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

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

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

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

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

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

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

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

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

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

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

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

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