The Experts below are selected from a list of 246 Experts worldwide ranked by ideXlab platform
Monika Lechleitner - One of the best experts on this subject based on the ideXlab platform.
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Misconception of the Valsalva maneuver.
International urogynecology journal, 2011Co-Authors: Helena Talasz, Markus Kofler, Monika LechleitnerAbstract:Dear Editor, In urogynecology, we notice a lack of scientific data regarding breathing-dependent synergies between diaphragm and pelvic floor muscles, and associated changes in intraabdominal and intrathoracic pressure distribution. In particular, the Valsalva maneuver, which is often applied to support urine or stool evacuation and to evaluate stress resistance of the urethra during urodynamic, ultrasound, andMRI studies is insufficiently defined. Sometimes it is even equated with an abdominal straining maneuver [1]. However, the two maneuvers reflect opposite respiratory patterns associated with different pelvic floor positions and differential pelvic floor muscle contractile status. The Valsalva maneuver is named after the Italian physician and anatomist Antonio Maria Valsalva (1666– 1723). His principal scientific interest was the human ear. He advised forceful expiration against closed nostrils and mouth in order to increase intrathoracic pressure that is transmitted through the open glottis to the oronasopharyngeal cavity, and thus opens Eustachian Tubes and inflates the middle ear. During expiration, abdominal and pelvic floor muscles contract together in order to increase intra-abdominal pressure and to push the diaphragm upwards (Fig. 1a) [2]. Prolonged increase in a b
Helena Talasz - One of the best experts on this subject based on the ideXlab platform.
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Misconception of the Valsalva maneuver.
International urogynecology journal, 2011Co-Authors: Helena Talasz, Markus Kofler, Monika LechleitnerAbstract:Dear Editor, In urogynecology, we notice a lack of scientific data regarding breathing-dependent synergies between diaphragm and pelvic floor muscles, and associated changes in intraabdominal and intrathoracic pressure distribution. In particular, the Valsalva maneuver, which is often applied to support urine or stool evacuation and to evaluate stress resistance of the urethra during urodynamic, ultrasound, andMRI studies is insufficiently defined. Sometimes it is even equated with an abdominal straining maneuver [1]. However, the two maneuvers reflect opposite respiratory patterns associated with different pelvic floor positions and differential pelvic floor muscle contractile status. The Valsalva maneuver is named after the Italian physician and anatomist Antonio Maria Valsalva (1666– 1723). His principal scientific interest was the human ear. He advised forceful expiration against closed nostrils and mouth in order to increase intrathoracic pressure that is transmitted through the open glottis to the oronasopharyngeal cavity, and thus opens Eustachian Tubes and inflates the middle ear. During expiration, abdominal and pelvic floor muscles contract together in order to increase intra-abdominal pressure and to push the diaphragm upwards (Fig. 1a) [2]. Prolonged increase in a b
Haibo Wang - One of the best experts on this subject based on the ideXlab platform.
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Otitis Media in Sperm-Associated Antigen 6 (Spag6)- Deficient Mice
2016Co-Authors: Xiaohui Bai, Jerome F Strauss, Zhibing Zhang, Haibo WangAbstract:Mammalian SPAG6 protein is localized to the axoneme central apparatus, and it is required for normal flagella and cilia motility. Recent studies demonstrated that the protein also regulates ciliogenesis and cilia polarity in the epithelial cells of brain ventricles and trachea. Motile cilia are also present in the epithelial cells of the middle ear and Eustachian Tubes, where the ciliary system participates in the movement of serous fluid and mucus in the middle ear. Cilia defects are associated with otitis media (OM), presumably due to an inability to efficiently transport fluid, mucus and particles including microorganisms. We investigated the potential role of SPAG6 in the middle ear and Eustachian Tubes by studying mice with a targeted mutation in the Spag6 gene. SPAG6 is expressed in the ciliated cells of middle ear epithelial cells. The orientation of the ciliary basal feet was random in the middle ear epithelial cells of Spag6-deficient mice, and there was an associated disrupted localization of the planar cell polarity (PCP) protein, FZD6. These features are associated with disordered cilia orientation, confirmed by scanning electron microscopy, which leads to uncoordinated cilia beating. The Spag6 mutant mice were also prone to develop OM. However, there were no significant differences in bacterial populations, epithelial goblet cell density, mucin expression and Eustachian tube angle between the mutant and wild-type mice, suggesting that OM was due to accumulation of fluid and mucus secondary to the ciliary dysfunction. Our studies demonstrate a role for Spag6 in the pathogenesis of OM in mice, possibly through its role in the regulation of cilia/basa
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otitis media in sperm associated antigen 6 spag6 deficient mice
PLOS ONE, 2014Co-Authors: Xiaohui Bai, Jerome F Strauss, Zhibing Zhang, Haibo WangAbstract:Mammalian SPAG6 protein is localized to the axoneme central apparatus, and it is required for normal flagella and cilia motility. Recent studies demonstrated that the protein also regulates ciliogenesis and cilia polarity in the epithelial cells of brain ventricles and trachea. Motile cilia are also present in the epithelial cells of the middle ear and Eustachian Tubes, where the ciliary system participates in the movement of serous fluid and mucus in the middle ear. Cilia defects are associated with otitis media (OM), presumably due to an inability to efficiently transport fluid, mucus and particles including microorganisms. We investigated the potential role of SPAG6 in the middle ear and Eustachian Tubes by studying mice with a targeted mutation in the Spag6 gene. SPAG6 is expressed in the ciliated cells of middle ear epithelial cells. The orientation of the ciliary basal feet was random in the middle ear epithelial cells of Spag6-deficient mice, and there was an associated disrupted localization of the planar cell polarity (PCP) protein, FZD6. These features are associated with disordered cilia orientation, confirmed by scanning electron microscopy, which leads to uncoordinated cilia beating. The Spag6 mutant mice were also prone to develop OM. However, there were no significant differences in bacterial populations, epithelial goblet cell density, mucin expression and Eustachian tube angle between the mutant and wild-type mice, suggesting that OM was due to accumulation of fluid and mucus secondary to the ciliary dysfunction. Our studies demonstrate a role for Spag6 in the pathogenesis of OM in mice, possibly through its role in the regulation of cilia/basal body polarity through the PCP-dependent mechanisms in the middle ear and Eustachian Tubes.
