bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unearthing a consistent bilateral R1 component of the laryngeal adductor reflex in awake humans
Authors: Téllez Maria J. , Ulkatan Sedat , Blitzer Andrew , Sinclair Catherine F. 
Published: September 2018

ObjectiveThe laryngeal adductor reflex (LAR) is an essential tracheobronchial protective mechanism resulting in vocal fold adduction to laryngeal stimulation. It was thought to consist of an early ipsilateral R1 component and a later, bilateral but highly centrally modulated R2 component. We recently demonstrated that bilateral R1 responses are robustly present in humans under general anesthesia. We herein give evidence that the R1 response is also bilateral in awake humans and is likely the primary component responsible for initiating the LAR.MethodsSeven volunteers were included (3 males, 4 females). The reflex was elicited by direct percutaneous monopolar needle stimulation of the internal superior laryngeal nerve. Electromyography traces from bilateral lateral cricoarytenoid muscles were recorded using hookwire electrodes. Reflex responses to variations in stimulus intensity and duration were evaluated.ResultsBilateral R1 responses were recorded in all patients, even during deep inspiration when the vocal folds were maximally abducted. R1, but not R2, responses increased linearly in amplitude, with sequential increases in both stimulation intensity (1–8 mA) and duration (100–500 µsec) (Pearson correlation 0.94).ConclusionContradicting over 40 years of research, we demonstrate that the R1 LAR component is consistently bilateral in awake humans. It increases linearly with stimulus intensity and is unaffected by conscious state suggesting minimal central control. These findings may provide a means to objectively stratify patients for risk of laryngeal aspiration, even in unconscious states, and its potentially cardinal role in disease states such as laryngospasm and sudden infant death needs to be reevaluated.Level of Evidence4. Laryngoscope, 2581–2587, 2018
Current practices in microvascular reconstruction in otolaryngology–head and neck surgery
Authors: Kovatch Kevin J. , Hanks John E. , Stevens Jayne R. , Stucken Chaz L. 
Published: September 2018

Objectives/HypothesisDespite major advances in the field of head and neck microvascular free tissue transfer (MFTT) over the past several decades, there are no standardized perioperative regimens for the care of patients undergoing free flap reconstructive surgery, and continued variation in practice exists. This study aimed to report current trends in the field of MFTT performed by otolaryngologists, including surgeon training, institutional operative practices, and perioperative management.Study DesignCross‐sectional survey.MethodsA survey of Accreditation Council for Graduate Medical Education–accredited residency programs and American Head and Neck Society fellowship sites was conducted.ResultsSeventy‐one (62.8%) programs responded, with 67 (94.4%) routinely performing MFTT and 23 (32.4%) having a dedicated microvascular fellowship program. Of institutions performing MFTT, 66 (98.5%) reported the use of a two‐surgeon team, most commonly both otolaryngologists (76.3%). Institutional MFTT volumes and donor site frequency are reported. Postoperative care includes routine admission to the intensive care unit (75.2%), step‐down unit (15.0%), or general care floor (8.1%). Postoperative flap monitoring practices, including modalities, personnel, and timing/frequency show institutional variation. Despite differences in postoperative monitoring regimen and management (sedation, anticoagulation, antibiotic use), surgeon‐reported measures of flap success rate (95.7%, standard deviation [SD] 4.7%) and complication rate (6.8%, SD 2.4%) show little difference across institutions.ConclusionsMany elements of MFTT perioperative care show continued variation at an institutional level. There is a notable shift toward the two‐team approach within otolaryngology. Self‐reported flap complication and success rates showed no significant differences based on perioperative care and monitoring regimen. Further study of perioperative practices should focus on standardization of care to improve overall outcomes in this complex patient population.Level of EvidenceNA Laryngoscope, 129:138–145, 2019
Enhancing pediatric airway safety using the electronic medical record
Authors: Rameau Anaïs , Wang Ellen , Saraswathula Anirudh , Pageler Natalie , Perales Shanna , Sidell Douglas R. 
Published: September 2018

