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Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P =.012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P <.001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P <.001) and risk of overall complications (P =.032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P =.049), postoperative bleeding (P =.036), and failure to wean off ventilator (P =.027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification. [ABSTRACT FROM AUTHOR]

Objective: The frequency of metastasis to level VI lymph nodes in advanced pyriform sinus squamous cell carcinoma (PSSCC) is unknown. We intended to analyze the clinical features and pathological presence or absence of level VI lymph node metastasis in patients with PSSCC. Methods: The data of 270 patients with previously untreated hypopharyngeal squamous cell carcinoma from 2006 to 2016 were obtained. Patients who underwent pharyngolaryngectomy for the pyriform sinus subsite with a curative intent with level VI dissection were included. We retrospectively analyzed the clinical Tumor-Node (TN) status (TNM classification of malignant tumors, eighth edition) and the presence or absence of pathological level VI lymph node metastasis. Results: A total of 34 patients were included. Eight patients (24%) had pathological level VI lymph node metastasis. The rate of pathological level VI lymph node metastasis was directly proportional to the clinical N status (P =.0002, Chi-square test for trend). In all, 5 patients with cN2b- 3 were classified as cN3b. Ipsilateral pathological level VI lymph node metastasis was observed in 1 patient, and bilateral metastasis was observed in 3 patients. There was no association between clinical T status or pyriform sinus apex invasion and pathological level VI metastasis (both P >.99, Fisher's exact test). Conclusions: PSSCC with cN3b is prone to bilateral level VI metastasis. We recommend that patients with PSSCC with cN3b should undergo bilateral level VI lymph node dissection. [ABSTRACT FROM AUTHOR]

Objective: Review a single institution's vestibular schwannoma (VS) microsurgery experience to determine (1) correlations between demographics, comorbidities, and/or surgical approach on hospital length of stay (LOS) and discharge disposition and (2) trends in surgical approach over time. Methods: Retrospective case series from a multidisciplinary skull base program at a tertiary care, academic hospital. All adult (>18 years) patients undergoing primary microsurgery for VS between 2008 and 2018 were included. Results: A total of 147 subjects were identified. Surgical approach was split between middle fossa (MF) (16%), retrosigmoid (RS) (35%), and translabyrinthine (TL) (49%) craniotomies. For the 8% of patients had other than routine (OTR) discharge. Mean LOS was significantly longer for patients undergoing RS than either MF or TL. Brainstem compression by the tumor was associated with longer LOS as were diagnoses of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease (PVD). For all discharges, the 40 to 50- and 50 to 60-year-old subgroups had significantly shorter LOS than the 70-years-and-older patients. For the 92% of patients routinely discharged, there was a significantly shorter LOS in the 40 to 50-year-olds compared to the 70-years-and-older patients. There was a significant shift in surgical approach from RS to TL over the study period. Conclusion: Over 90% of VS microsurgery patients were routinely discharged with a median hospital LOS of 3.2 days, both of which are consistent with published data. There is an inverse relationship between age and LOS with patients older than 70 years having significantly longer LOS. Brainstem compression, COPD, PVD, and the RS approach negatively affect LOS. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Objective: To assess preoperative psychological burden in patients with vestibular schwannoma (VS). Methods: A total of 100 patients undergoing VS resection between September 2019 and June 2020 completed preoperative psychological screening. The Hospital Anxiety and Depression Scale (HADS) was applied the day before surgery, and a score >14 was considered clinically important. Univariate and multivariate logistic regression analyzes were used to identify risk factors associated with increased preoperative psychological stress. Results: Of the 100 patients who underwent VS resection, 44% were male, with a mean age of 45.9 years. Twenty-two (22%) had HADS scores >14. For the univariate analysis, risk factors associated with elevated psychological burden included time since diagnosis, number of symptoms, headache, vertigo, and nausea and/or vomiting. In the regression analysis, the number of symptoms and greater time from diagnosis to treatment correlated with higher preoperative psychological stress. Conclusion: Nearly 1 in 4 patients with VS experienced clinically significant emotional burden preoperatively. Number of symptoms and greater time from diagnosis to treatment contributed to this psychological burden. [ABSTRACT FROM AUTHOR]

Introduction: Frontal sinusitis in the pediatric population is a disease that has not been thoroughly studied or characterized. The goals of this study are to characterize the clinical presentation, radiologic variables, treatment modalities, complications, and prognosis associated with acute and chronic frontal sinus disease in the pediatric population. Methods: IRB-approved retrospective cohort study of pediatric patients who were diagnosed with acute (AFS) or chronic frontal sinusitis (CFS) and underwent frontal sinus surgery at a tertiary level Children's Hospital from 2006 to 2016. Patients with AFS were compared to patients with CFS. Statistical analysis completed using chi-square test or Fisher's exact test, statistical significance set at P <.05. Results: A total of 19 patients with AFS and 15 patients with CFS were analyzed. There was a male predominance in AFS and female predominance in CFS (P <.05).AFS patients were less likely to have allergies, prior sinus disease, or significant comorbidities (P <.05).Additionally, AFS patients presented with constitutional, neurologic, and ocular symptoms. The CFS group had predominantly sinonasal symptoms. CT-scan analysis showed that AFS patients had higher prevalence of complex frontal anatomy (Type-II cells, concha bullosa) compared with CFS patients (P <.05). Culture results were positive in 78% of the AFS group, with S. Anginosus (53%), Anaerobes (20%), and normal flora (17%). In the CFS group cultures were positive in 60% of the patients, 56% grew normal flora, 13% H. Influenzae, 6.5% Pseudomonas, and 24.5% other species. CFS patients were more likely to have persistent sinus disease and require repeat sinus procedures (P <.05). Conclusion: There are 2 distinct presentations of frontal sinus disease in the pediatric population. Patients with AFS vary significantly from those with CFS. Males, ages 13 to 18 years old, who cultured positive for S. Anginosus (former S.Milleri) dominated the AFS subgroup. Whereas as female patients with a history of allergic rhinitis and muco-cilliary disease were more prominent in the CRS subgroup. Correct identification and understanding of these 2 different entities are crucial for the appropriate short and long-term patient management. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study is to describe the 30-day postoperative sequelae of pediatric choanal atresia repair and identify predictive factors for adverse events. Study Design: The American College of Surgeons' National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database was searched between January 2012 and December 2015 to identify pediatric patients status post choanal atresia repair. Postoperative outcomes included surgical site complications, readmissions, and total length of stay. Results: A total of 178 children underwent choanal atresia repair. The overall complication rate was 6.2%, while the 30-day readmission rate was 15%. Patients with CHARGE had a longer mean duration of hospitalization (26.91 days vs 8.05 days, P =.013). Additionally, patients ≤10 days of age had longer duration of hospitalization (17.84 days vs 9.24 days, P ≤.001) and higher readmission rates (33.30% vs 10.1%, P =.001). Among the nonsyndromic cohort, ventilator dependence was a predictor of postoperative complications (odds ratio [OR] = 16.08, P <.001), higher readmission rates (OR = 5.46, P =.002), and a longer hospital stay (OR = 18.69, P <.001). Conclusion: Analysis of the 2012-2015 NSQIP-P data set reveals that patients with a diagnosis of CHARGE and those ≤10 days of age have a longer duration of hospitalization. Increased risk of postoperative complications and longer duration of hospitalization were both influenced by chronic steroid use and ventilator dependence. [ABSTRACT FROM AUTHOR]

