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Background: Post-nasal drip (PND) is likely multifactorial in etiology which may be attributed to excessive sinonasal secretions or an increase in mucous viscosity from chronic sinusitis or allergic rhinitis. Increased throat sensitivity due to inflammatory changes have been postulated as a possible cause, which may be secondary to laryngopharyngeal reflux (LPR). Methods: Patients presenting with a primary complaint of post-nasal drip were prospectively enrolled into the cohort study. All patients underwent nasal endoscopy, flexible laryngoscopy, in-vitro allergy testing, and computed tomography (CT) imaging. Patients were also asked to fill out a SNOT-22 questionnaire and a reflux severity index (RSI) form. Results: 33 patients were enrolled in the study of which 22 completed all necessary procedures. In our cohort of patients the average SNOT score was 43±22, and the average RSI was 22±7. Twenty-one of the 22 patients had RSIs consistent with LPR. Reflux finding scores (RFS) as evaluated and averaged between two laryngologists found that all patients in the cohort met criteria for LPR with an average RFS of 12.6±2.1. Fourteen of the 22 patients had a positive RAST. Seventeen of the patients in the cohort had CT scans that were normal. The average Lund Kennedy score was 0.9±1.4 with 14 of the 22 patients having unremarkable nasal endoscopies. Conclusions: Patients with PND benefit from consideration of empiric treatment with PPIs, dietary modification given the high rates of LPR. Consideration should also be given to allergy testing prior to any consideration for CT imaging.

Caloric restriction (CR) is the leading non-pharmacological intervention to delay induced and spontaneous tumors in pre-clinical models. These effects of CR are largely attributed to canonical inhibition of pro-growth pathways. However, our recent data suggest that CR impairs primary tumor growth and cancer progression in the murine 4T1 model of triple negative breast cancer (TNBC), at least in part, through reduced frequency of the myeloid-derived suppressor cells (MDSC). In the present study, we sought to determine whether injection of excess MDSCs could block regression in 4T1 tumor growth and metastatic spread in BALB/cJ female mice undergoing daily CR. Our findings show that MDSC injection impeded CR-mediated protection against tumor growth without increasing lung metastatic burden. Overall, these results reveal that CR can slow cancer progression by affecting immune suppressive cells. Impact statement: Inoculation of MDSCs from donor mice effectively impedes the ability of calorie restriction to protect against primary tumor growth without impacting lung metastatic burden in recipient animals. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11357-022-00635-y.

Objectives: To report a resident-led otolaryngology clinic experience at an independent Federally Qualified Health Center (FQHC) with an affiliated academic center. We compared delivery of subspecialty care for underserved patients in a unique resident run clinic to standard care at the university staffed subspecialty clinics. Methods: Retrospective cohort study of surgical patients seen at the Social Action Community Health System (SACHS) otolaryngology clinic over a one-year period compared with a matched control cohort of patients having similar procedures at the affiliated faculty academic practice. Measured endpoints were case type, time of referral to consultation, time interval between surgical decision and date of surgery, surgical complications, as well as post-surgical follow up. Results: A total of 687 new patients were seen at SACHS clinic, with approximately 18% ultimately undergoing surgery. All otolaryngology sub-specialties were represented including otology, facial plastics, and head and neck oncology. SACHS patients had overall slightly higher median interval times from referral to consultation and from surgical decision to date of surgery though this did not reach significance. There were no differences in surgical outcomes or complication rates between the SACHS cohort and faculty cohort. Conclusions: We demonstrate a mutually beneficial partnership between a fully resourced FQHC system and an otolaryngology residency program to provide reciprocally beneficial training experience and effective health care delivery.

Objectives The primary goal of this study was to examine how well findings of cervical esophageal stenosis on modified barium swallow (MBS) and esophagram correlate with clinical improvement following dilation in patients with a history of head and neck (H&N) cancer. Methods A retrospective review was performed at an academic hospital. The study population included H&N cancer patients with a history of neck dissection surgery who underwent esophageal dilation from 2010 to2018. Pre and postdilation swallowing function was assessed. The Functional Outcomes Swallowing Scale (FOSS) and Functional Oral Intake Scale (FOIS) were used as outcome measures. Results The 95 patients were included. All patients had imaging prior to dilation. Post‐dilation FOSS and FOIS scores were significantly improved (P, The aim of this study was to determine the ability of the modified barium swallow (MBS) and esophagram to accurately predict cervical esophageal stenosis in patients with history of head and neck cancer that would benefit from esophageal dilation. A retrospective review was performed at an academic hospital of patients who had previous neck dissection surgery for cancer and underwent esophageal dilation from 2010‐2018. These imaging studies appear to have mixed reliability as predictors of response to esophageal dilation in this population that is high risk for cervical esophageal stenosis.

