bluuebunny/crossref_metadata_2025 huggingface dataset:
The Nuts and Bolts of Maintenance of Certification
Authors: Teng Marita S. , Miller Robert H. , Malekzadeh Sonya , Smith Shane
Published: September 2014

Program Description:

This miniseminar addresses a common knowledge gap regarding the purpose and process of maintenance of certification (MOC) in our field. Expert panelists include representatives from the American Board of Otolaryngology and the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) Education Council. Attendees will understand MOC as a 4‐component, lifelong learning and quality improvement program. We will address concerns, anxieties, and misconceptions of part III MOC; 2 panelists who have recently taken and passed the part III examination (1 academic and 1 private practice) will describe their experiences and recommendations. Finally, we will share AAO‐HNS educational resources designed for lifelong learning and MOC preparation.

Educational Objectives:

(1) Recognize MOC as a lifelong learning and quality improvement program. (2) Understand the 10‐year cycle and the specific requirements for each of the 4 components of MOC. (3) List AAO‐HNS educational resources designed for lifelong learning, maintenance of certification, and recertification.
Contemporary Management of Unilateral Vocal Fold Paralysis
Authors: Verma Sunil P. , Bryson Paul C. , Rosen Clark A. , Mau I‐fan Theodore , Garrett C. Gaelyn
Published: September 2014

Program Description:

This course will provide a comprehensive review of unilateral vocal fold paralysis (UVFP) management. The causes and workup of UVFP will be discussed. Special attention will be paid to office evaluation including utility of stroboscopy and laryngeal electromyography. Intervention including operating room–and office‐based injection laryngoplasty will be described. The benefits of thyroplasty, arytenoid adduction, arytenopexy, and reinnervation will be debated. Case presentations will be used to highlight teaching points. Ample time will be allotted for audience participation and questions.

Educational Objectives:

(1) Describe how to perform a vocal fold injection. (2) Compare different methods to treat unilateral vocal fold paralysis.
Sudden Sensorineural Hearing Loss: What Every Otolaryngologist Should Know
Authors: Lustig Lawrence R. , Megerian Cliff A. , Wanna George B. , Zeitler Daniel M. , Haynes David S.
Published: September 2014

Program Description:

Idiopathic sudden sensorineural hearing loss (ISSHL) has no known etiology. However, numerous studies have addressed this important problem. This miniseminar, sponsored by the American Academy of Otolaryngology—Head and Neck Foundation (AAO‐HNSF) Otology and Neurotology Education Committee, will summarize existing literature with regard to the evaluation and treatment of ISSHL. We will review AAO‐HNSF guidelines, studies on the efficacy of steroids, antivirals, hyperbaric oxygen, and other treatments. Lastly, we will discuss treatment options when hearing does not recover.

Educational Objectives:

(1) Implement the recommended evaluation of patients with sudden hearing loss. (2) Recognize the benefits of oral versus intratympanic steroids for sudden hearing loss. (3) Analyze the utility of nonsteroidal treatments when steroids and other modalities fail.
Pediatric Sleep‐Disordered Breathing: Evidence‐Based Approach to Evaluation and Management
Authors: Anne Samantha , Rosenfeld Richard M. , Ishman Stacey L. , Goldstein Nira A. , Friedman Norman R.
Published: September 2014

Program Description:

Sleep‐disordered breathing (SDB) affects more than 10% of all children, and tonsillectomy and adenoidectomy (T&A) is one of the most common surgeries done nationally. This miniseminar will review available current national guidelines on evaluation of SDB, including the use of polysomnogram and indications for T&A. Outcomes in routine, syndromic, obese, neurologically affected, and other cases will be reviewed. Lastly, surgical options for failures to cure with T&A will be discussed. Case studies will be presented that will demonstrate principles presented and foster discussion among panelists.

Educational Objectives:

(1) Describe patient characteristics that necessitate evaluation with polysomnogram versus proceeding with treatment based on clinical history and examination. (2) Identify common reasons for failure to cure SDB with routine T&A. (3) Demonstrate knowledge of available surgical options for these cases.
Pediatric Tonsillectomy after the Black Box: Strategies for Keeping Our Patients Safe and Comfortable
Authors: Goldman Julie L. , Eisenberg Lee D. , Ishman Stacey L. , Bannister Carolyn F.
Published: September 2014

Program Description:

This panel format miniseminar will provide perspectives on best practices in care of the pediatric tonsillectomy patient with regard to anesthetic practices, criteria for admission, and pain management. The goals of the presentation are to provide guidelines for safe and effective pain management, raise awareness regarding “red flags” in children who may require advanced anesthesia expertise, and propose algorithms for identifying and managing those children who may be at high risk for complications.

Educational Objectives:

(1) Provide safe and effective nonnarcotic postoperative pain management in pediatric tonsillectomy patients. (2) Identify children at increased risk for posttonsillectomy complications. (3) Recognize patients who will most benefit from the expertise of a pediatric anesthesiologist and/or a higher level of postoperative care.
From Start to Finish: Management of Chronic Rhinosinusitis
Authors: Holbrook Eric H. , Batra Pete S. , Chandra Rakesh K. , Chiu Alexander G. , Han Joseph , Sindwani Raj
Published: September 2014

Program Description:

Although our understanding of chronic rhinosinusitis (CRS) has improved, patients prove to be a diagnostic and therapeutic challenge. The variability in presentation contributes to the difficulty in providing effective medical and/or surgical therapy for each patient, and straightforward, all‐encompassing guidelines are lacking. As more innovative treatments arise, choices available to otolaryngologists become overwhelming. The purpose of this miniseminar is to provide a stepwise approach to the overall management of CRS patients. The panelists will cover aspects of patient care including evaluation and diagnosis, tailored medical management, surgical choice and optimization, and postoperative management.

