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Patients on extracorporeal membrane oxygenation (ECMO) are infrequently nourished via oral feeding due to aspiration risks. Patients with COVID-19 and on ECMO represent a subpopulation that has additional factors that may affect their swallow function. This study aimed to describe the swallow function and ability to maintain oral feeding in patients with COVID-19 while on ECMO. A retrospective study of patients with COVID-19 who started veno-venous ECMO at the beginning of the COVID-19 pandemic (March 2020 and August 2020) was conducted at a tertiary care hospital. Clinical swallow evaluations and videofluoroscopic swallow studies (VFSS) were analyzed using standardized measurement scales. Pearson's correlation coefficient (r) identified relationships between ECMO and swallowing function at different time points. 19 patients were included; all underwent clinical swallow evaluation and 4 underwent VFSS while on ECMO. Mean age was 43.2 years (standard deviation: 9.2), mean duration of ECMO was 65.7 days (58.7), and mean duration of intubation was 14.4 days (8.6). All patients were able to undergo swallow function evaluation, regain swallow function, and resume oral feeding while cannulated. Duration of ECMO and time to feeding tube removal was positively correlated (r = 0.747, p < 0.001) with patients demonstrating less functional swallowing independence and requiring a more modified diet upon oral diet initiation. Clinical swallow evaluation and videofluoroscopic swallowing evaluation are possible for COVID-19 patients actively on ECMO. Patient swallow function can improve, and oral diet can be achieved while on ECMO, demonstrating benefit of SLP surveillance and swallowing assessment prior to ECMO decannulation., Competing Interests: Declarations. Declarations of Interest: The authors have no financial or non-financial interests to disclose. Research Involving Human Participants: All procedures in this study were conducted in accordance with the Rush University Medical Center Institutional Review Board (No. 2012 − 0103) approved protocols. Informed Consent: The Rush University Medical Center Institutional Review Board approved a waiver of consent for this study (No. 2012 − 0103) due to this study being declared secondary research due to the information regarding human subjects being de-identified, the subjects were not contacted, and the subjects were not re-identified., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study compares results from three dichotic listening experiments involving different methods of attention control. In each experiment, participants completed a dichotic listening task requiring two responses to syllables and we noted the order of report for the responses. In Experiment 1, participants reported from a specific ear first in trial blocks. In Experiment 2, an arrow cue indicated the ear of first report. In Experiment 3, a tone was presented to the ear of first report. Free recall in which participants reported the two syllables in any order was also included as a baseline. Results indicated a tendency to report from the right ear first in free recall, producing more reports from that ear, reflecting a right ear advantage (REA). In all cueing conditions, an overall REA emerged but it shifted to a left ear advantage (LEA: more reports from the left ear) when the left ear was cued. Additionally, larger laterality scores ([Right - Left]/[Right + Left]) for the conditions where the right ear was cued, relative to where the left ear was cued, suggests that attention control is limited in overriding the structural auditory asymmetries. We discuss the implications of these results for models of dichotic listening.

Purpose: To examine the patient experience of laryngopharyngeal reflux diagnosis and factors that contributed to perceived difficulty with the process., Materials and Methods: A 32-question anonymous survey was administered to individuals over 18 years old who reported a diagnosis of laryngopharyngeal reflux. The survey contained questions regarding demographics and individuals' experiences during the diagnostic workup along with the generic short patient experiences questionnaire. Percentages were calculated for all variables. Kendall rank correlation coefficient was performed to measure the strength and direction of association between laryngopharyngeal reflux workup and perceived difficulty with diagnosis., Results: Of the 232 respondents, 59.9 % reported difficulty with the diagnostic process. Strong positive correlations were found between perceived difficulty with laryngopharyngeal reflux diagnosis and the following factors: total number of physicians seen (τ b  = 0.483, p < 0.001), time from symptom onset (τ b  = 0.300, p < 0.001), and time from first physician visit (τ b  = 0.479, p < 0.001). Results from the generic short patient experiences questionnaire showed moderate negative correlations