Search

To compare patient, disease and treatment characteristics of patients treated for recurrent respiratory papillomatosis (RRP) at a public county versus a private hospital. A retrospective cohort study was conducted of adult patients undergoing treatment for RRP at a tertiary-care academic center (TAC, n = 48) versus public safety net hospital (PSNH, n = 14), both staffed by the same Otolaryngology providers. There was no difference between cohorts in age, gender, medical comorbidities, history of juvenile-onset presentation, or history of prior treatment at a different institution. PSNH patients were more likely to be Hispanic/Latino, primarily speak Spanish, have public or no insurance, and reside in a zip code with lower median income compared with TAC patients. Despite living significantly closer to the hospital, PSNH patients were more likely than TAC patients to present with respiratory symptoms (50% versus 20.8%, P = 0.04), and exhibit more than one involved laryngeal subsite at their first surgical intervention (78.6% versus 27.1%, P = 0.001). They also had high rates of referral for otolaryngologic care via the emergency department (42.9%) rather than outpatient specialty referral (35.7%) and were more likely than TAC patients to require urgent intervention (21.4% versus 2.1%, P = 0.03). There was no difference in time interval from first clinic visit to procedure date or total number of treatments. PSNH patients present with more severe and symptomatic RRP disease compared with TAC patients. This finding may be related to sociodemographic disparities leading to poorer access in care. [ABSTRACT FROM AUTHOR]

1. To survey how vocal fatigue manifests itself in the vocal range of a sample of professional, female opera singers. 2. To assess laryngeal videostroboscopic changes of one professional, female opera singer before and after extended operatic singing. Survey study : 296 professional, female opera singers were recruited to participate in an anonymous research survey querying the temporary impact of vocal fatigue in professional, female opera singers. 46.3% of participants described themselves as singing mainstage roles at large, A-level opera houses. Singers were asked to report where in their vocal range they experienced the effects of vocal fatigue and could choose more than one response. Single-subject study : One professional, female opera singer (the author) underwent two laryngeal videostroboscopic exams pre and post vocal loading. The exams were evaluated and compared independently by two blinded laryngologists. The results of the survey found that 42.9% of the total responses from professional, female opera singers indicated a temporary impact on the lower middle range (≈C4-F4) as a result of vocal fatigue. 36.5% of participants experienced a temporary impact on their lowest range (≈below C4) and 19.6% reported a temporary impact on their higher range due to vocal fatigue. The results of the single-subject study showed reduced glottal closure pattern in the postloading, lower middle range, head voice condition. A large proportion (64.9%) of the professional, female opera singers surveyed reported increased difficulty navigating their lower middle range and/or lowest range after extended operatic singing. These results support the single-subject study, which found that after vocal loading, there was a decrease in glottal competence while singing in head voice in the lower middle range. [ABSTRACT FROM AUTHOR]

To compare flexible distal-chip laryngoscopy (FDL) and rigid telescopic laryngoscopy (RTL) in image quality and diagnostic ability. Prospective cohort study; blinded comparison. Eighteen normal adult subjects were recruited to undergo both FDL and RTL and normalized videos were recorded. Three blinded laryngologists compared the videos for color fidelity, illumination, resolution, and vascularity, and indicated superiority with FDL, RTL, or no difference. Raters also reported if an abnormality was seen and in which video it was better visualized. Videos for two subjects were repeated to assess intra-rater reliability, making 20 video comparisons across 3 raters for a total of 60 ratings. Differences in responses were analyzed via Mann-Whitney U and Pearson Χ 2. Inter-rater reliability was assessed via Fleiss' kappa, and intra-rater reliability was assessed via percent agreement. RTL was rated superior in all categories of image quality (47 vs 5 vs 8, P < 0.01; 47 vs 7 vs 6, P < 0.01; 51 vs 5 vs 4, P <0.01; 44 vs 9 vs 7, P < 0.01, respectively). An abnormality was seen 33 times with both modalities and 6 times with RTL only. When seen with both modalities, visualization was superior in RTL compared with FDL (29 vs 4, P <0.01). There was significant superiority of RTL in all categories of image quality, with slight inter-rater agreement for color fidelity, resolution, and vascularity. RTL was also significantly better for visualization of abnormalities. These findings suggest superior image quality in RTL compared with FDL, but further research is required to determine if this difference is clinically significant. [ABSTRACT FROM AUTHOR]

