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  • 1
    Online Resource
    Online Resource
    Comparative Treatment Outcomes for Idiopathic Subglottic Stenosis: 5‐Year Update
    Wiley ; 2023
    In:  Otolaryngology–Head and Neck Surgery Vol. 168, No. 6 ( 2023-06), p. 1570-1575
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 168, No. 6 ( 2023-06), p. 1570-1575
    Abstract: The North American Airway Collaborative (NoAAC) previously published a 3‐year multi‐institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re‐enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision‐making. Level of evidence: 2—prospective cohort study.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Issue
    URL: Article
    DOI: 10.1002/ohn.v168.6
    DOI: 10.1002/ohn.190
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 2
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    Online Resource
    Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis
    Wiley ; 2016
    In:  The Laryngoscope Vol. 126, No. 6 ( 2016-06), p. 1390-1396
    Details
    In: The Laryngoscope, Wiley, Vol. 126, No. 6 ( 2016-06), p. 1390-1396
    Abstract: Idiopathic subglottic stenosis (iSGS) is a rare and potentially life‐threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes. Study Design Medical record abstraction. Methods Utilizing an international, multi‐institutional collaborative, we collected retrospective data on patient characteristics, treatment, and clinical outcomes. We investigated variation between and within open and endoscopic treatment approaches and assessed therapeutic outcomes; specifically, disease recurrence and need for tracheostomy at last follow‐up. Results Strikingly, 479 iSGS patients across 10 participating centers were nearly exclusively female (98%, 95% confidence interval [CI], 96.1–99.6), Caucasian (95%, 95% CI, 92.2–98.8), and otherwise healthy (mean age‐adjusted Charlson Comorbidity Index 1.5; 95% CI, 1.44–1.69). The patients presented at a mean age of 50 years (95% CI, 48.8–51.1). A total of 80.2% were managed endoscopically, whereas 19.8% underwent open reconstruction. Endoscopic surgery had a significantly higher rate of disease recurrence than the open approach (chi 2 = 4.09, P = 0.043). Tracheostomy was avoided in 97% of patients irrespective of surgical approach (95% CI, 94.5–99.8). Interestingly, there were outliers in rates of disease recurrence between centers using similar treatment approaches. Conclusion Idiopathic subglottic stenosis patients are surprisingly homogeneous. The heterogeneity of treatment approaches and the observed outliers in disease recurrence rates between centers raises the potential for improved clinical outcomes through a detailed understanding of the processes of care. Level of Evidence 4. Laryngoscope , 126:1390–1396, 2016
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v126.6
    DOI: 10.1002/lary.25708
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 3
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    Online Resource
    Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 3 ( 2021-03), p. 587-591
    Details
    In: The Laryngoscope, Wiley, Vol. 131, No. 3 ( 2021-03), p. 587-591
    Abstract: Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety. Study Design Case Series. Methods The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported. Results A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51 years, and median BMI was 25 kg/m 2 . Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16 minutes. At the end of case, median end tidal CO 2 was 50 mmHg, and median minimum SpO 2 was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO 2 of 0.844 mmHg/min of apneic time. Conclusions THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non‐laser surgery in appropriately selected patients. To ensure safety, back‐up plans such as jet ventilation and microlaryngeal ETT should be available. Level of Evidence 4 Laryngoscope , 131:587–591, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v131.3
    DOI: 10.1002/lary.28776
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 4
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    Online Resource
    Hemodynamic Parameters during Laryngoscopic Procedures in the Office and in the Operating Room
    Wiley ; 2016
    In:  Otolaryngology–Head and Neck Surgery Vol. 155, No. 3 ( 2016-09), p. 466-472
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 155, No. 3 ( 2016-09), p. 466-472
    Abstract: Previous research has shown that office‐based laryngoscopic procedures can induce hemodynamic changes, including tachycardia and severe hypertension, calling into question the safety of these procedures. However, comparison between office and operating room (OR) procedures has not been carried out. Therefore, we prospectively measured hemodynamic variables in both settings to compare hemodynamic changes between office and OR procedures. Study Design Prospective cohort study. Setting Single academic center. Subjects and Methods Subjects undergoing office and OR laryngoscopic procedures were prospectively identified, and 92 OR and 70 office subjects were included. Heart rate and blood pressure were measured at established time points before, during, and after the procedures. Descriptive and comparative statistical analyses were conducted. Results Severe hemodynamic events, either tachycardia or severe hypertension (blood pressure 〉 180 mm Hg systolic or 〉 110 mm Hg diastolic), occurred significantly more frequently in OR than office procedures (41% vs 20%; P =. 006). OR severe hemodynamic events occurred more commonly than previously reported rates in the office (41% vs 28%; P =. 012). Regression analyses showed that the odds of having a severe hemodynamic event were 3.66 times higher in OR versus office procedures. Conclusion Severe hemodynamic events are more likely to occur in the OR than in the office during laryngologic procedures. While larger studies will be required to establish rates of dangerous cardiovascular events in laryngoscopic procedures, hemodynamic parameters indicate that office‐based procedures have a safety benefit for procedures that can be conducted in either setting.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599816645809