between perceived difficulty with diagnosis and the following factors: perceived competence of physician (τb = -0.228, p < 0.001), perception that the physician cared for the patient (τb = -0.253, p < 0.001), perceived interest the physician had in the patient (τb = -0.259, p < 0.001), and time interacting with the physician (τb = -0.226, p < 0.001)., Conclusions: Respondents report difficulty being diagnosed with laryngopharyngeal reflux. This correlates with increased time to receive a diagnosis, increased number of physicians seen, and factors related to the patient-physician relationship. Physicians can improve patient experience by focusing on clear communication with interactive patient appointments, and scheduling high yield diagnostic tests., Competing Interests: Declaration of competing interest Alexander Barna and Angelica Mangahas have no conflicts of interest to report. Inna A. Husain is a consultant for Acclarent, INC and the Vice President of Education for Reflux Raft, (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aims to examine the lasting effects of the coronavirus disease 2019 (COVID-19) pandemic on inpatient otolaryngology consultations. Methods: In a retrospective analysis, inpatient otolaryngology consultations at an urban, academic tertiary care center were reviewed over the course of 2 years (Jun 2019-Jun 2021). The consultations were categorized by time period based on the local data for COVID-19 hospitalizations and deaths as follows: pre-COVID (Jun 2019-Feb 2020), Surge 1 (Mar 2020-May 2020), Surge 2 (Oct 2020-Jan 2021), and Post Surge (Mar 2021-Jun 2021). Results: A total of 897 patients undergoing an inpatient otolaryngology consultation across all 4 time periods were included for analysis. The average consultations per day was 1.67 ± 0.24 in pre-COVID times, and dropped acutely to 0.86 ± 0.33 consultations per day during Surge 1. The consultation volume was not statistically different from pre-COVID levels during Surge 2 (1.33 ± 0.35) and Post Surge (1.60 ± 0.20). Reason for consultation and procedures performed did not vary significantly between pre-COVID times and Post Surge, except that consultation for postoperative complaint was less frequent in Post Surge (4.8% vs 1.0%, P  = .02). More patients had been screened with rapid antigen COVID testing in Post Surge versus Surge 1 (20.1% vs 7.6%, P  = .04). Conclusions: Inpatient otolaryngology consultation volumes, indications, and procedures performed at an urban, academic institution returned to pre-COVID levels after being significantly impacted during Surge 1., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Granular cell tumor of the larynx is an uncommon, typically benign lesion that may be confused for a malignant neoplasm based on histopathology. This review examines cases of granular cell tumor of the larynx in adults to highlight key distinctions in diagnosis/management and demonstrate how misclassification may lead to unnecessary escalations in therapy., Data Sources and Methods: A systematic search of PubMed, Ovid, and EBSCO Search Hosts was completed in December 2021. The search yielded 501 articles with 87 full-text articles included in the review. Primary search terms included granular cell, tumor, larynx, and adult. Primary endpoints were patient presentation, primary management, pathological features, and disease course., Results: A systematic review of 87 articles identified 200 patients with granular cell tumors (GCTs) of the larynx. Of the 200 patients, 50.3% were males and 49.7% were females. Of these, 54.0% were reported as white patients, and 46.0% were reported as black patients. The most common presenting symptoms were dysphonia (85.9%) and stridor/dyspnea (14.1%). On examination, the lesions were most commonly polypoid/nodular and firm. Pseudoepitheliomatous hyperplasia (PEH) was identified in 33.5% of cases, and 2% of cases were malignant. GCTs were misdiagnosed as other malignant lesions in 11% of cases. In benign cases, 13.5% of patients underwent additional surgeries beyond simple excision/laryngofissure, including laryngectomy and neck dissection. Less than 2% of lesions reoccurred., Conclusion: Granular cell tumors of the larynx are typically benign lesions that may be misdiagnosed with unnecessary escalation of treatment. However, most lesions resolve via primary surgical excision. Laryngoscope, 134:1523-1530, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Describe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting., Study Design: Retrospective cohort study., Setting: Long-term acute care hospital., Subjects and Methods: A retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed., Results: Amongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found., Conclusion: LTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function., Competing Interests: Declaration of competing interest We have no conflicts of interest to disclose., (Published by Elsevier Inc.)

