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Objective: Chemoradiation (CRT) for nonlaryngeal head and neck cancer (HNC) can lead to voice and swallowing dysfunction. The purpose of this study was to examine voice and swallowing from the patient's perspective at least 5 years after treatment. Design: Patient survey. Methods: Twenty-eight patients treated with primary or adjuvant CRT at least 5 years ago (mean = 10.7 years, SD = 5.5, range, 5-28) completed a survey created based on previously validated questionnaires (the Patient Perception of Swallowing Function Questionnaire, PPSFQ; the Eating Assessment Tool, EAT-10; the Voice Handicap Index, VHI-10; the Voice Related Quality of Life, V-RQOL). Results: Patients reported some voice and swallowing dysfunction (39% of V-RQOL scores in categories of fair, poor, or worst possible and 32% of VHI-10 scores ≥20 or greater than 50% of the maximum; 39% of PPSFQ scores greater than 50% of the maximum and 32% of EAT-10 scores ≥20 or 50% of the maximum). There was a correlation between V-RQOL and VHI-10 scores (Pearson product moment correlation coefficient r =.96, calculated probability value p = 0), PPSFQ and EAT-10 scores (r = 0.87, p = 0.8 × 10−8), as well as between V-RQOL and PPSFQ/EAT-10 scores (r =.94, p = 0), VHI-10 and PPSFQ/EAT-10 scores (r =.97, p = 0). Conclusions: Perceived voice and swallowing dysfunction following CRT for nonlaryngeal HNC can persist or worsen beyond 5 years. [ABSTRACT FROM AUTHOR]

Purpose: Using a functional model of airway granulation tissue in laryngotracheal stenosis, we investigated changes in histopathology and inflammatory markers within granulation tissue in response to an interleukin-1 receptor antagonist (IL-1Ra). This study allows us to further delineate the immune response to wound healing and potentially identify treatment markers. Methods: Laryngotracheal complexes (LTCs) of donor mice underwent direct airway injury. The LTCs were transplanted into subcutaneous tissue of recipient mice in 2 groups: IL-1Ra treated and untreated. The IL-1Ra–treated arm received daily intraperitoneal injections of IL-1Ra for 3 weeks. The LTCs were then harvested. Granulation formation was measured. The mRNA expression of transforming growth factor (TGF) beta and IL-1 was quantified using real-time reverse transcript polymerase chain reaction. Results: There were statistically significant differences in lamina propria thickness. There were no statistically significant changes in mRNA expression of TGF-β and IL-1β between the treated and untreated specimens. Conclusions: Using a previously described murine model, we delineate inflammatory markers that can be targeted for potential therapy. While the levels of inflammatory markers do not change significantly, the lamina propria thickness shows that the effects of IL-1 have been inhibited. The early use of the IL-1Ra will inhibit the efficacy of IL-1 in the inflammatory cascade and can prevent early granulation formation. [ABSTRACT FROM AUTHOR]

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

Objectives: We undertook to describe the genetic and protein composition of subglottic stenosis (SGS) by measuring an array of protein expression and messenger RNA levels within human SGS tissue. We also sought to compare this human array to cytokine expression from a murine model of SGS in order to confirm the effective translational nature of our animal model. Methods: Human granulation tissue from 10 patients with early symptomatic SGS was compared to control bronchus. The expression levels of 24 different cytokines were measured by a Luminex protein assay and real-time polymerase chain reaction. Results: The protein expression in human SGS mirrors that seen in murine SGS. Transforming growth factor βl, inter- leukin Iβ, and matrix metalloproteinase 9 were markedly elevated in both human and mouse SGS tissues. The protein array showed a statistically significant elevation in the proinflarnrnatory cytokines tumor necrosis factor α, interleukin 1, granulocyte macrophage colony-stimulating factor, and interferon γ. Conclusions: This is the first study, to our knowledge, to measure an array of protein expression within human SGS tissue. The expression profile suggests that symptomatic tracheal granulation tissue is mostly within the early inflammatory phase of wound healing and has only begun fibrotic and angiogenic remodeling. This study validates our murine model of SGS, and also helps to define the exact pathways of tissue injury, in the hope of leading to new treatments for this difficult condition. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were 1 ) to understand which anatomic variables are associated with failed endoscopic exposure of Zenker's diverticulum and 2) to enable preoperative selection of patients suitable for endoscopic repair of Zenker's diverticulum on the basis of anatomic variables. Methods: We performed a prospective, Institutional Review Board-approved study of 30 patients undergoing attempted endoscopic repair of Zenker's diverticulum. Three categorical variables (sex. presence of maxillary dentition, and Mallampati score) and 6 continuous variables (age, neck circumference, hyomental distance, neck length, neck extension, and body mass index [BMI]) were collected before operation and then correlated to successful endoscopic exposure of the Zenker's pouch by use of a Fisher's exact test and Student's t-test, respectively. Results: Exposure was unsuccessful in 9 of 30 patients (30%). Factors that correlated significantly with exposure failure included a shorter neck length (7.2 ± 1.2 cm; p = 0.047), a shorter hyomental distance (5.0 ± 1.1 cm; p = 0.004), and a higher BMI (27.2 ±4.0 kg/m2; p = 0.05). The presence of maxillary dentition did not reach significance in exposure failure, but did show a trend toward an association. Conclusions: Surgical exposure in endoscopic repair of Zenker's diverticulum tends to be significantly less successful in patients with short necks, decreased hyomental distance, and/or a high BMI. An open approach should be considered in this patient population. [ABSTRACT FROM AUTHOR]