Objective: To compare the management of pediatric chronic rhinosinusitis (PCRS) between members of the American Rhinologic Society (ARS) and the American Society of Pediatric Otolaryngology (ASPO). Study Design: Comparison of surveys. Methods: A web-based survey was distributed to ASPO membership twice in September-October 2016. Data were compared to previously published data from ARS membership in March-April 2016. Results: ASPO survey completion rate was 22%. ARS members were more likely to employ oral steroids in initial (P = .025) and maximal medical management (P = .001). ASPO members more commonly performed adenoidectomy before computed tomography (CT) (P < .001). Both groups commonly included adenoidectomy as part of initial surgical management (90% vs 94%, P = .316), while ASPO members more frequently performed adenoidectomy alone (70% vs 43%, P = .001). If initial surgical treatment failed, both groups commonly performed endoscopic sinus surgery (ESS; 81% vs 88%, P = .56) with a similar extent including frontal (P ≥ .207) and sphenoid (P ≥ .304) surgery. Conclusions: Pediatric chronic rhinosinusitis management is similar between groups, yet there are differences including oral steroid use, relative order of CT versus adenoidectomy, and performing concomitant procedures with adenoidectomy. Both groups commonly perform ESS with similar surgical extent if prior surgical treatment fails. Management by both groups is largely in agreement with published consensus statements. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the predictive value of ultrasonography (US) patterns based on the 2015 American Thyroid Association (ATA) guidelines for malignancy in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) nodules. Methods: From January 2014 to August 2015, 133 thyroid nodules that were initially diagnosed as AUS/FLUS on fine needle aspiration (FNA) were included in this study. Each nodule was assigned a category with US patterns defined by the ATA guidelines. Clinical characteristics and US patterns were compared between the benign and malignant nodules, and malignancy rates were calculated according to the ATA guidelines. Results: The malignancy rate in the very low suspicion group was 0.0% in AUS/FLUS nodules. When applying the ATA guidelines, significant differences existed for US patterns between the benign and malignant nodules in the AUS group (P = .032) but not the FLUS group (P = .168). Conclusions: Ultrasonography patterns by the 2015 ATA guidelines can provide risk stratification for nodules with AUS cytology but not for ones with FLUS cytology. For nodules with AUS/FLUS cytology with the very low suspicion pattern of the ATA guidelines, follow-up US might be recommended instead of repeat FNA. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the nature of surgical preparation among otolaryngology residents nationwide, determine the self-rated effectiveness and efficiency of case preparation practices, and identify potential means for educational improvement. Methods: A survey examining the study objectives was developed and distributed to otolaryngology residents nationwide. Survey response data were submitted to descriptive analysis and comparative analyses between junior and senior residents. Literature regarding case preparation among otolaryngology residents was reviewed. Results: Among 108 resident respondents, the most commonly used resources included textbooks (86.1%), surgical education websites (74.1%), and surgical atlases (66.7%). Time was the primary limitation (cited by 84.3%) and convenience the predominant factor influencing resource selection (92.5%). On a 5-point Likert scale, mean scores regarding effectiveness and efficiency of case preparation were 3.53 ± 0.68 and 3.19 ± 0.88, respectively. Senior residents compared to junior residents were more likely to rate their preparation as effective (3.75 ± 0.54 vs 3.40 ± 0.72, P = .008) and efficient (3.45 ± 0.85 vs 3.03 ± 0.86, P = .02). Conclusion: Otolaryngology residents do not consistently rate their case preparation as effective or efficient. While there appears to be progress in self-directed learning throughout residency, room for improvement remains, with potential avenues for such improvement explored here. [ABSTRACT FROM AUTHOR]

Objects: Dizziness makes up a diagnostic and treatment challenge. The diagnostic accuracy of the medical history and vestibular physical examination in cases of vestibular symptoms is not clear. The aim of this study is to determine the association between vestibular physical examination, vestibular questionnaires, and electronystagmography (ENG) test in patients with vestibular symptoms. Methods: This is a prospective study of 135 adults with vestibular symptoms. The subjects underwent targeted physical examination and filled vestibular questionnaires, including the Dizziness Handicap Inventory (DHI), before ENG testing. The results of the physical examination and questionnaires were compared with the final ENG findings. Results: Of patients who had normal ENG results, 32.1% (17/52) showed abnormal physical examination, and 48.8% (40/82) of the patient who had normal physical examination showed abnormal ENG results (P = .46). Among patients with severe disability by DHI, 46.4% (13/28) had an abnormal ENG, and 42.9% (12/28) had a normal ENG (P = .39). Conclusions: This study did not demonstrate association between vestibular physical examination, vestibular questionnaires, and ENG results. Although history (augmented by questionnaires) and physical examination are the initial steps in the evaluation of vertigo, the current study suggests that they should be complemented by objective testing for evaluation of inner ear origin of vertigo. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the content and readability of health information regarding partial tonsillectomy. Methods: A web search was performed using the term partial tonsillectomy in Google, Yahoo!, and Bing. The first 50 websites from each search were evaluated using HONcode standards for quality and content. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and SMOG score. The Freeman-Halton extension of Fisher's exact test was used to compare categorical differences between engines. Results: Less than half of the websites mentioned patient eligibility criteria (43.3%), referenced peer-reviewed literature (43.3%), or provided a procedure description (46.7%). Twenty-two websites (14.7%) were unrelated to partial tonsillectomy, and over half contained advertisements (52%). These finding were consistent across search engines and search terms. The mean FKGL was 11.6 ± 0.11, Gunning-Fog Index was 15.1 ± 0.13, Coleman-Liau Index was 14.6 ± 0.11, ARI was 12.9 ± 0.13, and SMOG grade was 14.0 ± 0.1. All readability levels exceeded the abilities of the average American adult. Conclusions: Current online information regarding partial tonsillectomy may not provide adequate information and may be written at a level too difficult for the average adult reader. [ABSTRACT FROM AUTHOR]