ObjectiveDifficult intubations are not uncommon in tertiary care children's hospitals, and effective documentation of the difficult airway is a fundamental element of safe airway management. The primary goal of our quality improvement initiative was to improve access to airway information via an alert and documentation system within the electronic medical record (EMR).MethodsWe created a difficult airway alert within the EMR, linking common airway evaluation templates used by specialists involved in airway management. We assessed the time required for different specialists to answer an airway information questionnaire using the electronic charts of patients before and after the EMR modification. Satisfaction with the EMR modification was also surveyed.ResultsQuestionnaires were administered to 12 participants before the Epic (Epic Systems Corp., Verona, WI) changes were implemented and to 19 participants after they were implemented. Each participant was asked to answer the airway data questionnaire for two patients, for a total of 24 questionnaires before the EMR changes and 38 questionnaires after the changes. Respondents averaged 7.24 minutes to complete the entire airway data questionnaire before the EMR changes and 3.16 minutes following modification (P < 0.0001). Correct airway information was more consistently collected with the modified EMR (98.6% vs 51.4%, P < 0.00001). Satisfaction surveys revealed that participants found the accessibility of airway data to be significantly improved following the EMR changes.ConclusionAn EMR airway alert that provides rapid access to relevant airway information critical tool during urgent and emergent events. Based on our preliminary data, further use of this instrument is expected to continue to improve patient safety and practitioner satisfaction.Level of Evidence4 Laryngoscope, 128:2885–2892, 2018
Continuous lumbar drainage and the postoperative complication rate of open anterior skull base surgery
Authors: Ringel Barak , Carmel‐Neiderman Narin N. , Peri Aviyah , Ben Ner Daniel , Safadi Ahmad , Abergel Avraham , Margalit Nevo , Fliss Dan M. 
Published: September 2018

Objectives/HypothesisAnterior skull base operations pose the risk for postoperative cerebrospinal fluid (CSF) leak. Routine lumbar continuous drainage catheter (LD) placement is intended to decrease CSF leaks and central nervous system (CNS) complications, but there are no sound evidence‐based data on its efficacy. The primary goal of this study was to review CNS complications following anterior open skull base surgery and their association with LD placement. The secondary goal was to define predictors for the development of early CNS complications.Study DesignRetrospective case series.MethodsWe conducted a retrospective analysis of all patients who underwent anterior skull base surgery between 2000 and 2016 at the Tel Aviv Sourasky Medical Center, an Israeli tertiary referral center.ResultsA total of 226 patients underwent open skull base surgery, of whom 118 had elective perioperative continuous LD insertion and 108 did not. Delayed complications were defined as those occurring more than 30 days after the index operation. Thirty‐one (26%) patients in the LD group had early CNS complications compared with only two (1.6%) in the non‐LD group, whereas 13 (11%) of the former patients had late CNS complications compared with four (3%) of the latter patients. Early systemic and late wound complications were also significantly more numerous in the LD group. On multivariate analysis, elective LD insertion and intracranial tumor extension were found to be predictors for developing early CNS complications.ConclusionsThe placement of continuous LDs might increase the risk of developing early and late CNS complications after open anterior skull base surgery.Level of Evidence4 Laryngoscope, 128:2702–2706, 2018
Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma
Authors: Sokoya Mofiyinfolu , Chowdhury Farshad , Kadakia Sameep , Ducic Yadranko 
Published: September 2018

Objectives/HypothesisWith positron emission tomography/computed tomography (PET/CT) now commonplace as a diagnostic tool, new questions have arisen regarding the utility and cost‐effectiveness of panendoscopy. In this retrospective review of a large cohort of head and neck squamous cell carcinoma of unknown primary (HNSCC‐UP), we describe the enduring utility of panendoscopy in the detection of the primary site of mucosal disease even when PET/CT is negative.Study DesignRetrospective cohort study.MethodsA retrospective analysis of patients presenting to the senior author (y.d.) from July 1 1997 to July 1 2017 with fine‐needle aspiration–proven metastatic squamous cell carcinoma to the neck. All patients underwent formal panendoscopy (direct laryngoscopy, bronchoscopy, and rigid esophagoscopy). Presence of squamous cell carcinoma on final pathology was examined.ResultsA total of 190 patients had HNSCC‐UP, with 87 positive and 103 negative on PET/CT. Of the PET/CT‐negative patients, 71 patients retained the HNSCC‐UP designation after panendoscopy. Eighteen patients (56% of cases) were found to have primary tonsillar squamous cell carcinoma. Eight of 32 primary sites were found in the base of tongue (25%), with HPV positivity in two of these patients. The sensitivity and negative predictive value of PET/CT in detecting the primary site in unknown primary head and neck squamous cell carcinoma in the total study population were 73.1% and 68.9%, respectively.ConclusionsSurgical panendoscopy has an important role in the workup of patients with unknown primary head and neck squamous cell carcinoma. There is a high rate of cancer diagnosis, even in PET/CT negative patients.Level of Evidence4 Laryngoscope, 2573–2575, 2018
The role of quality‐of‐life instruments in predicting voice therapy dropout
Authors: Kavookjian Hannah , Holcomb Andrew , Garnett James D. , Kraft Shannon 
Published: September 2018

