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  • SAGE Publications  (10)
  • Bock, Jonathan M.  (10)
  • 1
    Online Resource
    Online Resource
    Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis
    SAGE Publications ; 2021
    In:  Annals of Otology, Rhinology & Laryngology Vol. 130, No. 10 ( 2021-10), p. 1116-1124
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 130, No. 10 ( 2021-10), p. 1116-1124
    Abstract: To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients. Methods: Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence. Results: The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression. Conclusions: Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/0003489421995283
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2033055-8
    detail.hit.zdb_id: 120642-4
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  • 2
    Online Resource
    Online Resource
    Analysis of Pepsin in Tracheoesophageal Puncture Sites
    SAGE Publications ; 2010
    In:  Annals of Otology, Rhinology & Laryngology Vol. 119, No. 12 ( 2010-12), p. 799-805
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 119, No. 12 ( 2010-12), p. 799-805
    Abstract: Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association. Methods: Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate–polyacrylamide gel electrophoresis Western blot analysis. Results: Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy. Conclusions: Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348941011901203
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2033055-8
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  • 3
    Online Resource
    Online Resource
    Arytenoid Repositioning Device
    SAGE Publications ; 2014
    In:  Annals of Otology, Rhinology & Laryngology Vol. 123, No. 3 ( 2014-03), p. 195-205
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 123, No. 3 ( 2014-03), p. 195-205
    Abstract: We report development of a device and technique to manage laryngeal paralysis through minimal-access arytenoid adduction (for unilateral paralysis) and arytenoid abduction (for bilateral paralysis). Methods: A human cadaver study coupled with directed engineering was used to develop instrumentation designed to secure the muscular process of the arytenoid into favorable adducted or abducted positions. Digital video, photography, and 3-dimensional computed tomographic (CT) imaging of cadaveric larynges were done to evaluate the surgical technique. Results: Testing of prototypes identified the ideal implant to be a 0.36-mm wire with a distal spring-wound coil placed through a trocar via a small drill hole in the anterior thyroid cartilage. An endoscopic view of transilluminated light through the pyriform sinus mucosa identified the tip location of the trocar adjacent to the muscular process of the arytenoid cartilage. Placement of the device through the trocar permitted rotation to engage the muscular process and/or adjacent soft tissue with the distal coil. Implant fixation to the thyroid cartilage positioned the vocal cord into either adduction or abduction. Three-dimensional CT imaging coupled with review of the video documentation established the feasibility of this technique. Conclusions: We confirm the feasibility of minimal-access arytenoid adduction and abduction through development of a new technique and device.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/0003489414522968
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 4
    Online Resource
    Online Resource
    Changing Patterns in Reflux Care : 10-Year Comparison of ABEA Members
    SAGE Publications ; 2015
    In:  Annals of Otology, Rhinology & Laryngology Vol. 124, No. 12 ( 2015-12), p. 940-946
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 124, No. 12 ( 2015-12), p. 940-946
    Abstract: To compare patterns of laryngopharyngeal reflux (LPR) diagnosis and management over time by American Broncho-Esophagological Association (ABEA) members. Methods: American Broncho-Esophagological Association members completed an online questionnaire focused on LPR evaluation and management in 2012; responses were compared to a 2002 survey. Results: Four hundred twenty-six members were emailed, of whom 63 (14.8%) responded. In both time periods, throat clearing, heartburn, globus, arytenoid edema, and erythema were considered highly related to LPR. Management in 2012 differed as respondents more commonly treated LPR empirically (82.6% vs 56.3%, P = .036). When adjunctive testing was ordered, dual pH probe were less frequently utilized in 2012 (61.5% vs 78.3%, P = .029). Either esophagogastroduodenoscopy (EGD) or transnasal esophagoscopy (TNE) was used more often in 2012 compared to EGD alone in 2002 (63.8% vs 42.4%, P = .020). Dual pH probe was regarded as the most sensitive and specific evaluation for LPR in both surveys, while the perceived sensitivity/specificity of EGD in 2012 was half that reported in 2002 (28.0% vs 56.3%, P = .003). Conclusion: Attitudes of ABEA members toward empiric treatment and adjunctive tests have changed between 2012 and 2002. While pH probe testing remains the test regarded as most sensitive/specific for evaluation of LPR, empiric management has become more common. Meanwhile, EGD use has increased despite a significant decrease in its perceived sensitivity/specificity.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/0003489415592407