Educational Objectives:

(1) Evaluate patients presenting with CRS and provide medical/surgical management recommendations for specific categories of CRS. (2) Discuss methods for improving surgical outcomes and recommend appropriate use of surgical devices/products for CRS. (3) Provide recommendations for effective postoperative management, use of subsequent in‐office procedures, and continued medical treatments for CRS.
Major Complications in FESS: Tips from Expert Surgeons
Authors: Tewfik Marc A. , Wormald Peter J. , Hwang Peter H. , Carrau Ricardo L. , Douglas Richard , Valentine Rowan
Published: September 2014

Program Description:

The risk of serious complications during endoscopic sinus surgery (ESS) is ever present. It is the responsibility of the operating surgeon to minimize the risks through meticulous preoperative preparation, careful operative technique, and diligent postoperative care. This miniseminar brings together some of the top sinus surgeons from around the world to share some of their technical pearls and experience regarding the treatment and avoidance of complications in ESS, as well as the latest research in the field. Through the use of clinical case‐based vignettes, topics that will be covered include CSF leak, orbital injury, and catastrophic hemorrhage.

Educational Objectives:

(1) Identify high‐risk situations preoperatively in patients undergoing functional ESS (FESS). (2) Apply intraoperative measures and technical pearls to avoid serious complications during FESS. (3) Elaborate a clear plan for the management of intraoperative emergencies, including orbital hematoma and internal carotid artery injury.
Ask the Experts: Sleep Surgery Potpourri
Authors: Friedman Michael , Weaver Edward M. , Yaremchuk Kathleen L. , Thaler Erica R. , Woodson B. Tucker , Kezirian Eric J.
Published: September 2014

Program Description:

Modification of uvulopalatopharyngoplasty (UPPP) as well as variation in treatment of hypopharyngeal obstruction are numerous. Selecting the right technique for the right patient often becomes the most difficult decision in treatment planning. It is often unclear if the proponents of a particular technique apply their “modifications” for every case or if there is a selection process. The purpose of this miniseminar is to present specific cases and hear the opinion of 5 experts on how they would treat the same patient.

Educational Objectives:

(1) Use the appropriate patient selection for a classic UPPP. (2) Determine when uvula preservation techniques are appropriate. (3) Examine the current thinking in tongue base reduction.
Pathogenic Biomarkers for Perineural Invasion in Adenoid Cystic Carcinoma
Authors: Kobayashi Kenya , Ando Mizuo , Omura Go , Saito Yuki , Yamasoba Tatsuya , Asakage Takahiro
Published: September 2014

Objectives:

Perineural invasion (PNI) has emerged as an adverse pathological feature of adenoid cystic carcinoma (ACC). Despite their importance, the local control factors involved in PNI remain unknown. Recent research has suggested that nerve growth factor (NGF) may be one of the important factors for PNI in other malignancies. Furthermore, in ACC, Myb overexpression related to the MYB–NFIB fusion gene has been correlated with PNI; however, this concept has been highly controversial. In this study, we examined the overexpression of NGF, its receptors (TrkA and p75NRT), and Myb in ACC cancer cells and investigated the relationship with PNI and local control.

Methods:

We retrospectively analyzed 47 patients with ACC who were surgically treated from 1991 to 2011. We reviewed NGF, TrkA, p75NRT, and Myb overexpression in the surgical specimens and examined the correlation with PNI, local control, and disease‐specific survival.

Results:

The overexpression rates of NGF, TrkA, p75NRT, and Myb were 66%, 66%, 30%, and 57%, respectively. NGF and TrkA were significantly overexpressed in the PNI‐positive group (NGF overexpression rate: PNI‐positive vs PNI‐negative, 88% vs 20%, P <. 001; TrkA overexpression rate: PNI‐positive vs PNI‐negative, 81% vs 33%, P <. 01). Moreover, patients with NGF overexpression had a significantly poorer 10‐year local control rate (75% vs 13%, P <. 05); however, p75NRT and Myb overexpression were not related to PNI.

Conclusions:

NGF and TrkA overexpression may contribute to PNI and cause local recurrence in ACC. However, Myb overexpression was not related to PNI in our analysis.
Tracheoesophageal Prosthesis Use Results in Durable Improvements in Vocalization and Overall Quality of Life
Authors: Sandulache Vlad C. , Srinivasan Ramya , Mohr Tiffany , Zevallos Jose P.
Published: September 2014

Objectives:

(1) Determine whether tracheoesophageal prosthesis (TEP) use is associated with improved quality of life. (2) Identify factors which negatively correlate with quality of life in patients utilizing TEP.

Methods:

Cross‐sectional analysis of total laryngectomy patients with and without TEP treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). Demographic, tumor, and treatment characteristics were reviewed. Functional status and quality of life were measured using the Voice Handicap Index (VHI), MD Anderson Dysphagia Index (MDADI), and University of Washington Quality of life Index (UW‐QOL).