Cancer incidence increases with age and is a leading cause of death. Caloric restriction (CR) confers benefits on health and survival and delays cancer. However, due to CR’s stringency, dietary alternatives offering the same cancer protection have become increasingly attractive. Short cycles of a plant-based diet designed to mimic fasting (FMD) are protective against tumorigenesis without the chronic restriction of calories. Yet, it is unclear whether the fasting time, level of dietary restriction, or nutrient composition is the primary driver behind cancer protection. Using a breast cancer model in mice, we compare the potency of daily CR to that of periodic caloric cycling on FMD or an isocaloric standard laboratory chow against primary tumor growth and metastatic burden. Here, we report that daily CR provides greater protection against tumor growth and metastasis to the lung, which may be in part due to the unique immune signature observed with daily CR., Caloric restriction (CR) has been shown as an effective intervention to reduce tumorigenesis, but alternative less stringent dietary interventions have also been considered. Here, the authors show that in a murine model of breast cancer CR has a larger effect on preventing tumorigenesis and metastasis compared to periodic caloric cycling.

While the novel coronavirus outbreak has profoundly altered health care systems across the globe, it has also affected similar change and devastation on the social, educational, and cultural communities upon which many rely, including communities of choral singers, solo performers, conductors, voice teachers, and the professionals that collaborate with them. Even as citizens of the most heavily impacted countries took to their balconies to serenade first responders and health care workers, singers of most genres who typically perform in ensembles have been told to not carry on their beloved practice. This message, promoted by the lay media and by early reports of “super-spreading” of the virus at choral events in the United States and abroad,1 , 2 has been reinforced by expert and nonexpert opinion regarding the transmissibility of SARS-CoV-2 through droplets and aerosols, the generation of respiratory particles when singing, and concern about the interpersonal interactions that routinely accompany vocal performance, both in groups and in one-on-one teaching situations. Unfortunately, there is a paucity of data about both how SARS-CoV-2 is transmitted by singing and how to bring communities of singers back together safely. The data available about disease spread through vocalization, most of which preceded the current pandemic, address primarily transmission of disease through droplets and aerosols and are specific neither to this virus nor to singing.3, 4, 5, 6 Specifically, there is a lack of data addressing how to congregate and sing safely in choral environments such as churches, concert halls and practice spaces, as well as stages, theatres and other venues. In addition, protective measures such as safest distancing between singers, wearing masks or other personal protective equipment (PPE), using larger rehearsal or performance spaces, reducing the number of singers inside a certain enclosed space, reducing the duration of rehearsals or performances, and using real time air and surface cleaning methods such as increased ventilation, UV-C light and HEPA filtration specific to a singing environment among other topics have not been studied well enough to provide evidence on which to base advice to the singing community. Opinion on these matters is plentiful and often divergent. A recent webinar with a panel of experts in the world of voice care and singing left the audience with the message, “There is no safe way for singers to rehearse together until there is a COVID-19 vaccine and a 95% effective treatment in place.”7 , 8 Although, this may ultimately prove to be accurate, evidence-based practice (defined as an approach to health that integrates scientific research, patient preferences and values, and clinical expertise to make the best recommendations possible) does not allow for such a definitive conclusion to be made at this time.9 It must be understood, that these recommendations and decisions are made not only on what scientific information is available but on intuition and unsystematic experience that is often biased and inaccurate. We do not understand all the risks posed by COVID 19 to ourselves, friends, family and colleagues, who wish to resume educational, performance, communal and congregational singing safely. Evidence-based practice demands that we critically evaluate our current state of knowledge to come up with the best possible information to disseminate. In this article, we review the information that exists relating to singing and COVID-19. This paper is intended to provide guidance based on what we know: the best available data, analyzed and scrutinized by a panel of experts in the medical, behavioral and basic science world of voice care, of whom many are professional singers, choir directors or teachers of singing. While it may not be able to afford any definitive answers, this work will offer suggestions of best practices for those singing groups that are willing to mitigate risk knowing that the risk cannot be brought to zero. Finally, this report will hopefully stimulate the larger voice research community to study the emerging consensus on safe resumption of singing and pursue scientific understanding of COVID-19.