Purpose: Long term acute care hospitals (LTACHs) saw a significant increase in COVID-19 patients with prolonged acute illness recovery. Speech language pathologists (SLP) in LTACHs were integral in assessing swallowing and providing rehabilitation for dysphagia, however, there is limited research on LTACHs and dysphagia. Our aim was to describe this unique dysphagia management experience to improve future patient care., Methods: Retrospective chart reviews were conducted for patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to October 31, 2021. Demographic information, videofluoroscopic swallow study (VFSS) reports with Penetration and Aspiration Scale (PAS) scores and SLP notes were reviewed. Descriptive statistics and chi-square analysis were performed., Results: A total of 213 patients met inclusion criteria. Most patients presented with tracheostomy (93.9%) and were NPO (92.5%) on admission. A strong correlation (p = 0.029) was noted between dependence on mechanical ventilation and significant airway invasion, as indicated by PAS score of 7 or 8 on VFSS. There was a strong association (p = 0.001) between patients who had tracheostomy placed within 33 days of VFSS and recommendation for thin liquids. Upon discharge, the majority of patients (83.57%) transitioned successfully to oral diets, however, a strong association (p = 0.009) between higher age (≥ 62) and NPO at discharge was demonstrated., Conclusion: Patients admitted post COVID-19 to LTACH, especially those requiring tracheostomy, demonstrated various degrees of dysphagia and benefited from SLP intervention and instrumental swallow assessments. Most patients admitted to LTACH for COVID-19 were successfully rehabilitated for dysphagia., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This meta-analysis synthesized longitudinal data on mean-level change in body image, focusing on the constructs of body satisfaction and dissatisfaction, body esteem, perceived attractiveness, valuation, self-objectification, and body shame. We searched five databases and accessed unpublished data to identify studies that assessed body image at two or more time points over six months or longer. Analyses were based on data from 142 samples representing a total of 128,254 participants. The age associated with the midpoint of measurement intervals ranged from 6 to 54 years. Multilevel metaregression models examined standardized yearly mean change, and the potential moderators of body image construct, gender, birth cohort, attrition rate, age, and time lag. Boys and men showed fluctuations in overall body image with net-improvements between ages 10 and 24. Girls and women showed worsening body image between ages 10 and 16, but improvements between ages 16 and 24. Change was greatest between ages 10 and 14, and stabilized around age 24. We found no effect of construct, birth cohort, or attrition rate. Results suggest a need to revise understandings of normative body image development: sensitive periods may occur somewhat earlier than previously believed, and body image may show mean-level improvements during certain age ranges., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To determine the efficacy of office-based intralesional steroid injections (ILSI) as a management therapy for adult subglottic stenosis (SGS)., Data Sources: A systematic review was completed using PubMed and Science Direct for office-based management of SGS due to various etiologies., Review Methods: The primary end point measured was a change in surgery free interval (SFI) between endoscopic procedures due to office-based serial ILSI. The secondary end point was to determine what percentage of patients did not require further operative intervention for SGS maintenance therapy after changing management to office-based serial ILSI., Results: We identified 187 abstracts, 4 of which were included in the analysis. The total number of participants was 55. The mean age was 50.4, and 78.1% were women. The etiologies were as follows: idiopathic (58.2%), postintubation/tracheotomy (29.1%), and autoimmune (12.7%). The SFI was reported in 3 of the 4 studies. The reported mean pre-ILSI SFI was 362.9 days and the post-ILSI SFI was 582.2 days. The secondary outcome was reported in 3 of the 4 studies. Forty-one of the 55 patients (74.5%) did not require further operative intervention during the duration of the study., Conclusion: This review explored office-based ILSI as a potential treatment option for patients with SGS. The limited data presented found ILSI significantly lengthened SFI, potentially reducing surgical burden. In addition, ILSI was found to be safe with few reported side effects.

Objectives: Laryngopharyngeal reflux (LPR) is an extraesophageal variant of gastroesophageal reflux disease associated with intermittent dysphonia, throat-clearing, and chronic cough. This study aims to evaluate the impact of race and insurance status on symptoms often attributable to LPR., Methods: Retrospective review of all patients with suspected LPR from 2017 to 2019 was performed at a tertiary care center. The diagnostic criteria comprised evaluation by a fellowship trained laryngologist and Reflux Symptom Index (RSI) scores. Demographics, patient history, and insurance status were recorded. Descriptive statistics were calculated for each parameter using SPSS version 22., Results: A total of 170 patients (96 White, 44 Black, 26 Latinx, 4 Asian) were included in this study. About 57.1% had private insurance, 30.6% had Medicare, and 11.8% had Medicaid. Black and Latinx patients demonstrated higher RSI scores (26.67 ± 8.61, P  = .017) when compared to their White and Asian counterparts. RSI scores between all 3 insurance types also varied significantly ( P  = .035). Medicaid patients reported higher RSI scores (28.65 ± 10.09, P  = .028), while private insurance patients reported significantly lower scores (23.75 ± 7.88, P  = .03). Controlling for insurance type eliminates the statistically significant association between RSI scores and Black and Latinx patients. Particularly, within the Medicaid group, Black, Latinx, and White patients did not have statistically different RSI scores., Conclusions: Black and Latinx patients presented with higher RSI scores than White and Asian patients. Similarly, Medicaid patients reported higher RSI scores than the Non-Medicaid cohort. These findings suggest that access to appropriate healthcare, due to varied insurance coverage and socioeconomic, may potentially influence symptoms attributed to LPR.