Results:

Sixty‐one patients were identified, including 27 patients using TEP communication and 34 using either nonverbal communication or electrolarynx. TEP use at time of evaluation was associated with significantly higher VHI (TEP vs no TEP, global: P =. 00, functional: P =. 01, and emotional: P =. 00), MDADI (TEP vs no TEP global: P =. 01, functional: P =. 03) and UW‐QOL scores (TEP vs no TEP P =. 00) compared with other forms of communication. The effect of TEP on VHI, MDADI, and UW‐QOL persisted even when we limited the analysis to patients with a follow‐up greater than 5 years. Total laryngectomy for recurrent cancer did not significantly impact VHI or UW‐QOL but was associated with worse MDADI scores for patients using TEP. A history of irradiation was not significantly associated with worse functional outcomes.

Conclusions:

TEP use is associated with durable improvements in quality of life and functional outcomes for veterans undergoing total laryngectomy. TEP placement should be considered in all total laryngectomy patients when technically feasible.
Using PD‐L1 to Induce Chemosensitization of Head and Neck Squamous Cell Carcinoma
Authors: Szymanowski Adam R. , Qiao Peter , Lajud Shayanne A. , Nagda Danish , Civantos Alyssa , O'Malley Bert W. , Li Daqing
Published: September 2014

Objectives:

(1) Investigate the impact of programmed cell death ligand 1 (PD‐L1) on the response to Cisplatin (CDDP) therapy in head and neck squamous cell carcinoma (HNSCC). (2) Quantify the effect of CDDP treatment on the expression of PD‐L1 in HNSCC cells. (3) Evaluate the impact of PD‐L1 down‐regulation on the chemosensitivty of HNSCC cells. (4) Describe the implications of PD‐L1 modulation on the efficacy of current platinum‐based chemotherapeutic agents in HNSCC.

Methods:

In vitro experiments were performed from November 2013 to January 2014 at the University of Pennsylvania Gene and Molecular Therapy Laboratory with 4 well‐characterized human HNSCC cell lines. Quantitative polymerase chain reaction (qPCR) and western blot were conducted to determine the baseline and post‐CDDP treatment PD‐L1 gene expression. Knockdown of PD‐L1 expression using siRNA was then performed to induce chemosensitization of HNSCC cells to CDDP. Cells treated with CDDP were compared with untreated controls to evaluate cytotoxicity.

Results:

Treatment of HNSCC cells with CDDP resulted in increased transcription and translation of PD‐L1 compared with baseline levels. Subsequent knockdown of PD‐L1 expression in HNSCC cells using siRNA resulted in increased CDDP cytotoxicity compared with control HNSCC cells.

Conclusions:

Increased PD‐L1 expression in response to CDDP therapy and improved chemosensitization with its down‐regulation are significant findings that highlight the role of PD‐L1 in determining the efficacy of chemotherapeutic agents. Our findings demonstrate that disruption of the PD‐L1 protein leads to increased sensitivity of HNSCC cells to CDDP, suggesting a potential combination therapeutic strategy for patients with CDDP‐resistant HNSCC.
The Anatomic Location and Distribution Pattern of Malignant and Premalignant Glottic Lesions
Authors: Shoffel‐Havakuk Hagit , Halperin Doron , Yosef Liron , Lahav Yonatan
Published: September 2014

Objectives:

(1) Describe the anatomic location and distribution pattern of glottic dysplasia and early glottic cancer over the vocal folds. (2) Better understand the anatomic locations where glottic carcinogenesis initiates.

Methods:

A cohort reviewing glottic dysplasia or carcinoma patients, in a referral center, between 2008 and 2013. Lesions were described in terms of location and size, and a novel grid system was used to map their anatomic distribution.

Results:

A total of 167 patients were included; 78 with dysplasia and 89 with T1 early glottic carcinoma. The medial aspect was found to be more involved than the superior aspect, 95% versus 71%, respectively (P <. 001). Using the grid system, the most involved area was the midpoint of the membranous vocal fold at the transition between the superior and medial aspects. Ninety‐seven percent of the lesions occupied this specific area, with no difference between smokers and nonsmokers. The vocal process mucosa was involved in 48 patients. Exclusive vocal process involvement was limited to 2 cases. All other 46 patients demonstrated extensive disease, encompassing more than half of the vocal fold's length. Carcinoma in situ and invasive carcinoma lesions tended to be larger and to involve the superior aspect, otherwise all lesion types showed similar pattern of distribution.

Conclusions:

Premalignant and malignant glottic lesions tend to involve the medial aspect of the vocal fold, and the midpoint of the membranous part in particular. This might correlate with the anatomic origin of glottic carcinogenesis.
Characteristics of Supraglottitis in Adults
Authors: Tamir Sharon‐Ovnat , Barbalat Irina , Marom Tal , Goldfarb Abraham , Roth Yehudah
Published: September 2014

Objectives:

Describe the demographics, clinical presentation, interventions, and outcomes of adult patients diagnosed with acute supraglottitis.

Methods:

We retrospectively identified adult patients with acute supraglottitis during the years 1990 through 2013 by using relevant International Classification of Disease codes. Data were extracted for demographic and clinical information.

