bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistently Elevated Parathyroid Hormone Despite Successful Parathyroid Surgery
Authors: Kim Anna , Duke William S. , Terris David J.
Published: September 2014

Objectives:

(1) Recognize that a number of patients with primary hyperparathyroidism will continue to manifest elevated parathyroid hormone (ePTH) despite achieving eucalcemia after curative parathyroidectomy. (2) Identify the preoperative factors that may contribute to this phenomenon. (3) Counsel patients and physicians regarding these factors to prevent unnecessary reoperative surgical procedures in response to postoperative elevated parathyroid hormone.

Methods:

Records of all patients who underwent curative primary surgery for single gland parathyroid adenomas at Georgia Regents Department of Otolaryngology Head and Neck Surgery between January 2009 and April 2013 were retrospectively reviewed. Patient demographic data and preoperative PTH, calcium, ionized calcium, 25‐OH‐vitamin D, creatinine, and glomerular filtration rate (GFR) levels were recorded, along with postoperative calcium, ionized calcium, and PTH levels. The values from patients with ePTH and normal PTH postoperatively were compared.

Results:

Of 119 patients meeting inclusion criteria, 30 (25.2%) demonstrated postoperative ePTH with eucalcemia. This group had significantly higher preoperative PTH (P =. 0021) and creatinine (P =. 0065) levels and a lower GFR (P =. 0016) than those with a normal postoperative PTH. The preoperative vitamin D level was not significantly associated with ePTH postoperatively (odds ratio [OR] = 1.56). Preoperative compromised renal function, specifically abnormal GFR (OR = 12.8), was significantly associated with ePTH postoperatively.

Conclusions:

The postoperative PTH levels remain elevated in 25.2% of patients achieving eucalcemia after surgery for primary hyperparathyroidism. This phenomenon was associated with compromised preoperative renal function. Physicians and patients must be aware of this condition to avoid subjecting patients to unnecessary further intervention.
Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006 to 2011 NSQIP Data Sets
Authors: Somerville Jessica M. , Verhalen Jon , Samant Sandeep , Jain Umang , Kim John , Saha Sujata
Published: September 2014

Objectives:

Studies evaluating complications after neck dissection alone or in conjunction with other procedures are sparse. We looked for predictors of adverse events after neck dissection using the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP), which tracks 30‐day complication rates in patients undergoing surgery at participating centers.

Methods:

In this retrospective review, 619 patients were identified using CPT codes specific for neck dissection. Clinical factors, comorbidities, epidemiologic factors, and procedure characteristics were analyzed with multiple regression to evaluate relationship to complication rates.

Results:

Twenty‐three percent of patients (142 of 619 patients) underwent neck dissection and experienced either a medical or surgical complication. Factors associated with adverse events included previous cardiac surgery (odds ratio [OR] 3.376, 95% confidence interval [CI] 1.084‐10.516, P =. 036), dyspnea (OR 2.568, 95% CI 1.06‐6.22, P =. 037), total work RVUs (OR 1.085, OR 1.041–1.131, P =. 001), and anesthesia time (OR 1.005, 95% CI 1‐1.009, P =. 036). Importantly, smoking, age, ASA class, and prior radiation or chemotherapy were not significant. Injury to accessory nerve and chyle leak are not specifically tracked in NSQIP.

Conclusions:

This study presents important benchmarks for medical and surgical complication rates, reoperation, and mortality observed with neck dissection in a large nationally abstracted patient sample. Cardiorespiratory morbidity and surgical complexity were found to be major drivers of complications. The true complication rates may be underrepresented due to inadequate tracking of procedure specific complications in NSQIP.
Relationship between Obesity, Diabetes, and the Risk of Thyroid Cancer
Authors: Oberman Benjamin S. , Khaku Aliasgher , Camacho Fabian , Goldenberg David
Published: September 2014

Objectives:

Analyze the relationship between obesity and type‐2 diabetes (DM‐II) and the development of differentiated thyroid cancer (DTC).

Methods:

Randomized case‐controlled retrospective chart review conducted for outpatient clinic patients between January 2005 and December 2012 at an academic medical center. Forty‐nine DTC patients were compared with 70 control group patients diagnosed with hyperparathyroidism with documented euthyroid state. Exposure variables consisted of the most recent body‐mass index (BMI) within 6 months prior to diagnosis of DTC and any report of DM‐II. Multivariate logistic regressions adjusting for sex, age, and year of body mass index (BMI) were used to assess the odds ratio of DTC with both BMI and DM‐II. No interventions were performed.

Results:

Comparison of means shows BMI was greater in patients with DTC (BMI = 37.83) than controls (30.36), P <. 0001, and DM‐II was more frequent in patients with DTC (29%) than controls (16%), P =. 08. The adjusted Odds Ratio for BMI was 1.12 (95% 1.06, 1.19, P <. 0002); the DM‐II adjusted Odds Ratio was 3.24 (95% 1.21, 8.70), P =. 0196. A Hosmer‐Ledeshow test did not detect misfit (p <. 05) in either model. The C‐value for the BMI model was 0.82 (bivariate = 0.81) and for the DM‐II model was 0.73.

Conclusions:

Our preliminary results show that obesity, and to a slightly lesser degree DM‐II, are significantly associated with DTC. BMI in particular was a strong predictive variable for DTC (C = 0.81 bivariate, C = 0.82 multivariate).
Robust Differences in Distant Metastases for p16 ± OPSCC: Implications for Future Targeted Therapy
Authors: Murrill Lauren L. , Jaber James J. , Mehta Vikas , Zender Chad A. , Kim Seungwon , Johnson Jonas T.
Published: September 2014

Objectives:

Historically, head and neck squamous cell carcinoma (HNSCC) has been considered a lymphatic malignancy with regional disease. Recently, this has been called into question. Our study aims to (1) illustrate the robust differences between p16+ and p16‐ oropharyngeal squamous cell carcinoma (OPSCC), and (2) provide circumstantial evidence that p16+ OPSCC has a predilection toward active vasculature invasion and hematogenous spread.