Objective: To determine the efficacy of ventilatory techniques by evaluating prevalence of technique failure and intraoperative hypoxia during endoscopic management of airway stenosis., Data Sources: A systematic review was conducted using PubMed and Embase for anesthesia techniques in endoscopic management of airway stenosis., Review Methods: The primary outcome measured was reports of partial and complete technique failure. The secondary outcome measured was intraoperative hypoxia., Results: We identified 7704 abstracts with 17 meeting criteria for analysis. The reported partial and complete ventilatory technique failures were: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % laryngeal mask airway, 0 % nonocclusive balloon dilator, 4.76 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, and 30.24 % jet ventilation. The reported rate of intraoperative hypoxia was: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, 2.18 % jet ventilation, 3.57 % laryngeal mask airway, and 5 % nonocclusive balloon dilator., Conclusion: Evone Flow-Controlled Ventilation with Tritube endotracheal tube had the lowest risk of technique failure and intraoperative hypoxia. Nonocclusive balloon dilator and laryngeal mask airway were also favorable techniques for ventilation. Jet ventilation showed a lower rate of intraoperative hypoxia, but a higher rate of failure. Newer techniques, such as Evone Flow-Controlled Ventilation with Tritube, nonocclusive balloon dilator and spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, may offer promise compared to older techniques like jet ventilation; however, larger studies with more uniform data are needed to determine their efficacy., Competing Interests: Conflict of interest, (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: To explore the impact of female sex on the experiences of trainees and surgeons in otolaryngology from LMIC and HIC., Methods: This study includes perspectives of five consultants and two resident physicians from the United States, United Kingdom, Uganda, Kenya and South Africa., Results: Six themes emerged from these interviews. Overall, LMIC and HIC women shared similar experiences of microaggressions during patients, working along ancillary staff, related to pregnancy, imposter syndrome, difficulties during job search, and unique barriers as consultant., Conclusions: The findings of this study highlight that gender disparities are present at all levels in Otolaryngology but can present differently depending on context. Laryngoscope, 133:547-551, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Bariatric surgery has been documented to improve comorbidities associated with obesity. Obesity can cause deposition of excess adipose tissue, narrowing of the vocal tract, and decreased lung capacity contributing to reduced vocal quality and increased vocal effort. Limited information is available regarding the impact of bariatric surgery on voice outcomes. This review seeks to examine the role of bariatric surgery on voice outcomes., Study Design: Systematic review., Methods: A systematic review was completed using PubMed and Embase for measures of vocal change before and after bariatric surgery. Studies were reviewed by three authors, and data related to acoustic, aerodynamic, auditory-perceptual, and patient-reported outcome measures were extracted., Results: Forty-nine abstracts were identified with seven meeting criteria for analysis. Voice outcomes pre and postbariatric surgery were measured across 122 individuals. Results revealed increased fundamental frequency (F 0 ) and increased maximum phonation time (MPT) during sustained vowel productions. Correlation coefficients for MPT for /a/ were -0.683 and -0.725 for F 0 , respectively, indicating a strong negative correlation between body mass index and MPT and F 0 . Trends toward improved auditory-perceptual ratings and improved patient-reported outcome measures were also noted. However, studies were limited by restricted patient demographics and limited use of standardized and/or comprehensive evaluation techniques., Conclusion: Weight loss associated with bariatric surgery can result in improved voice outcomes; however, the mechanism by which it helps is unclear. To better understand this, otolaryngologists and speech-language pathologists may consider advocating for pre- and postsurgery voice evaluation in patients undergoing bariatric surgery., Competing Interests: Conflict of Interest Disclosures None reported, (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To highlight various patient, tumor, diagnostic, and