Results:

A total of 288 eligible patients were enrolled. Diagnosis was made by either indirect or fiber‐optic laryngoscopy (or both modalities). The incidence rate of acute supraglottis was 4.3 out of 100,000 patients/year, with a steep rise during the years 1999 through 2013. A slight male predominance was observed (n = 160, 56%). The mean age was 50 ± 16 years, and 77% were 30 to 70 years old. Sore throat (94%) and dysphagia (88%) were the most common presenting symptoms, which had begun 2 days prior to hospitalization. Comorbidities were reported in 62% of the patients. Swabs were obtained in 17% of patients, of those 23% were positive. Patients were hospitalized either in the otolaryngology department (n = 255, 89%) or in the intensive care unit (ICU) (n = 33, 11%). Of the ICU patients, 19 (58%) had an airway securing intervention procedure (84% upon admission, 16% during initial 24 hours surveillance). Amoxicillin‐clavulanate was administered in 61% of patients. Intravenous and inhalational corticosteroids were administered in 190 (66%) patients. The mortality rate was 0.003%.

Conclusions:

The signs and symptoms of supraglottitis in adults are different from those in the pediatric population. Patients presenting with sore throat, dysphagia, or odynophagia should be cautiously suspected for supraglottitis until proven otherwise. Treatment includes intravenous antibiotics and steroids and outcomes are excellent.
Clinical Study of Postoperative Swallowing in Multiple System Atrophy
Authors: Ueha Rumi , Nito Takaharu , Yamauchi Akihito , Uranaka Tsukasa , Yamasoba Tatsuya
Published: September 2014

Objectives:

Some patients with multiple system atrophy (MSA) require surgical management such as tracheostomy and laryngeal closure with the evolution of diseases such as severe dysphagia and/or respiratory disorder. There are few reports about the relationship between dysphagia and vocal cord paralysis (VCP) and about postoperative feeding in MSA patients. The aim of this study is to describe clinical management and outcomes of surgical treatment in MSA patients.

Methods:

From 2001 to 2013, 16 MSA patients (11 males) underwent surgical procedures. All cases were retrospectively evaluated for vocal fold fixed position, degree of dysphagia, the duration between the onset of dysphagia (or dyspnea) and surgery, and perioperative feeding.

Results:

The mean age was 64.3 years (range, 52‐76 years). Tracheostomy was made in 9 patients, and laryngeal closure was performed in 11 patients. Four of 7 patients underwent laryngeal closure (LC) 7.5 weeks (2 to 14) after tracheostomy. Eleven patients had severe dysphagia. The bilateral vocal folds were fixed in a median position in 13 patients. The duration from onset of MSA and surgery was 3 to 111 months (median 59 months). All patients with LC were preoperatively unable to take anything from mouth, but postoperatively all of them regained complete/partial oral intake.

Conclusions:

In MSA patients, a correlation between dysphagia and VCP is suggested, however it was revealed that dysphagia does not always precede VCP. This study also showed that LC enables patients to take food orally, regardless of severe dysphagia.
Effects of Effortful Swallow on Esophageal Function in Patients with Presumed Esophageal Motility Disorders
Authors: Kiell Eleanor P. , Lintzenich Catherine R.
Published: September 2014

Objectives:

(1) Describe the changes in esophageal amplitude and swallow duration during an effortful swallow in patients with esophageal pathology. (2) Understand the utility of the effortful swallow in rehabilitation of esophageal dysmotility disorders.

Methods:

Prospective case control study in which 10 patients referred for esophageal manometry were enrolled. Each participant performed 20 swallow trials (10 effortful and 10 normal) where amplitude and duration of swallow were measured at 4 different sensors (1 striated, 1 mixed, and 2 smooth muscle sites). The effects of the swallow condition (effortful vs noneffortful), sensor site, and sex on esophageal peak pressure and swallow duration were examined.

Results:

The study included 10 participants (8 females, 2 males). There were several patients in whom the effortful swallow showed a statistically significant increase in peak swallow pressure or duration of the measured swallow at a particular sensor. This was not consistent across all patients nor across a particular sensor. There were more statistically significant changes in males compared with females.

Conclusions:

Despite clear evidence in previous studies demonstrating that volitional manipulation of the oropharyngeal phase of swallowing affects esophageal physiology in healthy individuals, a small study of patients with esophageal pathology is unable to demonstrate similar results. In future studies, we will aim to include a greater number of patients with diagnosed esophageal dysmotility.
Extraesophageal Reflux in Patients Undergoing General Endotracheal Tube Anesthesia
Authors: Regenbogen Elliot , Oleszak Slawomir P. , Corrado Thomas , Shroyer Annie L. , Goldstein Jordan , Marzouk Mark , Pearl Michael L.
Published: September 2014

Objectives:

Explore hypopharyngeal exposure to abnormally high or low pH during surgery performed under general endotracheal tube anesthesia and to compare results to published normative 24‐hour data.

Methods:

Twenty volunteers for this prospective cohort study were recruited from June through September 2013. A wireless Dx‐pH monitoring system was used during surgery. A drop from baseline to pH <5.5 was defined as a hypopharyngeal event, with thresholds pH 4.0, 4.5, and 5.0 also examined. Results were compared with supine events published by Chheda et al in 2009.