Methods:

A multi‐institutional, retrospective study of 1060 patients with OPSCC undergoing definitive treatment between 1979 and 2012. Patients were divided into 2 cohorts: p16+ and p16‐ OPSCC. Differences in distant metastases (DM) between the 2 cohorts were assessed for risk factors, rate and temporal differences, phenotypic behavior, and post‐DM progression‐free and disease‐specific survival.

Results:

Of the 1060 patients, 105 patients had DM. Thirty‐four were p16‐ and 71 were p16+. Full statistical analysis has yet to be completed, but preliminary findings conclude that of the p16‐ patients with DM, only 6% had disseminated disease (distant metastases at >1 site) as compared with 70% of p16+ patients with DM. Distant disease in p16+ patients included brain and unique bilateral lung findings.

Conclusions:

Our large, multi‐institutional study supports the previously reported claim that patients with p16+ OPSCC have a unique phenotypic disseminated behavior. This calls into question the belief that HNSCC is a lymphatic malignancy. Our data suggest that p16+ disease has a predilection toward active vasculature invasion evidenced by atypical end‐organ DM and dissemination profile. This study's findings coupled with data in the literature may have implications for future p16+ OPSCC targeted therapy.
The Role of Targeted Therapy and Oncogene Dependence on the PIK3CA Mutation
Authors: Wirtz Eric D. , Hoshino Daisuke , Weaver Alissa M.
Published: September 2014

Objectives:

(1) Determine the role of oncogene dependence on one of the more common and targetable oncogenes in head and neck squamous cell carcinoma (HNSCC) PIK3CA. (2) Evaluate the consequence of this oncogene on the effectiveness of newly developed targeted therapies.

Methods:

A basic science study was performed to test the hypothesis that PI3KCA hot spot mutations confer increased sensitivity or oncogene addiction to PI3K and related inhibitors. The PI3KCA hotspot mutations—E545K and H1047R—were engineered within the HNSCC cell line SCC25. Cell viability was measured using high throughput microscopy to determine the survivability cell lines expressing the hotspot mutations compared with control cell lines when treated with increasing concentrations of newly developed targeted therapies 17‐AAG, GDC‐0941, and Trametinib.

Results:

Surprisingly, hotspot E545K and H1047R mutations conferred increased rather than reduced survivability when treated with increased concentrations of the respective HSP90, PI3K, and MEK inhibitors, 17‐AAG, GDC‐0941, and Trametinib compared to the SCC25 control cell lines.

Conclusions:

(1) The PIK3CA mutations within our engineered cell model did not lead to oncogene dependent cell death when treated with targeted therapy including direct inhibition of the Phosphatidylinositol 3‐kinase (PI3K) enzyme. (2) Oncogene addiction to PIK3CA hot spot mutations, if it occurs, is likely to evolve in vivo in the context of additional molecular changes that remain to be identified.
Surgical Outcomes in Primary Parotid Cancer
Authors: Cannon Richard B. , Buchmann Luke O. , Terakedis Breanne E. , Hitchcock Ying J. , Hunt Jason P.
Published: September 2014

Objectives:

Surgeries performed for primary parotid malignancies vary, and the oncologic outcomes are undetermined. This study aims to: (1) Describe surgical outcomes of superficial versus total parotidectomy, and (2) describe surgical outcomes of observation versus cervical lymphadenectomy in patients with a N0 neck.

Methods:

Records of 129 consecutive patients with non‐metastatic primary parotid cancer treated from 1988 to 2010 at the University of Utah and Intermountain Healthcare were reviewed. Treatment was superficial (47%) or total (53%) parotidectomy, 31% underwent concurrent cervical lymphadenectomy, and 67% received adjuvant radiotherapy due to high‐risk features. Patient demographics, tumor characteristics, surgical treatments, and oncologic outcomes were statistically analyzed.

Results:

Average age at diagnosis was 52 years. Mean follow‐up was 7.4 years. Patient demographics, tumor grade, and histology were not predictive of recurrence or survival. Matching patients with Stage I/II disease (n = 74) and comparing superficial versus total parotidectomy, there was no difference in 5‐year disease free rate, and 5‐ and 10‐year overall survival rates (85%, 95%, and 88% versus 84%, 84% and 67%, respectively). Also, for Stage III (n = 18) and IV (n =33) disease there was no difference. For 101 patients with a N0 neck, 81 were observed and 20 underwent an elective cervical lymphadenectomy; there was no difference in outcomes (76%, 85%, and 72% versus 73%, 87%, and 67%, respectively).

Conclusions:

Treatment of primary parotid cancer requires meticulous surgical dissection and gross tumor resection; however, superficial versus total parotidectomy or observation versus elective cervical lymphadenectomy does not affect tumor recurrence rates or overall survival outcomes.
Transoral Surgery versus Primary Chemoradiation for Advanced Stage Head and Neck Squamous Cell Carcinoma
Authors: Lo Emily J. , Truelson John M. , Myers Larry L. , Nedzi Lucien , Yordy John , Hughes Randall , Sumer Baran D.
Published: September 2014

Objectives:

Compare functional and survival outcomes between patients with advanced stage head and neck squamous cell cancer (HNSCC) treated with primary transoral surgery versus primary chemotherapy and radiation.