Objectives: Thyroid surgeons frequently encounter outpatients with mobile vocal cords complaining of lower-pitched voices following thyroidectomy. This study investigated the clinical and pathological parameters affecting voice pitch following thyroid surgery. Methods: We analyzed the data of 393 patients with mobile vocal cords and who also underwent thyroid surgery. Speaking fundamental frequency (SFF) and fundamental frequency (F0) were compared before and after surgery. Results: Approximately 26.7% of patients had significantly lowered SFFs (ΔSFF ≥ 12 Hz), and 30.2% exhibited significantly lower sustained vowel F0s (ΔF0 ≥ 12 Hz) following thyroid surgery. On multivariate analysis, only gender: female remained a significant predictor of a clinically significant change in SFF following thyroid surgery (P < .001). Gender: female and extent of surgery: total remained significant predictors of a clinically significant change in F0 after surgery (P = .006 and P = .007, respectively). Conclusions: Appreciable proportions of patients experience lower-pitched voice and related vocal symptoms early after thyroid surgery. Such problems develop more frequently in females who underwent total thyroidectomy. [ABSTRACT FROM AUTHOR]

Objectives: An intraoperative neural response telemetry-ratio (NRT-ratio) was established, which can provide information about the intraoperative intracochlear electrode array position for perimodiolar electrodes. Methods: In a retrospective controlled study in 2 tertiary referral centers, the electrophysiological data sets of 50 patients with measured intraoperative auto-NRTs and postoperative radiological examinations were evaluated. All patients were implanted with Nucleus slim straight electrodes. The NRT-ratio was calculated by dividing the average auto-NRT data from electrodes 16 to 18 with the average from electrodes 5 to 7. Using a flat panel tomography system or a computed tomography, the position of the electrode array was certified radiological. Results: Radiologically, 2 out of 50 patients were identified with an electrode translocated from the scala tympani into the scala vestibuli. The radiologically estimated electrodes indicating a scalar change showed a regular NRT-ratio but nonspecific NRT-level changes at the localization of translocation. [ABSTRACT FROM AUTHOR]

Objectives: The effects of age-related hearing loss are severe. Early detection is essential for maximum benefit. However, most hearing-impaired adults delay obtaining treatment. Diagnostic hearing testing at an appropriate facility is impractical, and new methods for screening audiometry aim to provide easy access for patients and reliable outcomes. The purpose of this study was to examine the accuracy of application-based hearing screening in an elderly population. Methods: The uHear application was downloaded to an iPad. Application-based hearing screening was performed in a non-soundproofed quiet room, and subsequently all participants underwent full diagnostic audiometry in a soundproof booth. Results: Sixty patients were recruited and completed both tests. Significant differences were observed between the hearing results obtained with the application and the standard audiogram at all frequencies and in both ears. Following subtraction of a constant factor of 25 dB from the application-based results in order to compensate for ambient noise, no significant differences in pure tone average were found between the 2 methods. Conclusions: The uHear application is inaccurate in assessing hearing thresholds for screening in the elderly. However, when site-specifically corrected, the uHear application may be used as a screening tool for hearing loss in an elderly population. [ABSTRACT FROM AUTHOR]

Purpose: Soccer participation continues to increase among all ages in the US. Our objective was to analyze trends in soccer-related facial injury epidemiology, demographics, and mechanisms of injury. Materials and Methods: The National Electronic Injury Surveillance System was evaluated for soccer-related facial injuries from 2010 through 2014. Results for product code “soccer” were filtered for injures to the face. Number of injuries was extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and mechanisms. Results: In all, 2054 soccer-related facial trauma entries were analyzed. During this time, the number of injures remained relatively stable. Lacerations were the most common diagnosis (44.2%), followed by contusions and fractures. The most common sites of fracture were the nose (75.1%). Of fractures with a reported mechanism of injury, the most common was head-to-head collisions (39.0%). Patients <19 years accounted for 66.9% of injuries, and athletes over 18 years old had a higher risk of fractures. Conclusions: The incidence of soccer-related facial trauma has remained stable, but the severity of such injuries remain a danger. Facial protection in soccer is virtually absent, and our findings reinforce the need to educate athletes, families, and physicians on injury awareness and prevention. [ABSTRACT FROM AUTHOR]

Objectives: To compare clinicians’ ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation. Methods: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings. Results: Clinicians were more likely to rate regularity on HSV versus VLS videos (P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location (P = .002). Supraglottic phase symmetry (P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions (P < .0001). Conclusions: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness of chemocauterization using trichloroacetic acid with or without suturing for the small tracheocutaneous fistula closure Methods: The Seoul National University Hospital database was analyzed retrospectively for 55 patients with a small tracheocutaneous fistula measuring less than 5 × 5 mm2. Of these, 39 patients were treated by chemocauterization only, and 16 patients were treated by chemocauterization with suturing. Demographic, perioperative data, and treatment outcomes were evaluated for all patients. Results: The success rate of single trial was 56.4% (31/55), and the final success rate after repeated procedures if indicated was 80.0% (44/55). There were no statistically significant differences in age, sex, cannulation period, fistula size, presence or absence of maturation suture during tracheostomy, number of procedures, and success rates. Interval between decannulation and procedure was significantly different among 2 groups. Conclusions: Trichloroacetic acid chemocauterization could be a simple, noninvasive, and safe method to close small tracheocutaneous fistula. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics. Methods: The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics. Results: There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting. Conclusions: The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age. Methods: Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample). Population: 64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student’s t test or the Mann-Whitney test were used. Results: The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences). Conclusions: There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies. [ABSTRACT FROM AUTHOR]

Objective: To identify characteristics in patients who undergo positive and negative bronchoscopy for a suspected airway foreign body (AFB). Methods: Review medical records between 2008 and 2012. Results: There were 145 patients who went to the operating room with the pre-bronchoscopy diagnosis of suspected AFB during the study period. There was an overall negative bronchoscopy rate of an average of 37%, with an annual range between 21% and 50%. The findings of history or suspicion of choking, asymmetric breath sounds, and wheezing were statistically more common in patients with an AFB. Chest roentograms (CXR) had a sensitivity and specificity of 62% and 57%. Twenty patients had a chest computed tomography (CT) scan, and 100% were clinically significant. Four CT scans were diagnostic of an AFB, and 16 patients avoided bronchoscopy after negative CT. Conclusions: In current clinical practice, it is difficult to identify patients with an AFB without performing bronchoscopy. This results in a significant number of negative bronchoscopes. Certain elements in the history and physical exam were more common in patients who were found to have an AFB. Our preliminary data suggest that chest CT scans may be useful to decrease the number of negative bronchoscopies. [ABSTRACT FROM AUTHOR]