Results:

The number and duration of hypopharyngeal events <15 minutes with pH below 4.0, 4.5, 5.0 and percentage of surgery time in hypopharyngeal events (from a pH = 5.5 to return to baseline) were similar to comparative data. However, including all duration events (> ≤ 15 minutes), the number and duration of events at all thresholds and the percentage of surgery time in hypopharyngeal events were consistently higher than comparative data. Most analyses with the potential predictive/confounding variables (ie, body mass index, Reflux Symptom Index, Voice Handicap Index‐10) yielded nonsignificant results.

Conclusions:

Extended pharyngeal exposure to moderately reduced pH levels (greater than sleeping or resting in a supine position) were documented. Approximately 20% of surgical patients may experience extensive exposure to pH <5.5 (over 1 hour, >30% of surgery time) and an additional 20% may experience moderate exposure to pH <5.5 (5‐20 minutes and/or 4% to 10% of surgery time). Additional studies are needed to predict which patients might be at elevated risk for this exposure as well as the impact of this exposure on clinical outcomes.
The Mayo Clinic Spasmodic Dysphonia Experience: A Demographic Analysis of 686 Patients
Authors: Patel Alpen B. , Pollei Taylor R. , Bansberg Stephen F. , Adler Charles H. , Lott David G. , Crujido Lisa R.
Published: September 2014

Objectives:

(1) Review demographic data collected over a 23‐year experience of 686 patients with spasmodic dysphonia (SD) who have been treated with onabotulinum toxinA (onaBTX‐A). (2) Compare demographic trends surrounding SD with previously published data.

Methods:

A retrospective chart review was conducted. A total of 686 patients with SD were treated with 6345 onaBTX‐A injections at Mayo Clinic Arizona between 1989 and 2013. Demographic data were compiled and analyzed. Patients were subdivided based on type of SD, presence of vocal tremor (VT), and presence of neurologic disorders. Family history of neurological disorders was also recorded.

Results:

In 686 patients, 432 patients were female (63.0%) and 254 patients were male (37.0%). A total of 630 patients (91.8%) were of the adductor type (AdSD) and 56 patients (8.2%) were of the abductor type (AbSD). AdSD patients noted symptom onset and began injections at an older age than AbSD patients (52.5; 60.6 years vs 43.7 years; 50.0 years, respectively). A total of 374 patients (54.5%) had VT, with 355 AdSD patients and 19 AbSD patients. A total of 45 patients (6.6%) had other movement disorders, such as blepharospasm (1.5%), torticollis (2.3%), limb dystonia (1.0%), or oromandibular dystonia (1.8%). Family history of SD was positive in 4 patients (0.6%) and of other dystonias in 9 patients (1.3%).

Conclusions:

Spasmodic dysphonia is a chronic and potentially disabling laryngeal dystonia resulting from disrupted motor control of the laryngeal musculature during phonation. This large series adds new insight and contributes to the current literature regarding the clinical scope and nature of SD.
Prevalence and Impact of Swallowing Disorders among United States Adults
Authors: Bhattacharyya Neil
Published: September 2014

Objectives:

(1) Determine the prevalence of swallowing problems and reported etiologies and (2) understand their impact among United States adults.

Methods:

The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was investigated.

Results:

An estimated 9.44 ± 0.33 million adults (mean age 52.1 years; 60.2 ± 1.6% female) reported a swallowing problem (4.0 ± 0.1%). Overall, 22.7 ± 1.7% saw a health care professional for their swallowing problem and 36.9 ± 0.1.7% were given a diagnosis. Females were more likely than males to report a swallowing problem (4.7 ± 0.2% versus 3.3 ± 0.2%, P <. 001). A total of 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422 ± 77 thousand cases; 11.2 ± 1.9%), followed by other neurological cause (269 ± 57 thousand; 7.2 ± 1.5%) and head and neck cancer (185 ± 40 thousand; 4.9 ± 1.1%). The mean number of days affected by the swallowing problem in the past year was 139 ± 7 days. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without (contrast, +8.1 lost workdays, P <. 001).

Conclusions:

Swallowing problems affect 1 in 25 adults annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.
Redesign of the Microsurgical Interface with a Novel, Computer‐Assisted “Virtual Microscope” System in Laser Phonomicrosurgery
Authors: Guastini Luca , Matos Leonardo , Deshpande Nikhil , Ortiz Jesus , Mora Francesco , Peretti Giorgio
Published: September 2014

Objectives:

(1) Augment surgeon skills through gesture scaling and magnified visualization. (2) Eliminate extensive training using intuitive stylus‐based manipulation. (3) Perform active constraints intraoperative planning assisting the surgeon.

Methods:

The virtual microscope elements system are: Motorized Micromanipulator, Graphics Stylus with Tablet, Virtual Microscope (VM), Configuration Interface (CI). The apparatus has been implemented and tested between July and December 2013 by resident surgeons and medical students. The surgeon performs the surgical tasks in the VM interface, consisting of modified head‐mount display and HD cameras attached to a microscope. The CI includes different categories: in‐surgery messages, choosing assistive features, system configuration, etc. The assistive features in the VM include: Precise aiming and incision with laser, defining virtual scan patterns allowing incision and ablation planning for automatic execution, defining regions where the laser is active (safe area), or inactive (dangerous area). The apparatus was compared with the state‐of‐the‐art Lumenis AcuBlade (AB) interface. Average path outcome measurements following error and statistical subjective evaluations of usability were made.

