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Objectives/Hypothesis: To identify the most influential publications in laryngology since 2000. Study Design: Modified Delphi process. Methods: Samples of laryngologists drawn from editors of leading journals, organization officers, and thought leaders were invited to participate in a modified Delphi identification of influential laryngology papers. Influential was defined as follows: yielding meaningful practice changes, catalyzing further work as a foundation for an important topic, altering traditional views, or demonstrating durability over time. Quality and validity were not among the selection criteria. Each participant nominated 5 to 10 papers in Round 1. These nominations, augmented with papers from bibliometric analysis, were narrowed further in Round 2 as participants identified their top 20. The 40 papers with the most Round 2 votes were discussed by video conference and then subjected to Round 3 voting, with each participant again selecting their top 20 most influential papers. Final results were collated by the number of Round 3 votes. Results: Sixteen of 18 invited laryngologists participated overall (all 16 in Rounds 1 and 3; 14 in Round 2). Twenty‐one papers were identified as most influential. One paper appeared on all 16 Round 3 lists; three papers with eight (50%) votes each were lasted to make the list. Eleven of these 21 focused on voice; three each related to cancer, airway, and swallowing; and one encompassed all of these clinical areas. Conclusions: This list of 21 influential laryngology papers serves to focus further research, provides perspective on recent advances within the field, and is an educational resource for trainees and practicing physicians. Level of Evidence: NA Laryngoscope, 132:406–412, 2022 [ABSTRACT FROM AUTHOR]

Objectives: Pain localized to the thyrohyoid region may be due to neuralgia of the superior laryngeal nerve (SLN), inflammation of the thyrohyoid complex, or a voice disorder. We present outcomes of treatment of paralaryngeal pain and odynophonia with SLN block. Study Design: Retrospective Review. Methods: A retrospective chart review of patients undergoing in‐office SLN block for paralaryngeal pain between 2015 and 2018 at two tertiary care centers was conducted. Patient demographics, indications, and response to treatment were analyzed. Results: Thirty‐eight patients underwent blockade of the internal branch of the SLN for paralaryngeal pain, with 10 excluded for incomplete medical records. Eighty‐two percent (23/28) reported an improvement in their symptoms. Patients underwent an average of 2.5 blocks (SD = 1.88, range 1–8), with 10 patients (36%) undergoing a single procedure. Of the 18 patients who underwent multiple blocks, nine had eventual cessation of symptoms (50%) compared to resolution in 6/10 undergoing a single injection. Eleven patients (39%) noted odynophonia related to vocal effort, and all of these patients had improvement in or resolution of their symptoms and were more likely to improve compared to those without odynophonia (P =.006). Of the four patients who had a vocal process granuloma (VPG) at presentation, three had complete resolution of the lesion at follow‐up. Conclusion: In‐office SLN block is effective in the treatment of paralaryngeal pain. It may be used as an adjunct in the treatment of vocal process granulomas, as well as voice disorders where odynophonia is a prominent symptom. Level of Evidence: 4 Laryngoscope, 132:401–405, 2022 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: We sought to characterize rates of progression to posterior glottic stenosis (PGS) from autoimmune or idiopathic subglottic stenosis. Study Design: This was a retrospective review. Methods: Patients from a tertiary‐care laryngology practice over a 10‐year period with autoimmune or idiopathic subglottic stenosis (SGS) were included. Patients with a history of prolonged intubation or other causes of iatrogenic stenosis were excluded. PGS was confirmed on videostrobolaryngoscopy recordings by a fellowship‐trained laryngologist. PGS type (1–4) was also recorded. Demographic information was recorded, and if applicable, autoimmune disease type was specified. Time until PGS was recorded along with the number of interventions. Chi‐squared analysis was used to compare PGS in autoimmune and idiopathic SGS. Results: A total of 77 patients were identified with autoimmune (32 patients) or idiopathic (45 patients) subglottic stenosis. Autoimmune