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Objective: To provide detailed guidance on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP) based on a detailed review of the scientific literature and a consensus of experts with real‐world clinical experience. Methods: A bevacizumab consensus working group (N = 10) was composed of adult and pediatric otolaryngologists, adult and pediatric oncologists, and a representative from the RRP Foundation (RRPF), all with experience administering systemic bevacizumab in patients with RRP. After extensive review of the medical literature, a modified Delphi method‐based survey series was utilized to establish consensus on the following key areas: clinical and patient characteristics ideal for treatment candidacy, patient perspective in treatment decisions, treatment access, initial dosing, monitoring, guidelines for tapering and discontinuation, and reintensifying therapy. Results: Seventy‐nine statements were identified across nine critical domains, and 45 reached consensus [clinical benefits of bevacizumab (3), patient and disease characteristics for treatment consideration (7), contraindications for treatment (3), shared decision‐making (incorporating the patient perspective) (5), treatment access (3), initial dosing and administration (8), monitoring (7), tapering and discontinuation (6), and reintensification (3)]. Conclusion: This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP. Level of Evidence: 5 Laryngoscope, 134:5041–5046, 2024 [ABSTRACT FROM AUTHOR]

Objectives: The adult‐onset focal dystonias are characterized by over‐active muscles leading to abnormal movements. For most cases, the etiology and pathogenesis remain unknown. In the current study, unbiased proteomics methods were used to identify potential changes in blood plasma proteins. Methods: A large‐scale unbiased proteomics screen was used to compare proteins (N = 6,345) in blood plasma of normal healthy controls (N = 49) with adult‐onset focal dystonia (N = 143) consisting of specific subpopulations of cervical dystonia (N = 45), laryngeal dystonia (N = 49), and blepharospasm (N = 49). Pathway analyses were conducted to identify relevant biological pathways. Finally, protein changes were used to build a prediction model for dystonia. Results: After correction for multiple comparisons, 15 proteins were associated with adult‐onset focal dystonia. Subgroup analyses revealed some proteins were shared across the dystonia subgroups while others were unique to 1 subgroup. The top biological pathways involved changes in the immune system, metal ion transport, and reactive oxygen species. A 4‐protein model showed high accuracy in discriminating control individuals from dystonia cases [average area under the curve (AUC) = 0.89]. Interpretation: These studies provide novel insights into the etiopathogenesis of dystonia, as well as novel potential biomarkers. ANN NEUROL 2024;96:110–120 [ABSTRACT FROM AUTHOR]

Objectives: Adult‐onset idiopathic laryngeal dystonia (LD) can be associated with the risk of spread to muscles in the body. Subjects with extralaryngeal onset of dystonia have exhibited spread to the larynx. Previous studies analyze the spread of other dystonias but emphasis has not been placed on LD. The objective was to identify demographic and clinical factors contributing to the spread of dystonia to and from the larynx. Methods: Data were obtained from the Dystonia Coalition (DC)‐patients from 49 international clinical centers. Clinical and demographic data was taken from 143 out of 409 patients with diagnosed LD. Patient criteria included adult‐onset LD diagnosed on exam with no co‐morbid neurologic conditions and no dystonia in other locations. Results: Among the 143 patients, 94 (65.7%) patients were diagnosed with focal laryngeal onset, with the remainder having extralaryngeal onset. Family history and age at study were statistically significant indicators of a patient developing laryngeal versus extralaryngeal onset of dystonia. Among the laryngeal onset group, 21 cases (22.3%) had an average time of 5.81 ± 5.79 years to spread from diagnosis, most commonly to neck (61.9%). Among extralaryngeal onset patients, mean time of larynx spread was 7.92 ± 7.737 years, most commonly to neck (22.7%). Conclusions: Our data indicates approximately a quarter of patients with laryngeal‐onset dystonia will exhibit spread. There were no demographic or clinical factors that were statistically predictive of the likelihood of spread from larynx. Patients with dystonia elsewhere in the body should be counseled on the possibility of spread to larynx, and vice versa. Level of Evidence: 4 Laryngoscope, 134:2295–2299, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Pulmonary papillomatosis is a rare but severe manifestation of recurrent respiratory papillomatosis (RRP). Efficacy data of systemic bevacizumab for pulmonary RRP are limited. This study's objective was to characterize disease response of pulmonary RRP to systemic bevacizumab. Methods: A retrospective