Collagen XIX is an extremely rare extracellular matrix component that localizes to basement membrane zones and is transiently expressed by differentiating muscle cells. Characterization of mice harboring null and structural mutations of the collagen XIX (Col19a1) gene has revealed the critical contribution of this matrix protein to muscle physiology and differentiation. The phenotype includes smooth muscle motor dysfunction and hypertensive sphincter resulting from impaired swallowing-induced, nitric oxide–dependent relaxation of the sphincteric muscle. Muscle dysfunction was correlated with a disorganized matrix and a normal complement of enteric neurons and interstitial cells of Cajal. Mice without collagen XIX exhibit an additional defect, namely impaired smooth-to-skeletal muscle cell conversion in the abdominal segment of the esophagus. This developmental abnormality was accounted for by failed activation of myogenic regulatory factors that normally drive esophageal muscle transdifferentiation. Therefore, these findings identify collagen XIX as the first structural determinant of sphincteric muscle function, and as the first extrinsic factor of skeletal myogenesis in the murine esophagus.

This article reviews the diagnoses and treatment of temporomandibular disorders (TMD) and outlines of the role of botulinum toxin (BoNT) in the treatment of myofacial TMD. This manuscript includes a brief history of the use of BoNT in the treatment of pain, the mechanism of action of BoNT, and the techniques for injections, adverse effects and contraindications when using BoNT to treat mayofacial pain caused by TMD.

Objectives/Hypothesis: To clarify the time course of recovery in patients with idiopathic vocal fold paralysis. Study Design: Retrospective chart review. Methods: Medical records for all patients with idiopathic vocal fold paralysis over a 10-year period were reviewed to obtain demographic and clinical information, including onset of disease and recovery of vocal function. Stroboscopic exams of patients who recovered voice were reviewed blindly to assess return of vocal fold motion.Results: Thirty-eight of 55 patients (69%) recovered vocal function. Time course of recovery could be assessed in 34 patients who did not undergo injection augmentation. The mean time to recovery was 152.8 6 109.3 days (left, 179.8 6 111.3 days; right, 105.3 6 93.7 days; P 5.088). Two-thirds of patients recovered within 6 months. Probability of recovery declined over time. Five of 22 patients who recovered voice had return of vocal fold motion; 17 did not. The mean time to recovery did not differ between these groups (return of motion, 127.4 6 132.3 days; no return of motion, 160.1 6 105.1 days; P 5.290).Conclusions: Sixty-nine percent of patients with idiopathic vocal fold paralysis recovered vocal function, two-thirds doing so within 6 months of onset. Age, gender, laterality, use of injection augmentation did not influence recovery rate. Declining probability of recovery over time leads us to consider framework surgery after 6 months in patients with idiopathic paralysis.

Objective: Our ability to speak is complex, and the role of the central nervous system in controlling speech production is often overlooked in the field of otolaryngology. In this brief review, we present an integrated overview of speech production with a focus on the role of central nervous system. The role of central control of voice production is then further discussed in relation to the potential pathophysiology of spasmodic dysphonia (SD).Data Sources: Peer-review articles on central laryngeal control and SD were identified from PUBMED search. Selected articles were augmented with designated relevant publications.Review Methods: Publications that discussed central and peripheral nervous system control of voice production and the central pathophysiology of laryngeal dystonia were chosen.Results: Our ability to speak is regulated by specialized complex mechanisms coordinated by high-level cortical signaling, brainstem reflexes, peripheral nerves, muscles, and mucosal actions. Recent studies suggest that SD results from a primary central disturbance associated with dysfunction at our highest levels of central voice control. The efficacy of botulinum toxin in treating SD may not be limited solely to its local effect on laryngeal muscles and also may modulate the disorder at the level of the central nervous system.Conclusion: Future therapeutic options that target the central nervous system may help modulate the underlying disorder in SD and allow clinicians to better understand the principal pathophysiology.

Objective To clarify the time course of recovery in patients with iatrogenic vocal fold paralysis. Study Design Retrospective chart review. Methods Medical records for all patients with iatrogenic vocal fold paralysis over a 10‐year period were reviewed to obtain demographic and clinical information, including onset of disease and recovery of vocal function. Stroboscopic exams of patients who recovered voice were reviewed blindly to assess return of vocal fold motion. Results One hundred and two patients of 114 (89%) recovered vocal function. Time to recovery could be assessed in 39 patients who did not undergo injection augmentation. The mean time to recovery was 181.8 ± 109.3 days (left: 166.4 ± 106.7 days; right: 221.8 ± 115.6 days; P value = 0.095). Patients were analyzed according to anatomical site of surgery (skull base, carotid endarterectomy, thoracic, neck and intubation); there was no significant difference in time to recovery (P value = 0.60). Twelve of the 39 patients had recovery of vocal fold motion. The mean time to vocal recovery did not differ between patients with return of motion versus no return of motion (140.6 ± 118.0 days vs. 200.1 ± 102.2 days; P value = 0.147). Conclusion Age, gender, laterality, and anatomical site of injury do not influence recovery rate in iatrogenic vocal fold paralysis. The probability of recovery decreases over time but more slowly in comparison with idiopathic vocal fold paralysis, reflecting the greater heterogeneity of injury type in the iatrogenic population. Commonly available aggregate recovery rates overstate the potential for recovery. Level of Evidence 4 Laryngoscope, 129:1159–1163, 2019

No abstract

Depression is common in multiple sclerosis (MS), with a reported lifetime prevalence of 25–50% and a median point prevalence of 14%. Identification and validation of brief screening tools is essential. The objective of this study was to determine whether the self-administered Patient Health Questionnaire-9 (PHQ-9) is a potentially useful screening tool for depression in an MS clinic population. The PHQ-9 is an increasingly used clinical tool that is brief and specifically queries the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders IV: Text Revision (DSM-IVTR) depression criteria, making it easier for the clinician to diagnose depressive disorders. It has been validated in multiple medical and neurological populations. A total of 248 patients were given the PHQ-9 in the clinic waiting room, and 225 (mean age 43 years, 69% women) provided full responses. Rates of PHQ-9 depression are reported based on two scoring methods. With syndrome-based PHQ-9 scoring, 26 patients (12%) met criteria for either major depression (n = 15, 7%) or subthreshold major depression (n = 11, 5%). With a cut score of ≥10, 19% met criteria for significant depression. Both results are comparable to reported prevalence rates of depression in the MS literature. Twenty patients meeting syndromal depression criteria on the PHQ-9 were available for formal psychiatric evaluation, and all were diagnosed with a depressive disorder. Depressive symptom profiles revealed a low frequency of frank depressed mood and a preponderance of somatic symptoms, particularly fatigue and sleep disturbance. These preliminary results suggest that the PHQ-9 may be a useful tool in screening for depression in outpatients with MS. A formal validation study is indicated.

Clinical features may be used to predict the likelihood of a patient obtaining ML. Nomograms may be useful to counsel patients who would benefit from early definitive surgery.