Results:

The average path following error (root mean square error value) was 0.25 mm while maximum error was 0.66 mm. VM is more accurate and superior to AB, which provided values of 0.51 mm and 1.20 mm, respectively, in earlier trials. The subjective evaluations of usability gave a score of 88.3 for the VM. Earlier trials with AB provided a score of 65.56. VM interface is simple, usable, easy to learn, and appropriate.

Conclusions:

The VM was created to provide improved precision, safety, and better ergonomics for microsurgery procedures. The system provides enhanced 3D visualization and allows delicate maneuvers.
Spasmodic Dysphonia: A 20‐Year Experience of Injecting Botulinum Toxin
Authors: Namin Arya W. , Christopher Kara , Eisenbeis John F.
Published: September 2014

Objectives:

(1) Report the initial dosing for adductor and abductor spasmodic dysphonia (ADSD, ABSD). (2) Identify trends in dosing for patients with SD over extended time.

Methods:

A retrospective review of the medical records of 149 patients who received 2484 Botox injections from the same physician at a tertiary medical center between January 1993 and December 2012. The location and dose of injection, age of the patient at injection, and the interval in days between injections were recorded.

Results:

There were 13 ABSD patients and 136 ADSD patients. The initial dose injected into each vocal fold for patients with ABSD (mean = 2.8 units) was significantly higher than for patients with ADSD (mean = 1.52; t = 4.46; P <. 001). Seventy patients received 10 or more injections during the study period (range, 1‐92 injections). Sixty‐six patients have been followed for greater than 5 years. There appear to be several trends which determine the proper dose for management of vocal cord spasms. One group establishes a stable dose with minimal side effects and adequate interval of normal phonation. A second group tends to have variability in the tolerance of side effects and voice results from each injection and requires dose modification continually over time.

Conclusions:

Analysis of this patient cohort receiving a high number of injections over an extended period of time reveals variable dosing patterns. This may represent subjective differences in patients’ ability to tolerate side effects of Botox treatment. It may also indicate variability in the etiology and pattern of this neurologic disease.
Utility of High‐Dose Corticosteroids in the Treatment of ACE‐Inhibitor–Induced Angioedema
Authors: Bangiyev John N. , Kieu Monica C. Q. , Ray Amrita , Cavaliere Salvatore , Amjad Esmael H.
Published: September 2014

Objectives:

Airway compromise is a common and dangerous presenting sign of ACE‐inhibitor–induced angioedema (AIIA). After a definitive airway is obtained, there is minimal evidence‐based data for the effectiveness of commonly used medical intervention. While dosing protocols for the treatment of AIIA vary between institutions, they usually contain a corticosteroid, H1‐blocker, and an H‐2 blocker. The aims of the study were: (1) Define ACE‐inhibitor‐induced angioedema. (2) Describe common upper aerodigestive subsites of involvement. (3). Discuss the role of corticosteroids in the management of ACE‐inhibitor–induced angioedema.

Methods:

We retrospectively reviewed 200 patient charts from a tertiary care center with diagnosed AIIA to determine the effectiveness of medications utilized in AIIA treatment. These patients were all admitted to the intensive care unit for airway monitoring. The intervention group (n = 100) received high dose steroids, H‐1 and H‐2 blockers IV. The control group (n = 100) received low dose or no steroids with or without H‐1 and H‐2 blockers. Outcome measures included length of hospital stay, length of ICU stay, emergent airway intervention, surgical airway intervention, and time intubated.

Results:

Preliminary data analysis supports a role for high dose corticosteroids in shortening length of stay (P <. 05) and decreasing surgical airway intervention (P <. 03). There is a trend for corticosteroids in reducing time intubated.

Conclusions:

These findings indicate that there is a role for medical management of upper aerodigestive AIIA with corticosteroids. These findings may ultimately help with the delineation of a standard protocol for AIIA.
Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap: Indications, Outcomes, and Technical Considerations
Authors: Lawson Bradley R. , Moreno Mauricio A.
Published: September 2014

Objectives:

Chimeric anterolateral thigh (ALT) free flaps are comprised of multiple skin paddles or muscular components, which allow for the reconstruction of complex 3‐dimensional defects. There is a paucity of data in the literature regarding the outcomes with this reconstructive option. We sought to describe our results with this technique and identify outcome predictors.

Methods:

Retrospective review of 24 patients undergoing reconstruction with a chimeric ALT free flap at an academic tertiary institution between 2009 and 2013. Demographics, indications, comorbidities, flap and functional outcomes were retrieved from the medical records and review of intraoperative photography. SPSS was used for data analysis.

Results:

The mean age was 57 years and the cohort primarily consisted of males (87.5%). The most frequent defects were: through‐and‐through pharyngoesophageal, n = 12 (50%) and skull base, n = 6 (25%). The flap consisted of double skin paddles in 11 cases (45.3%) and a skin paddle with an independent muscular component in 13 (54.7%). The mean skin paddle area was 62 cm2. There were no total flap losses; partial loss (secondary skin paddle) was observed in 3 cases and was related to severe congestive heart failure (P =. 005) and malnutrition (P =. 002). Postoperative fistula was associated to immunodeficiency (P =. 02) and malnutrition (P =. 004). All except one patient who underwent pharyngeal reconstruction resumed oral diet. The mean time to resume diet was 27 days.