Objective: Dysphagia and associated aspiration pneumonia are commonly reported sequelae of Parkinson’s disease (PD). Previous studies of swallowing in patients with PD have described prolonged pharyngeal transit time, delayed onset of pharyngeal transit, cricopharyngeal (CP) achalasia, reduced pharyngeal constriction, and slowed hyolaryngeal elevation. These studies were completed using inconsistent evaluation methodology, reliance on qualitative analysis, and a lack of a large control group, resulting in concerns regarding diagnostic precision. The purpose of this study was to investigate swallowing function in patients with PD using a norm-referenced, quantitative approach. Methods: This retrospective study includes 34 patients with a diagnosis of PD referred to a multidisciplinary voice and swallowing clinic. Modified barium swallow studies were performed using quantitative measures of pharyngeal transit time, hyoid displacement, CP sphincter opening, area of the pharynx at maximal constriction, and timing of laryngeal vestibule closure relative to bolus arrival at the CP sphincter. Results: Reduced pharyngeal constriction was found in 30.4%, and a delay in airway closure relative to arrival of the bolus at the CP sphincter was the most common abnormality, present in 62% of patients. Previously reported findings of prolonged pharyngeal transit, poor hyoid elevation, and CP achalasia were not identified as prominent features. [ABSTRACT FROM AUTHOR]

Objectives: (1) To describe clinical and radiologic findings in patients with esophageal foreign bodies. (2) To examine the sensitivity and specificity of history, physical examination, and radiologic studies in children with suspected foreign body ingestion. Methods: A retrospective cohort study was performed evaluating all children who underwent esophagoscopy for suspected foreign body ingestion at our institution from 2006 to 2013. Results: Five hundred forty-three patients were included (54% male). Average age was 4.7 years (SD = 4.1 years). Foreign bodies were identified on esophagoscopy in 497 cases (92%). Ingestion was witnessed in 23% of cases. Most common presenting symptoms were choking/gagging (49%), vomiting (47%), and dysphagia/odynophagia (42%). Most patients with foreign bodies had a normal exam (76%). Most foreign bodies were radiopaque (83%). In 59% of patients with normal chest radiographs, a foreign body was present. Sensitivity and specificity of 1 or more findings on history, physical examination, and imaging were 99% and 0%, 21% and 76%, and 83% and 100%, respectively. Conclusions: Most patients with esophageal foreign bodies are symptomatic. Although many patients will have a normal physical examination, an abnormal exam should increase suspicion for a foreign body. Most esophageal foreign bodies are radiopaque, but a normal chest radiograph cannot rule out a foreign body. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the dynamic upper airway changes occurring in an obstructive sleep apnea (OSA) rabbit model using dynamic computerized tomography (CT). Methods: In this study, 2.5 U of botulinum toxin type A was injected into the genioglossus to paralyze the tongue in the OSA group (n = 7). The control group was injected with normal saline (n = 7). Apnea-hypopnea index was measured using ApneaLink at baseline and at 1, 2, 3, 4, 6, and 8 weeks post-injection. Anterior to posterior (AP) and transverse diameters at the levels of the palate and tongue base were measured using a dynamic CT at baseline and at 1 and 2 weeks post-injection. Results: The success rate of OSA induction was higher in the OSA group (P = .02). In the OSA group, transverse and AP diameters at the palate level and AP diameter at the tongue base level significantly decreased 2 weeks post-injection (P = .01). Conclusions: A single obstruction site may constitute the primary pathogenesis in some OSA patients, even when the involvement of multiple sites is indicated. These findings may contribute to the identification of OSA pathogenesis and improve the planning of treatment based on the primary cause of OSA. [ABSTRACT FROM AUTHOR]

Objective: To compare 2 surgical techniques for implantation of a percutaneous bone anchored hearing device: (1) a minimal skin punch incision without additional skin incision or soft tissue reduction and (2) implantation with an epidermal flap and soft tissues reduction. Study Design: Prospective study. Setting: Tertiary care referral center. Subjects and Methods: Forty patients consecutively implanted (18 males and 22 females). Twenty patients underwent implantation by means of epidermal flap and soft tissues reduction (dermatome group), and 20 patients underwent skin punch resection without soft tissues reduction (punch group). Main outcome measurements: surgical adverse events, surgical time, skin healing, skin tolerance (Holgers classification), and skin appearance and implant failure. Results: The surgical time was shorter with the punch technique (P < .05). The postoperative healing was satisfactory in both groups. All implants were loaded after the healing period. The skin tolerance was good in both groups by Holgers classification (punch, 85.7%/dermatome, 86%) with no significant difference. There were no severe adverse skin events in the punch group. The appearance of the skin around the implant was improved by the punch technique. Conclusion: The implantation of the currently available percutaneous bone anchored hearing implants with a minimal skin punch skin resection without additional skin incision or soft tissue reduction shortens the surgery and improves the postoperative appearance. The skin tolerance is at least as good as with techniques with that include soft tissue reduction. [ABSTRACT FROM AUTHOR]

Objective: Middle meatal synechiae formation after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) leads to higher rates of revision surgery. We aimed to determine if there are different rates of postoperative synechiae following ESS for CRS between patients who received a nonabsorbable spacer (NAS) placed in the ethmoid cavity versus patients who had a steroid-impregnated absorbable spacer (AS) placed at the middle meatal entry. Methods: We conducted a retrospective cohort study of patients who underwent ESS for CRS at a single tertiary referral center from October 2009 to October 2013. We collected data on synechiae formation between the middle turbinate and lateral nasal wall within 1 month of surgery and postoperative epistaxis. Results: One hundred forty-six patients with 252 nasal cavities (52.0%) received steroid-impregnated AS, and 128 patients with 233 nasal cavities (48.0%) received NAS. Synechiae formation occurred in 2.0% of cavities with AS and 5.6% of cavities with NAS, but this difference was not statistically significant (OR = 0.34, P = .052). One patient in each cohort had significant postoperative epistaxis requiring additional nasal packing (P > .99). Conclusion: Steroid-impregnated absorbable spacers had statistically insignificant reduction in postoperative synechiae formation when compared to nonabsorbable spacers. Low rates of postoperative epistaxis were observed regardless of the type of spacer used. [ABSTRACT FROM AUTHOR]