Objectives: Aspiration following radiotherapy for head and neck cancer (HNC) is a common event, but not all patients with aspiration will develop pneumonia. Our aim was to identify predictors of pneumonia in patients with aspiration following radiotherapy for HNC. Methods: We performed a retrospective study of 52 patients referred for modified videofluoroscopic barium swallow (MVBS) testing at our institution from 2003 to 2007 in order to identify clinical variables associated with the diagnosis of aspiration pneumonia. Results: Independent risk factors for the development of pneumonia were tracheobronchial aspiration on MVBS testing (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.2 to 20.5; p = 0.025), malnutrition (OR, 4.4; 95% CI, 1.3 to 14.7; p = 0.018), and smoking history (OR, 1.04 per pack-year; 95% CI, 1.01 to 1.07; p = 0.011). Through logistic regression analysis, we developed a bivariate predictive model with a sensitivity of 58%, a specificity of 90%, a positive predictive value of 79%, and a negative predictive value of 77% for the development of aspiration pneumonia in our patient population. Conclusions: Depth of aspiration on MVBS testing, malnutrition, and smoking history were strongly associated with the development of aspiration pneumonia in our patient population. The use of clinical variables to determine the risk of aspiration pneumonia is feasible and may help identify high-risk patients. [ABSTRACT FROM AUTHOR]

Objectives: We present a case series of 10 patients with unilateral true vocal fold paralysis who presented with airway obstruction. Methods: A retrospective review of the authors' patients at 2 institutions with unilateral true vocal fold motion impairment was carried out over a 10-year period. Of these, 10 patients were identified who presented with stridor and dyspnea as a result of synkinesis. Six cases were a result of thyroidectomy, 1 case resulted from recurrent laryngeal nerve section for spasmodic dysphonia, 1 case occurred after anterior cervical diskectomy and fusion, and in 2 cases no cause was identified. Results: Three patients underwent tracheotomy. Two patients underwent partial arytenoidectomy. Seven patients underwent botulinum toxin injection; 2 were treated with breathing therapy, and in 1 case breathing therapy was recommended. Seven patients underwent treatment with more than 1 method. Conclusions: Unilateral vocal fold paralysis may present with airway obstruction as a result of synkinesis. Treatment should be incremental and starts with breathing therapy and botulinum toxin injection. Partial arytenoidectomy or tracheotomy may be necessary for refractory cases. [ABSTRACT FROM AUTHOR]

We report the case of a 56-year-old black woman with a locally aggressive chondrosarcoma at an unusual tumor site: the right arytenoid cartilage. The tumor extended from the superior pole of the right arytenoid cartilage to the soft-tissue areas of the right aryepiglottic fold, piriform sinus, and interarytenoid area. We undertook a conservative surgical approach by performing an endoscopic transoral CO2 laser resection, a right arytenoidectomy with wide soft-tissue margins, and a tracheotomy in anticipation of postoperative edema. Surgical exploration revealed that the tumor extended into the cricoid cartilage. Histopathology demonstrated a low-grade chondrosarcoma of the conventional variant. Clear margins were obtained by staged procedures. Chondrosarcomas of the larynx typically exhibit low-grade histopathology, and affected patients have a low incidence of metastasis and a good prognosis. Even so, these tumors can present diagnostic and therapeutic challenges. Surgical resection provides adequate airway protection and sound oncologic safety while preserving speech and swallowing, and these should be the surgeon's goals in this setting. Options include open laryngofissure, thyrotomy, organ preservation with partial laryngectomy, and endoscopic laser resection. [ABSTRACT FROM AUTHOR]