Methods:

Retrospective case‐control trial at an academic tertiary referral center. We identified a surgical group (SG) comprised of 37 patients with previously untreated stage III and IV HNSCC who underwent either transoral robotic surgery (TORS) or transoral laser microsurgery (TLMS) and a nonsurgical group (NSG) of 75 patients treated with primary chemotherapy and radiation between July 2007 and November 2011. NSG was matched to SG by age, sex, tumor location, stage, tobacco and alcohol use, and ECOG status. Tracheostomy and percutaneous gastrostomy tube (PEG) rates during treatment and at follow‐up, as well as survival outcomes, were examined.

Results:

There were no statistically significant differences in the matched variables. Significantly fewer patients in the SG compared with the NSG still had PEG at follow‐up, 8% versus 25%, respectively (P =. 031). All patients in the SG versus 92% of the NSG were eventually decannulated. Seventy‐eight percent of the SG required postoperative radiation. The SG received an average radiation dose of 6164 ± 340 cGY versus 6854 ± 264 cGy for the NSG (P =. 001). Kaplan‐Meier analysis showed no significant difference in survival outcomes.

Conclusions:

Comparison between the primary transoral surgery and primary chemoradiation groups for treatment of advanced HNSCC demonstrates similar survival outcomes. Patients who undergo surgery receive significantly lower doses of radiation, and most are able to regain functional swallow and be successfully decannulated.
Widespread Vitamin D Deficiency in Patients Undergoing Thyroidectomy
Authors: Singer Michael C. , Chaudhary Hamad
Published: September 2014

Objectives:

Vitamin D deficiency is thought to increase the risk of symptomatic hypocalcemia after thyroidectomy. While often assessed after surgery in patients who develop hypocalcemia, many surgeons do not routinely evaluate vitamin D status preoperatively. This study (1) characterized the frequency preoperatively of vitamin D deficiency in patients undergoing thyroid surgery in the northern United States and (2) identified groups at increased risk of vitamin D deficiency.

Methods:

Case series with prospectively maintained database at an: academic medical center. Patients undergoing thyroid surgery between January and December 2013 were included. Preoperative 25‐hydroxy vitamin D, parathyroid hormone (PTH), and ionized calcium levels were obtained on all patients. Patients with 25‐hydroxy vitamin D levels less than 20 ng/mL were considered deficient and were repleted.

Results:

Of 110 patients who underwent thyroid surgery during the 12‐month study period, 44 (40%) were vitamin D deficient. A total of 33 out of 44 deficient patients had secondary hyperparathyroidism. Black and Hispanic patients (P =. 003), those undergoing surgery for hyperthyroidism (P =. 007), and patients under 50 years old were more likely to be deficient (P =. 01).

Conclusions:

While select groups are more susceptible, in the northern United States vitamin D deficiency is pervasive in patients undergoing thyroidectomy. Given its impact on postoperative calcium status, surgeons should consider routinely assessing preoperative vitamin D status and, if necessary, supplementation.
Clinical Experiences of NBI Laryngoscope in Diagnosis of Laryngeal Lesions
Authors: Qi Xinmeng , Jin Chunshun , Yu Dan , Zhao Xue , Liu Xueshibojie , Cheng Jinzhang , Zhang Dejun
Published: September 2014

Objectives:

(1) Describe the use of narrowband imaging (NBI) to enhance diagnostic sensitivity and accuracy in an impressive number of patients. (2) Develop a complete description list of each laryngeal condition, which can serve as a criteria for further laryngoscopic examinations and diagnosis.

Methods:

This study was conducted between January 2012 and October 2013 at the Department of Otolaryngology, the second hospital attached to Jilin University (Changchun Jilin, China). A total of 3675 patients (2092 males, 1583 females; mean age 50.2 ± 19.5 years) were enrolled in this study. All 3675 patients underwent laryngoscopy equipped with conventional white light and NBI system. A total of 1153 lesions were classified into different groups according to their histopathological results.

Results:

On NBI view, mucosa of a normal vocal fold was light brown. Intraepithelial vessels displayed blue‐green, which were in striking contrast to the surrounding mucosa. Polyps demonstrated a color of light green. Cysts and mucocele appeared as light white. Leukoplakia was shown as a white color and hyperplastic epithelial lesions appeared as a slightly brownish color. Erythroplakia appeared as well‐distributed dark brown lesions. Pachydermia displayed light white with a quite different shape from that of cysts. Papilloma were shown as quite delicate green. Abnormal submucosal microvessel changes visualized in laryngeal carcinoma lesions were shown as typical scattered dark brownish spots. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view calculated from these results were 98.81 and 99.89%, respectively.

Conclusions:

The advent of NBI is a breakthrough in the field of assessing laryngeal diseases, especially malignant ones.
Detection and Characterization of Laryngeal Reflex Pathology in Mouse Models of Human Diseases
Authors: Farmer‐Shock Leslie , Gallemore Brandon , Oberto Richard , Hinkel Cameron , Lever Tersa
Published: September 2014

Objectives:

The laryngeal adductor reflex (LAR) is readily triggered in healthy, awake humans by delivering a puff of air to the laryngeal entrance via an endoscope passed through the nose into the throat. LAR impairment has been identified (but not well‐characterized) in people with amyotrophic lateral sclerosis (ALS) and is highly correlated with dysphagia. We propose to develop a nonsurgical approach for longitudinal investigation of the LAR in mice.

Methods:

We designed and constructed an elaborate prototype air pulse delivery system for use with mice. The system interfaces with a miniature endoscope that is small enough for oral insertion into the laryngeal entrance and contains a working channel through which calibrated puffs of air can be delivered, synchronized with rate and phase of the respiratory cycle.