Objective: To assess and correlate tinnitus annoyance in normal-hearing patients with auditory brainstem response and with anxiety/depression. Methods: A sample of 84 individuals with tinnitus and normal hearing levels (pure-tone thresholds ≤25 dB HL) was compared to a matched control group of 47 normal-hearing individuals without tinnitus. All participants underwent auditory brainstem response testing. Tinnitus annoyance was assessed using the Tinnitus Handicap Inventory and depression and anxiety using the Beck Depression Inventory and Beck Anxiety Inventory, respectively. We compared auditory brainstem response and anxiety/depression symptoms between groups. In the study group, we correlated the degree of tinnitus annoyance with normal/abnormal auditory brainstem response and presence/level of anxiety/depression symptoms. Results: All controls had normal auditory brainstem response; 30 patients with tinnitus had abnormal results. Thirty-five patients with tinnitus had depression and 41 anxiety, while only 2 controls had depression and none had anxiety, with a significant between-group difference (P < .001). Normal/abnormal auditory brainstem response showed no association with tinnitus annoyance, anxiety, or depression. A higher degree of tinnitus annoyance was associated with severity of depression and anxiety. Conclusions: Increased tinnitus annoyance was positively correlated with greater severity of anxiety and depression in normal-hearing patients but was unrelated to normal/abnormal auditory brainstem response. [ABSTRACT FROM AUTHOR]

Objectives: 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. [ABSTRACT FROM AUTHOR]

Background: Though minimally invasive video-assisted thyroidectomy (MIVAT) offers many advantages over traditional thyroid surgery, its adoption in North America has been limited. This study analyzes the largest series of MIVAT in North America to explore its safety. Methods: A prospectively maintained database of all patients undergoing thyroid surgery by a single surgeon from 2003 to 2011 at an academic tertiary care medical center was evaluated. Demographic information, surgical and pathologic data, and postoperative outcomes were analyzed. Results: Beginning in 2005, a total of 260 MIVATs were performed during the study period. Outpatient surgery was accomplished in 234 MIVATs (90%). MIVAT patients were predominantly young (46.8 ± 14.8 years vs 52.4 ± 14.6 years for conventional thyroidectomy) and female (88.5% vs 75.5% for conventional thyroidectomy). There were no cases of permanent hypoparathyroidism or permanent recurrent laryngeal nerve dysfunction. Observed complications included transient recurrent laryngeal nerve dysfunction (n = 10; 3.8%), cellulitis (n = 1; 0.4%), and temporary hypocalcemia (n = 6; 2.3%). The overall complication rate for MIVAT (6.5%) was lower than the overall complication rate in conventional thyroidectomy (18.5%, P < .0001). Conclusion: MIVAT can be performed safely with a low complication profile in a high-volume practice. The safety of MIVAT represented by this experience supports broader adoption across surgical practices. [ABSTRACT FROM AUTHOR]

Objective: We hypothesize that many cases of dysphonia of unclear etiology are a form of sicca caused by anticholinergic medication use, and we aim to determine their association. Study Design: This was a cross-sectional study conducted over a 6-month time period. Participants were drawn from a tertiary care laryngology practice within an academic institution. Methods: One hundred forty-nine patients met inclusion criteria. Patients rated the symptom of chronic hoarseness; scores were compared with participants’ medication lists, comorbidities, age, and sex, and a multivariate logistic regression model was developed. Significance was set at P < .05. As a secondary analysis, participants rated a variety of other symptoms using the Voice Handicap Index-10, Reflux Symptom Index, and the GRBAS scale, which were likewise compared to anticholinergic use. Results: Any patient taking at least 1 anticholinergic medication had a 2.32 increased odds (P = .03) of experiencing hoarseness. If the patient was taking 2 or more anticholinergic medications, those odds rose to 4.52 (P = .009). Conclusion: This is the first study, to our knowledge, that implicates medication use as a major risk factor for dysphonia of unclear etiology. An awareness of this association is invaluable when attributing cause to hoarseness and when considering treatment options. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the impact of p16INK4a (p16) expression on clinical efficacy of induction low-dose fractionated radiation therapy (LDFRT) with concurrent chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).Study Design:Historical cohort study.Setting:Tertiary medical center.Methods:A total of 66 Patients with locally advanced SCCHN were enrolled in 2 clinical trials using paclitaxel, carboplatin, and concurrent LDFRT induction therapy. Patients were evaluated for response to induction by a multidisciplinary team and then were given definitive treatment. Adequate tissue samples from the pretreatment biopsies of 42 individuals were identified and analyzed for p16 expression. Expression was correlated with clinical outcomes.Results:Of 42 tumors, 15 (35.7%) were positive for p16. Patients with p16-positive tumors had improved response to induction, but this was not statistically significant (P = .06). Five-year overall survival was 80% in p16-positive patients and 58% in p16-negative patients (P = .025).Conclusions:p16 Expression affects treatment response in patients treated with induction LDFRT with concurrent chemotherapy. This is similar to results reported for standard induction chemotherapy. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the efficacy of adjuvant chemotherapy with oral 5-fluorouracil prodrug S-1 for oropharygeal squamous cell carcinoma (OPC) patients infected with human papillomavirus (HPV). Topics discussed include the methods used for patients treatment, the statistical analysis for HPV-positive and HPV-negative, and the survival analysis according to S-1 administration. The study concludes the curability of HPV patients using S-1 adjuvant chemotherapy.

The article presents a study which examines the incidence, management, and outcome of the postoperative hemorrhage after the transoral oropharyngectomy for the lateral oropharynx cancer. The study reviewed the resected lateral oropharynx from cancer patients from 1972-2012. Results show that postoperative hemorrhage occur in patients with lateral oropharynx cancer can cause death, and mentions the effectivity of hemostasis as a treatment.

The article presents a study which examines the diagnostic yield of the BRAFV600E mutation test for patients diagnosed with conventional papillary thyroid carcinoma (cPTC) based on Bethesda System for Reporting Thyroid Cytopathology (BSRTC). Topics discussed include the methods used for thyroid nodules diagnosis such as fine-needle aspiration (FNA), and DNA Extraction. It concludes that suspicious ultrasound (US) features is helpful in diagnosing thyroid nodules using mutation test.

The article presents the study on the differences in the chronic laryngopharyngeal neuropathy management strategies of American and European laryngologists. The study involved a survey of members of trade associations American Laryngological Association adn the European Laryngological Society. The results reportedly revealed significant differences in laryngologists' familiarity with laryngopharyngeal neuropathy.