Vocal fold mucous retention cysts are an important etiology of dysphonia and have classically been treated via microsurgical excision under general anesthesia. We present four cases that were treated with a novel technique of awake potassium-titanyl-phosphate laser-assisted marsupialization under local anesthesia. Reasons for in-office treatment included older age, medical comorbidities, and desire to avoid surgery/general anesthesia. No recurrences were observed and all patients had improved vocal quality, with a mean reduction in Voice Handicap Index-10 of 12.5. Hence, awake potassium-titanyl-phosphate laser treatment exhibits potential as a modality for addressing vocal fold mucous retention cysts in select patients with favorable outcomes. [ABSTRACT FROM AUTHOR]

Awake injection laryngoplasty (IL) is becoming increasingly utilized in the inpatient setting, especially as a therapeutic option for patients with vocal fold immobility immediately following cardiothoracic surgery. While prior studies consistently demonstrate complication rates below 3%, significant bleeding has not been reported as a major complication in any awake IL case series. The objective of this report is to highlight a case of intractable bleeding following awake inpatient bedside IL in a patient on KVAD (Koji Takeda Ventricular Assist Device) extracorporeal membrane oxygenation (ECMO). Case Report. A 24-year-old female admitted to the cardiac ICU for asystole was placed on KVAD ECMO for heart failure of unknown etiology. She was extubated and listed for cardiac transplant. On postoperative day 14, she underwent a left vocal fold injection at bedside to treat fold paralysis with a large glottic gap causing her complete aphonia, dysphagia, and chronic aspiration. Seven hours post procedure, the patient had to be reintubated due to intractable bleeding. A direct laryngoscopy was performed at bedside and continuous trickle of blood from the injection site at the superior posterior lateral surface of the vocal fold was stopped using a combination of epi-pledgets and hemostatic matrix. The same procedure had to be performed again due to further bleeding 2 days later and permanent hemostasis was achieved. During the week post injection, the patient required transfusion of 5 units of pRBC's. One month later the patient underwent successful orthotopic heart transplantation and was transferred from the ICU to a stepdown unit, and then a rehabilitation unit. No further IL hemorrhage occurred. Although a few studies have discussed the safety of IL in patients receiving anticoagulation, this case report demonstrates intractable bleeding requiring intubation and intervention to achieve hemostasis in a patient on KVAD ECMO. This report highlights the importance of weighing the risks and benefits of vocal fold injection in this patient population. [ABSTRACT FROM AUTHOR]

Idiopathic ulcerative laryngitis (IUL) is a rare disorder characterized by ulceration in the mid-membranous portions of the vocal folds. The etiology and optimal management of this condition are poorly understood. We aimed to survey laryngologists on their experiences with managing IUL in order to better understand the diagnosis and treatment of this unusual condition. An online survey was sent to 149 laryngologists practicing at academic institutions in the United States. Survey questions assessed respondents' professional backgrounds and clinical experiences with IUL. Individual responses were tallied and calculated as percentages of total responses. A total of 96 out of 149 academic laryngologists completed the survey, leading to an overall response rate of 64.4%. All respondents reported that they had encountered IUL in practice, including 56.3% who reported having seen 1–10 cases, 22.9% reporting 11–20 cases, and 20.8% reporting greater than 20 cases over their careers. Dysphonia (99.0%) and cough (84.4%) were the two co-occurring primary presenting symptoms reported. Most base diagnosis on laryngeal videostroboscopy (93.8%). Fungal/bacterial cultures and operative biopsy had been performed by approximately 30% of respondents with occasional candidiasis reported but otherwise negative or nonspecific results. Common therapies used were empiric: antireflux therapy (91.7%), modified voice rest (91.7%), and oral steroids (80.2%). Among survey respondents with experience managing more than 10 cases of IUL, many found complete voice rest (60.0%), oral steroids (55.9%), behavioral cough suppression (46.7%), and modified voice rest (46.3%) to be at least moderately effective treatment options. Resolution of symptoms was most commonly reported to occur over the course of 1–3 months (59.4%) and recurrences were seen not very often or never (85.4%). However, permanent sequelae were common, including vocal fold stiffness (89.6%) and dysphonia (81.3%). IUL is a rare disorder of unknown etiology. Diagnosis is typically made with laryngeal videostroboscopy and spontaneous resolution occurs over 1–3 months. Laryngologists commonly treat empirically with antireflux therapy, voice rest, antimicrobials, and oral steroids. While no empiric treatment appears to be highly effective for the management of IUL, complete or modified voice rest, oral steroids, and behavioral cough suppression may be the most effective of the currently available options. Further research is necessary to improve the understanding and optimal management of IUL. [ABSTRACT FROM AUTHOR]