Objectives/HypothesisVoice therapy (VT) is essential to the successful management of voice disorders. Despite this, two‐thirds of patients drop out of therapy before completion. In this study we examine whether responses to specific question items or domains from the Voice Handicap Index (VHI) are associated with VT compliance.Study DesignSingle‐institution retrospective cohort study.MethodsAll patients presented to a tertiary care center between January 2011 and June 2016 with dysphonia. Patients were excluded if seen by speech language pathology (SLP) for preoperative assessment only, there was no order for therapy, or there was no documentation of therapy performed at outside facilities. Data collected included VHI responses, demographics, diagnosis, social history, and clinical exam. Patients were divided into three groups for analysis: 1) did not attend therapy, 2) partially completed therapy, or 3) completed therapy.ResultsOf 489 patients referred for VT, 36.2% did not attend, 36.0% partially completed VT, and 27.8% completed VT. Patients who did not attend had significantly lower scores in VHI, VHI‐10, and each of the VHI domains. There was a significant difference in age between VT groups, with those electing to not attend representing older age. Patients who attended VT were more likely to use their voice for work (P = .015). There were statistically significant differences among the groups for six VHI question items.ConclusionsUnderstanding patient motivations, whether a patient uses their voice for work, and specific responses to the VHI questionnaire may allow clinicians to better understand patient engagement in voice therapy.Level of Evidence4 Laryngoscope, 128:2832–2837, 2018
Adenoidectomy With Balloon Catheter Sinuplasty: A Randomized Trial for Pediatric Rhinosinusitis
Authors: Gerber Mark E. , Kennedy Aimee A. 
Published: September 2018

Objectives/HypothesisTo compare treatment outcomes in pediatric patients with chronic rhinosinusitis (CRS) using adenoidectomy and maxillary sinus irrigation with or without balloon catheter sinuplasty (BCS).MethodsProspective, randomized, and blinded. Patients between 2 and 12 years who met clinical and computed tomography criteria for CRS unresponsive to maximal medical therapy and no prior sinus‐ or adenoid‐related procedures were eligible. Twenty‐five patients were randomized, had surgery, and completed the follow‐up. The control group underwent adenoidectomy with maxillary sinus irrigation alone; the treatment group underwent the same, with the addition of maxillary BCS for the maxillary sinus irrigation. Patients and parents were blinded to group assignment throughout the follow‐up time frame. A validated questionnaire, the Sinus and Nasal Quality of Life Survey (SN‐5), was used to measure health status changes and quality of life (QOL) at baseline, 6 months, and 12 months postintervention. Data was analyzed using t tests and multivariate linear regression.ResultsThere were 12 patients in the BCS group and 13 in the control group. Other than a higher atopic history in the control group (P = 0.047), there were no significant differences (P = 0.07) in the two groups (demographics and baseline SN‐5 scores). Following surgery, both groups demonstrated similar improvement in QOL scores and median SN‐5 scores in all domains (number of sinus infections, nasal obstruction, allergy symptoms, emotional distress, and activity limitations).ConclusionThe addition of BCS to adenoidectomy/maxillary sinus irrigation did not provide additional QOL and sinonasal symptom improvement in the surgical treatment of pediatric CRS.Level of Evidence1b Laryngoscope, 128:2893–2897, 2018
Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P
Authors: Rawal Rounak B. , Farquhar Douglas R. , Kilpatrick Lauren A. , Drake Amelia F. , Zdanski Carlton J. 
Published: September 2018

