (excluding reflux) had abnormal findings, which included muscle tension dysphonia (40.1%), vocal fold (VF) masses (unilateral 48.9%, bilateral 30.7%), vascular abnormalities (unilateral 27.0%, bilateral 5.8%), sulcus (unilateral 17.5%, bilateral 5.1%), VF hypomobility (unilateral 36.3%, bilateral 5.9%), phase (30.6%) and amplitude (44.8%) asymmetries, and glottic insufficiency (49.3%). Follow-up examinations revealed a significant increase in laryngopharyngeal reflux (χ(2) = 7.043; P < 0.05)., Conclusions: We found a higher prevalence of abnormal findings compared with previous studies, which we attributed to a more inclusive definition of abnormal pathologies, improvements in SVL technology, and possibly increased experience with SVL interpretation. This high prevalence of abnormal findings in asymptomatic singers further supports the importance of baseline examinations., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The reported prevalence of sulcus vocalis (SV)/type III, a pathologic groove in the vibratory margin of the vocal fold, varies greatly in the literature. Difficulties in visualizing the defect and a variety of descriptions have complicated the evaluation of SV. The objective of this study was to determine the prevalence of SV by reviewing strobovideolaryngoscopy (SVL) examinations in subjects with and without dysphonia., Study Design: Retrospective chart review., Methods: Charts and SVL images were reviewed for subjects with and without dysphonia and analyzed using standard statistical techniques., Results: SVL images were reviewed for 94 nondysphonia subjects and 100 dysphonia subjects. For all subjects, 19.6% had type I, 2.1% had type II, and 5.7% had type III/SV. Per vocal fold, 14.7% had type I, 1.3% had type II, 3.1% had type III/SV and 13.1% had scar. The prevalence of SV per subject was not significantly different between the two groups (8% of dysphonia subjects, 3.2% of nondysphonia subjects). Male gender, decreased amplitude, decreased waveform, and hypodyamic motion were significantly higher in the dysphonia SV subjects compared with the non-SV subjects. All other SVL characteristics were not significantly different in subjects with SV compared with non-SV subjects., Conclusions: We report a prevalence of SV/type III at 3.1% (per vocal fold) and 5.7% (per subject). Higher frequencies of male gender and waveform abnormalities were seen in the dysphonia SV subjects only. There were no significant differences in nondysphonia subjects with or without SV., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the mesenteric tissue oxygenation response in preterm infants fed and not fed during red blood cell (RBC) transfusions., Study Design: Prospective, observational comparison of mesenteric oxygenation using near-infrared spectroscopy in preterm infants (<33 weeks' at birth) who were fed or not fed during RBC transfusion. Tissue oxygenation means were examined up to 48 hours after each transfusion event., Results: Mean mesenteric regional oxygen saturation (rSO2) slopes during RBC transfusion of fed (n = 9) vs not fed (n = 8) infants ranged from -0.23 to +0.23 (mean 0.04) with no differences between groups (P = .480). However, following transfusions, postprandial mesenteric oxygenation means significantly declined in infants fed during transfusion compared with infants not fed during transfusion (P < .001). Infants fed during RBC transfusion had a mean 2.16 point decrease in rSO2 mesenteric oxygenation with each sequential feeding post-transfusion, whereas infants not fed during RBC transfusion increased their rSO2 postprandial mesenteric oxygenation by a mean of 2.09 points., Conclusions: Mesenteric tissue oxygenation during RBC transfusion is not influenced by feeding status. However, infants fed during RBC transfusion had, for the next 15 hours, decreasing postprandial mesenteric tissue oxygenation patterns compared with infants not fed during RBC transfusion. Feeding during RBC transfusions may increase the risk for mesenteric ischemia and the development of transfusion-related necrotizing enterocolitis in preterm infants., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To present a novel design for a stent for management of a traumatic supraglottic