treatment characteristics of laryngeal chondrosarcoma (LC) as well as elucidate factors that may independently affect overall survival (OS) for LCs., Study Design: Retrospective cohort study., Setting: National Cancer Database (NCDB)., Methods: All LC cases from 2004 to 2016 were extracted from the NCDB. Several demographic, diagnostic, and treatment variables were compared between LC subgroups using χ 2 and analysis of variance tests. Univariate and multivariate survival analyses were performed for LCs using univariate Kaplan-Meier analysis and Cox proportional hazards regression models., Results: There were 348 LCs included in the main cohort. LCs were predominantly non-Hispanic white males with similar rates of private and government insurance (49.4% vs 45.4%). Most LCs (81.6%) underwent primary surgery, particularly partial and total laryngectomy. The 1-, 5-, and 10-year survivals for LC were 95.7%, 88.2%, and 66.3%, respectively. On multivariate analysis, lack of insurance ( P = .019; hazard ratio [HR], 8.21; 95% CI, 1.40-48.03), high grade ( P = .001; HR, 13.51; 95% CI, 3.08-59.26), and myxoid/dedifferentiated histological subtypes ( P = .0111; HR, 10.74; 95% CI, 1.71-67.33) correlated with worse OS. No difference in OS was found between partial and total laryngectomy., Conclusion: This is the first multivariate survival analysis and largest single cohort study of LCs in the literature. Overall, LCs enjoy an excellent prognosis, with insurance status, grade, and histology as the main predictors of survival.

Objectives: The current study seeks to identify the correlation between in-office spirometry data and voice-related quality of life in patients with subglottic stenosis (SGS)., Methods: Patients with SGS of any etiology were included when in-office spirometric data was available in addition to voice-related patient-reported outcomes (PROM) data in the form of the Voice Handicap Index-10 (VHI-10) and/or the Voice-Related Quality of Life (V-RQOL) survey. Overall survey scores and individual question responses were assessed for degree of correlation to spirometric data., Results: Twenty-nine patients were included in the final analysis. Overall mean total VHI-10 scores totaled 7.15 (SD 9.11), while mean overall V-RQOL scores totaled 78.41 (SD 16.45). Both PEF and PIF rates correlated to total scores on the VHI and V-RQOL surveys. This correlation was stronger with PIF than with PEF, and with the V-RQOL than with the VHI. Questions related to breathlessness most closely correlated with spirometric data., Conclusion: Voice-related QOL is impacted in patients with SGS in a predictable way. Breathlessness while speaking may be more impactful than inability to produce speech in this population., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose Upper airway patency is crucial in a patient's ability to tolerate a one-way speaking valve (SV). Traditional assessment of airway patency is mainly subjective. We developed four noninvasive methods to assess patency (leak volume, transtracheal pressure [TTP], end-tidal CO 2 , and Mallampati score) in our institution. This study was aimed to evaluate the effectiveness of the four methods and explore the relationship between the patient's upper airway patency and SV trial tolerance. Method A retrospective cohort study was conducted to enroll adult patients with tracheostomies eligible for an SV trial from April 2019 through January 2020. An in vitro study was also implemented to explore the relationship between upper airway patency and noninvasive measurements. Results Forty patients (22 men and 18 women) were included; 16 used SV in-line with mechanical ventilation. Twenty-four patients tolerated an SV trial of > 10 min; they had lower TTP (3.0 [2.0-9.0] vs. 15.0 [9.3-21.3] cm H 2 O, p < .001), higher leak volume (268.5 ± 177.2 vs. 88.6 ± 99.6 ml, p = .038), and lower percentage of patients with Mallampati Classification IV (16.7 vs. 50.0%, p = .035), compared to the 16 patients who did not tolerate an SV trial. Twenty-two patients with a TTP of ≤ 9 cm H 2 O had higher percentage tolerating an SV trial than those with a TTP of > 9 cm H 2 O (86.4 vs. 35.3%, p = .002). The in vitro study demonstrated a strong correlation between upper airway patency and TTP, peak inspiratory flow, and tidal volume inhaled from the upper airway. Conclusions TTP, Mallampati classification, and leak volume can be used to assess upper airway patency for adult patients with tracheostomies undergoing an SV trial. A TTP of ≤ 9 cm H 2 O might indicate adequate upper airway patency to tolerate the SV trial.