review was performed to identify patients with pulmonary RRP seen at three medical institutions. Clinical symptoms, CT findings, and disease response were compared before and after initiation of systemic bevacizumab therapy. Disease response was categorized as complete response, partial response, stabilization, or progression for each subsite involved by papilloma. Results: Of the 12 pulmonary RRP patients treated with systemic bevacizumab, 4 (33.3%) were male, and 11 (91.7%) were juvenile‐onset RRP patients. All presented with laryngeal, tracheal, and pulmonary RRP. The median (range) age at first bevacizumab infusion was 48.1 (19.5–70.2) years. Progression to pulmonary malignancy was identified in 3 (25.0%) patients, 2 before initiation of and 1 after complete cessation of bevacizumab therapy. Clinical symptoms such as dyspnea (75.0% vs. 25.0%; p = 0.01) and dysphagia and/or odynophagia (33.3 vs. 0.0%; p = 0.03) were significantly decreased following bevacizumab therapy. Compared with pre‐treatment baseline, 9 (75.0%) patients experienced a stable‐to‐partial response in the lungs to systemic bevacizumab, and 10 (83.3%) experienced partial‐to‐complete responses in the larynx and trachea. Conclusion: Systemic bevacizumab is effective in stabilizing progression in even the most severe cases of RRP, with both a dramatic reduction in laryngeal and tracheal disease as well as a stable‐to‐partial response of pulmonary involvement in a majority of patients. Level of Evidence: 4 Laryngoscope, 134:577–581, 2024 [ABSTRACT FROM AUTHOR]

Intermittent left supraclavicular swelling is an uncommon and elusive condition that can lead to extensive diagnostic workups to determine the etiology and treatment. One potential cause is partial, intermittent, or complete thoracic duct occlusion (TDO). We report on a patient who presented with chronic, intermittent left supraclavicular swelling and abdominal pain that was relieved by thoracic duct angioplasty. Thoracic duct occlusion should be included in the differential diagnosis of left supraclavicular swelling. Lymphatic imaging can facilitate the diagnosis and allows for potential percutaneous treatment. Laryngoscope, 134:1313–1315, 2024 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, immunogenicity, and efficacy of INO‐3107, a DNA immunotherapy designed to elicit targeted T‐cell responses against human papillomavirus (HPV) types 6 and 11, in adult patients with recurrent respiratory papillomatosis (RRP; NCT04398433). Methods: Eligible patients required ≥2 surgical interventions for RRP in the year preceding dosing. INO‐3107 was administered by intramuscular (IM) injection followed by electroporation (EP) on weeks 0, 3, 6, and 9. Patients underwent surgical debulking within 14 days prior to first dose, with office laryngoscopy and staging at screening and weeks 6, 11, 26, and 52. Primary endpoint was safety and tolerability, as assessed by treatment‐emergent adverse events (TEAEs). Secondary endpoints included frequency of surgical interventions post‐INO‐3107 and cellular immune responses. Results: An initial cohort of 21 patients was enrolled between October 2020 and August 2021. Fifteen (71.4%) patients had ≥1 TEAE; 11 (52.4%) were Grade 1, and 3 (14.3%) were Grade 3 (none treatment related). The most frequently reported TEAE was injection site or procedural pain (n = 8; 38.1%). Sixteen (76.2%) patients had fewer surgical interventions in the year following INO‐3107 administration, with a median decrease of 3 interventions versus the preceding year. The RRP severity score, modified by Pransky, showed improvement from baseline to week 52. INO‐3107 induced durable cellular responses against HPV‐6 and HPV‐11, with an increase in activated CD4 and CD8 T cells and CD8 cells with lytic potential. Conclusion: The data suggest that INO‐3107 administered by IM/EP is tolerable and immunogenic and provides clinical benefit to adults with RRP. Level of Evidence: 3 Laryngoscope, 133:3087–3093, 2023 [ABSTRACT FROM AUTHOR]

Objective: The clinical course of recurrent respiratory papillomatosis (RRP) varies from spontaneous remission to severe airway obstruction with wide variability in recurrence. Standard treatment involves debulking to improve voice and/or breathing. Non‐surgical therapies are emerging in hopes of non‐operative disease control. This retrospective review analyzes long‐term safety, efficacy, and durability of clinical control in the largest reported series of parenteral bevacizumab in adults with RRP. Methods: Twenty‐three patients with known RRP who have been receiving off‐label systemic bevacizumab were included. Dosage, infusion interval, number of cycles, debulking requirements, subjective outcomes, adverse events, and reasons for treatment termination were investigated. Results: Patients have been followed for an average of 791.43 (21–1468) days. The most common starting dosing regimen was 15 mg/kg at 3 weeks in 11 followed by 10 mg/kg at 6 weeks intervals in 6 individuals. Long‐term maintenance dosage varied with