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 5
    Online Resource
    Online Resource
    Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review
    Wiley ; 2023
    In:  The Laryngoscope
    Details
    In: The Laryngoscope, Wiley
    Abstract: There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described. Data Sources MEDLINE, EMBASE, and the Cochrane databases. Review Methods A scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes. Results After systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term. Conclusion Endoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope , 2023
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Article
    DOI: 10.1002/lary.30994
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 6
    Online Resource
    Online Resource
    Respiratory Laryngeal Dystonia: Characterization and Diagnosis of a Rare Neurogenic Disorder
    Wiley ; 2020
    In:  The Laryngoscope Vol. 130, No. 12 ( 2020-12), p. 2843-2846
    Details
    In: The Laryngoscope, Wiley, Vol. 130, No. 12 ( 2020-12), p. 2843-2846
    Abstract: Respiratory laryngeal dystonia (RLD) is poorly understood and rarely reported in the literature. Patients have atypical laryngeal movement resulting in airway obstruction. This motion is neurogenic in nature, is constant while awake, nonepisodic, and non–trigger dependent. Given its rarity, it is often misdiagnosed for inducible laryngeal obstruction; however, it is refractory to medical and behavioral management. Although this condition has been addressed in the literature, this report is the largest case series characterizing presenting symptomology, multimodal treatment outcomes, and longitudinal course of these patients, and proposes a set of diagnostic criteria to aid in clinical identification of RLD patients. Our objectives were to characterize RLD clinically and offer diagnostic guidelines to clinicians. Study Design A prospective case series with a retrospective analysis at a tertiary referral center. Methods A review of clinical records and videostroboscopic analysis of 16 patients treated for respiratory laryngeal dystonia from October 2005 to October 2018 was performed. Results Sixteen patients with respiratory laryngeal dystonia were included. The common features of this group were persistent, nonepisodic dyspnea and stridor with laryngoscopic evidence of paradoxical vocal fold motion. Our patients had no structural neurologic abnormalities. These patients typically failed respiratory retraining therapy and medical management of laryngeal irritants. In our series, 100% of patients underwent respiratory retraining therapy, 68.8% received laryngeal botulinum toxin injection, and 31.3% required tracheostomy. Conclusions RLD is a rare and challenging condition. The disorder can be severely disabling, and treatment options appear limited. A multidisciplinary approach may be helpful. Some patients responded to laryngeal botulinum injection and medical management, whereas others required tracheostomy for symptom control. Laryngoscope , 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v130.12
    DOI: 10.1002/lary.28559
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 7
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    Online Resource
    The Role of Bilateral Superior Laryngeal Nerve Block in Managing Refractory Chronic Cough
    Wiley ; 2023
    In:  The Laryngoscope
    Details
    In: The Laryngoscope, Wiley
    Abstract: The aim was to investigate the utilization and efficacy of bilateral superior laryngeal nerve block in patients with refractory chronic cough. Methods A retrospective chart review of 164 patients with refractory chronic cough who underwent bilateral SLN block at a single institution between November 2018 and September 2022 was performed. Demographics, comorbidities, and patient‐reported outcomes including pre‐ and postinjection Leicester Cough Questionnaire (LCQ) scores were collected and analyzed. Results The cohort underwent an average of 2.97 bilateral injections (range 1–22), containing either corticosteroid and local anesthetic or corticosteroid alone. Notably, 116 of 164 of patients reported an average of 67.3% reduction in their symptoms, with the treatment effect lasting 7.60 weeks on average. The average pre‐ and postinjection LCQ scores were 9.70 and 13.82, respectively. A lower LCQ score represents a greater impairment of health status due to cough, and the minimum important change is 1.3 points between questionnaires. The average improvement on LCQ following bilateral SLN block was 4.11 points for this cohort. Conclusion The use of in‐office bilateral SLN block is an effective treatment that can be used alone or in conjunction with oral medications for the treatment of refractory chronic cough. Level of Evidence 4 Laryngoscope , 2023
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Article
    DOI: 10.1002/lary.31061
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 8
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    Online Resource
    Laryngeal Botulinum Toxin Injection for Vocal Tremor: Utility of Concurrent Strap Muscle Injection
    Wiley ; 2019
    In:  The Laryngoscope Vol. 129, No. 6 ( 2019-06), p. 1433-1437
    Details
    In: The Laryngoscope, Wiley, Vol. 129, No. 6 ( 2019-06), p. 1433-1437