The article presents the comparative study on the outcomes of cricotracheal resection and staged laryngotracheoplasty for adults with subglottic stenosis. It discusses how the study was conducted which involved subglottic stenosis patients at a tertiary academic institution from 2000 to 2012. The results reportedly revealed that both treatment methods have excellent long-term recannulation rates.

The article presents a preliminary study concerning the link between laryngeal sensory deficits and penetration or aspiration. It compares two methods of testing laryngeal sensation, the air pulse and touch method, and determines which one has more correlation with Penetration-Aspiration Scale scores. The study suggests that laryngeal sensory loss identified by the touch method has an association with compromised airway protection.

The article presents a study concerning the rate of prognosis and patterns of failure for patients who remain intubated after head and neck surgery and then underwent delayed extubation. The risk factors for postextubation failure were identified through univariable logistic regression analysis. Results suggest hemorrhage and upper airway edema as the most common reasons for the failure.

Objective: This study aimed to determine if preoperative impedance testing changed management and if testing was associated with surgical outcome in patients undergoing airway reconstruction. Methods: Retrospective review of patients who had impedance testing prior to airway reconstruction at a tertiary pediatric hospital from January 2010 to September 2011. Charts were reviewed for demographics, medical/surgical history, impedance testing, and surgical outcomes. Results: Fifty-seven patients were included. Forty-seven (82%) were premature. Forty-seven (82%) had a primary diagnosis of subglottic stenosis. Twenty-six (45%) had prior airway surgery. Thirty-six (63%) had gastroesophageal reflux and 21 (36%) had undergone fundoplication. Patients without fundoplication had a median 46 total reflux, 7 proximal, and 14.5 acidic events compared to a median 5 total reflux, 0 proximal, and 0 acidic events in patients with fundoplication. Impedance testing changed management in 22% (8/36) of nonfundoplication patients and 9.5% (2/21) of fundoplication patients. In unadjusted analysis, fewer fundoplication patients had successful surgery compared to those without (33% vs 67%, P = .01). Prematurity, age at surgery, and previous airway surgery were also important predictors of surgical success. Conclusion: Fewer patients than anticipated had a change in management. Impedance testing was unlikely to change management in fundoplication patients. Patients with fundoplication were less likely to have a successful outcome, suggesting that factors other than reflux influence airway reconstruction outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The objectives were to determine the prevalence of laryngeal dysplasia and associated human papilloma virus (HPV) subtypes in adult patients, 18 years or older, suffering from laryngeal papillomatosis at a tertiary care institution. Study Design: Retrospective cohort study. Methods: Patients with biopsy proven laryngeal papillomatosis were identified via chart review. All available pathology specimens were reviewed by a dedicated head and neck pathologist to confirm/refute the diagnosis of laryngeal dysplasia, and grade the level of dysplasia. Interrater agreement was compared using cross-tabulation methods. Specimens identified to be positive for dysplasia underwent further testing via in situ hybridization for low-risk (6/11) or high-risk (16/18) HPV subtypes. Results: Of the 85 subjects identified to have laryngeal papillomatosis, 24(28%) demonstrated laryngeal dysplasia. There was good interrater agreement on the presence of dysplasia; however, there was only fair agreement on the grade of dysplasia. Of the pathology specimens tested for HPV subtype, the majority of patients (62%) were positive for HPV 6/11, including all high-grade dysplasia patients. Three (12%) dysplasia specimens were negative for both high- and low-risk HPV subtypes. Conclusions: We found a 28% prevalence of dysplasia in our patient population with the majority of patients positive for low-risk HPV subtypes indicating that high-risk HPV subtypes do not predispose laryngeal papilloma patients to dysplasia. [ABSTRACT FROM AUTHOR]

Objective: We sought to compare postoperative pain and complications in patients undergoing free tissue transfer for reconstruction of head and neck defects with and without ketorolac. Methods: In this retrospective cohort study, we identified patients who underwent head and neck free tissue transfer procedures at the University of Iowa between July 2010 and December 2012. A subset of patients received ketorolac as an anti-platelet agent. Main outcome measures include postoperative analgesic use, pain scores, and bleeding complications. Results: We identified 138 free tissue transfers, with 42 procedures in the ketorolac cohort. In the first 7 postoperative days, patients in the ketorolac and non-ketorolac cohorts received equivalent narcotic doses (morphine equivalents, 48.9 mg/day vs 46.6 mg/day, P = .72). The ketorolac group reported higher mean pain scores (3.1 vs 2.4, P = .004). Ketorolac use was not associated with need for transfusion (P = .86) or number of days with neck drains (P = .79). Conclusion: Ketorolac did not demonstrate a significant analgesic effect in this group of patients in terms of pain scores and opioid requirements. However, there also was no evidence to suggest a higher likelihood of bleeding complications. Ketorolac may be safely used as an anti-platelet agent, with narcotic requirements unchanged. [ABSTRACT FROM AUTHOR]

Objectives: Laryngotracheal reconstruction (LTR) procedures for repair of complex congenital or acquired airway stenosis of the larynx and/or trachea in pediatric patients have advanced over recent decades. The aim of the present project was to investigate the relationships among diagnoses, type of surgical intervention, and laryngeal findings in a post- LTR patient cohort to identify factors associated with adequate airway protection and swallowing outcomes. Methods: A retrospective review of 30 airway patients undergoing simultaneous or close interval functional laryngeal and swallowing examinations was completed. Analyses of the data were performed to examine factors associated with postoperative airway protection and swallowing function. The patient cohort was separated into 2 groups according to the adequacy of their airway protection (aspiration and no aspiration) as judged by clinicians via instrumental examination. Results: Data analyses revealed statistically significant differences between the 2 groups for 3 key parameters: laryngeal closure, laryngeal closure timeliness (relative to bolus flow), and overall swallowing coordination. Conclusions: These findings contribute to the knowledge of laryngeal closure patterns present in patients undergoing airway reconstruction and the effect on the essential laryngeal function of airway protection during swallowing. Implications of the data for swallowing function in this population are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative complications, especially pharyngocutaneous fistulization (PCF), are more frequent after total laryngectomy (TL) performed for salvage after (chemo)radiotherapy than after primary TL The aim of this study was to identify the incidence of PCF, predictive factors for PCF, and the relationship of PCF to survival. Methods: We performed a retrospective chart review of 217 consecutive patients treated with TL between 2000 and 2010. Univariate and multivariable analysis with logistic regression was used to identify factors associated with PCF. We used a Kaplan-Meier survival analysis. Results: The overall incidence of PCF was 26.3% (57 of 217 cases). The incidence of PCF after primary TL was 17.1 % (12 of 70), that after salvage TL was 25.5% (25 of 98), that after TLE for a second primary was 37.5% (9 of 24), and that after TL for a dysfunctional larynx was 44.0% ( I I of 25). The predictive factors for PCF were hypopharynx cancer (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.74 to 7.71; P = .001), an albumin level of less than 40 g/L (OR, 2.20; 95% CI, 1. 12 to 4.33; P = .022), previous chemoradiotherapy (OR, 3.38; 95% CI, 1.34 to 8.52; P = .010), more-extended pharyngeal resection (P = .001), and pharynx reconstruction (P = .002). The median duration of survival was 30 months (95% CI, 17.5 to 42.5); the 2-year overall survival rate was 54%. The median duration of survival of patients with PCF was 23 months (95% CI, 9.4 to 36.6), and that of those without PCF was 31 months (95% CI, 15.0 to 47.0; P = .421). The 2-year overall survival rate was 48% in patients with PCF and 57% in those without PCF (P = .290). Conclusions: Incidence of PCF after TL is significantly higher in patients with hypopharynx cancer, previous chemoradiotherapy, a low albumin level, more-extended pharyngeal resection, or pharynx reconstruction. The occurrence of PCF does not influence the rate of survival. [ABSTRACT FROM AUTHOR]