ObjectivesNeonates weighing < 2.5 kg have known higher rates of surgical mortality and morbidity, but this remains unexamined specifically for tracheostomy. We present outcomes of neonates undergoing tracheostomy stratified by weight.MethodsRetrospective review of the American College of Surgeons National Surgical Quality Improvement Program–Pediatric from 2012 to 2014. Patients undergoing tracheostomy were included. Thirty‐day mortality and major/minor complication rates were stratified by weight (group 1: < 2.5 kg; group 2: ≥ 2.5 kg and < 4 kg; group 3: ≥ 4 kg). Patient comorbidities were assessed for independent risk factors of morbidity and mortality.ResultsOf 183,233 patients, 543 underwent tracheostomy. Forty‐four patients were group 1 (mean: 2.2 kg ± 0.25); 170 patients were group 2 (mean: 3.31 kg ± 0.42); and 329 patients were group 3 (mean: 6.4 kg ± 2.7). Between groups 1 and 2, there were no significant differences in mortality (P = 0.47), major complication rates (P = 0.99), or minor complication rates (P = 0.64). In comparing all three groups, there were no significant differences in mortality (P = 0.47), major complication rates (P = 0.80), or minor complication rates (P = 0.77). The overall 30‐day mortality for all patients was 4.24%. In a multivariate logistical regression model, weight group did not change the odds of all negative outcomes (group 1: odds ratio [OR] of 0.71; 95% confidence interval [CI], 0.33–1.53 and group 2: OR of 0.78; 95% CI, 0.50–1.22). Bronchopulmonary dysplasia was the only independent significant predictor of major complications (OR, 1.69; 95% CI, 1.02–2.79) (P = 0.04).ConclusionOur data indicate that 30‐day mortality and morbidity outcomes for neonatal tracheostomy are not affected by weight. Overall 30‐day mortality should be discussed with caregivers preoperatively.Level of Evidence4 Laryngoscope, 129:500–505, 2019
Cardiovascular endpoints for obstructive sleep apnea with twelfth cranial nerve stimulation (CARDIOSA‐12): Rationale and methods
Authors: Dedhia Raj C. , Quyyumi Arshed A. , Park Jeanie , Shah Amit J. , Strollo Patrick J. , Bliwise Donald L. 
Published: September 2018

Objectives/HypothesisTo determine the effect of therapeutic levels of hypoglossal nerve stimulation therapy (HGNS), compared to subtherapeutic levels of HGNS, on 24‐hour ambulatory blood pressure, sympathetic activity, and vascular function.Study DesignDouble‐blind, sham‐controlled, randomized crossover trial of 10‐week duration at a university medical centerMethodsThe target enrollment is 60 randomly assigned subjects. Interventions are active versus sham (subtherapeutic) HGNS therapy.ResultsThe primary outcome is 24‐hour ambulatory systolic blood pressure. Secondary outcomes include 24‐hour ambulatory diastolic blood pressure, nocturnal systolic and diastolic pressure, muscle sympathetic nerve activity, pre‐ejection period, flow‐mediated dilation, and pulse wave velocity.ConclusionsThe Cardiovascular Endpoints for Obstructive Sleep Apnea With Twelfth Cranial Nerve Stimulation study is designed to examine obstructive sleep apnea and test the effects of HGNS on the cardiovascular system through a sham‐controlled trial in patients with moderate–severe obstructive sleep apnea.Level of Evidence1 Laryngoscope, 2635–2643, 2018
Demographic predictors of head and neck cancer survival differ in the elderly
Authors: Massa Sean T. , Cass Lauren M. , Challapalli Sai , Zahirsha Zisansha , Simpson Matt , Ward Gregory , Osazuwa‐Peters Nosayaba 
Published: September 2018