Brain imaging studies have identified multiple neuronal networks and circuits in the brain with altered functioning in patients with schizophrenia. These include the hippocampo-cerebello-cortical circuit, the prefrontal-thalamic-cerebellar circuit, functional integration in the bilateral caudate nucleus, and the salience network consisting of the insular cortex, parietal anterior cingulate cortex, and striatum, as well as limbic structures. Attributing psychotic symptoms to any of these networks in schizophrenia is confounded by the disruption of these networks in schizophrenic patients. Such attribution can be done with isolated dysfunction in any of these networks with concurrent psychotic symptoms. We present the case of a patient who presents with new-onset hallucinations and a stroke in brain regions similar to the salience network (insular cortex, parietal cortex, and striatum). The implication of these findings in isolating psychotic symptoms of the salience network is discussed.

A gossypiboma is a mass within a patient’s body comprising a cotton matrix surrounded by a foreign body granuloma. We describe an unusual presentation of a gossypiboma presenting in a 32-year-old man with acute epigastric pain and haematemesis. His surgical history revealed an emergency laparotomy following a road traffic accident 16 years ago. Initial gastroscopy showed extrinsic stomach compression. An abdominal ultrasound scan followed by a CT scan evidenced a large, well-defined, predominantly cystic mass with some solid areas occupying the left hypochondrium. Conservative management with insertion of a percutaneous drain proved to be inefficient. A laparotomy was performed; intraoperatively, the cyst was found to be ruptured and within it, a large surgical gauze was found. This was removed but required a distal pancreatectomy and gastrectomy for complete excision. He was discharged on day 74 of admission with outpatient follow-up.

Objectives: Vocal fold injury can be irreversible, leading to vocal fold scarring, with permanent functional effects and no optimal treatment. A porcine model of vocal fold scarring was used to test effects of decorin and primed vocal fold fibroblasts in vitro using a cell migration assay and immunoblotting, and by using functional measurements of porcine larynges and excised porcine vocal folds. Methods: In vitro: primary pig vocal fold fibroblasts (PVFFs) were subjected to cell migration assays (scratch) and treated with decorin 20 μg/mL, hepatocyte growth factor (HGF) 200 ng/mL, epidermal growth factor (EGF) 1 nM, or transforming growth factor-β1 10 ng/mL. Cells also underwent decorin dose response testing. Scratch assays were analyzed in MetaMorph® Imaging; cell lysates were processed for MMP-8 and type I collagen content. Eleven pigs underwent unilateral vocal fold stripping procedures. At day 3 postoperatively, subjects underwent superficial injection into the affected vocal fold either with decorin 20 μg/mL or 1 × 106 HGF-primed fibroblasts. Larynges were harvested and either used for ex vivo laryngeal testing or for rheological testing. Results: Scratch assay indicated significantly reduced cell migration in PVFFs treated with decorin or HGF. MMP-8 production was increased (P

Importance An aging population experiences an increase in age-related problems, such as presbyphonia. The causes of pathologic presbyphonia are incompletely understood. Objective To determine what distinguishes pathologic presbyphonia from presbylaryngis. Design, Setting, and Participants This was a cohort study at an outpatient otolaryngology subspecialty clinic of a tertiary academic referral center. Participants were consecutive consenting adults older than 74 years without laryngeal pathologic abnormalities who visited the clinic as participants or companions. Patient questionnaires, otolaryngologic, video stroboscopic, and voice examinations were compiled. Patients were divided into groups based on whether they endorsed a voice complaint. Three blinded authors graded stroboscopic examinations for findings consistent with presbylaryngis (vocal fold bowing, vocal process prominence, glottic insufficiency). Main Outcomes and Measures Voice Handicap Index–10, Reflux Symptom Index, Cough Severity Index, Dyspnea Index, Singing Voice Handicap Index-10 , Eating Assessment Tool -10, Voice-Related Quality of Life (VRQOL), and Short-Form Health Survey; face-sheet addressing social situation, work, marital status, education, voice use, transportation; acoustic and aerodynamic measures; and a full otolaryngologic examination, including videostroboscopic imaging. Results A total of 31 participants with dysphonia (21 were female; their mean age was 83 years [range, 75-97 years]) and 26 control participants (16 were female; their mean age was 81 years [range, 75-103 years]) completed the study. Presbylaryngis was visible in 27 patients with dysphonia (87%) and 22 controls (85%). VHI-10 and VRQOL scores were worse in patients with pathologic presbyphonia (median [range] VHI-10 scores, 15 (0-40) vs 0 (0-16) and median VRQOL score, 19 [0-43] vs 10 [10-23]). All other survey results were indistinguishable, and no social differences were elucidated. Acoustic measures revealed that both groups averaged lower than normal speaking fundamental frequency (mean [SD], 150.01 [36.23] vs 150.85 [38.00]). Jitter was 3.44% (95% CI, 2.46%-4.61%) for pathologic presbyphonia and 1.74% (95% CI, 1.35%-2.14%) for controls (d = 0.75). Shimmer means (95% CI) were 7.8 2 (6.08-10.06) for the pathologic presbyphonia group and 4.84 (3.94-5.72) for controls (d = 0.69). Aerodynamic measures revealed an odds ratio of 3.03 (95% CI, 0.83-11.04) for patients with a maximum phonation time of less than 12 seconds who had complaints about dysphonia. Conclusions and Relevance Presbylaryngis is present in most ambulatory people older than 74 years. Some will endorse pathologic presbyphonia that has a negative effect on their voice and quality of life. Pathologic presbyphonia seems to be influenced by respiratory capacity and sex. Further study is required to isolate other social, physiologic, and general health characteristics that contribute to pathologic presbyphonia.