Objective: Type III sulcus is a pathologic structural deformity of the vocal folds that is challenging to accurately diagnose without endoscopic examination under anesthesia. This study aims to further define the clinical presentation and examination features shared among a patient cohort intraoperatively diagnosed with type III sulcus., Study Design: Case series with chart review., Setting: Tertiary laryngology practice., Subjects and Methods: All patients diagnosed intraoperatively with type III sulcus from 2002 to 2014 at a tertiary laryngology practice were included. Clinical history of presenting symptoms, videostroboscopy, and intraoperative and histologic findings were reviewed., Results: Twenty-two patients were included in the study. A majority were female (77%) and had a mean age of 32.4 years. All patients endorsed hoarseness, and 86% were defined as professional voice users. Endoscopic examination revealed bilateral type III sulcus in 23% of patients. The most common preoperative stroboscopic findings included decreased mucosal wave (100%), dilated vessel (95%), phase asymmetry (91%), additional benign lesion (91%), and cyst (82%). Histology revealed epithelial changes of atypia and keratosis., Conclusion: Both the severity of dysphonia and the difficulty observing structural malformations of the vocal folds make type III sulcus challenging to preoperatively diagnose. This study reports the clinical and endoscopic features seen within a cohort of patients with type III sulcus.

Objective: The aging larynx undergoes structural changes that have functional consequences for voice production known as presbyphonia. Treatment of presbyphonia includes voice therapy and surgery. This review seeks to examine voice outcomes after surgery for presbyphonia., Data Sources: Three electronic databases (PreMed, ScienceDirect, Embase) were reviewed for articles published between 1 January 1900 and 1 June 2019., Review Methods: Original English-language studies examining surgical treatment of presbyphonia in elderly patients (≥65 years) were included according to PRISMA. Two researchers independently analyzed articles. Outcome measures were extracted from and qualitatively compared across studies., Results: Of the 118 articles identified, five satisfied eligibility criteria. In all studies, diagnosis of presbyphonia was based on videostroboscopy. 85 patients (61M, 21F) were evaluated. 37.6% underwent implantation thyroplasty (IT), 48.2% underwent injection augmentation (IA), 7.1% underwent both, and 7.1% underwent basic-fibroblastic growth factor (b-FGF) injection. Average patient age was 71.3 years. Average follow-up time was 5.4 months. Three months post-intervention, IT patients self-reported greater improvement in quality of life (QoL) metrics compared to IA patients. Aerodynamic measures, like mean phonation time, were significantly improved in IT and IA, but not b-FGF-injected patients. All patients experienced improvements in the auditory perception of voice three months post-intervention., Conclusion: Surgical modalities currently utilized for presbyphonia include IT and IA, with bFGF-injection being trialed abroad. IT patients reported enhanced QoL relative to IA and bFGF-injected patients. Overall there is a paucity of high-power, prospective studies that explore the efficacy of these modalities. Moreover, wide variability exists in reported outcomes among published studies., Competing Interests: Declaration of competing interest HJB: No conflicts of interest; no financial disclosures. DZ: No conflicts of interest; no financial disclosures. IAH: No conflicts of interest; no financial disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed., Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms., Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001)., Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

Objectives/hypothesis: To characterize the epidemiology of primary laryngeal lymphoma and to determine the prognostic factors affecting survival in patients with this disease., Study Design: A retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database, including cases from 1973 to 2014., Methods: A population-based analysis was conducted with patients from more than 15 different geographic regions across the United States. Patients were chosen based on a diagnosis of lymphoma and a primary lymphoma site within the larynx. Two hundred cases were eligible based on the inclusion criteria, and characteristic as well as clinical variables were then extracted from the database and analyzed. Characteristic and clinical variables included age, race, sex, primary site of lymphoma involvement, general histology, specific histologic subtype, tumor grade, and Ann Arbor staging. Exposure variables that were analyzed included radiation therapy and chemotherapy. Overall survival (OS) and disease-specific survival (DSS) were the main outcomes calculated using multivariate analysis., Results: A total of 200 cases of laryngeal lymphoma were identified. The mean age at diagnosis was 64.2 years. The cohort was composed of 53% males. B-cell non-Hodgkin's lymphoma (NHL) accounted