Gerald Berke - Academia.edu (original) (raw)

Papers by Gerald Berke

JAMA otolaryngology-- head & neck surgery, Aug 1, 2015

Importance-Scientific understanding human voice production to date is a product of indirect inves... more Importance-Scientific understanding human voice production to date is a product of indirect investigations including animal models, cadaveric tissue study, or computational modeling. Due to its invasive nature, direct experimentation of human voice production has previously not been possible. The feasibility of an ex-vivo perfused human phonatory model has recently allowed systematic investigation in virtually living human larynges with parametric laryngeal muscle stimulation. Objective-In this study, the relationship between adductor muscle group stimulation and the open quotient (OQ) of vocal fold vibration was investigated using an ex-vivo perfused human larynx. Design-Human perfused tissue study. Setting-Physiology Laboratory. Participants-Human larynx is recovered from research-consented organ donors within two hours of cardiac death. Interventions, Main Outcomes and Measures-Perfusion with donated human blood is reestablished shortly after cardiac death. Human perfused phonation is achieved by providing subglottal airflow under graded neuromuscular electrical stimulation bilaterally to the intrinsic adductor groups and cricothyroid muscles. The phonation resulting from the graded states of

Journal of the Acoustical Society of America, Mar 1, 1991

The in vivo canine model of the larynx was used to measure transglottic pressures and air flow du... more The in vivo canine model of the larynx was used to measure transglottic pressures and air flow during phonation. Conditions of supraglottal resistance were also simulated. Pressure drop-flow curves were compared with data on collapsible tubes. The in vivo in canine model of the larynx demonstrates a number of features similar to oscillation in collapsible tubes.

Laryngoscope, Apr 1, 2006

Selective laryngeal adductor denervationreinnervation surgery for the treatment of adductor spasm... more Selective laryngeal adductor denervationreinnervation surgery for the treatment of adductor spasmodic dysphonia was reported in 1999 in 21 patients with encouraging results. Here, we report longterm results of this procedure. Surgical outcome was evaluated using patient surveys and perceptual voice assessment. Measured outcomes included Voice Handicap Index (VHI)-10 scores, patient questionnaire, and perceptual evaluation for voice breaks and breathiness. Patient survey was obtained from 83 patients, and perceptual voice evaluation was performed in voice samples from 46 patients. Average follow-up interval was 49 months. Mean VHI-10 scores improved from a mean of 35.6 to 12.7. Eighty-three percent showed significantly improved VHI-10 scores, representing improved physical, social, and emotional well-being. There was a high degree of patient satisfaction, with 91% agreeing that their voice is more fluent after the surgery. Perceptual evaluation of postoperative voice samples revealed voice breaks in 26% (15% mild, 4% moderate, 7% severe) and breathiness in 30% (11% mild, 13% moderate, 6% severe). A majority of patients had stable, long-lasting resolution of spasmodic voice breaks.

Otolaryngology-Head and Neck Surgery, Mar 1, 2006

OBJECTIVEEagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but im... more OBJECTIVEEagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES.STUDY DESIGNPatient histories, radiographic tests, and operative reports of 3 patients over a 3‐month period were prospectively collected.SETTINGTertiary referral otolaryngology service.RESULTSAll patients had resolution of symptoms relating to their elongated styloid processes after surgical resection.CONCLUSIONAlthough sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly.SIGNIFICANCEPatients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition.EBM rating: C‐4© 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved.