Dennis S. Poe - One of the best experts on this subject based on the ideXlab platform.
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Eustachian tube mucosal inflammation scale validation based on digital video images
Otology & Neurotology, 2015Co-Authors: Ilkka Kivekas, Leena Poyhonen, Antti A Aarnisalo, Markus Rautiainen, Dennis S. PoeAbstract:BACKGROUND The most common cause for Eustachian tube dilatory dysfunction is mucosal inflammation. The aim of this study was to validate a scale for Eustachian tube mucosal inflammation, based on digital video clips obtained during diagnostic rigid endoscopy. METHODS A previously described four-step scale for grading the degree of inflammation of the mucosa of the Eustachian tube lumen was used for this validation study. A tutorial for use of the scale, including static images and 10 second video clips, was presented to 26 clinicians with various levels of experience. Each clinician then reviewed 35 short digital video samples of Eustachian Tubes from patients and rated the degree of inflammation. A subset of the clinicians performed a second rating of the same video clips at a subsequent time. Statistical analysis of the ratings provided inter- and intrarater reliability scores. RESULTS Twenty-six clinicians with various levels of experience rated a total of 35 videos. Thirteen clinicians rated the videos twice. The overall correlation coefficient for the rating of inflammation severity was relatively good (0.74, 95% confidence interval, 0.72-0.76). The intralevel correlation coefficient for intrarater reliability was high (0.86). For those who rated videos twice, the intralevel correlation coefficient improved after the first rating (0.73, to 0.76), but improvement was not statistically significant. CONCLUSION The inflammation scale used for Eustachian tube mucosal inflammation is reliable and this scale can be used with a high level of consistency by clinicians with various levels of experience.
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Update on Eustachian tube dysfunction and the patulous Eustachian tube.
Current opinion in otolaryngology & head and neck surgery, 2005Co-Authors: J. Fredrik Grimmer, Dennis S. PoeAbstract:Purpose of review The purpose of this review is to summarize the recent knowledge on Eustachian tube dysfunction and the patulous Eustachian tube. Recent findings A clinically useful test for Eustachian tube function is still lacking. Narrowing of the isthmus alone was demonstrated to be an insufficient cause of otitis media. Inflammatory mediators identified within the Eustachian tube and middle ear cells were causally linked with otitis media with effusion. Increasing evidence was found that allergic disease and reflux may be two of the most important contributors of tubal inflammation causing otitis media with effusion. The adenoid size and proximity to the torus tubaris may also be important in considering which patients with persistent otitis media with effusion may benefit from adenoidectomy. Computed tomography scan has documented loss of soft tissue within the cartilaginous Eustachian tube in patients with patulous Eustachian Tubes. An endoscopic approach to seal the tubal lumen has been found to be effective in relieving patulous symptoms. Summary These studies suggest that allergic rhinitis and gastroesophageal reflux should be investigated in patients with Eustachian tube dysfunction. Adenoidectomy should also be considered in patients who have adenoids that obstruct the torus tubaris. Patients with a patulous Eustachian tube may benefit from an endoscopic closure. Further research is needed to identify a clinically useful test for Eustachian tube dysfunction.