Results:

We have successfully used this prototype system to evoke and video record (30 fps) the LAR in 10 healthy, C57BL/6 mice under light anesthesia, thus demonstrating proof of concept. Objective quantification of several LAR parameters is currently underway, including total LAR duration, duration of adduction versus abduction phases, and velocity of dorsal angle adduction and abduction.

Conclusions:

This study provides novel evidence that mice have an LAR similar to humans and that several parameters of the LAR can be objectively quantified in this small animal model. Additional research will include laryngeal brainstem response (LBR) recordings evoked by air pulse triggering of the LAR to elucidate pathological neural substrates in mouse models of ALS and other human diseases that cause dysphagia.
Evaluation of Airway and Voice following Posterior Transverse Cordotomy for Bilateral Vocal Fold Paralysis
Authors: O'Dell Karla D. , Allensworth Jordan J. , Schindler Joshua S.
Published: September 2014

Objectives:

Objectively describe the change in glottic airflow following unilateral transverse posterior cordotomy for bilateral true vocal fold paralysis based on peak inspiratory flow rate and pulmonary function tests. Evaluate the impact of unilateral posterior cordotomy on voice related quality of life.

Methods:

Retrospective chart review of 17 patients with bilateral vocal fold paralysis undergoing CO2 laser posterior transverse cordotomy from January 2008 through December 2013 in an academic medical center. Preoperative and postoperative pulmonary function tests were reviewed including the peak inspiratory flow rate (PIF) and maximal inspiratory flow at 50% of forced vital capacity (PIF50). The results of the 30‐item voice handicap index (Voice Handicap Index), an externally validated survey, were recorded pre‐ and postprocedure.

Results:

There was a statistically significant (P <. 0014) improvement in mean peak inspiratory flow rates postprocedure (2.89 L/s) compared with preprocedure (1.57 L/s). There was a 44% improvement in peak inspiratory flow rate following unilateral posterior transverse cordotomy. Expiratory flow loops did not reflect changes in airway following the procedure. There was no statistically significant change (P <. 475) in the voice handicap index scale preoperative and postoperative (55 and 41, scale 0‐100).

Conclusions:

Unilateral posterior transverse cordotomy for bilateral true vocal fold paralysis results in a 44% improvement in peak inspiratory flow rates. Preoperative pulmonary function tests can be used to evaluate the potential success of cordotomy alone for glottis stenosis. This procedure does not result in any statistically significant change in voice related quality of life.
Functional Electrical Stimulation of the Larynx with a Flexible Ribbon Electrode Array
Authors: Bliss Morgan R. , Wark Heather , McDonnall Daniel , Smith Marshall E.
Published: September 2014

Objectives:

This study explored the selectivity of epimysial stimulation of the larynx using multi‐channel electrode arrays. Recruitment curves from electrode channels within the array were compared, focusing on differences between location of the electrode and specific muscle activation.

Methods:

This was a prospective, nonrandomized acute animal study. Four cats underwent surgical implantation of electrode arrays into the posterior cricoarytenoid muscle. The airway was secured with a tracheostomy, and the glottis was visualized with a 0° 4‐mm telescope while individual and combinations of electrodes within the array were stimulated with varying current. Digitized recordings of stimulated vocal folds were analyzed using imageJ and the degree of vocal fold abduction was measured to create recruitment curves.

Results:

Electrodes implanted along the medial aspect of the posterior cricoarytenoid stimulated graded physiologic degrees of abduction depending on the amplitude of stimulation current. Electrodes implanted laterally along the posterior cricoarytenoid stimulated greater degrees of simultaneous adduction with abduction. The electrode array allowed mapping of most useful electrode position, so that only one implantation procedure was required to yield good results, thus limiting trauma to the larynx. Electrode arrays with more electrodes were more likely to contain electrodes that were appropriately positioned for optimal abduction.

Conclusions:

Acute studies of implanted electrode arrays into the posterior cricoarytenoid produce graded physiologic degrees of abduction necessary for respiration. Further chronic studies are warranted to investigate long term feasibility and durability of this electrode design.
Increased Macrophages and T‐Lymphocytes Precede Fibrosis in a Mouse Model of Laryngotracheal Stenosis
Authors: Hillel Alexander T. , Ding Dacheng , Namba Daryan
Published: September 2014

Objectives:

Identifying the inflammatory cells mediating laryngotracheal stenosis (LTS) could allow for identification and modulation of specific immune mechanisms to reduce the development of airway fibrosis. The objective of this study is to (1) introduce a novel mouse model of LTS and 92) define the inflammatory cell infiltrate preceding fibrosis.

Methods:

The experimental design was a 21‐day prospective controlled in‐vivo in‐situ animal study. The mouse laryngotracheal complex was chemomechanically injured with a bleomycin‐coated wire brush. Mice were sacrificed at 7, 14, and 21 days. Specimens were examined using histology to assess mucosal inflammation and fibrosis. Immunohistochemistry (IHC) and gene expression analysis were performed to delineate inflammatory cells. Results were compared with 2 control groups: (1) mice with no tracheal injury; and (2) mice that underwent tracheal injury with a saline‐coated wire brush.

Results:

Histology demonstrated progressive thickening of the subepithelial lamina propria with an increased inflammatory infiltrate including lymphocytes, neutrophils, and macrophages that peaked at Day 7. This transitioned to resolving inflammation and initial fibrosis by Day 14 with progression of fibrosis to day 21. Gene expression and IHC confirmed increased T‐cells and macrophages compared to controls. IHC staining was positive for CD4+ T‐lymphocytes.