    Abstract: Vocal tremor is a neurologic disorder that can be treated with laryngeal botulinum toxin injections (LBTX). We sought to describe our experience with thyroarytenoid and concurrent strap muscle injection. Study Design Retrospective chart review. Methods A chart review was performed of all patients with a primary diagnosis of vocal tremor treated with LBTX from 2012 through 2017. Results Twenty‐one patients were included (mean age 69 years, 100% female). Thirteen patients (62%) had a minor component of spasmodic dysphonia in addition to their tremor. Fourteen patients had vertical and horizontal components to their tremor, and two had horizontal tremor alone. The remaining five patients did not have clear characterization of their tremor. A total of 49 injections were reviewed (25 thyroarytenoid [TA], 24 thyroarytenoid and strap muscle [TA+S] ), and patients reported subjective voice benefit with 48 (96%) of these (92% TA, 100% TA+S). When available, the postprocedural change from baseline Voice Handicap Index‐10 and Consensus Auditory Perceptual Evaluation of Voice scores were calculated (mean overall: −1.9, −7.8; TA: −2.7, −3.5; TA+S: −1.4, −10.3, respectively). Subjective patient improvement ratings (scale 0%–100%) were obtained for 46 injections, with a mean of 70% improvement per injection. Of patients with both horizontal and vertical tremor, outcomes were improved with TA+S injection versus TA alone (mean improvement 74% vs. 35%, P   〈  .005). Conclusions There is utility in the characterization of vertical and horizontal components of vocal tremor. Patients with both appear to have increased benefit with injection of strap muscles in addition to thyroarytenoid muscles. Level of Evidence 4 Laryngoscope , 129:1433–1437, 2019
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v129.6
    DOI: 10.1002/lary.27631
    Language: English
    Publisher: Wiley
    Publication Date: 2019
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  • 9
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    Online Resource
    The Application of Superior Laryngeal Nerve Block for Non‐Cough Laryngeal Hypersensitivity
    Wiley ; 2023
    In:  The Laryngoscope
    Details
    In: The Laryngoscope, Wiley
    Abstract: To investigate the effect of superior laryngeal nerve (SLN) block in patients with non‐cough complaints relating to laryngeal who have failed conventional medical therapy. Methods Retrospective chart review of 46 patients who underwent SLN block for non‐cough indications between July 2019 and March 2022 was performed. Demographics, comorbidities, and patient‐reported outcomes were collected. The primary diagnoses for this group included: odynophagia, throat pain, cervicalgia, muscle tension dysphonia, globus sensation, hyoid bone syndrome, and Eagle syndrome. Results The cohort underwent an average of 1.24 bilateral injections (range 0–7) and 0.87 unilateral injections (range 0–4). About 35 of 46 patients reported an average of 51.0% improvement in their symptoms, with the treatment effect lasting 7.60 weeks on average. On subgroup analysis, the patients with spasmodic dysphonia, odynophagia, and hyoid bone syndrome had the best percent improvement on average (75%–77.5%). Patients with globus sensation had the lowest percent improvement on average in response to this therapy, reporting only about 25%. Five patients experienced a mild adverse reaction immediately following injection which resolved spontaneously. Conclusion The use of in‐office SLN block for non‐cough disorders involving the larynx requires further study with larger sample sizes to better delineate the efficacy of these applications. Level of Evidence 4 Laryngoscope , 2023
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Article
    DOI: 10.1002/lary.31075
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 10
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    Variability of Ratings in the Otolaryngology Standardized Letter of Recommendation
    Wiley ; 2016
    In:  Otolaryngology–Head and Neck Surgery Vol. 154, No. 2 ( 2016-02), p. 287-293
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 154, No. 2 ( 2016-02), p. 287-293
    Abstract: To determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR). Study Design Retrospective review. Setting Academic otolaryngology training program. Subjects and Methods 496 SLORs to the Cleveland Clinic Otolaryngology Training Program were reviewed. The SLORs were extracted from the applications and analyzed. The distributions of ratings across the 10 categories were statistically analyzed including distribution and standard deviation. Rankings were grouped into deciles for this analysis. Results Ratings across the 10 domains revealed clustering of results across the top 2 deciles. The distribution of the bell‐shaped curve was shifted significantly to the left, representing the upper deciles. No evidence of gender or geographic bias was found. Longer length of time of association between the applicant and the letter writer correlated to a higher ranking. Conclusion The explosion of applications being sent out by candidates for otolaryngology residency programs has prompted the implementation of the SLOR. The lack of variation in the ratings across the 10 domains does not allow for differentiation among student applicants. Reliance on the narrative letter of recommendation attached to the SLOR still remains the most significant way to differentiate among applicants. Refinements will need to be made in either the structure or use of the SLOR for it to be a more useful tool.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599815623525
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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