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analysis of the dysfunctional Eustachian tube by video endoscopy
Otology & Neurotology, 2001Co-Authors: Dennis S. Poe, Ashraf Saad Abouhalawa, Osama AbdelrazekAbstract:Objective Human Eustachian Tubes with known pathologic conditions of the ear were inspected endoscopically, and video recordings were made for slow-motion analysis of the pathophysiologic changes. Setting Ambulatory office in a tertiary referral center. Subjects Forty-four adults with 64 ears having pathologic conditions. Interventions Transnasal endoscopic examination of the nasopharyngeal opening of the Eustachian tube during rest, swallowing, and yawning to study the dilatory movements of the Eustachian tube. Main Outcome Measures Slow-motion video analysis of the dilatory movements of the Eustachian tube. Results Sixty-four ears and Eustachian Tubes with pathologic changes were studied. Tubal function was graded on (1) the extent of lateral excursion and progression of dilatory wave as estimates of tensor veli palatini and dilator tubae muscle function, reduced function being observed in 43 Tubes; (2) the degree of mucosal disease, which was significant in 48 Tubes; (3) obstructive mucosal changes, which were present in 15 Tubes; (4) ease and frequency of tubal dilation with maneuvers—26 Tubes opened moderately, 21 opened minimally, and 11 were unable to open; and (5) patulous Tubes—all 6 clinically patulous Tubes showed concavities in the superior third of the tube, which is convex in normal subjects. All Tubes with active pathologic conditions of the ear (otitis media with effusion, tympanic membrane retraction, draining ear, cholesteatoma) had significant abnormalities. A correlation could not be made between the severity of middle ear disease and the severity of observed Eustachian tube dysfunction. Conclusions Slow-motion endoscopic video analysis is a potentially useful technique in classifying types of pathologic changes in the Eustachian tube. Additional studies of dysfunctional Tubes are needed to predict outcomes in operative ear cases and to design intratubal therapy for chronically dysfunctional Tubes.
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analysis of Eustachian tube function by video endoscopy
American Journal of Otology, 2000Co-Authors: Dennis S. Poe, I Pyykko, Hannu J Valtonen, Juha SilvolaAbstract:Objective: Human Eustachian Tubes (ET) were inspected in vivo endoscopically, and video recordings were made for careful slow-motion analysis of normal physiologic function. Setting: Ambulatory office in a tertiary referral center. Subjects: Thirty-four adults, 17 with no history of ET dysfunction (2 of whom had tympanic membrane perforations), 17 with known ET dysfunction. Interventions: Transnasal endoscopic examination of the nasopharyngeal opening of the Eustachian tube during rest, swallowing, and yawning. Main Outcome Measures: Video analysis of ET opening movements. Results: Normal ETs had four consistent sequential movements: ( I ) palatal elevation causing passive, then active, rotation of the medial cartilaginous lamina; (2) lateral excursion of the lateral pharyngeal wall; (3) dilation of the lumen, caused primarily by tensor veli palatini muscle movement beginning distally and inferiorly, then opening proximally and superiorly; and (4) opening of the tubal valve at the isthmus caused by dilator tubae muscle contraction. Dysfunctional ETs had intraluminal edema, polyps, or minimal muscle movement. Conclusions: Slow-motion endoscopic video analysis may be a useful new technique for the study of Eustachian tube physiology. Consistent muscle movement patterns were demonstrated in normal subjects but were absent in abnormal subjects. More studies of normal and abnormal patterns are needed to establish useful clinical correlates.
Lauren O. Bakaletz - One of the best experts on this subject based on the ideXlab platform.
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Challenge protocol time table.
2013Co-Authors: Elizabeth M. Brockson, Laura A. Novotny, Joseph A. Jurcisek, Glen Mcgillivary, Martha R. Bowers, Lauren O. BakaletzAbstract:Protocols to assess the ability of M. catarrhalis to induce OM in RSV-compromised juvenile chinchillas. For both protocols, nasopharyngeal mucosae, Eustachian Tubes and middle ear mucosae were collected for culture at the time of sacrifice. Bullar washes were performed upon bisection of the bullae to recover planktonic M. catarrhalis.
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M. catarrhalis ascended from the chinchilla nasopharynx to the middle ear.
2013Co-Authors: Elizabeth M. Brockson, Laura A. Novotny, Joseph A. Jurcisek, Glen Mcgillivary, Martha R. Bowers, Lauren O. BakaletzAbstract:Proof of concept study: M. catarrhalis was cultured from 100% of homogenates of nasopharynges, Eustachian Tubes and middle ear mucosae seven days after exclusively intranasal bacterial challenge (white bars). In addition, 60% of ears remained culture positive for M. catarrhalis eleven days after intranasal bacterial challenge (black bars).
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development of a chinchilla model to allow direct continuous biophotonic imaging of bioluminescent nontypeable haemophilus influenzae during experimental otitis media
Infection and Immunity, 2005Co-Authors: Laura A. Novotny, Kevin M Mason, Lauren O. BakaletzAbstract:We transformed a nontypeable Haemophilus influenzae clinical isolate with a plasmid containing the luxCDABE operon driven by the H. influenzae outer membrane protein P2 promoter. Herein, we demonstrate the ability to detect bioluminescence and to monitor infection within the nasopharynges, Eustachian Tubes, and middle ears of chinchillas after intranasal and transbullar challenges.