Conclusions:

Chemomechanical injury of the mouse trachea in situ was successful and may be used as a model to study LTS. Bleomycin accelerates fibrosis as compared to controls with saline‐coated wire brush injury. Macrophages and CD4+ T‐lymphocytes precede the development of fibrosis in this mouse model and should be further investigated as mediators of LTS.
Microsurgical Release of the Cover and Fibrin Glue Implantation for Treatment of Sulcus and Scars
Authors: Campos Guillermo , Mantilla Natalia , Ospina Javier A.
Published: September 2014

Objectives:

Sulcus vocalis and scars of the vocal folds reduce pliability of the cover impairing vibration. Severity of dysphonia is directly related to magnitude of structural damage. The purpose of surgical treatment is to restore anatomy in order to re‐establish function. The aim of the study was to evaluate the effectiveness of microsurgical liberation of scars and placement of fibrin glue implants into the subepithelial space of the vocal folds to improve pliability.

Methods:

Fifteen patients (age range, 13‐69 years) with diagnosis of sulcus and/or scars were classified into 3 groups, according to severity of structural damage: Group 1: Unilateral, localized lesions with minimal subepithelial compromise. Group 2: Sulcus and/or scars with subepithelial fibrosis. Group 3: Severe scarring. Microsurgical liberation of scar tissue and placing of fibrin glue implants were performed. Fibrin glue components are mixed until solidified. An implant is tailored and it is placed into the subepithelial space. All patients were evaluated preoperatively and postoperatively with stroboscopy. Voice quality changes were assessed by means of the Voice Handicap Index 30 questionnaire.

Results:

The technique offered significant vibratory pattern and voice quality improvement in group one and better vibratory pattern and moderate voice quality improvement in group 2. In group 3, although some vibratory improvement was achieved, voice quality results were not satisfactory in 4 out of 5 patients.

Conclusions:

The technique described is useful for treatment of vibratory impairment caused by sulcus and/or scarring of the vocal folds in which structural damage is limited. In extensive lesions results show little improvement.
Narrow Band Imaging: Demonstration of Laryngeal Micro‐vascularization in Normal and Pathological Conditions
Authors: Shoffel‐Havakuk Hagit , Halperin Doron , Yosef Liron , Lahav Yonatan
Published: September 2014

Objectives:

With blue and green light only, narrow band imaging (NBI) allows better visualization of mucosal micro‐vascular architecture. Intra‐epithelial papillary capillary loops (IPCL) is a classification of vascular patterns based on previous esophageal NBI studies. The aims of the study were to: (1) Study the normal micro‐vascular anatomy of the larynx by means of NBI. (2) Better understand the clinical applications of NBI in laryngeal lesions. (3) Assess the relative advantages and disadvantages of NBI versus white light imaging in the larynx. (4) Assess the relevance of previously described IPCL classification in laryngeal pathologies.

Methods:

A prospective comparative study including patients who arrived for laryngeal examination at an ENT referral center in 2013. White light images and NBI were compared in each patient to assess relative advantages of each modality. Micro‐vascular architecture was described by IPCL classification.

Results:

A total of 110 patients were included and underwent video‐stroboscopy, flexible distal‐chip endoscopy, and NBI of the larynx. Thirty‐two patients had a normal larynx, 54 had benign conditions, and 24 had malignant lesions. Distinct characteristics of vascular patterns were visualized by NBI in normal tissues, as well as a wide spectrum of benign and malignant conditions. In several patients with malignant and premalignant conditions, NBI revealed more extended disease than what was observed by white light imaging.

Conclusions:

Using NBI along with white light imaging, while understanding the unique microvascular fingerprint of each laryngeal pathologic condition, can assist the physician in differential diagnosis. In specific conditions, including malignant and premalignant lesions, NBI can bring better assessment of lesions’ size and extension.
A New Coupling Device to Record Fiber‐Optic Laryngoscopies onto a Smartphone: A Pilot Study
Authors: Brant Jason A. , Leahy Kevin , Mirza Natasha
Published: September 2014

Objectives:

Evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded directly onto smartphones using a novel coupling device.

Methods:

Prospective, blinded study at a tertiary referral hospital. Inpatients requiring laryngoscopy underwent bedside flexible fiberoptic endoscopy. A smartphone was then attached to the endoscope using a novel coupling device and the same examination was recorded. The laryngologist performing the live examination documented their findings on a standardized scoring sheet. A second laryngologist, blinded to the findings of the first, evaluated the recorded examination using an identical scoring sheet.

Results:

Eighteen patients were evaluated from July 2013 to January 2014. Evaluation of airway patency was identical (Kappa 1.0, P <. 001). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa 0.687, P <. 001). There was no disagreement on the sidedness of the vocal fold involved (3 left, 1 right, 1 bilateral). There was 1 paretic‐paralytic and 2 normal‐paretic discrepancies. Subjective evaluation of the mucosa over each subsite showed moderate reliability (Kappa 0.515, P <. 001).

Conclusions:

There is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings of those examinations using a coupling device to transfer the recordings on to smart phones. Critical findings such as airway patency and vocal fold motion showed the highest correlation, subjective evaluation of the quality of the mucosa showed more variability.
Noninvasive versus Rigid Endoscopic Evaluation of Upper Aerodigestive Tract in Penetrating Neck Trauma
Authors: Jalisi Scharukh , Jumaily Jeffrey S. , Winter Leslie , Burke Peter
Published: September 2014

Objectives:

(1) Describe the effectiveness of current diagnostic modalities in diagnosing upper aerodigestive tract injuries. (2) Recognize the potential complications of rigid endoscopy in trauma patients.

Methods:

This is a retrospective chart review of patients admitted between January 1998 to May 2008 with penetrating neck trauma in all zones who underwent assessment with physical examination, barium swallow, computed tomography, and/or endoscopy. The sensitivity and specificity of these modalities were calculated and compared.