web., Methods: Case report and literature review (PubMed 1964-2013)., Results: A 48-year-old man was presented after penetrating laryngeal trauma. He had severe dysphonia and was tracheotomy dependent. He had been treated previously with open reduction and fixation of laryngeal fracture. On examination, we identified an avulsed left vocal fold and a supraglottic web. He initially underwent reapproximation of the avulsed left vocal fold, and subsequently, the supraglottic web was treated using a stent designed by the senior author (R.T.S.). In addition, he underwent later resection of scar tissue to improve dysphonia and then he was decanulated., Conclusions: There are a few techniques presented in the literature and mostly are adaptations of subglottic stenosis management techniques. Individualized treatment is needed for these difficult cases. We present our experience with supraglottic web treatment to expand the literature on this uncommon disorder., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives/hypothesis: Although oral topical anesthesia is used routinely before rigid laryngeal endoscopy, no study has determined whether oral topical anesthesia changes voice quality. Our goal was to determine the effects of topical anesthesia on voice., Study Design: Prospective cohort study., Methods: Adult patients presenting to a laryngology practice who required rigid laryngeal endoscopy as part of the routine clinical visit were eligible for the study. Voices were recorded before and after oral topical benzocaine (14%)/butamben (2%)/tetracaine (2%) (ie, cetacaine) spray. Consensus auditory perceptual evaluation of voice (CAPE-V) protocol was used for the voice recordings and was the primary outcome measure. Recordings were presented randomly to two blinded speech-language pathologists specialized in voice. Secondary outcome measures were fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (N/H) on sustained /i/ and speaking F0., Results: One hundred two patients participated in the study. There was no significant difference in CAPE-V measurements before and after topical anesthesia for all six attributes: overall severity (P = 0.145), roughness (P = 0.214), breathiness (P = 0.761), strain (P = 0.053), pitch (P = 0.301), and loudness (P = 0.320). There was no significant difference in jitter (P = 0.315), shimmer (P = 0.942), N/H (P = 0.128), and speaking F0 (P = 0.320). F0 /i/ decreased by a mean of 4.8Hz, which was statistically significant (P = 0.003), but probably not clinically significant., Conclusion: There was no clinically significant voice change after oral topical anesthesia., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives/hypothesis: To evaluate the degree of dysplasia following cidofovir injections while documenting human papillomavirus (HPV) type in patients with recurrent respiratory papillomatosis (RRP)., Study Design: Retrospective chart review., Methods: Demographic data, operative reports, and pathology results were reviewed from 25 patients with RRP who had had cidofovir injections. All patients included had adult onset RRP, no history of immunosuppression, well-controlled laryngopharyngeal reflux, and no current smoking history. Eight patients were excluded because they did not meet the inclusion criteria., Results: Seventeen patients had adequate data for analysis and 40 subsites were identified with sufficient data for analysis. Patients negative for both low and high risk did not have progressive dysplasia at the conclusion of the study. Of the patients with positive viral typing, 70% had progressive disease at the conclusion of the study. No patients progressed to carcinoma or carcinoma in situ. The average pre- and post-treatment dysplasia scores were analyzed using a Student paired t test. There was no difference in mean dysplasia score, indicating that there was no increased risk of dysplasia following cidofovir treatment., Conclusions: To our knowledge, this is the first study looking at the degree of dysplasia while documenting HPV types in RRP. Our study suggests that HPV type appears to be relevant in the disease progression of RRP and that cidofovir does not increase the risk of dysplasia., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