the least intensive regimen being 10 mg/kg at 14‐week intervals. Subjective improvement of voice and/or breathing was reported in 18/23 subjects. The median time for patients that needed a procedure after treatment was 634 days. Procedures after infusions decreased from 3.08 ± 2.48 procedures in the year prior to 0.52 ± 1.12 during systemic Bevacizumab, and to 0.86 ± 2.05 after stopping bevacizumab. Therapy termination occurred in 8 subjects where only 3 were due to adverse events. Conclusion: Parenteral bevacizumab remains a well‐tolerated treatment for patients with recalcitrant RRP. There appears to be a durable reduction in the frequency of debulking surgery requirements although on a maintenance regimen. Laryngoscope, 133:2725–2733, 2023 [ABSTRACT FROM AUTHOR]

Purpose: This study sought to investigate whether a significant difference exists in attendance, cancellations, and no-shows between in-person therapy and telepractice. The authors hypothesized that telepractice no-show and cancellation rates would be less than in-person no-show and cancellation rates. Method: This retrospective study manually reviewed and analyzed attendance, no-show, and cancellation data over a 3-month span of in-person–only visits (September 2019–November 2019) and a 3-month span of telepractice visits (September 2020–November 2020) conducted at the Emory Voice Center, a tertiary care practice in urban Atlanta, Georgia. Additionally, data were collected for each patient’s full course of therapy outside of the 3-month windows and analyzed for attendance, no-show, and cancellation patterns. Results: Data from 521 patients were available for review from the selected time frame. In 2019 (in-person), 157 patients met inclusion criteria, and in 2020 (telepractice), 176 patients were included. Therapy initiation, therapy attendance, and no-show rates had significant increases in the telepractice year, and cancellations made greater than 24 hr before the appointments had a significant decrease in the telepractice year. Furthermore, the overall course of therapy showed significantly fewer missed appointments and more attended appointments in the telepractice year. Conclusions: Patients participating in voice therapy via telepractice are more likely to initiate treatment and attend treatment and less likely to cancel sessions compared with patients receiving treatment in person. These data combined with extant data on telepractice treatment efficacy indicate that telepractice should be considered standard of care and offered to all patients seeking treatment, as it removes many reported barriers to treatment. [ABSTRACT FROM AUTHOR]

Summary: Chronic infections of the larynx are notorious 'copycats' of squamous cell carcinoma. Patients typically present with a historical picture and symptoms identical to those seen in a neoplastic setting: [...]

Objectives: Current patient‐reported outcome measures do not adequately capture the impact of spasmodic dysphonia (SD) on communication in daily life situations. The aim of this study was to validate the Communicative Participation Item Bank (CPIB), which specifically measures a disease's impact on daily conversational situations, as an outcome measure for SD. Study Design: Multi‐institutional prospective cohort study. Methods: A prospective study was conducted with administration of the 46‐question CPIB and the Voice Handicap Index‐10 (VHI‐10) to 190 participants with SD before (time 1) and 6 weeks after (time 2) botulinum toxin injection. Differential item function (DIF) analyses were performed to examine potential item bias. Paired t‐tests were used to assess change in each of the CPIB and VHI‐10 scores after treatment. Pearson correlations were calculated between the CPIB and VHI‐10. Results: DIF analyses revealed no clinically meaningful difference between the item parameters generated for this SD sample and the original CPIB calibration sample. There were statistically significant changes between the pre‐treatment and post‐treatment time points for both the CPIB and VHI‐10. Correlations between the CPIB and VHI were moderate‐high. Conclusions: The CPIB item bank, General Short Form, and scoring parameters can be used with people with SD for valid and reliable measurement of the impact of communication disorders on communication in everyday life. The CPIB is sensitive to changes with intervention, proving useful for clinical and research purposes to assess the efficacy and effectiveness of interventions. Level of Evidence: Level 2, prospective observational research with an experimental design (ie, cohort study). Laryngoscope, 131:859–864, 2021 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Recurrent respiratory papillomatosis (RRP) is a rare, potentially life‐threatening, disease that impacts the voice, breathing, and quality of life of patients. Frequent surgical interventions may be needed to control symptoms. We examined the safety and efficacy of utilizing parenteral bevacizumab in the management of severe RRP in adults. Study Design: This is a retrospective review of clinical management approaches in a group of patients with severe RRP defined as having a high disease burden, frequent need for debridement, and/or tracheobronchial disease. Patients were initially treated with 15 mg/kg of bevacizumab at 3‐week intervals. Bevacizumab dosing and frequency was then individually titrated down. Results: Fourteen adults received a median of 8.5 (range 2–17) bevacizumab infusions over approximately 24 months. All had a history of laryngeal RRP with 6/14 having additional tracheobronchial lesions. Patients required a median of 4 (range 2–11) procedures in the year prior to treatment. Only 3/10 (30%) patients who continued therapy required any additional procedures. Bevacizumab administration was generally well tolerated, with four patients discontinuing therapy. Medical reasons included severe epistaxis and hypertension and thrombocytopenia in an individual with systemic lupus erythematosus. Common side effects included hypertension (grade 2), headache (grades 1–2), elevated creatinine (grades 1–2), and epistaxis (grade 3). Conclusions: Intravenous bevacizumab for the primary treatment of severe RRP in adults appears clinically effective and safe. Expected and typically mild side effects related to bevacizumab were observed. Continued investigation of bevacizumab through a prospective clinical trial is warranted. Level of Evidence: 4. Laryngoscope, 131:E921–E928, 2021 [ABSTRACT FROM AUTHOR]

Objectives: To validate the use of a high-fidelity phonomicrosurgical trainer.Study Design: A high-fidelity phonomicrosurgical trainer, based on a previously validated model by Contag et al.,1 was designed with multilayered vocal folds that more closely mimic the consistency of true vocal folds, containing intracordal lesions to practice phonomicrosurgical removal. A training module was developed to simulate the true phonomicrosurgical experience. A validation study with novice and expert surgeons was conducted.Methods: Novices and experts were instructed to remove the lesion from the synthetic vocal folds, and novices were given four training trials. Performances were measured by the amount of time spent and tissue injury (microflap, superficial, deep) to the vocal fold. An independent Student t test and Fisher exact tests were used to compare subjects. A matched-paired t test and Wilcoxon signed rank tests were used to compare novice performance on the first and fourth trials and assess for improvement.Results: Experts completed the excision with less total errors than novices (P = .004) and made less injury to the microflap (P = .05) and superficial tissue (P = .003). Novices improved their performance with training, making less total errors (P = .002) and superficial tissue injuries (P = .02) and spending less time for removal (P = .002) after several practice trials.Conclusion: This high-fidelity phonomicrosurgical trainer has been validated for novice surgeons. It can distinguish between experts and novices; and after training, it helped to improve novice performance.Level Of Evidence: N/A. Laryngoscope, 127:888-893, 2017. [ABSTRACT FROM AUTHOR]

An anterior glottic web is an abnormal fusion of the anterior aspect of the membranous vocal folds. Noncongenital glottic webs are usually iatrogenic from intubation or laryngeal surgery. We present six adult patients whose initial in-office diagnoses were consistent with "idiopathic" benign anterior glottic webs as determined by three laryngologists (a.m.k., j.m.b., m.j.p.). Further evaluation revealed the diagnoses of laryngeal squamous cell carcinoma in all cases. The high risk of malignancy in cases of idiopathic anterior glottic web necessitates biopsy for tissue diagnosis of all such lesions. Laryngoscope, 129:2118-2120, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR).Study Design: Retrospective review of billing records.Methods: Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures.Results: Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures.Conclusions: For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures.Level Of Evidence: NA Laryngoscope, 126:1385-1389, 2016. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic laryngotracheal stenosis (LTS) continues to be a known complication of indwelling endotracheal tubes (ETTs). It is well established that secondary scar formation caused by inflammation and mucosal injury are the main mechanisms by which stenosis occurs. Additionally, there are reports of bacterial colonization of ETTs and its potential association with tracheal scar formation. We describe 4 cases of patients with history of intubation and/or tracheostomy and presumed LTS that improved with the management of concurrent bacterial laryngotracheitis. Methods: A retrospective case series of 4 subjects initially diagnosed at a tertiary care center with posterior glottic or subglottic stenosis and positive bacterial laryngotracheal cultures was performed. Results: All 4 patients with presumed LTS had culture-proven bacterial growth isolated from the laryngotrachea and were treated with adjunct antibiotics. In the first 3 cases, complete resolution of upper airway obstruction was achieved. The fourth patient had notable improvement in her airway status without the need for additional surgical intervention. Conclusion: This case series suggests that bacterial growth within the airway may play a larger role in adult postintubation airway injury. Those patients presenting with concern for LTS and symptoms suspicious for an ongoing bacterial infection may benefit from adjunct antibiotic therapy. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The primary objective of this study is to assess the adequacy of clinical and laboratory-based phonomicrosurgical training in otolaryngology residency programs using a self-report survey. The study aims to establish whether there is a need and desire for focused surgical training in phonomicrosurgery. Study Design Self-report Internet-based questionnaire. Methods An anonymous survey was sent to all current residents in otolaryngology training programs in the United States and Canada. For portions of the analysis, the residents were categorized into two groups-junior (R2 and R3) and senior (R4 and R5). Results One hundred ninety-one residents responded to the survey (USA: 166; Canada: 25), representing a 34.3% response rate. Approximately one-half of residents stated that their residency program includes a rotation during which the main emphasis is laryngology. Only 18.8% of residents were 'very' satisfied with the phonomicrosurgery experience that their program offers and 21.6% of senior residents felt 'very' comfortable performing a phonomicrosurgical removal of a vocal fold lesion. Whereas the vast majority of respondents found temporal bone laboratory training to be helpful, 82% had never performed laboratory training in phonomicrosurgery. The majority (87.4%) felt that their comfort level with phonomicrosurgery would increase if they had access to laboratory-based training. Conclusion Our study suggests that there is a lack of emphasis on clinical and laboratory-based training in phonomicrosurgery and that there is a need and desire for focused surgical training in phonomicrosurgery. Level of Evidence Level 4. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the voice and vocal fold pliability outcomes of European Laryngological Society (ELS) deep type I (subepithelial) and type II (subligamentous) cordectomies for early glottic cancer. Methods: We reviewed the medical records of patients with glottic carcinoma at a tertiary care medical center between 2005 and 2011. Their procedures were stratified into ELS type I and ELS type II cordectomies. The data recorded included age, gender, tumor stage, recurrence, patient-assessed voice-related quality of life, perceptual voice evaluation, and stroboscopy. Results: Four patients were identified as having subepithelial cordectomy, and 13 as having subligamentous cordectomy. The average preoperative and postoperative voice-related quality of life scores were 65 and 74 for the ELS I cohort and 64 and 95 for the ELS II group. The preoperative and postoperative perceptual voice evaluation scores were 56 and 35 for the ELS I cohort and 45 and 21 for the ELS II cohort. The ELS I cohort had a moderately to severely reduced mucosal wave, with 75% of patients demonstrating glottic insufficiency, whereas the ELS II cohort had a mildly to moderately reduced mucosal wave, with 8% of patients demonstrating glottic insufficiency. The survival outcomes were the same. Conclusions: Patients who underwent subligamentous excision of early glottic cancer had significantly improved postoperative voice and stroboscopy scores. This finding suggests that if tumor resection reaches the vocal ligament, and minimal superficial lamina propria can be preserved, subligamentous cordectomy should be performed. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: To determine the clinical yield of neck and chest computed tomography in the initial assessment of patients with idiopathic unilateral true vocal fold paresis. Study Design: Retrospective chart review. Methods: A retrospective chart review of consecutive adult patients with idiopathic unilateral true vocal fold paresis diagnosed by stroboscopy in a tertiary-care voice center from 2003 to 2010. Results: There were 176 patients with unilateral vocal fold paresis of which 81 subjects had idiopathic unilateral true vocal fold paresis. Of these, 60 patients (74.1%) had a computed tomography workup. Fifty-nine patients (98.3%) had a normal computed tomography while one patient had a single mediastinal lymph node that was PET-CT negative. This demonstrates an initial 1.7% yield and ultimate 0% yield of the computed tomography workup. Conclusion: Our results suggest that computed tomography workup has a low yield for occult neck and mediastinal pathology in patients with idiopathic unilateral true vocal fold paresis. Chest and neck computed tomography may not be clinically beneficial provided