Results:

Physical examination appears to be unreliable due to poor sensitivity in this study. Direct laryngoscopy appears to be more sensitive than flexible laryngoscopy. Bronchoscopy was not frequently performed and 1 patient (2%) had tracheal repair diagnosed with rigid bronchoscopy. Rigid esophagoscopy was performed more commonly than flexible esophagoscopy. Both types of esophagoscopies detected the 2 (4%) esophageal injuries. Computed tomography scan was nonspecific due to presence of subcutaneous air in most patients. Barium swallow had a 100% negative predictive value in our study and did not miss any injuries. There were 5 patients (10%) who had postprocedure symptoms that can be potentially attributed to rigid endoscopy including teeth injury, and upper and lower extremity weakness and paresthesias.

Conclusions:

Barium swallow appears to be a reliable study which did not miss any significant injuries. Endoscopic studies, especially rigid ones, carry a risk of C‐spine complications that should be recognized in trauma patients.
Office‐Based Photoangiolytic Laser Treatment of Reinke's Edema: Safety and Voice Outcomes
Authors: Koszewski Ian J. , Hoffman Matthew R. , Young William G. , Dailey Seth H.
Published: September 2014

Objectives:

The office‐based use of photoangiolytic lasers may be a viable option in the treatment of Reinke's edema. We aimed to determine the safety and efficacy of this technique.

Methods:

We performed a retrospective analysis of patients undergoing office‐based laser treatment of endoscopy‐proven Reinke's edema between January 2007 and November 2013. Safety was evaluated by reviewing complications. Efficacy was analyzed by comparing pre‐ and postprocedural aerodynamic, acoustic, and voice handicap index (VHI) measurements, and by quantifying procedure tolerance. Data were analyzed using paired t tests, if parametric, or signed rank tests, if not parametric. Complete datasets were not available for all subjects; sample size for each parameter is reported with the corresponding result.

Results:

Nineteen patients met inclusion criteria. There were no major complications. Phonation threshold pressure decreased after treatment (n = 4; 8.21 ± 2.10 vs 6.69 ± 2.59 cmH2O; P =. 049). Phonatory frequency range increased (n = 12, 180 ± 67 vs 363 ± 295 Hz; P =. 003) while percentage jitter decreased (n = 12; 4.05 ± 2.83 vs 1.65 ± 1.10%; P =. 004). VHI also decreased (n = 14; 56 ± 26 vs 37 ± 27; P <. 001). Five procedures were truncated due to benign patient intolerance.

Conclusions:

This study represents the largest series of patients undergoing office‐based photoangiolytic laser treatment specifically for Reinke's edema. Our data suggest that this is a safe and effective modality to treat Reinke's edema, though patient intolerance of the procedure may represent a barrier.
Outcomes and Resource Utilization of Endoscopic Mass‐Closure Technique for Laryngeal Clefts
Authors: Balakrishnan Karthik , Cheng Esther , de Alarcon Alessandro , Sidell Douglas R. , Hart Catherine K. , Rutter Michael J.
Published: September 2014

Objectives:

(1) Describe operative time and materials for a mass‐closure endoscopic laryngeal cleft repair technique. (2) Determine swallowing and endoscopic outcomes of this technique.

Methods:

Case series of children with confirmed diagnosis of type 1, 2, and 3 laryngeal clefts from 2008 to 2013 in a tertiary pediatric aerodigestive program. Interventions: Endoscopic mass cleft closure; pre‐ and postoperative swallow evaluations. Outcomes: Operative time, number of sutures, laser use, endoscopic findings, aspiration or penetration on postoperative swallow evaluation.

Results:

Eighteen patients were studied. Mean age 5.8 ± 4.9 years (range, 0.3‐7 years). Sixteen had type I cleft, 1 had type II, and 1 had type III. Four had unilateral or bilateral vocal fold immobility preoperatively. Fifteen underwent functional endoscopic evaluation of swallow (FEES) and/or videofluoroscopic swallow study (VSS) preoperatively; 14 showed laryngeal penetration and/or aspiration. Mean operating time was 76.6 ± 40.9 minutes (range, 43‐181 minutes) with a fellow or resident participating in all cases. Operating time was unchanged by laser use (P =. 15) or presence of tracheostomy (P =. 34). Mean 2.5 ± 0.6 sutures were required for each repair (range, 2‐4). Twelve patients spent 1 postoperative night in hospital. Mean follow‐up was 87.7 ± 15.8 months (range, 1 week‐61.2 months). Sixteen patients have had postoperative endoscopy to date; intact repair was noted in all 16. Postoperative VSS was available for 8 patients and demonstrated persistent aspiration in 2 patients, with further improvement expected in 1 as sensation returned. No operative complications occurred.

Conclusions:

The endoscopic mass‐closure technique is safe, fast, technically straightforward, and produces swallowing outcomes similar to traditional techniques. Postoperative hospital stay is brief, and repairs remain intact over long‐term follow‐up.
Type 1 Thyroplasty as an Outpatient Surgery: Safety and Cost Effectiveness
Authors: Gross Brian C. , Patel Neil S. , Ekbom Dale C.
Published: September 2014

Objectives:

Determine the safety and cost effectiveness of type 1 thyroplasty as outpatient surgery without a surgical drain or post‐anesthesia care unit (PACU) observation. Study Design: Prospective cohort study.

Methods:

Patients with vocal cord immobility (n = 25) were surgically managed with an outpatient type 1 thyroplasty under conscious sedation without a surgical site drain from April 1, 2013, through October 1, 2013. Eighteen of 25 patients were transported directly from the operating room to the nursing unit, completely avoiding the PACU. Historical inpatient controls (n = 25) were included for comparison. Postoperative complications were recorded. A cost analysis was conducted to compare inpatient versus outpatient surgery.