CXC chemokine receptor 3 (CXCR3) signaling promotes keratinocyte migration while terminating fibroblast and endothelial cell immigration into wounds; this signaling also directs epidermal and matrix maturation. Herein, we investigated the long-term effects of failure to activate the "stop-healing" CXCR3 axis. Full-thickness excisional wounds were created on CXCR3 knockout((-/-)) or wild-type mice and examined at up to 180 days after wounding. Grossly, the CXCR3(-/-) mice presented a thick keratinized scar compared with the wild-type mice in which the scar was scarcely noticeable; histological examination revealed thickening of both the epidermis and dermis. The dermis was disorganized with thick and long collagen fibrils and contained excessive collagen content in comparison with the wild-type mice. Interestingly, the CXCR3(-/-) wounds presented lower tensile/burst strength, which correlates with decreased alignment of collagen fibers, similar to published findings of human scars. Persistent Extracellular matrix turnover and immaturity was shown by the elevated expression of proteins of the immature matrix as well as expression of matrix metallopeptidase-9 MMP-9. Interestingly, the scars in the CXCR3(-/-) mice presented evidence of de novo development of a sterile inflammatory response only months after wounding; earlier periods showed resolution of the initial inflammatory stage. These in vivo studies establish that the absence of CXCR3(-/-) signaling network results in hypertrophic and hypercellular scarring characterized by on-going wound regeneration, cellular proliferation, and scars in which immature matrix components are undergoing increased turnover resulting in a chronic inflammatory process.

We determined whether a two-part space-conforming polyethylene glycol/dopa polymer-based gel promoted healing of contaminated wounds in mice. This silver-catalysed gel was previously developed to be broadly microbiocidal in vitro while being biocompatible with human wound cell functioning. Full-thickness wounds were created on the backs of mice. The wounds were inoculated with 10(4) CFU of each of four common skin wound contaminants, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumanii and Clostridium perfringens. The wounds were then treated with our multifunctional polymer-based gel, the commercially available NewSkin product, or left to heal untreated. The untreated wounds were overtly infected, and presented detectable bacterial loads over the entire 21-day healing period, while the gel and NewSkin groups presented significantly smaller rises in bacterial levels and were cleared of detectable colonies by the third week, with the gel group clearing the bacteria earlier. While all three groups healed their wounds, the polymer-based gel-treated group demonstrated significantly earlier re-epithelialization and dermal maturation (P

Bilateral vocal fold immobility is an uncommon but serious condition with many causes. Accordingly, accurate diagnosis is essential in order to treat patients promptly and avoid long-term sequelae. Historically, diagnosis has been performed in the operating room with the patient under general anesthesia. We present the case of a patient who was diagnosed with bilateral vocal fold immobility by in-office arytenoid palpation that required only topical anesthesia of the larynx. The patient subsequently underwent appropriate treatment. In our opinion, office-based arytenoid palpation is a simple, safe, and accurate procedure for diagnosing bilateral vocal fold immobility.

Creutzfeldt-Jakob disease is a rare type of spongiform encephalopathy. Affected patients present with constitutional symptoms, which progress to severe mental deterioration and movement disorders. Dizziness is the most common early otologic symptom. Few reports in the literature describe patients with Creutzfeldt-Jakob disease who present with sudden-onset hearing loss as their primary symptom for seeking treatment. This paper discusses one such patient and reviews the clinical presentation, treatment options, and relevant literature.