The aim of this study was to examine the survival dynamics of several epidemic health care-associated (HA) and community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) in planktonic state in widely employed denture-cleaning solutions. The bacteriocidal activity of five widely employed denture-cleaning formulations were examined against five phage-types of HA-MRSA (EMRSA 15, EMRSA 16, Irish 1, Irish 2, unique type), as well as a CA-MRSA strain, in this study. Viable MRSA cells (circa 10(5) cfu/mL) were coincubated with optimum recommended working concentrations of denture-cleaning solutions for up to 17 hours (overnight). Recovery experiments were unable to isolate any of the inoculated MRSA organisms 10 minutes post inoculation. The significance and impact of this short study indicates that HA-MRSA and CA-MRSA are not able to remain culturable for 10 minutes in planktonic form, in commonly used denture-cleaning formulations widely available on the UK High Street, suggesting that these formulations may be useful in lowering the numbers of MRSA. Further work is however required to examine the more complex survival dynamics of MRSA in naturally derived denture biofilm, associated with dental plaque and the use of such cleaning formulations.

Background: The aim of this study was to examine the survival dynamics of several epidemic nosocomial and community-acquired methicillin-resistant Staphylococcus aureus (MRSA) strains on copper alloy coins., Methods: Six different phage types of nosocomial MRSA (Irish 1, Irish 2, EMRSA 15, EMRSA 16, distinct type, and untypeable), as well as community-acquired MRSA, were examined in this study. Two isolates of each type were studied, resulting in a total of 14 organisms being examined. Cells were harvested from overnight cultures of Columbia blood agar (Oxoid) supplemented with 5% (wt/vol) defibrinated blood to make a 0.5 McFarland inoculum standard. An inoculum of each MRSA isolate in 5-microl volume was added to washed, dried, and presterilized 1-penny copper-plated steel coins, equating to log(10) 5 colony-forming units (cfu) and allowed to dry naturally at ambient temperatures in the dark., Results: Recovery experiments were unable to isolate any of the inoculated organisms 4 hours postinoculation. To ascertain whether this was a toxic effect from the copper alloy of the coins or a physical desiccation effect, experiments were repeated on glass and plastic, and similar results were demonstrated. The effect of soil was investigated by repeating the experiment with (60)Co irradiated pus and sterile blood, and we were able to demonstrate the survival of all organisms after at least 2 weeks storage in the dark at ambient temperature, during which the quantitative counts were reduced by approximately 1-log unit and 2-log units for blood and pus, respectively., Conclusion: This study demonstrates that all epidemic nosocomial- and community-acquired MRSA do not survive when no organic protection is offered but survive well when soil (pus and blood) is present, thus offering protection from drying. This study indicates that contaminated coins may serve as potential vehicles for MRSA.

Automatic external defibrillators (AEDs) will be used by spouses, family members, emergency first-responders, and the citizenry at large. Such use, however, raises a number of clinical, training, psychological, and public health issues. Clinical issues: Is cardiac arrest to be verified by the operator or the AED? Second verification systems, such as breath detectors, produce errors of omission, but greatly expand the pool of potential users. The relative merits of high sensitivity and low specificity in arrest verification must be defined by clinicians relative to the setting and the potential users. AEDs require cessation of basic CPR during their assessment periods; clinicians must determine the tradeoff between long interruption of basic life support and much earlier delivery of countershocks. Training issues: Criteria for those to be trained include consideration of who the patient will be and who the AED operator might be. AEDs pose a familiar adult education problem, that is, acquisition of a new psychomotor skill and retention of that skill for long periods before performance. What are the best teaching techniques? Currently available AEDs have different designs for device-operator interaction. Which design is most likely to assure proper performance during an actual arrest? Psychological issues: What are the psychological effects of learning about, living with, and eventually using an AED? The development of the automatic external defibrillator constitutes the most recent attempt to achieve early defibrillation of patients in cardiac arrest. The potential public health effect of such devices is enormous.

We performed a study to determine how many patients at highest risk for an episode of ventricular fibrillation (those who have already survived such an event) are potential candidates for automatic external defibrillator placement and accepting of such a device in their homes. All VF survivors in King County, Washington, during 1984 were screened for possible enrollment in the study. Of 95 survivors of out-of-hospital VF, 63 (66%) were eligible and of 47 patients approached, 38 (81%) agreed to participate in the study. These findings suggest that approximately half (product of 66% and 81% acceptance rate equals 53%) of VF survivors potentially could use automatic external defibrillators.

The ability of lay persons to learn and retain defibrillation skills using an automatic external defibrillator (AED) was assessed. Thirty-four family members of cardiac arrest survivors were trained in CPR techniques and defibrillation, and evaluated for performance of skills immediately following training and at six-week and three-month follow-ups. All but two were successfully trained to complete three cycles of CPR interspersed with three defibrillatory shocks in an average of four minutes with the first shock delivered in an average of two minutes. Although there were decrements in the speed and quality of performance at each follow-up period (P less than .01), we conclude that most lay persons can learn to operate an AED safely and under simulated conditions provide defibrillatory shocks an average of eight minutes faster than typical response times of emergency medical technicians. These results suggest that AEDs can be placed in many homes of patients at high risk for cardiac arrest.