The Lombard effect (LE) is a phenomenon in which speakers adjust their vocal production by raising the volume in noisy environments. As a result, the LE can create problems of vocal strain, fatigue and potential injury. This study aims to examine the difference in vocal intensity output in subjects wearing unilateral hearing protection versus no hearing protection in the presence of background noise. Each subject was seated inside a sound booth wearing a head-mounted microphone. Subjects were asked to read an excerpt from "The Rainbow Passage" while various levels of background noise were played: 50, 60, 70, and 80 dBA (Multitalker Babble). Each noise level was played while the subject was with and without unilateral ear protection (Optime 98 Earmuff [3M]) in random order. The earmuff has a noise reduction rating of 25 dB. After each reading of the text, subjects were asked to rate communication disturbance, vocal clarity, and discomfort during talking using a 10 cm visual analogue scale. The LE is reduced from 0.38 dB/dB to 0.29 dB/dB with unilateral ear occlusion. However, self-perception of disturbance, clarity and comfort were not affected by unilateral occlusion, only by noise level. Unilateral hearing protection reduces the LE and may protect against phonotrauma when speaking in an environment with loud background noise. [ABSTRACT FROM AUTHOR]

The study to investigates the effects of self-affirmation on the performance of women under stereotype threat. It is found that self-affirmation improved the performance of women under threat, but it did not affect men's performance.

It is well understood that hearing plays an important role in accurate vocal production. Singers in particular rely on auditory cues and auditory feedback to reproduce specific pitch contours. Therefore, even mild hearing loss may have a detrimental effect on a singer's ability to perform. This study investigates the effect of hearing loss on self-reported vocal production in singers, specifically in the domains of pitch matching, pitch maintenance, vowel production, and dynamic control as well as the effect of hearing loss on vocal handicap. An 18-item electronic self-report survey was distributed to the members of the National Association of Teachers of Singing and to the Voice Foundation. Data collected included demographics, the Singing Voice Handicap Index-10 (SVHI-10), and a series of closed and open-ended questions. Demographic variables, variables related to the SVHI-10, and variables related to the newly introduced survey were included in a hierarchical regression analysis to determine significant relationships. Among 206 eligible participants, 37 individuals reported a voice problem, 58 reported hearing loss, and 19 reported concurrent hearing loss and a voice problem. Among males, there were no significant differences between hearing impaired and normal hearing singers in reported pitch matching, pitch maintenance, dynamic control, and vowel matching when those with voice problems were excluded and included. However, in females, when singers with voice problems were excluded, there was a significant difference between hearing impaired and normal hearing singers in pitch matching (P = 0.38). Additionally, when singers with voice problems were included in the female subset, significant differences emerged between the hearing impaired and normal hearing singers in areas of pitch matching (P = 0.01) and vowel matching (P = 0.02). Further, controlling for gender, when excluding voice problems, there was a significant difference between the SVHI-10 scores of normal hearing (mean = 9.03) and hearing impaired participants (mean = 11.30, P = 0.02). This difference continued to be significant when including those with voice problems (normal hearing mean = 9.97, hearing impaired mean=14.1, P <0.0001). Additionally, individuals with hearing impairments were more likely to report higher perceived vocal handicap scores as reflected on the SVHI-10 than normal hearing respondents (P = 0.002). Other factors associated with higher likelihood of SVHI-10 score include older age (P = 0.008), having a voice problem (P <0.0001), and being paid to sing within the past six months (P = 0.001). When controlling for voice problems, singers with hearing impairments subjectively did not perceive that they performed less accurately on pitch matching, pitch maintenance, dynamic control, and vowel matching, yet they scored higher on the SVHI-10 indicating vocal handicap. Further study is needed to characterize the relationship between perceived and measured vocal accuracy in singers with hearing loss. [ABSTRACT FROM AUTHOR]