Otolaryngology-Head and Neck Surgery, Dec 1, 2004

To develop a canine model of vocal fold scar and to evaluate its treatment with lamina propria re... more To develop a canine model of vocal fold scar and to evaluate its treatment with lamina propria replacement therapy using autologous cultured fibroblasts. MATERIALS AND METHODS: Full thickness of the lamina propria layer in canine vocal folds was injured with a laser. Fibroblasts were cultured and expanded in the laboratory from a buccal mucosal biopsy. The scarred vocal folds were treated with 3 weekly injections of fourth, fifth, and sixth passage autologous fibroblasts. Mucosal waves and acoustic parameters were measured at baseline, after scarification, and several months after injection therapy. Histologic evaluation of the vocal folds for fibroblasts, collagen, elastin, reticulin, and hyaluronic acid was performed. RESULTS: Nine beagle dogs were used, and 1 animal served as control. Vocal fold scarring resulted in absent or severely limited mucosal waves and significantly worse acoustic parameters. Significant improvements in mucosal waves and acoustic parameters were obtained after lamina propria replacement therapy. After therapy, mucosal waves became normal in 4 animals and near normal in the other 4. No statistical difference was found in mucosal waves between baseline and post-therapy. All animals tolerated therapy without complications. The treated vocal folds demonstrated an increased density of fibroblasts, collagen, and reticulin, a decreased density of elastin, and no change in hyaluronic acid. CONCLUSIONS AND SIGNIFICANCE: Therapeutic options for vocal fold scars are limited. Lamina propria replacement therapy in the form of autologous cultured fibroblasts improves mucosal pliability and returns normal or near normal mucosal waves in experimentally scarred vocal folds. This novel therapeutic modality may hold new promise for treating vocal fold scars.

Journal of Voice, Nov 1, 2022

Journal of the Acoustical Society of America, Nov 1, 1990

Recent studies have indicated that glottal resistance varies inversely as a function of flow rate... more Recent studies have indicated that glottal resistance varies inversely as a function of flow rate [M. E. Smith and G. S. Berke, J. Acoust. Soc. Am.

Otolaryngology-Head and Neck Surgery, Sep 1, 1990

Surgical manipulation of the laryngeal framework (phonosurgery) is rapidly gaining interest and a... more Surgical manipulation of the laryngeal framework (phonosurgery) is rapidly gaining interest and attention. To date, however, a comparative objective evaluation of the various phonosurglcal techniques has not been reported. A theoretic model of the larynx, a four-mass model based on the work of Ishizaka (J Acoust Soc Am 1976:60:1193-8) and Koizumi et al. (J Acoust Soc Am 1987;82:1179-92), was developed and adapted to simulate laryngeal biomechanlcal behavior, as understood by current research. The model was then applied to a comparative evaluation of phonosurgical techniques. Input parameters that correlate laryngeal function and model simulation were devel oped. Surgical procedures were categorized according to their effect on these pa rameters. A model simulation of these techniques allowed comparison and prediction of the results of phonosurgery and a better understanding of the issues involved with surgical alteration of the voice. (OTOLARYNGOL HEAD NECK SURG 1990;103:380.)

Human Pathology, Sep 1, 2013

Sclerosing polycystic adenosis is an extremely uncommon, recently described, sclerosing lesion of... more Sclerosing polycystic adenosis is an extremely uncommon, recently described, sclerosing lesion of the salivary glands that appears histologically similar to fibrocystic changes of the breast. The key histopathologic features of sclerosing polycystic adenosis include lobular proliferation of ductal and acinar elements, cystically dilated ducts exhibiting frequent apocrine and sebaceous metaplasia, eosinophilic intracytoplasmic granules within some acinar-type cells, intraductal epithelial hyperplasia, and dense fibrosis. Most described cases have occurred in the major salivary glands, particularly the parotid gland. Although most authorities consider sclerosing polycystic adenosis to be a pseudoneoplastic process, the occurrence of dysplasia and carcinoma in situ of ductal epithelium reported recurrence rates of up to 30%, and recent evidence of clonality suggests a possible neoplastic etiology. However, there have been no cases of metastasis. Herein, we report the first case of sclerosing polycystic adenosis of the sinonasal tract in a 79-year-old woman presenting with a sinonasal mass.