Objectives: We performed a prospective cohort study in a pediatric tertiary care center to determine whether preoperative sleep architecture is associated with complete resolution of nocturnal enuresis (NE) after adenotonsillectomy. Methods: Thirty-seven pediatric patients with primary NE who underwent adenotonsillectomy for obstructive sleep apnea (OSA) were evaluated. Preoperative polysomnograms, as well as preoperative and postoperative reports of NE, were recorded. We performed χ2 analysis, Fisher's exact test (for p values), and Mests to evaluate the impact of multiple demographic characteristics on sleep architecture, comparing children with resolved NE to those with unresolved NE after adenotonsillectomy. Results: The patients' mean age was 8.0 years (SD, 2.32 years). All children had presurgical primary NE. No age or gender differences were identified between children with resolved NE and those with unresolved NE. After surgery, more than half of the participants had resolution of NE. A higher percentage of boys had unresolved NE (χ2 = 3.63 ; p = 0.06). Improvement of NE was identified in children with a higher obstructive apnea-hypopnea index and more desaturation events. Eleven of the 12 children with prolonged stage 2 sleep reported resolution of NE (p = 0.001). Children with an obstructive apnea-hypopnea index of greater than 10 had a significantly greater rate of resolution of NE (p = 0.01). Logistic regression demonstrated that an elevated body mass index and the interaction of severe OSA and prolonged stage 2 sleep predicted resolution of NE. All 10 children with severe OSA and an abnormal total time spent in stage 2 sleep had resolution of NE. Conclusions: Adenotonsillectomy is a treatment option for children with OSA and NE. Postoperative resolution of NE was seen in 51.4% of patients who underwent adenotonsillectomy. The children with both severe OSA and prolonged stage 2 sleep were 3.4 times as likely to have postoperative resolution of NE. These results suggest that there are significant differences in preoperative sleep architecture between children whose NE resolves after adenotonsillectomy and those whose NE does not resolve. [ABSTRACT FROM AUTHOR]

Objectives: We compared the voice outcomes after cricotracheal resection (CTR) and airway dilation in adult women. Methods: We performed long-term comprehensive voice assessments in 23 adult women treated for laryngotracheal stenosis, including acoustic and perceptual measurements of voice, videostroboscopy, the Voice Handicap Index, and an open-ended subjective questionnaire. Results: Voice measures were abnormal in both groups. Objective pitch and loudness measurements were significantly more impaired after CTR than after dilation. Perceptual ratings of voice were worse after CTR than after dilation, particularly with regard to breathiness, pitch, and loudness. The CTR group was more likely to report a voice disorder, reported significantly more voice symptoms, and had higher voice handicap scores. Videostroboscopy was frequently abnormal in both groups, with more evidence of vocal hyperfunction after CTR. Self-ratings of breathing and swallowing were generally high in both groups, but voice satisfaction was rated lower after CTR. Conclusions: Voice was more significantly negatively impacted by CTR than by dilation. Surprisingly, many individuals in both groups reported improvements--a finding that possibly highlights the impact of laryngotracheal stenosis on airflow and vocal function before surgery. The importance of patient selection and preoperative counseling is emphasized, along with the potential need for voice therapy. [ABSTRACT FROM AUTHOR]

Objectives: The resolution of inflammation is an active process controlled by several anti-inflammatory and pro-resolution mediators. Lipoxin A4, an endogenous lipid mediator, is a potential pro-resolution mediator that could attenuate inflammation. This study was conducted to elucidate the role of lipoxin A4 in upper airway inflammation. Methods: Nasal secretions were collected from patients with chronic rhinosinusitis with nasal polyposis, patients with allergic rhinitis, and control subjects. The concentration of lipoxin A4 was measured by enzyme-linked immunosorbent assay. Nasal tissues were obtained from nasal polyps and inferior turbinates during endonasal surgery. The mRNA expressions of lipoxygenases (LOXs), lipoxin receptor (formyl peptide receptor-like 1; FPRL-1), and cysteinyl leukotriene type 1 receptor (CysLTIR) in nasal tissues were examined by reverse-transcription polymerase chain reaction. Tissue localization of FPRL-1 was determined by immunohistochemical staining. The in vitro effect of lipoxin A4 on airway epithelial cells was also examined. Results: A significant concentration of lipoxin A4 was found in nasal secretions, and the concentration was increased in patients with allergic rhinitis. The mRNA expressions of 5-LOX, 15-L0X-1, FPRL-1, and CysLTIR were significantly greater in nasal polyps than in inferior turbinates. FPRL-1 was localized in nasal epithelial cells. Lipoxin A4 inhibited tumor necrosis factor α-induced interleukin 8 release from airway epithelial cells via its receptor FPRL-1. Conclusions: These results indicate that lipoxin A4 may play a role in the resolution of upper airway inflammation. A low concentration of lipoxin A4 may be involved in chronic inflammation of the upper airways. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the effectiveness of specially processed cereal (SPC) as a suitable adjunctive treatment for Meniere's disease. Methods: We performed a randomized double-blinded, placebo-controlled, crossover study in a tertiary referral center of patients who had a diagnosis of Meniere's disease based on the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery ( AAO-HNS). The main outcome measure was the AAO-HNS Functional Level Scale (FLS). Results: Thirty-nine patients completed the study without any reported complications. The mean pretreatment FLS score for the entire study cohort was 3.8 (median, 4; range, 1 to 6). The overall FLS score improved significantly (p < 0.001 ), to 2.8 (median, 3), after SPC treatment. No patients showed worsening on the FLS during SPC or placebo treatment. Of the 39 patients, 23 showed improvement on the FLS, and no change was observed in the remaining 16. The median improvement on the FLS in these 23 patients was 2 points (mean, 1.7; range, 1 to 4). The mean FLS score after placebo cereal treatment was not significantly different from baseline (p = 0.452), but was significantly higher than that after SPC treatment (mean, 3.7; p < 0.001). The marginal difference observed between the baseline FLS score and the placebo FLS score was due to the fact that 5 patients reported 1 -point improvements on the FLS after placebo treatment. Nevertheless, significantly fewer patients improved on placebo than on SPC (p < 0.001). Conclusions: Treatment with SPC appears to be well tolerated by most patients (91%) without any complications. More than half (59%) of the study cohort reported subjective improvement in functional level. [ABSTRACT FROM AUTHOR]