Assessment of the viability of enhanced gas recovery (EGR), in which CO 2 is injected into natural gas reservoirs, requires accurate and appropriate reservoir simulations. These necessitate provision of parameters describing dispersion between the fluids. Here we systematically measure fluid dispersion in various rock cores (sandstones and carbonates), both dry and at irreducible water saturation, at reservoir conditions. In this manner we evaluate the impact of the irreducible water on the miscible displacement processes. As such this represents the first measurement of dispersion as a function of water saturation for supercritical gases in consolidated media. Complementary measurements of water spatial distribution along the rock axis, as well as the pore size distribution occupied by the water were performed using magnetic resonance techniques. Irreducible water was found to increase dispersivity by a factor of up to 7.3. The dispersion coefficient ( K ) was measured as a function of velocity and the data for both dry and water-containing samples were successfully combined on a K –Péclet number ( Pe ) plot, enabling ready future inclusion into EGR reservoir models. The power-law dependence of K upon Pe produced an exponent of 1.2 for dry and water-saturated sandstones and 1.4 for dry and water-saturated carbonates, consistent with literature results ( Bijeljic et al., 2011; Honari et al., 2015 ). [ABSTRACT FROM AUTHOR]

As industry moves toward the production of oil and gas resources in deep offshore environments, the prospective formation of natural gas hydrates under low temperature, high-pressure conditions poses an increasing risk of pipeline blockage. Successful management of this risk requires a precise forecast of the hydrate growth rate. Such predictions should incorporate quantitative descriptions of both deterministic and probabilistic hydrate phenomena. In this work, we present a first step towards such a quantitative risk assessment for systems that form hydrate slurries, based on a consideration of the stochastic nature of hydrate formation. Our framework introduces a new approach to risk assessment, by coupling a laboratory-derived probabilistic nucleation model with existing deterministic calculations for hydrate slurry viscosification. This new approach is used to extend a previously-described hydrate risk algorithm, the Hydrate Flow Assurance Simulation Tool (HyFAST), which enables the rapid assessment of hydrate slurry viscosification using the most advanced models available. Importantly, while the previous version of HyFAST was constrained to calculations in flowloop and autoclave geometries, for which it is sufficient to consider a single volume element, the new version of the HyFAST algorithm allows calculations for flowlines wherein a series of multiple volume elements are considered. The advanced hydrate formation models within this algorithm allow identification of critically important hydrate formation scenarios, and may serve as a screening tool for cases that then require study within rigorous hydrodynamic packages such as OLGA ® or LedaFlow ® to examine behaviour during key transient events. By coupling the outputs of our predictive algorithm and quantitative risk framework, we demonstrate a new capability to assess what constitutes an acceptable level of hydrate formation. We use this algorithm in a series of case studies that compare the effectiveness of common hydrate mitigation strategies over the life of a reservoir, including the optimization of a wellhead choke opening for both production rate and hydrate blockage risk. [ABSTRACT FROM AUTHOR]

Reinjection of CO 2 into producing natural gas reservoirs is considered as a promising technology to improve gas recovery, mitigate atmospheric emissions and control climate change. However, natural gas and CO 2 are miscible at reservoir conditions and could result in CO 2 contamination of produced natural gas. This mixing process and consequently the viability of Enhanced Gas Recovery (EGR) projects can be quantitatively determined by reservoir simulations – such simulations require a description of gas dispersion. Here we conduct fluid transport experiments through carbonate and sandstone rock cores at various reservoir conditions to evaluate the effect of medium heterogeneity on the dispersion between supercritical CO 2 and CH 4 , accounting for erroneous contributions from entrance/exit and gravitational effects. Early breakthrough and long-tailed profiles are observed for one of the carbonate cores (Ketton) which is attributed to the existence of intra-grain micro-pores, which results in a persistent pre-asymptotic transport regime. Thus a revised model (Mobile-Immobile Model) was successfully used for this core to obtain dispersion coefficients characteristic of the eventual asymptotic regime. Both heterogeneous carbonate rocks considered exhibit higher dispersion than that observed in previously-measured homogeneous sandstone cores (Honari et al., 2013). The power law describing the dependency of dispersion coefficient on Péclet number at comparatively high interstitial displacement velocities gave an exponent of 1.2 for sandstones and 1.4 for carbonates, consistent with literature predictions (Bijeljic and Blunt, 2006; Bijeljic et al., 2011) based on pore-scale simulations. [ABSTRACT FROM AUTHOR]