Archives of Otolaryngology-head & Neck Surgery, Sep 1, 2001

he complaint of a clicking in the throat when swallowing is uncommon but very discomforting and p... more he complaint of a clicking in the throat when swallowing is uncommon but very discomforting and painful for those who experience it. It is such an unusual complaint that symptoms may be dismissed as psychogenic because a cause for the problem may not be readily apparent. We present a series of 11 cases in which all patients had an audible clicking or popping noise in the throat associated with neck and throat pain when swallowing or turning the neck. The most helpful diagnostic procedure was careful examination and palpation of the neck while the patient swallowed to localize the side and source of the clicking. Laryngeal computed tomographic (CT) scans helped in some cases to demonstrate thyroidcartilage and/or vertebral body asymmetry. Each case was treated with surgery of the neck and larynx to trim the portion of the thyroid cartilage causing the clicking. In most cases the superior cornu of the thyroid cartilage projected posteriorly and medially. Surgery was successful in all cases to eliminate the symptoms. Though an uncommon complaint, our experience suggests that the clicking throat is a surgically treatable problem.

Otolaryngology-Head and Neck Surgery, Aug 1, 1995

respectively, caudal to the emergence of cranial nerve XI. These same cervical plexus nerves on a... more respectively, caudal to the emergence of cranial nerve XI. These same cervical plexus nerves on average emerged from the posterior border of the sternocleidomastoid 10.32 mm and 14.64 ram, respectively, caudal to the puncture nervosum. An average of approximately two (actual, 1.94) nerves from the cervical plexus (range, one to three nerves) crossed the anterior border of the levator scapulae to either innervate this muscle on its superficial surface or just at its anterior border. Cervical plexus contributions crossed the anterior border of the levator scapulae in a superior to inferior progression. The two most superior contributions crossed the anterior border of the levator scapulae on average 15~03 ram. and 21.50 mm. respectively inferior to this muscle's intersection with the sternocleidomastoid. In any given neck specimen, cervical plexus nerves emerging from the posterior border of the sternocleidomastoid in route to the levator scapulae could branch or come together, which explains the difference in the average number of nerves that crossed the anterior border of the levator scapulae compared with the average number that emerged from the posterior border of the sternocleidomastoid. On average, the dorsal scapular nerve after piercing scalenus medius crossed deep to the anterior border of the levator scapulae 43.23 mm inferior to this muscle's intersection with the sternocleidomastoid. All innervation to the levator was deep to the prevertebral fascia. Among study parameters, statistically significant (p <0.05) differences were not encountered between right and left necks. Conclusions: The levator scapulae receives predictable motor supply from the cervical and brachial plexi. Our data elucidate surgical anatomy useful to head and neck surgeons.

Laryngoscope, 2009

Introduction Laryngeal tuberculosis is an uncommon disease that occurs in less than 1% of tubercu... more Introduction Laryngeal tuberculosis is an uncommon disease that occurs in less than 1% of tuberculosis cases. [1] For this reason, physicians usually do not include tuberculosis in the differential diagnosis of patients with laryngeal disease. However, since the incidence of tuberculosis is rising worldwide, it is important to consider this infectious disease when assessing patients with suspicious findings on history, along with documented laryngeal pathology. We report a case of an immuno-competent young female with laryngeal tuberculosis that masqueraded as squamous papillomatosis on both laryngoscopic and histologic examination.

Current Opinion in Otolaryngology & Head and Neck Surgery, Dec 1, 2000

Spasmodic dysphonia is a focal dystonia of the larynx. Most patients have the adductor variety ch... more Spasmodic dysphonia is a focal dystonia of the larynx. Most patients have the adductor variety characterized by a stereotypical strained and strangled voice quality. Intralaryngeal botulinum toxin (Botox) injection remains the mainstay of spasmodic dysphonia treatment. Botox, however, is limited by a short window of therapeutic effect and most patients need multiple injections each year. Some patients may additionally become resistant to the effects of Botox. Other chemotherapeutic agents are being sought to induce chemodenervation or chemomyectomy. Surgical treatment is also showing a resurgence after the initial trials in the 1970s and 1980s. Bilateral selective denervation of the laryngeal adductors with reinnervation by the ansa cervicalis holds promise for an excellent long-term treatment for adductor spasmodic dysphonia.

