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Importance: Clinicians and patients benefit when they have a clear understanding of how medical conditions influence patients' life experiences. Patients' perspectives on life with unilateral vocal fold paralysis have not been well described., Objective: To promote patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis., Design, Setting, and Participants: This study used mixed methods: surveys using the voice and dysphagia handicap indexes (VHI and DHI) and semistructured interviews with adults with unilateral vocal cord paralysis recruited from a tertiary voice center. Recorded interviews were transcribed, coded using a hierarchical coding system, and analyzed using an iterative inductive-deductive approach., Main Outcomes and Measures: Symptom domains of the patient experience., Results: In 36 patients (26 [72%] were female, and the median age and interquartile range [IQR] were 63 years [48-68 years]; median interview duration, 42 minutes), median VHI and DHI scores were 96 (IQR, 77-108) and 55.5 (IQR, 35-89) at the time of interviews, respectively. Frustration, isolation, fear, and altered self-identity were primary themes permeating patients' experiences. Frustrations related to limitations in communication, employment, and the medical system. Sources of fear included a loss of control, fear of further dysfunction or permanent disability, concern for health consequences (eg, aspiration pneumonia), and/or an inability to call for help in emergency situations. These experiences were modified by the following factors: resilience, self-efficacy, perceived sense of control, and social support systems., Conclusions and Relevance: Effects of unilateral vocal fold paralysis extend beyond impaired voice and other somatic symptoms. Awareness of the extent to which these patients experience frustration, isolation, fear, and altered self-identity is important. A patient-centered approach to optimizing unilateral vocal fold paralysis treatment is enhanced by an understanding of both the physical dimension of this condition and how patients cope with the considerable emotional and social consequences. Recognizing the psychosocial dimensions of disease allows clinicians to communicate more effectively, be more empathetic, and to better personalize treatment plans, which may lead to improved patient care and patient satisfaction.

Objective: Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies. A systematic review of the literature on dysphagia-related PRO measures was performed to (1) identify all currently available measures and (2) to evaluate each for the presence of important measurement properties that would affect their applicability., Design: MEDLINE via the PubMed interface, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument database were searched using relevant vocabulary terms and key terms related to PRO measures and dysphagia. Three independent investigators performed abstract and full text reviews. Each study meeting criteria was evaluated using an 18-item checklist developed a priori that assessed multiple domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (6) scoring and interpretation, and (7) burden and presentation., Results: Of 4950 abstracts reviewed, a total of 34 dysphagia-related PRO measures (publication year 1987-2014) met criteria for extraction and analysis. Several PRO measures were of high quality (MADS for achalasia, SWAL-QOL and SSQ for oropharyngeal dysphagia, PROMIS-GI for general dysphagia, EORTC-QLQ-OG25 for esophageal cancer, ROMP-swallowing for Parkinson's Disease, DSQ-EoE for eosinophilic esophagitis, and SOAL for total laryngectomy-related dysphagia). In all, 17 met at least one criterion per domain. Thematic deficiencies in current measures were evident including: (1) direct patient involvement in content development, (2) empirically justified dimensionality, (3) demonstrable responsiveness to change, (4) plan for interpreting missing responses, and (5) literacy level assessment., Conclusion: This is the first comprehensive systematic review assessing developmental properties of all available dysphagia-related PRO measures. We identified several instruments with robust measurement properties in multiple diseases including achalasia, oropharyngeal dysphagia, post-surgical dysphagia, esophageal cancer, and dysphagia related to neurological diseases. Findings herein can assist clinicians and researchers in making more informed decisions in selecting the most fundamentally sound PRO measure for a given clinical, research, or quality initiative., (© The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To describe the incidence, clinical presentation, and performance of cochlear implant (CI) recipients with tip fold-over., Study Design: Retrospective case series., Setting: Tertiary referral center., Patients: CI recipients who underwent postoperative computed tomography (CT) scanning., Intervention(s): Tip fold-over was identified tomographically using previously validated software that identifies the electrode array. Electrophysiologic testing including spread of excitation or electric field imaging (EFI) was measured on those with fold-over., Main Outcome Measure(s): Location of the fold-over; audiological performance pre and postselective deactivation of fold-over electrodes., Results: Three hundred three ears of 235 CI recipients had postoperative CTs available for review. Six (1.98%) had tip fold-over with 5/6 right-sided ears. Tip fold-over occurred predominantly at 270 degrees and was associated with precurved electrodes (5/6). Patients did not report audiological complaints during initial activation. In one patient, the electrode array remained within the scala tympani with preserved residual hearing despite the fold-over. Spread of excitation supported tip fold-over, but the predictive value was not clear. EFI predicted location of the fold-over with clear predictive value in one patient. At an average follow-up of 11 months, three subjects underwent deactivation of the overlapping electrodes with two of them showing marked audiological improvement., Conclusion: In a large academic center with experienced surgeons, tip fold-over occurred at a rate of 1.98% but was not immediately identifiable clinically. CT imaging definitively showed tip fold-over. Deactivating involved electrodes may improve performance possibly avoiding revision surgery. EFI may be highly predictive of tip fold-over and can be run intraoperatively, potentially obviating the need for intraop fluoroscopy.