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 5
    Online Resource
    Online Resource
    Massive Zenker Diverticulum
    SAGE Publications ; 2012
    In:  Ear, Nose & Throat Journal Vol. 91, No. 8 ( 2012-08), p. 319-320
    Details
    In: Ear, Nose & Throat Journal, SAGE Publications, Vol. 91, No. 8 ( 2012-08), p. 319-320
    Type of Medium: Online Resource
    ISSN: 0145-5613 , 1942-7522
    URL: Article
    DOI: 10.1177/014556131209100805
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 1131745-0
    detail.hit.zdb_id: 2067528-8
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  • 6
    Online Resource
    Online Resource
    Reactive Intracordal Fibrovascular Lesion
    SAGE Publications ; 2012
    In:  Ear, Nose & Throat Journal Vol. 91, No. 2 ( 2012-02), p. 54-56
    Details
    In: Ear, Nose & Throat Journal, SAGE Publications, Vol. 91, No. 2 ( 2012-02), p. 54-56
    Type of Medium: Online Resource
    ISSN: 0145-5613 , 1942-7522
    URL: Article
    DOI: 10.1177/014556131209100204
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 1131745-0
    detail.hit.zdb_id: 2067528-8
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  • 7
    Online Resource
    Online Resource
    Laryngopharyngeal Reflux : Paradigms for Evaluation, Diagnosis, and Treatment
    SAGE Publications ; 2014
    In:  Annals of Otology, Rhinology & Laryngology Vol. 123, No. 10 ( 2014-10), p. 677-685
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 123, No. 10 ( 2014-10), p. 677-685
    Abstract: This study aimed to describe current patterns for diagnosis and treatment of laryngopharyngeal reflux (LPR) and analyze differences between laryngologists and non-laryngologists. Methods: American Academy of Otolaryngology–Head and Neck Surgery and American Broncho-Esophagological Association members were invited to complete an online survey regarding evaluation, diagnosis, and treatment of LPR. Subgroup analysis was performed to identify differences between respondents who completed laryngology fellowships (LF) and those who did not (NL). Results: Of 159 respondents, 40 were LF. Video documentation of laryngopharyngeal exams was almost universal among LF (97% vs 38%, P 〈 .0001). Use of rigid (100%, P = .002) and flexible distal-chip technologies (94%, P = .004) was more common among LF. Diagnostic criteria were similar between the groups, with symptoms of heartburn, globus, and throat clearing thought most suggestive of LPR. Adjunctive tests most commonly used were barium esophagram and dual-probe pH testing with impedance. Laryngology fellowship-trained respondents used dual pH probes with impedance more often ( P = .004). They were more likely to prescribe twice daily proton pump inhibitors with concurrent H2-blocker medication initially ( P = .004) and to treat for longer than 4 weeks ( P = .0003). Conclusion: Otolaryngologists are in agreement on symptoms and physical features of LPR; however, significant differences exist between laryngologists and non-laryngologists on the use of adjunctive testing and treatment strategies.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/0003489414532777
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2033055-8
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  • 8
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    Online Resource
    Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction
    SAGE Publications ; 2013
    In:  Annals of Otology, Rhinology & Laryngology Vol. 122, No. 2 ( 2013-02), p. 100-108
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 122, No. 2 ( 2013-02), p. 100-108
    Abstract: We sought to review the dysphagia-related outcomes and quality of life in a series of patients with upper esophageal sphincter (UES) dysfunction treated with cricopharyngeal (CP) botulinum toxin (BTX) injection, and to identify patient characteristics or CP muscle histologic features that predict efficacy of BTX injection. Methods: A retrospective chart review was performed on patients with UES dysfunction who underwent CP BTX injection. Dysphagia-related quality-of-life questionnaires based on the Eating Assessment Tool (EAT-10) were mailed to patients. Results: Forty-nine patients (30 female, 19 male; average age, 59 ± 16 years) with UES dysfunction have been treated at our institution with CP BTX injection since 2000. Seventeen of these patients also