Annals of Otology, Rhinology, and Laryngology, Oct 1, 1989

Recent reports have suggested that blood flow to the vocal fold decreases during phonation. Howev... more Recent reports have suggested that blood flow to the vocal fold decreases during phonation. However, these studies relied on indirect measures of blood flow, such as tissue oxygen tension. Among the differing methods of measuring blood flow, one of the most sensitive is the microsphere surface technique. This technique has been effective in assessing the overall and regional blood flow to a number of dif ferent organs, including the cochlea. Employing an in vivo canine model, we injected microspheres into the left atrium. From there, they were distributed and became entrapped in the tissues in proportion to blood flow. We measured the blood flow to the entire vocal fold, as well as the lamina propria and muscularis layers. The results revealed a statistically significant (p< .002) increase in blood flow on phona tion. The increase, however, was due to increased flow to the muscularis layer. The flow to the lamina propria remained unchanged dur ing phonation. KEY WORDS-blood flow, canine vocal fold, phonation.

Annals of Otology, Rhinology, and Laryngology, Jul 1, 1999

Successful laryngeal transplantation will require adequate reinnervation of the larynx to allow p... more Successful laryngeal transplantation will require adequate reinnervation of the larynx to allow phonation, coordinated swallowing, and respiration. A delay between laryngectomy and transplantation would be necessary in oncology patients because of the need for immunosuppression. In these patients, reinnervation of the donor organ would require "banking" and recovery of dormant recipient recurrent laryngeal nerves (RLNs). This pilot study was undertaken to compare the effectiveness of RLN storage using 1 of 2 techniques: 1) inserting the nerve into a muscle pocket or 2) anastomosing the proximal RLN stump to the ansa cervicalis. Six months following nerve transection and "banking," the proximal anterior branch of the RLN was reanastomosed to the distal anterior segment and the posterior branch was anastomosed directly to the posterior cricoarytenoid muscle. Tensionometry, image analysis, and electromyographic data were collected 1 year later. Results show reinnervation of adductors and abductors with both techniques. Banking of the RLN branches during total laryngectomy is effective and should permit delayed physiological reinnervation following laryngeal transplantation.

Annals of Otology, Rhinology, and Laryngology, Dec 1, 2003

A canine model for recurrent respiratory papillomatosis (RRP) was developed with canine oral papi... more A canine model for recurrent respiratory papillomatosis (RRP) was developed with canine oral papillomavirus (COPY) inoculated into the buccal mucosa and supraglottic larynx of 5 beagles. The animals received systemic immunosuppression with daily oral prednisone at doses of 0, I, 2, 3, and 4 rug/kg. Buccal papillomata developed at 6 weeks in all animals and regressed by 10 weeks in the animals that received°and I rug/kg. The other animals had continuous growth of their buccal papillomata for 26 weeks. The animal that received 2 mg/kg developed papillomata on the lingual surface of the epiglottis that continued to grow through 26 weeks. Systemic oral prednisone successfully maintained COPY-induced oral and laryngeal papillomata in beagles. Thus, COPY-induced oral and laryngeal papillomata that are prednisone-maintained may have utility as a model for RRP. KEY WORDS-canine oral papillornavirus, immunosuppression, larynx, recurrent respiratory papillomatosis.

Journal of Voice, 1991

Summary Measurements of air pressure and flow were made using an in vivo canine model of the lary... more Summary Measurements of air pressure and flow were made using an in vivo canine model of the larynx. Subglottic pressures at varying flow rates were taken during phonation induced by laryngeal nerve stimulation. Results showed that during constant vocal fold stiffness, subglottic pressure rose slightly with increased air flow. The larynx in the in vivo canine model exhibited a flow-dependent decrease in laryngeal airway resistance. Increasing flow rate was associated with an increase in frequency of phonation and open quotient, as measured glottographically. Results from this experiment were compared with a theoretical two-mass model of the larynx and other theoretical models of phonation. The influence of aerodynamic forces on glottal vibration is explained by increased lateral excursion of the vocal folds during the open interval and shortening of the closed interval during the glottal cycle.

Otolaryngologic Clinics of North America, Feb 1, 2006

Otolaryngology-Head and Neck Surgery, Nov 1, 1992