for 74% of cases, whereas natural killer/T-cell NHL accounted for 10% of cases. A total of 53.1% of patients received radiation therapy, whereas 47.5% received chemotherapy. The median OS was 9.15 years and median DSS was 24.5 years. OS at 2, 5, and 10 years was 74%, 63%, and 44%, respectively. On multivariate analysis, older age, male sex, and advanced Ann Arbor staging were associated with worse OS, whereas only male sex and advanced Ann Arbor staging were associated with worse DSS (all P values < .05). Radiation and chemotherapy were not associated with improved survival., Conclusions: Female sex and lower Ann Arbor staging are independent positive prognostic indicators for survival, whereas other clinical variables such as grade and histology do not have an effect on survival. Radiation and chemotherapy do not appear to confer a mortality benefit in patients with primary laryngeal lymphoma, which may have implications on clinical decision making as well as patient education about disease prognosis., Level of Evidence: 4. Laryngoscope, 128:2044-2049, 2018., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Presence of fat, oil, and grease (FOG) in wastewater is an ever-growing concern to municipalities and solid-waste facility operators. FOG enters the sewer system from restaurants, residences, and industrial food facilities. Its release into the sewer system results in a continuous build-up that causes eventual blockage of sewer pipes. Several researchers have investigated FOG deposition based on the local conditions of sewers and lifestyle. This paper attempts to review the physical and chemical characteristics of FOG, sources of FOG, and potential chemical and biological reactions of FOG. The effect of the aforementioned factors on the FOG-deposition mechanism is also discussed. Moreover, insight into the current control and treatment methods and potential reuse of FOG is highlighted. It is expected that this review would provide scientists and the concerned authorities a holistic view of the recent researches on FOG control, treatment, and reuse.

Objectives/hypothesis: To describe the surgical approaches and materials used to repair spontaneous cerebrospinal fluid (CSF) otorrhea of temporal bone origin., Study Design: Retrospective case review at a tertiary academic medical center., Methods: All patients presenting with spontaneous CSF otorrhea or rhinorrhea over a consecutive 8-year period were included. Clinic charts and operative reports were reviewed to obtain the clinical presentation, examination findings, diagnostic test results, intraoperative findings, operative technique, and postoperative follow-up. Surgical approach and materials used for repair were determined by the location of the defect(s) and surgeon preference., Results: Seventeen patients underwent 19 operations for repair of spontaneous CSF otorrhea or rhinorrhea. The mean age was 61 years and the male to female ratio was 5:12. All female patients had a body mass index (BMI) greater than 30 mg/kg. The most common presenting symptom was otorrhea after a myringotomy or placement of a tympanostomy tube. A middle fossa craniotomy was used in 17 approaches. The most common defect sites were located over the tegmen mastoideum and tegmen tympani. Multiple materials were used in most repairs including allogenic bone cement and autologous materials. One patient had persistent otorrhea after a transmastoid approach and required a middle fossa craniotomy to repair a tegmen mastoideum defect., Conclusions: Spontaneous CSF otorrhea is uncommon and often not diagnosed until a myringotomy or tympanostomy tube is placed. The middle fossa craniotomy provides the best exposure for defects involving the middle fossa floor. Both alloplastic and autologous materials are highly successful in repairing the defect(s) responsible for CSF otorrhea. No infections of the alloplastic bone cement occurred in our series.

A simple extraction procedure was used for preparing cell surface proteins (CSPs) from Shigella dysenteriae type 1. The preparations obtained using either buffer or water extractions were free from lipopolysaccharide (LPS), as well as cytoplasmic and periplasmic proteins. By SDS-PAGE, about 25 polypeptides were detected, and Western-blot analysis recognised 15 polypeptide antigens. When analysed by crossed immunoelectrophoresis, using anti-Shigella dysenteriae type 1 rabbit sera, 18 antigenic bands were identified. Proteins obtained by this method were found to be highly immunogenic in rabbits. The cell-surface proteins were compared to outer membrane proteins (OMPs) obtained from the S. dysenteriae type 1 strain by a standard procedure involving lysozyme-EDTA extraction, sucrose density centrifugation, and detergent treatment. They were found to contain periplasmic, cytoplasmic, and lipopolysaccharide contaminants. Thus, the procedure described here offers a quick and simple alternative for obtaining relatively pure cell surface proteins from Shigella dysenteriae type 1. This method will be useful when immunogenically active proteins free from other cellular components are required for studies.