Highlights: [•] Pulsed flow dispersion measurements of supercritical CO2–CH4 in rock cores. [•] Measurement of dispersivity as a characteristic length for the dispersion process. [•] Reconciliation of this dispersion data with that for packed beds. [•] An EGR dispersion correlation accounting for velocity, temperature and pressure. [Copyright &y& Elsevier]

Summary: Objective/Hypothesis: To determine the efficacy of the potassium titanyl phosphate (KTP) laser in lesion reduction, as well as preservation of mucosal wave and glottic closure in a cohort of patients with benign laryngeal pathology across multiple institutions. Study Design: Multi-institutional and retrospective. Methods: One hundred two patients who underwent in-office KTP procedures at multiple academic laryngology practices with at least a single follow-up visit were included. Image analysis was used to quantify vocal fold lesion size before and after treatment. A subset of images was analyzed by expert reviewers to determine the impact of this treatment on glottic closure and mucosal wave. Results: Statistically, when considering all lesions, KTP induced a significant reduction in lesion size. Post hoc analyses revealed some lesion specificity; all lesions decreased in size, with the exception of vocal fold scar. Mucosal wave and glottic closure were improved or unchanged in more than 90% of the patients examined. The inter- and intrarater reliabilities of the lesion quantification method were excellent. Conclusions: With great care and insight, the KTP laser appears to be a valuable tool for the treatment of various benign laryngeal lesions. Furthermore, KTP laser therapy appears to preserve or improve mucosal wave and glottic closure. The lesion measurement protocol previously described by our group appears to be reliable. [Copyright &y& Elsevier]

Abstract: The enhanced recovery of natural gas by the injection and sequestration of CO2 is an attractive scenario for certain prospective field developments if the risks of gas contamination or early CO2 breakthrough can be assessed reliably. Simulations of enhanced gas recovery (EGR) scenarios require accurate dispersion parameters at reservoir conditions to quantify the size of the miscible CO2–CH4 displacement front; several experimental studies using core-flooding equipment aimed at measuring such parameters have been reported over the last decade. However, such measurements are particularly challenging and the data produced are generally afflicted in their repeatability by limited experimental control and in their accuracy by systematic errors such as gravitational and core-entrance/exit effects. We review here the existing experimental data pertaining to EGR by CO2 sequestration and also report new measurements of longitudinal CO2–CH4 dispersion coefficients at temperatures of 40–80°C, pressures of 8–12MPa and interstitial velocities of 0.05–1.13mms−1 [14.2–320ftday−1] in 5–10cm long sandstone cores with permeabilities of 12 and 460mD. The core-floods were conducted in both a horizontal and vertical orientation, with significant gravitational effects observed for low velocity floods in horizontal cores with high permeabilities. We also analyzed the effects of tubing and core entrance/exit effects on the measurements and found that the latter resulted in apparent dispersion coefficients up to 63% larger than would be due to the core alone. Our results indicate that dispersivities for CO2–CH4 at these supercritical conditions are less than 0.001m, which indicates that excessive mixing will not occur in EGR scenarios in the absence of conformance effects such as heterogeneity coupled with injection well pattern. Inclusion of such conformance effects is essential for detailed reservoir simulation. [Copyright &y& Elsevier]

Summary: Introduction: Prolonged intubation may lead to medial arytenoid cartilage erosion and cricoarytenoid joint scarring with subsequent glottic insufficiency. This has been referred to as postintubation phonatory insufficiency (PIPI). Reports on treatment outcomes for this condition are lacking. Methods: A single institution retrospective chart review from January 2007 to present was preformed for PIPI diagnosis. Data were collected for intubation, symptoms, diagnosis, interventions, and outcomes. Results: Five patients with PIPI underwent treatment to improve voice. Patient 1 underwent thyroplasty with adduction arytenopexy. Patient 2 had a revision thyroplasty and subsequently two injections of the posterior defect and true vocal fold. Patient 3 underwent injection of the medial arytenoid defect. Patient 4 had injection augmentation of the anatomic deficiency and the ipsilateral true vocal fold. Patient 5 underwent thyroplasty with adduction arytenopexy. Limited to no phonatory improvement was achieved in any case. Conclusions: The management of patients with PIPI is difficult. Currently, no reliable means are available to restore cartilaginous defects in the respiratory glottis. Patients with this condition should be counseled as to the difficult nature of treatment. [Copyright &y& Elsevier]