Objectives: We sought to identify factors that would predict hearing preservation in the treatment of semicircular canal labyrinthine fistulas. Methods: Between 1990 and 2010, 97 patients with semicircular canal fistulas were operated on and enrolled in this retrospective study. In 62 patients the matrix was removed and the fistula was sealed, whereas in 35 patients the canal was drilled, the matrix was detached, and the canal was occluded. Perioperative corticosteroids were administered in 51 patients. The main outcome measures were the bone conduction thresholds evaluated at 1 year after the operation. Factors considered for possible association with hearing preservation included age, gender, site and size of the fistula, primary versus revision surgery, surgeon, perioperative corticosteroid treatment, and surgical management of the fistula. Results: The bone conduction hearing level was improved in 16 patients, remained unchanged in 73 patients, and had worsened in 11 patients. On the univariate analysis, good hearing was predicted by grade II fistula, canal plugging, and corticosteroid treatment. However, none of these factors attained significance in the logistic regression model. Conclusions: In surgery of semicircular canal fistulas, good hearing outcomes are to be expected if perioperative corticosteroids are administered, matrix removal and fistula sealing is performed in grade II fistulas, and canal occlusion is performed in grade III and IV fistulas. [ABSTRACT FROM AUTHOR]

Objectives: There has been a reemergence of syphilis among men who have sex with men over the past decade, especially in patients infected with human immunodeficiency virus (HIV). This study was aimed at describing the oropharyngeal manifestations of secondary syphilis in HIV-infected patients. We also sought to determine the clinical risk factors for the development of oropharyngeal syphilitic lesions in patients with secondary syphilis. Methods: We performed an observational, comparative, retrospective study of HIV-infected patients who were admitted to a tertiary referral center in Mexico City and who had syphilis according to the criteria of the US Centers for Disease Control and Prevention. Results: We identified 44 patients with syphilis, 31 of whom had secondary syphilis and 9 of whom had oropharyngeal manifestations. Lesions involving the anterior tonsillar pillar were the most common, observed in 5 patients; and tongue lesions were observed in 3 patients. In the patients with secondary syphilis, multivariate analysis showed that the development of oropharyngeal lesions was not associated with age, CD4 and CD8 cell counts, or HIV RNA viral load. Conclusions: The present work shows that oropharyngeal manifestations of secondary syphilis and overlapping stages of syphilis are frequent in HIV-infected patients. To the best of our knowledge, this is the first comparative study of the oropharvnseal manifestations of syphilis in HIV-infected patients. [ABSTRACT FROM AUTHOR]

Objectives: Surgical resection of oral cancer can result in altered speech, swallowing, and quality of life (QOL). To date, the oral outcome variables of tongue strength, tongue and jaw range of motion, and saliva production have not been extensively assessed. This pilot study was done to assess tongue strength along with other oral outcomes and their relationship to performance status for speech, swallowing, and QOL after partial glossectomy. Our aim was to create a norm for what should be considered a normal tongue strength value in this population. We hypothesized that patients with tongue strength of 30 kPa or greater would perform better on the performance status scale and various QOL measures than do patients with tongue strength of less than 30 kPa. Methods: We used a cross-sectional design in this study. The postoperative assessment included 1) Performance Status Scale and Karnofsky Performance Status Scale; 2) oral outcome variables of tongue strength, jaw range of motion, and saliva production; and 3) patient-rated QOL ratings via Eating Assessment Tool, M. D. Anderson Dysphagia Inventory, EORTC-H&N35, and Speech Handicap Index. Results: Patients with tongue strength of at least 30 kPa performed better on the performance status scales and various QOL measures. The cutoff score of 30 kPa for tongue strength measures revealed a trend in predicting performance on the scales and QOL measures. Conclusions: The oral outcome variables correlated with performance status for speech, swallowing, and QOL. We propose a norm for tongue strength in this population, based on the trend seen in this group of patients, as none previously existed. Future studies are under way that incorporate a larger sample size to further validate this norm. Future studies will also examine oral functional outcome measures in a larger population by including other oral and oropharyngeal sites to help predict speech and swallow performance status and QOL. [ABSTRACT FROM AUTHOR]

Objectives: After laryngectomy, pulmonary protection is mostly acquired by means of a heat and moisture exchanger (HME) that is placed on an airtight seal around the stoma. The effects of HMEs on the tracheal climate have been well described, and the filtration effect of an HME with an electrostatic filter has been described in vitro. The effects of HME use in patients have been documented in several trials in different countries. The follow-up time of the patients in these trials, however, is limited. Less is known about long-term use of HMEs, and studies describing long-term compliance with HME use are scarce. This study investigated the long-term use of HMEs in laryngectomees. Methods: Questionnaires were sent to 195 laryngectomees, and 75 questionnaires were returned. Results: More than 85% of the respondents used an HME, of whom 77% were compliant users (ie, use for more than 20 hours per day). The incidence of pulmonary illnesses (either before or after surgery) was about 25%. More than 90% of the respondents were heavy smokers before laryngectomy. One third of the respondents are regularly exposed to dusty environments. Compliant HME users tend to make less use of external humidifiers and vaporizers, and have better pulmonary status and lower health-care costs. Regarding quality of life, patients who use a FreeHands device tended to have more frequent social contacts (r = 0.251; p = 0.030). The prevalence of depression is high, pointing to an urgent need to recognize and treat psychiatric problems such as depression and suicidal ideation in this patient group. Conclusions: These findings have implications for any postlaryngectomy research that uses pulmonary parameters. [ABSTRACT FROM AUTHOR]