Objectives: We sought to describe the findings of modified barium swallow study after chemoradiation in patients with head and neck cancer and to correlate these findings with clinical variables, including gastrostomy tube dependence and clinical pneumonia. Methods: We retrospectively reviewed 49 patients at a tertiary care center who underwent modified barium swallow study for dysphagia after chemoradiation. Results: Patients with nonlaryngeal lesions had increased cricopharyngeal impairment (27.8% versus 0.0%; p = .04). Patients who underwent concomitant chemotherapy had increased epiglottic changes relative to those who had radiotherapy alone (66.7% versus 30.8%; p = .05). Clinical pneumonia developed in 3 1.9% of the patients, and 79.6% required gastrostomy tube placement for a mean duration of 18.1 months. Conclusions: Chemoradiation effects deglutition at multiple levels. A large percentage of patients will develop pneumonia and feeding tube dependence. This study is among the largest to correlate the results of modified barium swallow studies to clinical variables in this patient population. This study highlights the significant incidence of gastrostomy tube dependence and pneumonia in these patients. [ABSTRACT FROM AUTHOR]

Objectives: This study was intended to 1) identify preoperative predictors of difficult laryngoscopy and 2) determine the role of obesity in difficulty of obtaining adequate laryngeal exposure. Methods: A prospective study was undertaken of 63 patients who were undergoing elective direct laryngoscopy. Thirty-six patients met the obesity criteria (body mass index of at least 30 kg/m2). Measurements of height, weight, and neck circumference and Mallampati and Cormack-Lehane scores were obtained. The ease of laryngeal exposure was recorded by the attending surgeon on a visual analog scale (VAS; 1 to 10). Difficult laryngeal exposure (DLE) was defined as a VAS score of at least 3. The candidate morphological predictors were investigated. Results: Obesity and Mallampati score were found to be predictors of DLE (p < .001). The VAS score was positively correlated with body mass index (p = .007), weight (p = .05), Mallampati score (p < .001), and Cormack-Lehane score (p < .001). Among obese patients, the VAS score was correlated with the Cormack-Lehane score (p .01), whereas in nonobese patients the VAS score showed a significant association with both the Mallampati (p = .02) and Cormack-Lehane (p = .01) scores. Conclusions: Obese patients and those with a Mallampati score of at least 2 posed a significantly higher risk of DLE. Preoperative identification of a potentially difficult airway may aid surgical planning and allow more effective communication with a collaborating anesthesiologist. [ABSTRACT FROM AUTHOR]

Objectives: This pilot study was designed to 1) identify predictors of difficult laryngeal exposure in obese patients, 2) develop strategies for efficient intubation and intraoperative visualization of the glottis, and 3) devise perioperative protocols for difficult laryngoscopies. Methods: We undertook a retrospective study over a 1-year period of 14 consecutive patients with a body mass index of more than 30 kg/m² who underwent elective direct laryngoscopy under general anesthesia. Measurements of height, weight, neck circumference, Mallampati score, and Cormack-Lehane classification of the airway were recorded. Problems encountered during anesthesia induction and emergence were also noted. The laryngologist recorded on a visual analog scale the degree of difficulty encountered in obtaining a binocular stereoscopic view and magnification, illumination, and suspension. Results: Anatomic challenges during difficult laryngoscopy included decreased neck extension, redundant folds of tissue in the oropharynx and hypopharynx, and upper airway collapsibility. Overall, there was an association between the incidence of difficult laryngeal exposure and the Cormack-Lehane score (r = .57; p = .03), but the Mallampati score was of limited utility to the laryngologist. Neck size in female patients correlated with the Cormack-Lehane score (p = .02). Neither weight nor body mass index were predictive of a difficult laryngeal exposure. Straight blade laryngoscopes with a distal flange allowed greater depth of insertion and provided the best visualization of the glottis. Conclusions: An appropriate clinical examination may help predict a difficult airway. However, further studies are warranted to fully characterize the anatomic predictors of a difficult laryngeal exposure. [ABSTRACT FROM AUTHOR]