pathologies included systemic lupus erythematosus, granulomatosis with polyangiitis (GPA), rheumatoid arthritis, relapsing polychondritis, and sarcoidosis, with GPA the most common (14/32). Patients with autoimmune SGS had a higher rate of PGS (10 of 32) compared to idiopathic subglottic stenosis (1 of 45) for an odds ratio of 20 (95% CI: 2.4–166.4, P =.006). Patients with idiopathic SGS were more likely to be female (all 45 compared to 29/32 autoimmune, P =.07) and older (mean 53 (range 29–75) compared to 46 (20–82), P =.02). Conclusions: In this large patient cohort, autoimmune SGS patients were found to have a higher likelihood of developing PGS compared to their idiopathic counterparts, suggesting that counseling for this progression may be warranted. Level of Evidence: 4 Laryngoscope, 131:1816–1820, 2021 [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: The objective of this study was to investigate the glottic gap area as a significant marker for the severity of presbyphonia as it relates to patient‐reported outcome measures (Voice Handicap Index‐10 [VHI‐10]) and stroboscopic findings. Study Design: Retrospective case‐control study conducted in an academic tertiary voice center. Methods: Patients seen at a tertiary voice clinic who were diagnosed with presbyphonia without other organic laryngeal pathology from January 2014 to December 2017 were included. Clinical data and laryngeal videostroboscopy videos were collected. Still images at the point of vocal process approximation during adduction were captured, and the glottic gap area was measured using ImageJ. These were compared to a control cohort. Correlations were made using Wilcoxon rank sum test, Mann–Whitney U test, and Pearson correlation coefficients. Results: Thirty‐three patients were included. Inter‐rater reliability of glottic area measurement was strong (intraclass correlation coefficient = 0.73, P <.001). Compared to controls, presbyphonia patients had a larger glottic gap area (P <.001) and greater open‐phase quotient on laryngeal videostroboscopy (P <.001). Larger glottic gap area did not correlate with patient‐reported vocal function as measured by VHI‐10 (P =.79) and did not correlate with presence of secondary muscle tension dysphonia (P =.99). In the presbyphonia cohort, the glottic gap area did not correlate with age (P =.29). Conclusions: Glottic gap area at the point of vocal process approximation during phonation can be reliably measured. Patients with presbyphonia have a larger glottic gap area and greater open‐phase quotient on stroboscopy, but these do not correlate with patient‐reported voice impairment or the presence of secondary muscle tension dysphonia (MTD). These data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary MTD alone. Level of Evidence: 4 Laryngoscope, 131:1594–1598, 2021 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine the incidence of abnormal fiberoptic endoscopic evaluation of swallowing (FEES) findings in patients with progressive neurologic disorders and identify the most commonly implemented dysphagia management strategies.Study Design: Retrospective Review.Methods: A retrospective review was performed of patients with neurodegenerative disease who underwent FEES at a tertiary-care center between 2008 and 2019. Patient demographics, diagnosis, and Eating Assessment Tool-10 (EAT-10) scores were recorded. Rates of penetration, aspiration, and functional change in management (FCIM) to include dietary modifications, home exercises, swallow therapy, surgical intervention (injection augmentation or esophageal dilation), or alternative means of nutrition (i.e., percutaneous enteral gastrostomy [PEG] tube) were calculated.Results: Two hundred nine FEES assessments were performed in 178 patients with a mean age of 64.8 years (standard deviation = ±14). The most common diagnoses were amyotrophic lateral sclerosis (32%) followed by Parkinson's disease or Parkinsonism (26%). FEES demonstrated penetration in 72.5% of patients and aspiration in 14.6%. Mean EAT-10 scores differed between patients with aspiration versus penetration versus normal FEES (24.7 vs. 14.9 vs. 13.9, respectively, P < .001). An FCIM was recommended in 88% of patients and most commonly included self-directed modifications (43%). Overall, 4.5% of patients underwent surgical intervention. A PEG tube was recommended for either supplemental or sole form of nutrition in 19% of the entire cohort.Conclusions: Most patients with neurodegenerative diseases presenting with dysphagia demonstrated abnormal FEES findings necessitating an FCIM, suggesting early dysphagia evaluation may be warranted in this cohort. These findings correlate with worsened EAT-10 scores in patients with aspiration or penetration on FEES.Level Of Evidence: 4 Laryngoscope, 131:726-730, 2021. [ABSTRACT FROM AUTHOR]