Objectives/HypothesisHead and neck squamous cell carcinoma (HNSCC) prognosis strongly correlates with demographic factors. This study aimed to determine whether demographic predictors of HNSCC survival differ between age cohorts, with an emphasis on the growing elderly demographic.Study DesignOutcomes research.MethodsAdults with squamous cell carcinoma of the upper aerodigestive tract were identified from the Surveillance, Epidemiology and End Results 18 database. Demographic and oncologic factors were compared between three age groups: 18 to 49, 50 to 74, and >75 years. Factors associated with cancer‐specific survival were assessed in each cohort using subdistribution hazard ratio (sHR) and 95% confidence interval (CI) produced by multivariate competing risk models.ResultsA cohort of 69,098 patients included 10,588 (15.3%) 75 years or older and 9,882 (14.3%) less than 50 years old. Older patients were more often female (35.4% vs. 25.1% aged 18–49 years and 20.4% aged 50–74 years), white (78.7% vs. 69.4% and 75.9%), insured (63.5% vs. 46.5% and 56.8%), and married (56.6% vs. 53% and 51.1%), but received adequate treatment less often (72.0% vs. 86.3% and 82.7%). In the older cohort, male sex was associated with lower mortality (sHR: 0.92, 95% CI: 0.85‐1.00), and unlike the younger cohorts, black race was no longer associated with mortality (sHR: 1.07, 95% CI: 0.94‐1.22). Marriage was associated with lower mortality in all age groups but with diminishing effects (single sHR: young 1.52, middle 1.31, older 1.14).ConclusionsElderly HNSCC patients have distinct effects from demographic prognostic factors and should be considered a separate subgroup with unique epidemiology, risks, and preferences.Level of Evidence2c Laryngoscope, , 129:146–153, 2018
Predictors of gastrostomy tube dependence in surgically managed oropharyngeal squamous cell carcinoma
Authors: Varma Vivek R. , Eskander Antoine , Kang Stephen Y. , Kumar Bhavna , Brown Nicole V. , Zhao Songzhu , Brock Guy , Agrawal Amit , Carrau Ricardo L. , Old Matthew O. , Ozer Enver , Rocco James W. , Schuller David E. , Dziegielewski Peter T. , Cipolla Michael J. , Teknos Theodoros N. 
Published: September 2018

ObjectivesTo elucidate predictive factors in the perioperative period resulting in gastrostomy tube (G‐tube) dependence for patients undergoing primary surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) in the modern era.MethodsTwo hundred and thirty patients with known OPSCC treated with primary surgery were screened and selected from a retrospective database spanning from 2002 to 2012 at The Ohio State University Wexner Medical Center (Columbus, Ohio), with univariable and multivariable logistic regression modeling used to determine independent predictive factors resulting in G‐tube dependence (defined as tube persistence/presence 1 year after surgery).ResultsSurgical approach, baseline characteristics, tumor (T)‐nodal‐metastasis stage, human papillomavirus status, extent of tissue resected, surgical complications, reconstructive technique, preoperative G‐tube presence, and adjuvant treatment were recorded. Patients undergoing open surgery for OPSCC without adjuvant treatment had 42.9% G‐tube dependence (44.6% with adjuvant chemoradiation [CRT]) compared to 0% for those undergoing transoral nonrobotic surgery (8.1% with adjuvant CRT) and 0% for those undergoing transoral robotic surgery (10.3% with adjuvant CRT). In multivariable analysis, greater than 25% of the oral tongue resected (odds ratio [OR] 12.29; P = 0.03), an open surgical approach (OR 5.72; P < 0.01) and T3/T4 tumor stage (OR 2.84; P = 0.02) were independent and significant predictors of G‐tube dependence.ConclusionSurgical approach, advanced tumor stage, and oral tongue resection may influence the development of nutritional dependence for surgically treated patients with OPSCC.Level of Evidence4 Laryngoscope, 129:415–421, 2019
The incidence of microscopic thyroglossal duct tissue superior to the hyoid bone
Authors: Garcia Erick , Osterbauer Beth , Parham David , Koempel Jeffrey 
Published: September 2018

ObjectiveDespite the success of the Sistrunk procedure, persistence of a thyroglossal duct cyst (TGDC), sinus, or remnant following excision remains a clinical problem. This is most likely due to the presence of microscopic disease that was not excised at the time of surgery. The purpose of this study is to determine the incidence of microscopic disease superior to the hyoid bone in children who have had either a primary or revision procedure for a TGDC.MethodsA prospective review of pathologic specimens was conducted of all consecutive patients undergoing TGDC excision by pediatric otolaryngologists at the Children's Hospital Los Angeles beginning March 2014 through July 2017 in both primary and revision procedures.ResultsMicroscopic disease was present superior to the hyoid bone in 25 of the 34 (74%) specimens and in 100% (6) of the specimens from a revision procedure.ConclusionThe majority of persons who have a TGDC will have microscopic disease superior to the hyoid bone. In order to minimize the incidence of persistence following a primary procedure, tissue superior to the hyoid bone should be removed routinely even if no gross disease is noted at the time of surgery. When performing a revision procedure, special attention should be given to the suprahyoid area as a likely site of persistent disease.Level of Evidence2b Laryngoscope, 129:1215–1217, 2019