Conclusions:

Chimeric ALT flaps represent an excellent alternative for reconstruction of complex defects. Patients with congestive heart failure, with immunodeficiency, and who are malnourished are at higher risk of partial flap loss. A second muscle paddle might be indicated in these cases.
Dizziness Profile and Clinical Features: A Population‐Based Survey in São Paulo City, Brazil
Authors: Oiticica Jeanne , Bittar Roseli S. M. , Mezzalira Raquel , Grasel Signe S.
Published: September 2014

Objectives:

In clinical practice, knowing the epidemiology of dizziness is essential. The aim of the study was to estimate the prevalence of dizziness among the adult population of the city of São Paulo, Brazil and describe the clinical features and level of discomfort.

Methods:

A cross‐sectional epidemiological survey was conducted in São Paulo, Brazil between April and October 2012. In this field study, 1960 household interviews were completed. The following variables were assessed: sex, age, clinical characteristics of dizziness, and dizziness disability index. Chi‐square test, Student t test, Tukey test, and logistic regression were used for statistical analysis (95% confidence interval).

Results:

The dizziness prevalence was 42%. Among 2 age groups, peaks of dizziness were observed: 49% among the 46 to 55 years old and 44% among the elderly subjects (>65 years old). Vestibular vertigo was estimated in 8.3% with a strong female preponderance (P <. 001). Symptoms caused disability in 27% of the affected respondents and were more frequent among women (P <. 001), who sought medical care more frequently (P <. 001). The dizziness disability index was significantly higher (P =. 0165) among subjects with lower educational level. There was no correlation between dizziness discomfort and the type of job.

Conclusions:

The prevalence of dizziness in São Paulo, Brazil, was established in 42%. Among the symptomatic subjects, 67% reported interruption of daily activities, but only 46% of them sought medical attention.
Lateral Skull Base Reconstruction: A Comparison of the Submental Flap to Free and Regional Flaps
Authors: Howard Brittany E. , Hayden Richard E. , Barrs David M. , Nagel Thomas H. , Hinni Michael L. , Donald Carrlene B.
Published: September 2014

Objectives:

(1) Recognize reconstructive options for lateral skull base defects. (2) Compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions.

Methods:

Retrospective review of surgical techniques used at a tertiary academic referral center between 2002 and 2014 to reconstruct lateral skull base composite defects involving facial skin, ear, and temporal bone. Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes.

Results:

Thirty‐one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions including squamous cell carcinoma (n = 22), basal cell carcinoma (n = 2), melanoma (n = 4), and sarcoma (n = 3). Defects were reconstructed with musculocutaneous free flaps (n = 9), pedicled latissimus dorsi flaps (n = 6), and pedicled submental flaps (n = 16). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time required for surgical resection was similar, time savings was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean 578 vs 455 minutes; P =. 0170) and duration of hospitalization (9 vs 4.9 days; P =. 0207). Submental flaps were significantly less likely to require revision debulking procedures (median = 0) compared to free flaps (median = 1.8; P =. 00002) and latissimus dorsi flaps (median = 1; P =. 0093). There was 100% flap survival.

Conclusions:

The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative times, duration of hospitalization, and flap revisions.
Encephaloceles of the Posterior Fossa: A Series of 10 Cases
Authors: Rereddy Shruthi K. , Mattox Douglas
Published: September 2014

Objectives:

(1) Describe 10 cases of posterior fossa encephaloceles. (2) Compare spontaneous posterior fossa encephaloceles to the more common middle fossa encephaloceles.

Methods:

This is a retrospective review of patients with surgically‐confirmed encephaloceles of the posterior fossa managed at a tertiary care center from 2006 to 2013. Clinical presentation, imaging, and operative findings were reviewed. Patient demographics were summarized with descriptive statistics.

Results:

Ten cases of surgically confirmed posterior fossa encephaloceles were identified. The median age of diagnosis was 45.5 years; 6 subjects were female, 4 were male. The median length of follow‐up was 18 months, with 2 subjects lost to follow‐up. Seven of 10 cases followed temporal bone surgery, craniotomy, or trauma. The remaining 3 out of 10 were spontaneous. Two of 3 subjects with spontaneous encephaloceles presented with pneumocephalus and 1 with cerebrospinal fluid otorrhea. Computed tomography scans in all cases showed bone loss and soft tissue protrusion from posterior fossa into the mastoid, with a radiologic differential of arachnoid granulation versus encephalocele. At surgical exploration, there was brain tissue protruding from a defect of the posterior fossa in all cases. One subject had a concomitant tegmen defect.

Conclusions:

Posterior fossa encephaloceles are much less common than middle fossa encephaloceles, only 23 have been reported to date. The difference is presumably due to intracranial pressure differences in the upright position. Given the location of these 3 spontaneous posterior fossa defects, as well as intraoperative findings of cerebral tissue within the mastoid, we suggest that these lesions are true encephaloceles and not just arachnoid granulations.
Hearing Loss in Patients with Inflammatory Bowel Disease
Authors: Shaul Chanan , Koslowsky Benjamin , Peleg Uri , Gross Menahem , Wengrower Dov
Published: September 2014

Objectives:

Inflammatory bowel disease (IBD) has many characteristics of autoimmune diseases. Sensorineural hearing loss has been reported in many autoimmune diseases. Little is known about hearing loss in patients with IBD.