Purpose: The purpose of this study was to perform a comprehensive systematic review of the literature on voice-related patient-reported outcome (PRO) measures in adults and to evaluate each instrument for the presence of important measurement properties., Method: MEDLINE, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument databases were searched using relevant vocabulary terms and key terms related to PRO measures and voice. Inclusion and exclusion criteria were developed in consultation with an expert panel. Three independent investigators assessed study methodology using criteria developed a priori. Measurement properties were examined and entered into evidence tables., Results: A total of 3,744 studies assessing voice-related constructs were identified. This list was narrowed to 32 PRO measures on the basis of predetermined inclusion and exclusion criteria. Questionnaire measurement properties varied widely. Important thematic deficiencies were apparent: (a) lack of patient involvement in the item development process, (b) lack of robust construct validity, and (c) lack of clear interpretability and scaling., Conclusions: PRO measures are a principal means of evaluating treatment effectiveness in voice-related conditions. Despite their prominence, available PRO measures have disparate methodological rigor. Care must be taken to understand the psychometric and measurement properties and the applicability of PRO measures before advocating for their use in clinical or research applications.

Purpose: To present the surgical technique and clinical outcomes of a novel modification to conventional meatoplasty., Materials and Methods: All consecutive patients undergoing canal wall down tympanomastoidectomy incorporating the one-cut meatoplasty technique between January 2009 and February 2013 were evaluated. Primary outcome measures included meatal stenosis requiring revision surgery, frequency of drainage beyond 2months postoperatively and results of a composite patient questionnaire incorporating the Chronic Ear Survey., Results: Twenty-eight of 36 (78%) eligible patients completed a questionnaire and were included. All ears underwent canal wall down tympanomastoidectomy utilizing the one-cut meatoplasty technique. At a mean follow-up of 38.0months, the average Chronic Ear Survey score was 78.6±2.6 points. There was only one case of postoperative meatal stenosis. Intermittent otorrhea developed in 14.3% of cases but was remedied by conservative measures including in-office cleaning, ototopical therapy and water precautions. Eighty-nine percent of patients denied any self-consciousness about the aesthetic appearance of the ear., Conclusions: The one-cut meatoplasty is an effective alternative to traditional techniques that is simple to perform. The results of the Chronic Ear Survey indicate that the one-cut meatoplasty supports a stable and healthy, open cavity with functional results that compare favorably to other series evaluating canal wall down tympanomastoidectomy with traditional meatoplasty. Additionally, patients report high satisfaction with the appearance of their ear, and all hearing aid users could continue to utilize a hearing aid without feedback, pain, or other difficulties related to poor fitting., (Copyright © 2015. Published by Elsevier Inc.)

Purpose: To evaluate the effect of cataract surgery on intraocular pressure (IOP) in patients with narrow angles and chronic angle-closure glaucoma (ACG) and to determine whether the change in IOP was correlated with the preoperative pressure, axial length (AL), and anterior chamber depth (ACD)., Setting: Private practice, Atlanta, Georgia, USA., Design: Retrospective case series., Methods: Charts of patients with narrow angles or chronic ACG who had cataract surgery were reviewed. All eyes had previous laser iridotomies. Data recorded included preoperative and postoperative IOP, AL, and ACD. The preoperative IOP was used to stratify eyes into 4 groups., Results: The charts of 56 patients (83 eyes) were reviewed. The mean reduction IOP in all eyes was 3.28 mm Hg (18%), with 88% having a decrease in IOP. There was a significant correlation between preoperative IOP and the magnitude of IOP reduction (r = 0.68, P < .001). The mean decrease in IOP was 5.3 mm Hg in eyes with a preoperative IOP above 20 mm Hg, 4.6 mm Hg in the over 18 to 20 mm Hg group, 2.5 mm Hg in the over 15 to 18 mm Hg group, and 1.4 mm Hg in the 15 mm Hg or less group. The mean follow-up was 3.0 years ± 2.3 (SD)., Conclusions: Cataract surgery reduced IOP in patients with narrow angles and chronic ACG. The magnitude of reduction was highly correlated with preoperative IOP and weakly correlated with ACD., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)