Objectives: Head trauma is a common cause of anosmia, but diagnosis is typically late, owing to more life-threatening sequelae of the injury. Herein, we describe our workup for a case of traumatic anosmia and the magnetic resonance imaging (MRI) findings both at the time of injury and at the 18-month follow-up. Methods: We present a case report and a review of the literature. Results: A 33-year-old woman presented to our institution with a chief complaint of loss of smell and taste following an occipital blow to her head that occurred when she was hit by a car while riding a bicycle. We present the findings of MRI performed at the time of the injury and at the 18-month follow-up. We describe the clinical progression of her disease. from symptoms of parosmic and phantosmic episodes accompanied by dysgeusia to total anosmia at the 18-month follow-up. Conclusions: We advocate the use of MRI, coupled with otolaryngology consultation and formal olfactory testing, in the diagnosis, management, and counseling of patients with anosmia sustained from head injury. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to evaluate magnetic resonance imaging (MRI) as an objective measure of survival of micronized acellular human dermal graft (Cymetra, LifeCell Corporation) injected into the thyroarytenoid isuscle for augmentation of unilateral vocal fold paralysis. Methods; We performed a retrospective review of MRI scans obtained in 6 patients in whom Cymetra was injected into the thyroarytenoid muscle. Gadolinium-enhanced MRI of the larynx was performed 3 days. 1 month, 8 months, 11 months, 15 months, and 21 months after injection. The survival of injected Cymetra was assessed according to information obtained from the MRI scan. Images were also obtained for 1 cm³ of reconstituted Cymetra paste. Results: The identification of Cymetra in the larynx is based on its proteinaceous content, TI-weighted images of the injected material in the true vocal fold showed hyperintense foci corresponding to injected Cymetra. Hyperintense signal was also present on the T2-weighted images. Persistence of the injected Cymetra was readily detectable by MRI for as long as 11 months. Conclusions: Cymetra is a viable treatment option for vocal fold augmentation. The duration of survival of Cymetra (as long as 11 months) makes it a good option in cases in which longer survival of the injectable material is needed. [ABSTRACT FROM AUTHOR]

We conducted a study of 47 patients with various voice disorders to determine the prevalence of concomitant psychopathology. The prevalence of psychiatric symptoms varied considerably among patients with the three most common voice disorders: 63.6% among patients with vocal fold paralysis, 29.4% among those with functional dysphonia, and 7.1% among those with spasmodic dysphonia. Levels of anxiety and depression correlated moderately with the severity of voice symptoms in patients with vocal fold paralysis, but not in those with functional or spasmodic dysphonia. Certain abnormal personality traits--including interpersonal sensitivity and distrust of others--were more common among patients with functional dysphonia. The low rate of psychopathology among patients with spasmodic dysphonia is consistent with rates reported in previous investigations. Our findings suggest that the prevalence of psychopathology in patients with voice disorders varies according to the specific voice diagnosis, as does the relationship between specific psychiatric and voice symptoms. [ABSTRACT FROM AUTHOR]

Examines voice production in patients supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Diagnosis through laryngeal stroboscopy; Presence of a periodic mucosal wave on anterior aspect of the arytenoid cartilage as the finding of the study; Modification to the Bless Strobospic rating to assess laryngeal functions.

Presents three case studies on the diagnosis and treatment of neck injuries using intravenous drug use. Common local complications from self-injection injuries; Diagnosis and initial management of self-injection injuries; Conclusions.

Presents information on a study which evaluated the treatment and diagnosis of sarcoidosis with nasal obstruction and septal perforation. Environmental agents that causes clustered cases of sarcoidosis; Pathologic hallmark of sarcoidosis; Clinical case report.

A 47-year-old man with a history of allergic rhinitis presented with a several-month history of nasal symptoms and gastroesophageal reflux disease. He also had clinical depression, for which he had been taking a selective serotonin reuptake inhibitor (SSRI). During evaluation, flexible laryngoscopy incidentally detected a left interarytenoid polyp. Biopsy identified the lesion as a moderately differentiated neuroendocrine carcinoma. In addition to conducting a metastatic workup, we determined that it was necessary to evaluate the functional status of the tumor prior to excision because the SSRI could precipitate a carcinoid syndrome. We discuss the characteristics and management of different neuroendocrine carcinomas of the larynx, and we review the potential complications of the carcinoid syndrome. [ABSTRACT FROM AUTHOR]