Objective: To compare voice outcomes of autogenous fat injection versus medialization laryngoplasty in patients with glottic insufficiency due to vocal fold paresis or atrophy.Methods: A retrospective review was performed from 2009 to 2017 of all patients who underwent lipoinjection or medialization laryngoplasty (ML) for glottic insufficiency. Charts were reviewed for demographic information, preoperative diagnosis, surgical intervention, Voice Handicap Index-10 (VHI-10) and Glottal Function Index (GFI) scores, follow-up time (minimum 3 months), and concomitant voice therapy.Results: Eighty-three patients were initially identified and limited to 28 based on the inclusion/exclusion criteria. Thirty-five procedures were performed with a total of 15 fat injections and 20 MLs. The mean age was 60.7 years in the lipoinjection group and 55.6 years in the ML group. There was no significant difference in pretreatment VHI-10 scores between the two groups. Using the lowest recorded voice scores during the follow-up period, both groups had a significant decrease (P < 0.05) compared to preoperative scores (VHI-10: fat decreased from 27.8 to 14.2, ML decreased from 30.5 to 9.1; GFI: fat decreased from 13.7 to 5.27, ML decreased from 13.6 to 4.6). When evaluating the entire follow-up period (median 19 months in fat group, 16.3 months in ML), only the ML group maintained a significant improvement in VHI-10 (median delta 14.5) and GFI (median delta 7) compared to preoperative scores.Conclusion: Although both autogenous fat injection and ML result in improved voice scores in the short term, the effect of fat injection appears to be limited, as evidenced by worsening VHI-10 and GFI scores over time.Level Of Evidence: 4 Laryngoscope, 129:1164-1168, 2019. [ABSTRACT FROM AUTHOR]

Objectives: In-office or operative injection laryngoplasty requires needle stability for accurate material placement. To date, no reports compare injection forces based on needle gauge, bends, length, or material type or temperature. We hypothesize these factors alter injection forces and could impact clinical use.Methods: Swine larynges were placed in a compression testing machine. Syringes were affixed to a stabilizing crossbeam. Straight needles (25G 1.5-inch; 27G 1.25-inch; or 9.8-inch malleable shaft 16G per oral with 24G tapered needle tip) were inserted into the swine vocal folds to simulate realistic tissue resistance pressure. Compressive loading was conducted at 40 mm/minute until steady-state force was achieved. Tests were completed with calcium hydroxylapatite (CaHa), carboxymethylcellulose, and hyaluronic acid at various temperatures and CaHa with various bends in the needles (n = 3 per group, comparisons performed by two-way analysis of variance (ANOVA), Tukey's post-hoc).Results: Needle size, shape, and temperature altered injection force. Steady-state force was highest with the per-oral needle at a mean of 44.55N compared to 26.44N and 29.77N in the 25G and 27G percutaneous needles, respectively (P < 0.001). Stiffness rate (initial increasing force vs. distance to initiate injection) ranged from 19.75N/mm (per oral) to 22.06N/mm (25G) to 24.56N/mm (27G), (P = 0.875). Adding multiple bends to the per-oral needle increased stiffness rate to 24.99N/mm (P = 0.035), whereas the 25G needle stiffness rate remained unchanged (P = 0.941), with the stiffness rate decreasing in the 27G needle with increasing bends (P = 0.033). Increased temperature decreased injection forces across all materials.Conclusion: Needle caliber, length, and bends impact steady-state forces and stiffness rates during vocal fold injection.Level Of Evidence: NA Laryngoscope, 129:1060-1066, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To evaluate the demographics, etiology, intraoperative findings, and treatment outcomes of patients with subglottic stenosis (SGS), comparing those patients aged <65 years to an elderly population aged ≥65 years.Study Design: Retrospective cohort study.Methods: Nine-year retrospective review of patients with SGS. Forty-eight adults presented for evaluation and treatment of SGS between January 2008 and December 2016. At the time of presentation, 41 were aged <65 