Results:

In our series of patients undergoing outpatient type 1 thyroplasty, only 1 of 25 (4.0%) postoperative hematoma was documented. No postoperative complications occurred in the inpatient control group. Outpatient type 1 thyroplasty cost $922 less than overnight surgery. Avoiding the PACU resulted in an additional $550 savings.

Conclusions:

Our prospective study demonstrated that outpatient type 1 thyroplasty without a surgical drain is a safe and cost‐effective surgery in appropriately selected patients. Furthermore, doing the surgery under light sedation allows the patient to be transported directly to the nursing unit, avoiding the additional cost of the post‐anesthesia care unit.
Voice Outcomes following Laser Surgery or Radiotherapy for T1 Glottic Cancer: Systemic Review and Meta‐Analysis
Authors: Greulich Matthew T. , Parker Noah P. , Lee Phil , Merati Albert L. , Misono Stephanie
Published: September 2014

Objectives:

Systematic review of literature on patient‐reported voice handicap following T1 glottic squamous cell carcinoma treatment using endoscopic surgery or radiation therapy.

Methods:

PubMed, Web of Science, and Scopus (1988‐2013) were searched for papers reporting Voice Handicap Index (VHI) after treatment of early glottic carcinoma. Review and reference cross‐checking were performed using a priori selection criteria. Study data were abstracted and publication quality categorized independently by 2 authors. Corresponding authors were contacted to maximize data for analysis. Meta‐analysis was performed using a random‐effects model.

Results:

Twenty‐three studies with VHI data following surgery (n = 7), radiation (n = 4), or both (n = 12) were reviewed. Meta‐analysis was then pursued with studies that included both modalities. Excluding studies reporting multiple T‐stages or systematic treatment selection bias, 5 retrospective cohort studies describing 238 patients in total were suitable for meta‐analysis. Depth of excision and follow‐up time (mean, 47 months; range, 1‐298 months) varied across studies. Three studies showed no VHI difference between treatment arms, 2 favored radiotherapy over surgery (one of which reported transmuscular cordectomy for all surgical patients), and none favored surgery. Meta‐analysis slightly favored radiotherapy over endoscopic surgery (mean difference 7.73, 95% confidence interval 0.29‐15.16, P =. 03, I2 = 63%).

Conclusions:

Best available evidence was Level 4 with significant heterogeneity. Current literature may suggest lesser patient‐reported voice handicap after radiation than endoscopic cordectomy, but the difference is of minimal clinical significance. Prospective randomized studies are needed for greater clarity when counseling patients.
Assessment of Mitochondrial Function and Membrane Potential in PK1 Cells Treated with Gentamicin and MitoQ
Authors: Ng Maria Raye Anne V. , Antonelli Patrick J. , Raisch Kevin , Joseph Jerin , Ojano‐Dirain Carolyn P.
Published: September 2014

Objectives:

Determine the effects of concurrent treatment with the aminoglycoside antibiotic gentamicin and mitoquinone (MitoQ), a mitochondria‐targeted derivative of the antioxidant ubiquinone that may protect against aminoglycoside ototoxicity, on mitochondrial function and membrane potential.

Methods:

This study was prospective and controlled. Mitochondrial membrane potential (MMP) was assessed by flow cytometry using MitoProbeTM JC‐1 Kit in untreated PK1 cells and cells exposed to low (100 µM) or high (2000 µM) dose gentamicin for 24 hours, with and without 0.5 µM each of MitoQ or idebenone (an untargeted ubiquinone). Mitochondrial function was determined using the Seahorse XF‐24TM flux analyzer.

Results:

MMP was not different in untreated cells and cells co‐incubated with low‐dose gentamicin and MitoQ or idebenone (P >. 05). Co‐incubation with high‐dose gentamicin and MitoQ or idebenone decreased MMP (P <. 0001), with MitoQ co‐incubation decreasing MMP to a greater extent compared with idebenone (P =. 0001). Basal oxygen consumption rate (OCR) was not different between treatments (P =. 15). Maximal OCR was not different between untreated cells and cells treated with MitoQ alone, low dose gentamicin alone, or the combination of MitoQ and low dose gentamicin (P >. 05). In contrast, cells treated with high dose gentamicin and in combination with MitoQ have reduced maximal OCR (P =. 037 and. 026).

Conclusions:

The combination of gentamicin and MitoQ holds the potential to disrupt mitochondrial function and membrane potential. This suggests a heightened need to monitor for toxicity in patients receiving both agents.
Canal Wall Reconstruction Tympanomastoidectomy with Mastoid Obliteration: Outcomes in Smokers
Authors: Buchanan Patrick C. , Golub Justin S. , Samy Ravi N.
Published: September 2014

Objectives:

(1) Describe the canal wall reconstruction with mastoid obliteration (CWR/MO) technique, (2) understand the benefits for eradication of cholesteatoma, and (3) assess for poorer outcomes in smokers.

Methods:

Retrospective study analyzing the results of CWR/MO in 82 adult subjects at a tertiary referral center between 2006 and 2013. Subjects were 19 to 79 years old (mean, 44 years) and underwent CWR/MO for either primary or recurrent cholesteatoma. Subjects were re‐evaluated with a second look tympanoplasty at least 6 months later. Long‐term follow up ranged from 6 to 96 months (mean, 33 months). Fisher's exact test was employed for significance.