underwent CP myotomy. Injections of BTX were occasionally repeated after the treatment effect subsided, and the BTX dose varied widely (average, 39 ± 19 units). Improvement in symptoms was noted by 65% of patients. The overall complication rate was minimal, although many patients complained of transient worsening of dysphagia after CP BTX injection. Biopsy specimens of the CP muscle were evaluated in the subset of patients with CP BTX injection who proceeded to myotomy, with results of neuropathic, myopathic, and mixed histologic subtypes. The EAT-10 scores demonstrated a general trend toward improved swallowing outcomes after CP BTX injection. Conclusions: This study reviewed findings from the largest published series of BTX treatment of UES dysfunction and evaluated the efficacy, patient satisfaction, and complications of this procedure. Dysphagia-related quality-of-life outcomes appear to be improved after CP BTX injection.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348941312200205
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
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  • 9
    Online Resource
    Online Resource
    Management of Zenker's Diverticulum in the Endoscopic Age: Current Practice Patterns
    SAGE Publications ; 2011
    In:  Annals of Otology, Rhinology & Laryngology Vol. 120, No. 12 ( 2011-12), p. 796-806
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 120, No. 12 ( 2011-12), p. 796-806
    Abstract: Zenker's diverticulum (ZD) is a common source of dysphagia with a well-established surgical treatment history. Variations may exist between practitioners in the preoperative, intraoperative, and postoperative management of patients with ZD because of recent evolutions in surgical approach toward an endoscopic technique. Methods: An online survey instrument was prepared and forwarded to the membership of the American Broncho-Esophagological Association (ABEA) to ascertain the current practice patterns of its members regarding numerous care parameters for patients with ZD. Results: Data on preoperative evaluation, operative care, postoperative management, and recalled incidence of complications, including mediastinitis, were evaluated. Subgroup analysis demonstrated significant differences in multiple care parameters for those surgeons who predominantly perform endoscopic operations (more than 80% willingness to perform endoscopic operations) compared to those who occasionally perform endoscopic operations (less than 80%), including average case number, advancement of oral intake, hospital discharge, use of antibiotics, and views on the efficacy of endoscopic surgical techniques. These changes were noted despite similar times since graduation from training for the two groups. Conclusions: These data present a contemporary snapshot of clinical care patterns of the ABEA membership for patients with ZD and suggest differences in care patterns for surgeons with a higher enthusiasm for endoscopic techniques and larger case volumes.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348941112001205
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 10
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    Online Resource
    Dysphagia Due to Adenoid Cystic Carcinoma of the Base of the Tongue
    SAGE Publications ; 2012
    In:  Annals of Otology, Rhinology & Laryngology Vol. 121, No. 6 ( 2012-06), p. 402-406
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 121, No. 6 ( 2012-06), p. 402-406
    Abstract: Although oropharyngeal neoplasia can often lead to dysphagia, salivary gland tumors rarely grow within the tongue base. We present the case of a 75-year-old man with adenoid cystic carcinoma of the base of the tongue causing profound dysphagia and weight loss, and provide a current literature review and update on the management of these rare tumors. Methods: We present a case report and a literature review. Results: Physical examination performed at the initial visit revealed a firm right base-of-tongue mass with no palpable lymphadenopathy. Flexible fiberoptic laryngoscopy confirmed a large submucosal mass at the right base of the tongue that obscured the right vallecula. Histopathologic analysis of the operative biopsy specimens revealed the classic features of adenoid cystic carcinoma. Treatment included radical pharyngotomy with wide local excision and primary closure, followed by postoperative radiation treatment. Conclusions: We demonstrate the clinical examination findings and histopathologic characteristics of this disease, and review the literature for clinical treatment recommendations for this rare cause of dysphagia.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348941212100607
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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    detail.hit.zdb_id: 120642-4
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