years and seven were aged ≥65 years.Results: Comparing the aged <65 years group to the aged ≥65 years group, the etiology was idiopathic SGS in 50.0% versus 42.8%, intubation-related SGS in 22.5% versus 28.6%, and granulomatosis with polyangiitis in 27.5% versus 28.6%, respectively. No statistically significant difference was noted in the two groups when comparing the demographics, etiology, treatment, intraoperative findings, or intertreatment interval (ITI).Conclusions: We sought to analyze an older patient population with SGS and found no statistically significant differences compared to a younger population. ITI trended toward older patients requiring surgery more frequently but was not significant.Level Of Evidence: 4 Laryngoscope, 129:1155-1158, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Neurogenic cough is believed to result from a sensory neuropathy involving the internal branch of the superior laryngeal nerve (SLN). We present our outcomes for the treatment of neurogenic cough with localized blockade of the internal branch of the SLN.Methods: A retrospective chart review of patients who underwent in-office percutaneous SLN block for treatment of neurogenic cough between 2015 and 2017 was conducted. Patient demographics, indications for injection, and response to treatment were recorded and analyzed. Cough severity index (CSI) scores before and after treatment were compared.Results: Twenty-three patients underwent percutaneous blockade of the internal branch of the SLN in the clinic setting, and five patients were excluded for incomplete records. The indication was neurogenic cough as a diagnosis of exclusion. The injectable substance used was a 1:1 mixture of a long-acting particulate corticosteroid and a local anesthetic. Unilateral injections were performed in 13 patients, and five patients underwent bilateral injections. Of the unilateral injections, 10 were left-sided. Patients underwent an average of 2.4 SLN block procedures (range 1-7). Mean follow-up time postinjection was 85.4 days (7-450 days). Cough severity index scores decreased significantly from an average of 26.8 pretreatment to 14.6 posttreatment (P < 0.0001).Conclusion: The SLN block is an effective treatment for neurogenic cough, with average CSI scores significantly improved following injection. Further study is necessary to determine the characteristics of patients' responses to treatment, long-term outcomes, and efficacy of the procedure when compared to placebo and other accepted treatments for neurogenic cough.Level Of Evidence: 4. Laryngoscope, 1898-1903, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To establish the rate of inflammatory reaction to hyaluronic acid (HA) in vocal fold injection augmentation, determine the most common presenting signs and symptoms, and propose an etiology.Study Design: Retrospective chart review.Methods: Patients injected with HA over a 5-year period were reviewed to identify those who had a postoperative inflammatory reaction. Medical records were reviewed for patient demographic information, subjective complaints, Voice Handicap Index-10 (VHI-10) scores, medical intervention, and resolution time. Videolaryngostroboscopy examinations were also evaluated.Results: A total of 186 patients (245 vocal folds) were injected with HA over a 5-year period, with a postoperative inflammatory reaction rate of 3.8%. The most common complaints in these patients were odynophagia, dysphonia, and dyspnea with vocal fold erythema, edema, and loss of pliability on videolaryngostroboscopy. All patients were treated with corticosteroids. Return of vocal fold vibration ranged from 3 weeks to 26 months, with VHI-10 scores normalizing in 50% of patients.Conclusions: This reaction may be a form of hypersensitivity related to small amounts of protein linked to HA. Alternatively, extravascular compression from the HA could lead to venous congestion of the vocal fold. The possibility of equipment contamination is also being investigated. Further studies are needed to determine the etiology and best treatment.Level Of Evidence: 4 Laryngoscope, 2016 127:445-449, 2017. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate a novel approach to cricoarytenoid joint (CAJ) injections.Study Design: Anatomic feasibility study.Methods: Five human cadaveric larynges providing 10 CAJ s were used to obtain trajectory measurements of a 27-gauge 1½-inch needle placed between the CAJ capsule and the contralateral cricothyroid membrane. Ten additional larynges providing 20 CAJ s were then used to assess the efficacy of applying the previously obtained measurements to guide 0.2-cc methylene blue injections of the CAJ using a 27-gauge 1½-inch needle. Successful injection was confirmed by direct visualization of methylene blue within the CAJ capsule.Results: The tip of the needle made a 70 ± 1.87 degree (confidence interval [CI] 95%) angle relative to the plane parallel to the anterior lamella of the cricoid cartilage; the needle was within the cricothyroid membrane 5 ± 0.77 mm (CI 95%) lateral to the midsagittal plane; the needle was 4 ± 0.80 mm (CI 95%) anteroinferior from the vocal process of the arytenoid cartilage as measured within the airway; and the distance from the point of airway entry and the CAJ capsule was 17 ± 2.42 mm (CI 95%). Twenty CAJ injections were attempted using the guidelines established here with an 85% success rate.Conclusion: The current approach to CAJ injection utilizes microlaryngoscopy in an operative setting. This study is the first to describe the accessibility of the CAJ through percutaneous injection using reliable landmarks, potentially allowing access to the joint in an office-based setting.Level Of Evidence: NA Laryngoscope, 127:199-203, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Supraglottic injection of botulinum toxin (Botox) has been described as an effective treatment for adductor spasmodic dysphonia (ADSD). Anecdotal evidence suggests that the patients have little to no breathiness after injection, but no formal longitudinal studies have been carried out to date. The purpose of this study was to examine the voice outcomes in patients with ADSD after supraglottic Botox injection.Study Design: Retrospective case series.Methods: Patients with ADSD who were treated with supraglottic Botox injections completed a qualitative self-evaluation of voice function after injection using the percentage of normal function (PNF) scale, a validated, quantitative scale from 0% (no function) to 100% (normal function). Posttreatment voice improvement after injection was determined using a Voice Handicap Index-10 (VHI-10) questionnaire.Results: A total of 198 supraglottic injections were performed between July 2011 and October 2014. Twenty-five questionnaires were completed. Mean postinjection PNF was 95.0% ± 8.4% and was significantly increased from the preinjection mean PNF (62.5%) ± 22.6% (P < 0.001). The mean best VHI-10 for all injections was 7.23. In 19 of 25 patients (76%), there was no reduction in PNF in the early postinjection period. In the remaining six patients (24%), the decline in mean vocal function was 9.2%.Conclusions: Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: There is a significant lack of uniform agreement regarding nomenclature for benign vocal fold lesions (BVFLs). This confusion results in difficulty for clinicians communicating with their patients and with each other. In addition, BVFL research and comparison of treatment methods are hampered by the lack of a detailed and uniform BVFL nomenclature. Study Design: Clinical consensus conferences were held to develop an initial BVFL nomenclature paradigm. Perceptual video analysis was performed to validate the stroboscopy component of the paradigm. Methods: The culmination of the consensus conferences and the video-perceptual analysis was used to evaluate the BVFL nomenclature paradigm using a retrospective review of patients with BVFL. Results: An initial BVFL nomenclature paradigm was proposed utilizing detailed definitions relating to vocal fold lesion morphology, stroboscopy, response to voice therapy and intraoperative findings. Video-perceptual analysis of stroboscopy demonstrated that the proposed binary stroboscopy system used in the BVFL nomenclature paradigm was valid and widely applicable. Retrospective review of 45 patients with BVFL followed to the conclusion of treatment demonstrated that slight modifications of the initial BVFL nomenclature paradigm were required. With the modified BVFL nomenclature paradigm, 96% of the patients fit into the predicted pattern and definitions of the BVFL nomenclature system. Conclusions: This study has validated a multidimensional BVFL nomenclature paradigm. This vocal fold nomenclature paradigm includes nine distinct vocal fold lesions: vocal fold nodules, vocal fold polyp, pseudocyst, vocal fold cyst (subepithelial or ligament), nonspecific vocal fold lesion, vocal fold fibrous mass (subepithelial or ligament), and reactive lesion. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Idiopathic ulcerative laryngitis (IUL) is a distinct, clinical entity that presents after a prolonged upper respiratory infection with cough. It is characterized by the development of bilateral ulcerations of the mid-membranous vocal folds followed by a protracted course of healing. The purpose of this review was to characterize the typical patient presentation, clinical findings, and prognosis. Study Design: Multi-institutional retrospective review Methods: Retrospective review of charts and videostroboscopic exams from patients with IUL at eight institutions. Results: Fifteen cases met the criteria for IUL and were included in the study. The mean age of the patients was 49 years, and 93% were female. All patients were nonsmokers. Multiple medical interventions were employed by the treating otolaryngologist during the course of the disease, none of which resulted in acute resolution of the ulcerations. The average time from initial presentation to resolution of the disease was 3.3 months. All of the patients reported that their voice was improved after resolution of the disease process. However, in the majority of the patients (60%) there were persistent vibratory abnormalities after resolution of the ulcerations. Conclusions: This is the first multi-institutional study to define the complete disease course of IUL and to establish diagnostic criteria. IUL is a rare yet well-recognized clinical entity; however, there is no established etiology for this condition and no definitive treatments have emerged. Further study is needed to establish the etiology/risk factors of this condition and to determine optimal medical management. [ABSTRACT FROM AUTHOR]

No abtracts. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Vocal fold augmentation with autologous fat has been widely used for the last 15 years with varying success. Autologous fat is biocompatible, readily available, and easily harvested, making it a commonly used material for vocal fold augmentation. Although felt to be a relatively safe procedure, few studies have looked at the complication rate of lipoinjection for vocal fold augmentation. Study Design: Retrospective review. Methods: Ninety-eight vocal fold injections were performed at one institution from 1997 to 2008. The charts were reviewed retrospectively, and age, diagnosis, side of procedure, concurrent procedures, length of follow-up, and complications during or subsequent to the injection were recorded in a database. Patients were excluded if data was inadequate to make a determination regarding complication during or after lipoinjection. Results: Eighty-eight patients met the criteria for review with an average age of 57.4 years. The most common indications for injection were vocal fold paresis, vocal fold scarring, and presbylaryngeus. Mean follow-up was 20.2 months with a range of 0 months to 126 months. Overall, four laryngeal complications occurred (4.5%), including three over-injections (3.4%) leading to poor voice quality and one granuloma formation (1.1%). The over-injections were managed using cordotomy with fat removal, resulting in vocal improvement in all cases. Conclusions: Although lipoinjection vocal fold augmentation is a safe procedure, over-injection of autologous fat is a risk. Lipoinjection for vocal fold augmentation can lead to over-injection with dysphonia in a small number of patients. The complications can be managed with lateral cordotomy and fat removal. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to describe the management of suboptimal injection of calcium hydroxylapatite during augmentation laryngoplasty. Study Design: A retrospective review was conducted at four Voice and Swallowing centers to identify patients who had a suboptimal injection of calcium hydroxylapatite during augmentation laryngoplasty. Results: Five patients (ages 19-75) were identified with an impaired voice secondary to a superficial injection of calcium hydroxylapatite or over-medialization of the true vocal fold. All patients underwent revision surgery with all experiencing subjective and objective improvement. Conclusion: Microflap excision can lead to successful return of vibratory function after a suboptimal injection of calcium hydroxylapatite. Complete control of the initial injection is paramount to avoiding this complication. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Laryngotracheal stenosis (LTS) represents a significant treatment dilemma faced by otolaryngologists. Recent topical use of Mitomycin C as an adjunctive treatment has proved helpful but does not completely prevent stenosis. Current literature suggests that transforming growth factor beta (TGFB) plays a significant role in the development of subglottic stenosis. We modified an existing canine model to test antitransforming growth factor beta (anti-TGFB) as a possible treatment for laryngotracheal stenosis. Study Design: Pilot study in a modified canine model. Methods: Eight mixed-breed dogs underwent cautery injury to the subglottic region creating subsequent laryngotracheal stenosis. Four dogs were treated with saline injection into the injury site and four dogs were treated with a combination of intravenous (5 mg/kg on day 0 and 5 of the experiment) and local injection of anti-TGFB (50 micrograms). Results: In the canine model of induced subglottic airway injury, a combination of intralesional and intravenous anti-TGFB results in a reduction in tracheal stenosis ( P < .05) and an increase in survival time ( P < .03) when compared to the saline control subjects. Conclusions: Anti-TGFB appears to be a useful adjunct in the treatment of LTS. Further study regarding the optimal dosing, route of administration, and timing of delivery is needed to understand the role of anti-TGFB in the treatment for laryngotracheal stenosis. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation of the laryngeal cartilage window during medialization thyroplasty. Study Design: Basic science. Methods: Forty thyroplasty windows were constructed in fresh, unpreserved cadaver larynges. A 6 × 13-mm rectangular window and a 4 × 4-mm round window were created on each side of the larynges in a symmetrical fashion. A standard surgical drill with a 3-mm cutting burr was used on one side; the ultrasonic surgical aspirator was used on the contralateral side. The time required for window construction was recorded, as was the status of the inner perichondrium at window completion. Results: For creation of the 6 × 13-mm window, a mean time of 128 seconds was required using a standard surgical drill. The mean time using the ultrasonic aspirator device was 91 seconds for the window of the same size ( P < .008). For the 4-mm round window, drilling completed the task in a mean time of 63 seconds, compared with 40 seconds ( P < .016) for the ultrasonic aspirator. On creation of the 6 × 13-mm window, there were 4 of 10 perichondrial violations in the drilled specimens, and there were no violations in creation of the window of the same size with the ultrasonic aspirator ( P = .12). The 4-mm round window had no perichondrium violations in the standard drill group and only 1 of 10 violations in the ultrasonic aspirator group ( P = .99). Conclusion: The study suggested that the ultrasonic surgical aspirator device may be an effective, efficient alternative to the standard drill for medialization thyroplasty window creation. Prospective clinical trials are warranted to better characterize its applicability. [ABSTRACT FROM AUTHOR]

Objective: To determine the change in pachydermia/posterior commissure hypertrophy in patients with laryngopharyngeal reflux disease (LPR) on long-term acid-suppressive therapy. Study Design: Retrospective chart review. Methods: Seventeen patients with LPR who were compliant with long-term acid-suppressive treatment and had good control of their symptoms for at least 20 months were examined. Pre- and posttreatment still laryngeal images from these patients were analyzed by five otolaryngologists blinded to patient information and were scored for pachydermia/posterior commissure hypertrophy according to the Reflux Finding Score (RFS) subset. Test-retest intraobserver reliability, intergrader correlations, as well as a paired t test for means of the data sets were then calculated. Results: There was no significant difference in the grading scores between the pre- and posttreatment group for degree of pachydermia/posterior commissure hypertrophy despite a prolonged treatment interval (mean = 32 months) ( P = .25). Conclusions: There is no statistically significant difference in the degree of pachydermia/posterior commissure hypertrophy found at diagnosis and after long-term acid suppressive therapy in patients with LPR. Therefore, it appears that pachydermia, as an isolated finding, is unreliable in determining the presence of active LPR. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Laryngeal pseudosulcus is an accurate prognostic indicator of laryngopharyngeal reflux (LPR) disease. Study Design Prospective study of 20 consecutive patients with laryngeal pseudosulcus. Pseudosulcus is infraglottic laryngeal edema that is thought to be secondary to LPR. All patients were evaluated with dual-channel pH probe 24-hour monitoring to evaluate for the presence of laryngopharyngeal reflux. Methods Twenty patients identified with laryngeal pseudosulcus on routine physical examination were included in the study. Each patient underwent a 24-hour dual-channel pH probe. The data were analyzed and compared with previously published normative data. The data included the total number of reflux episodes and the percentage of time the pH dropped below 4 at the proximal probe. Results Eighteen of the 20 patients with laryngeal pseudosulcus were found to have LPR. The mean number of reflux episodes at the proximal probe was 29.4 (range, 3-82). The mean percentage of time the pH dropped below 4 was 1.15%. In the upright position the mean value was 1.59% and in the supine position it was 0.19%. This gives pseudosulcus a positive predictive value for LPR of 90%. Conclusion This study shows laryngeal pseudosulcus to be an accurate predictor of laryngopharyngeal reflux disease. [ABSTRACT FROM AUTHOR]

Objectives: Examine the long-term histological effects of Silastic medialization using a canine model. Study Design: Prospective study evaluating the effects of Silastic medialization in six canine larynges. Methods: Two subject groups were evaluated. The first group of four dogs underwent recurrent laryngeal section followed by Silastic medialization on the paralyzed side and placement of a smaller implant on the mobile side. Two of the dogs were sacrificed at 9 months and two at 2 years. The second subject group consisted of two additional dogs who underwent Silastic medialization followed by removal of the implants at 7 months and were sacrificed 18 months later. The larynges were then processed, sectioned in the axial plane, and examined microscopically. Results: Histological findings of both the mobile and paralyzed sides showed a thin (<0.5 mm) fibrous capsule surrounding the implant and minimal inflammatory response. Vocal fold mobility was maintained in all cases in which the recurrent laryngeal nerve was left intact. Capsule formation and inflammatory response were similar in all cases. Conclusions: Minimal tissue reactivity over a prolonged period of time suggests that long-term results of Silastic medialization remain stable in paralyzed and mobile vocal folds for up to 2 years. Similar tissue response in the subjects in which the Silastic block was removed also suggests that Silastic medialization is a reversible procedure. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to evaluate whether the addition of topical mitomycin-C (MMC) application to the wound site after endoscopic treatment of laryngotracheal stenosis (LTS) resulted in measurable improvement in clinical outcomes. Study Design and Setting: A retrospective chart review of patients with LTS treated by the senior author over a 6-year period was performed. The treatment groups were stratified into two main categories: 1) endoscopic treatment alone and 2) endoscopic treatment + topical MMC. The 'symptom-free' interval was determined (in months) for each subject using a two-tailed t test for statistical analysis of the control/study groups. Results: Sixty-seven procedures were performed in 36 patients with LTS with a mean of 1.86 surgical treatments per patient. The mean duration of the symptom-free interval after endoscopic treatment for LTS was 4.9 months in the endoscopic-only treatment group and 23.2 months in the endoscopic group receiving topical MMC. The symptom-free interval observed in the MMC group was significantly longer than the control subjects ( P = 1 × 10−11). Conclusions: The results of this study suggest that MMC is an effective adjuvant in the treatment of LTS. The results of this study provide strong supporting evidence that topical MMC is an effective adjuvant in the treatment of LTS. [ABSTRACT FROM AUTHOR]

The article focuses on therapeutic treatment for patients in field of laryngology by laryngologists in an office based setting. Topics discussed include advantages in operating patients in upright position where they can phonate is to monitor voice quality, effect of office based procedure on safety and cost reduction, and technological advances in the field including chip-tip flexible endoscope, high-speed imaging, and new injection materials.