Methods:

A prospective blinded comparative study was conducted over a 3‐year period. IBD patients and controls underwent a complete otolaryngology examination and audiometry test.

Results:

A total of 105 participants (76 patients and 29 controls) took part in this study. A total of 59 (77%) had Crohn's disease (CD) and 17 (23%) had ulcerative colitis (UC). Mean age was 36 years, 51% were males and 40% of the patients were presently hospitalized due to IBD exacerbation. Sixteen of 76 (21%) of the IBD patients complained of hearing loss since first IBD diagnosis and 13% had current hearing disabilities. Audiometric examination revealed that any hearing loss (mild to severe) was found in 23 (30%) of the IBD population, compared with 3 (10%) of the control group (P <. 05). Sensorineural was the hearing deficiency type in 93% of them. Out of 46 patients, whose extraintestinal manifestation (EIM) status was clearly documented, 43% (n = 20) had EIMs. Hearing loss was present in 5 out of 20 (25%) of these patients, compared with 0 out of 23 who did not have EIMs (P <. 01). IBD phenotype, current hospitalization, and disease type were not different between these groups.

Conclusions:

Sensorineural hearing loss may be another EIM of IBD. It is found in 30% of IBD patients, and in up to 43% of patients with other EIMs. Early hearing evaluation should be recommended to IBD patients who have other EIMs.
Hearing Preservation after Middle Fossa Vestibular Schwannoma Removal: Are the Results Durable?
Authors: Quist Tyler , Givens Daniel J. , Gurgel Richard K. , Chamoun Roukoz , Shelton Clough
Published: September 2014

Objectives:

(1) Describe hearing preservation rates following microsurgical excision of vestibular schwannoma (VS) via middle cranial fossa (MCF) approach. (2) Evaluate long‐ term hearing outcomes after hearing preservation.

Methods:

This is a retrospective case series of patients with VS who underwent resection via a MCF approach between February 1998 and December 2009 at a tertiary care academic medical center. Audiograms including pure tone average (PTA) and word recognition score (WRS) were obtained preoperatively, immediately postoperatively, and at 5‐year follow‐up.

Results:

Sixty patients underwent MCF during the study period. Preoperative serviceable hearing (American Academy of Otolaryngology—Head and Neck Surgery class A/B) was present in 52 (86%) of the 60 subjects, with an average PTA of 22 dB (range, 1‐50 dB) and an average WRS of 97% (range, 76‐100%). Immediate postoperative serviceable hearing was maintained in 29 (55%) of the subjects, with an average PTA and WRS of 31 dB (5‐50 dB) and 96% (70‐100%), respectively. Five‐year follow‐up was obtained for 18 of the 29 subjects. After 5‐year follow‐up, 14 (78%) of the 18 subjects maintained serviceable hearing with an average PTA and WRS of 33 dB (4‐49 dB) and 95% (84‐100%), respectively. Of the 4 patients who did not maintain class A/B hearing, average change in PTA and WRS was 17 dB (5.5‐23 dB) and 16% (0%‐40%), respectively. The patient with the most dramatic change in 5‐year hearing had a tumor recurrence.

Conclusions:

For patients with VS in whom serviceable hearing is preserved following MCF approach, the long term hearing outcome remains durable in the majority of patients.
Learning Curves of Syllabus Otological Procedures: Monitoring Trainee Progress and Understanding Competence
Authors: Awad Zaid , Hayden Lindsay , Muthuswamy Keerthini , Ziprin Paul , Darzi Ara , Tolley Neil S.
Published: September 2014

Objectives:

Otolaryngology trainees in the United King‐dom undergo regular procedure‐based assessments (PBAs) throughout training, however, these are rarely used to monitor progress or measure competence. The assessment tool is procedure specific and produced by the Joint Committee of Surgical Training. It consists of 6 domains: consent, planning, preparation, exposure/closure, operative technique, and postoperative care. The aim of the study was to validate PBA in assessing otolaryngology trainees and to identify the level and pace at which trainees show competence in syllabus otological procedures.

Methods:

This is a longitudinal study from October 2008 to October 2013. We analyzed all PBAs submitted by North‐Thames London otolaryngology trainees, including junior or core trainees (CT) and senior specialty trainees (ST). We calculated and used the overall score (oS) mean and standard deviations to draw procedure‐specific learning curves for common otological operations.

Results:

A total of 3306 PBAs from 46 trainees were analyzed, 621 were otological. PBA was highly reliable showing internal consistency (Cronbach's Alpha: 0.921) and discriminated between different grades (CT and ST, Mann‐Whitney‐U: P <. 001) and levels within each grade (CT1‐2 and ST3‐8, Kruskal Wallis: P <. 001). All domains contributed to the calculated score and the most predictive was operative technique. Three procedures achieved sufficient power (n > 100, 90% confidence) to draw learning curves. The procedures were: ventilation tubes, tympanoplasty, and mastoidectomy.

Conclusions:

PBA is valid for assessing ENT trainees. Procedure‐specific competency curves can be drawn to set milestones and deliver targeted training. They can help understand the pace and level at which trainees master individual otological procedures replacing arbitrary numbers currently in use.