the patient has good otolaryngologic and medical follow-up. Laryngoscope, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Despite the fact that a wide variety of head and neck methicillin-resistant Staphylococcus aureus (MRSA) infections have been described, only four cases of MRSA laryngitis are reported in the literature. Our clinical experience suggests that this diagnosis is more common and can be more subtle that previously reported. The objective of this study was to identify and describe the clinical presentation, diagnosis, treatment, and outcomes of MRSA and methicillin-sensitive S aureus (MSSA) laryngitis, highlighting the in-office workup of these patients. Study Design: Retrospective case series. Methods: All patients with a culture-proven diagnosis of S aureus laryngitis treated within the Emory Voice Center, Department of Otolaryngology-Head and Neck Surgery at Emory University between 2007 and 2011. Demographic, diagnostic, and treatment data were retrospectively collected from the patients' hospital records. Results: Three patients with culture-proven MRSA laryngitis were identified. Three further cases of MSSA were also identified. Patients ranged in age from 34 to 74 years. All three patients with MRSA were diabetics. All six patients in the study were current or past users of cigarettes. The most common presenting symptoms were vocal roughness, vocal fatigue, and decreased vocal endurance. There were no symptoms of airway or swallowing compromise. The duration of symptoms at the time of initial assessment ranged from 3 months to 5 years, and most patients had undergone numerous previous treatments. Common signs on laryngeal examination included thickened vocal fold epithelium, whitish debris or the appearance of leukoplakia, edema, and crusting. Signs and symptoms were similar in MRSA and MSSA patients. The diagnosis was made in all patients via awake in-office culture of the larynx. All patients were treated with a prolonged course of trimethoprim-sulfamethoxazole (2-4 weeks). Although repeated courses of treatment were required, most patients had an excellent response to treatment. Conclusions: This is the largest, single, case series of patients with MRSA laryngitis. Our study findings suggest that the diagnosis may be more common than previously recognized, and that the presenting signs and symptoms may be subtle and similar to MSSA. Diagnosis can be made via in-office laryngeal culture. Clinicians must have a high index of suspicion for this diagnosis. Laryngoscope, 2012 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The current trends in geriatric voice referrals including the number of patients over the age of 65 years seen per year, the common diagnostic patterns, and specifically the number of patients with vocal atrophy were assessed. Study Design: Retrospective cohort study. Methods: A retrospective chart review of all patients seen at the Emory Voice Center for otolaryngologic complaints between the years of 2004 and 2009 was performed. Results: Of the 6,360 patients seen over a 6-year period, 21% were over the age of 65 years. Fifty-eight percent of patients over the age of 65 years had vocal complaints, with the most common diagnoses being vocal atrophy (25%), neurologic vocal dysfunction (23%), and vocal fold immobility (19.2%). Of those patients diagnosed with vocal atrophy, the majority opted for voice therapy (57%), followed by reassurance (39%), and injection laryngoplasty (6%). There was a statistically significant improvement in mean pretherapy and post-therapy voice-related quality of life (VRQOL) score. Conclusions: As the number of people in the over 65-year-old age bracket increases, so do the number of geriatric referrals. Although diagnostic trends remain the same, vocal atrophy is becoming more prevalent, with a large number of patients seeking intervention. This will likely result in an increased need for health resources in the future. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The aim of this study was to define the coprevalence of tremor with spasmodic dysphonia (SD).Study Design: A single-institution, prospective, case-control study was performed from May 2010 to July 2010.Methods: Consecutive patients with SD (cases) and other voice disorders (controls) were enrolled prospectively. Each participant underwent a voice evaluation and an evaluation for tremor.Results: There were 146 voice disorder controls and 128 patients with SD enrolled. Of patients with SD 26% had vocal tremor, 21% had nonvocal tremor. Patients with SD were 2.8 times more likely to have coprevalent tremor than the control group (odds ratio = 2.81; 95% confidence interval, 1.55-5.08), and only 35% of patients with SD had been seen by a neurologist for the evaluation of dystonia and tremor.Conclusions: Tremor is highly prevalent in patients with SD. It is important for each patient diagnosed with SD to undergo an evaluation for tremor, and this is especially important in patients diagnosed with vocal tremor. [ABSTRACT FROM AUTHOR]