Results:

Twenty‐one of 82 subjects (26%) had residual cholesteatoma on second look, including 10 of 29 smokers (34%) and 11 of 53 nonsmokers (21%) (P =. 19). Five subjects (6%) had a retraction pocket without cholesteatoma on second look, including 3 smokers (10%) and 2 nonsmokers (4%). Twelve subjects (15%) had recurrent cholesteatoma on long term follow up, including 6 smokers (21%) and 6 nonsmokers (11%) (P =. 33). Three subjects (4%) required a canal wall down (CWD) procedure at some point during the follow up period, including 1 smoker (3%) and 2 nonsmokers (4%) (P = 1).

Conclusion:

CWR/MO is an alternative to CWD without creation of a mastoid bowl. A second look is recommended to eliminate any residual/recurrent disease. This technique resulted in an overall recurrence rate of 15%, comparable to the CWD technique. Despite a trend towards increased recurrent disease in smokers, this did not reach significance.
Comparison of Hearing Status of HIV‐Exposed and ‐Unexposed Newborns and Immunovirologic Correlates in HIV‐Exposed Newborns
Authors: Fasunla Ayotunde J. , Nwaorgu Onyekwere G. , Taiwo Babafemi , Olaleye David O. , Murphy Robert L. , Adewole Isaac F. , Akinyinka Olusegun O.
Published: September 2014

Objectives:

(1) Compare hearing status of HIV‐exposed newborns with HIV‐unexposed newborns and (2) determine the association between their hearing threshold and maternal and newborn laboratory parameters.

Methods:

A cohort audiometric study of newborns in secondary and tertiary hospitals between October 2012 and September 2013. Subjects studied: Consecutive 126 HIV‐exposed and 121 HIV‐unexposed newborns. Interventions: Hearing screening and thresholds of the newborns were done with Auditory Brainstem Response and compared against maternal highly active antiretroviral therapy (HAART), CD4 cell counts, RNA viral loads, and newborn CD4 percentage. Outcome measurements: Hearing threshold levels of both groups were measured and analyzed using appropriate statistics.

Results:

A total of 9.5% of HIV‐exposed and 5% of unexposed newborns had hearing impairment (P =. 1771; relative risk [RR] = 1.9206 [0.7445‐4.9549]). A total of 6.4% of HIV‐exposed and 2.5% HIV‐unexposed newborns had hearing threshold >20 dBHL (P =. 1578). There was no significant association between the hearing threshold of HIV‐exposed newborn and maternal CD4 cell counts (P =. 059) but there was a significant association with maternal viral load (P =. 034). Study showed a significant difference in the hearing of the 119 HAART‐exposed newborns and 7 unexposed newborns (P =. 002; RR = 0.13 [0.05‐0.32]).

Conclusions:

There was a trend toward more hearing loss in HIV‐exposed newborns and a significant difference between the hearing thresholds of HIV‐exposed newborns with CD4 % of ≤25 and >25. There is a significant association between newborn hearing threshold and mothers’ viral load. This background information supports the need for further study on the role of in‐utero exposure to HIV and HAART in newborn hearing loss.
Efficacy of Antibiotic Prophylaxis Prior to Tympanoplasty with Mastoidectomy for Contaminated Cholesteatoma
Authors: Pierce Nathan , Antonelli Patrick J.
Published: September 2014

Objectives:

Evaluate the efficacy of combined anti‐staphylococcal and anti‐pseudomonal preoperative antibiotics for preventing surgical site infections following tympanoplasty with mastoidectomy for contaminated cholesteatoma.

Methods:

Retrospective chart review of medical records of patients who underwent tympanoplasty with mastoidectomy for cholesteatoma were reviewed. Only cases considered to have contaminated or dirty/infected surgical fields were included. The primary outcome measure was postoperative perichondritis, pinna abscess, periotic cellulitis, and periotic abscess requiring systemic antibiotics or surgical intervention.

Results:

Charts of 362 patients who underwent tympanoplasty with mastoidectomy were reviewed, and 195 met inclusion criteria. Preoperative antibiotics included single doses of clindamycin and ceftazidime or gentamicin prior to incision. Patients that received no preoperative antibiotics had an infection rate of 11% and those given perioperative antibiotics had a rate of 1% (P =. 02).

Conclusions:

Use of preoperative antibiotics covering both staphylococcus and pseudomonas species appears to be efficacious for the prevention of surgical site infections following tympanoplasty with mastoidectomy for contaminated cholesteatoma.
Efficacy of Common Reagents for Killing Ticks in the Ear Canal
Authors: Orobello Nicklas C. , Ojano‐Dirain Carolyn P. , Kaufman Phillip E. , Antonelli Patrick J.
Published: September 2014

Objectives:

Determine if widely available solutions can effectively kill ticks that may be found in the human ear canal.

Methods:

This study was prospective, controlled, and blinded. Lone star ticks (Amblyomma americanum), both nymphal and adult, were submerged in 1 of 4 preparations in test tubes (20/group) for 20 minutes. Ticks were agitated by intermittent probing. Activity of adult ticks was video‐recorded during the exposure period. A blinded investigator viewed the videos of adult ticks and directly observed the nymphal ticks during the exposure period to determine the time until death (ie, movement cessation). Mortality was assessed immediately after exposure, and confirmed 24 and 48 hours after exposure.

Results:

Acetone killed ticks most rapidly (nymph mean time, 185.1 s; adult mean, 562.9 s). Isopropanol 70% (nymphs, 328.9 s; adults, 1128.4 s) and ethanol 95% (nymphs, 294.0 s; adults, 1129.4 s) took longer to kill the ticks. All ticks treated with 4% lidocaine survived. These differences were significant (nymphs, P <. 0001; adults, P <. 0001).

Conclusions:

Acetone is the most effective of the tested, commonly available solutions to kill ticks in the ear canal.