Amanda Hu

Three-dimensional Educational Computer Model of the Larynx: Voicing a New Direction

OBJECTIVES To create a 3-dimensional (3D) educational computer model of the larynx, to assess the feasibility of this learning module on a Web-based platform, and to obtain student feedback on the module. DESIGN Male and female adult cadaveric necks were scanned with microcomputed tomographic and magnetic resonance imaging scanners. Key structures were identified on each slice of the computed tomogram and/or magnetic resonance image and analyzed with a segmentation software package. Then, the images were exported into Microsoft Powerpoint. Visual text and audio commentary were added. Real cases of a childs larynx, an adult with a tracheostomy, and a patient with laryngeal carcinoma were included. The computer module was launched on a password-protected, Web-based platform. PARTICIPANTS Fifty-eight first-year medical students (38% male; mean [SD] age, 23 [1.8] years) were invited to evaluate the module and to complete a survey. RESULTS Most students thought that the 3D computer module was effective (60%), clear (66%), and user friendly (72%); most students (81%) thought that it was easier to understand laryngeal anatomy when they could visualize it in 3D; and most students (83%) said that they would like lectures better if they were supplemented with 3D computer modules. CONCLUSION A 3D educational computer model of the larynx has been successfully created and warmly received by medical students.

Prospective study of voice outcomes and patient tolerance of in‐office percutaneous injection laryngoplasty

In‐office percutaneous injection laryngoplasty is a common treatment for glottal insufficiency. Our objective was to prospectively study voice outcomes and patient tolerance of the procedure.

Voice disorders in the workplace: productivity in spasmodic dysphonia and the impact of botulinum toxin.

The impact of the disordered voice on standard work productivity measures and employment trends is difficult to quantify; this is in large part due to the heterogeneity of the disease processes. Spasmodic dysphonia (SD), a chronic voice disorder, may be a useful model to study this impact. Self‐reported work measures (worked missed, work impairment, overall work productivity, and activity impairment) were studied among patients receiving botulinum toxin (BTX) treatments for SD. It was hypothesized that there would be a substantial difference in work‐related measures between the best and worst voicing periods. In addition, job types, employment shifts, and vocal requirements during the course of vocal disability from SD were investigated for each individual, and the impact of SD on these patterns was studied.

Hunsaker mon-jet tube ventilation: A 15-year experience†‡

The Hunsaker Mon‐Jet tube (HMJT) (Xomed, Jacksonville, FL) has been used effectively for subglottic ventilation. We previously reported a series of 552 patients over a 10‐year period with no major complications. This is a continuation of that series with an additional 5 years of cases.

A need for otolaryngology education among primary care providers

Objective : Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Presented at the American Academy of Otolaryngology – Head & Neck Surgery 2011 Annual Meeting, San Francisco, USA, on Tuesday, September 13, 2011. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods : PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results : Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion : There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs.

Factors Associated With Patient-perceived Hoarseness in Spasmodic Dysphonia Patients

OBJECTIVES/HYPOTHESIS The American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines on Hoarseness distinguishes between hoarseness, which is a symptom perceived by the patient, and dysphonia, which is a diagnosis made by the clinician. Our objective was to determine factors that are associated with patient-perceived hoarseness in spasmodic dysphonia (SD) patients. STUDY DESIGN Retrospective study. METHODS Adductor SD patients who presented for botulinum toxin injections from September 2011 to June 2012 were recruited. The main outcome variable, Voice Handicap Index-10 (VHI-10), was used to quantify patient-perceived hoarseness. Clinical data, Hospital Anxiety and Depression Scale (HADS), and VHI-10 were collected. Clinician-perceived dysphonia was measured by a speech-language pathologist with Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). Statistical analysis included univariate analyses and multiple linear regression. RESULTS One hundred thirty-nine SD patients had VHI-10 score of 26.0 ± 7.2 (mean ± standard deviation), disease duration of 10.5 + 7.0 years, CAPE-V overall score of 43.2 ± 21.8, HADS anxiety score of 6.7 ± 3.8, and HADS depression score of 3.6 ± 2.8. In univariate analyses, there were positive correlations (P < 0.05) between VHI-10 and female gender, CAPE-V overall, older age, HADS anxiety, and depression. There was no correlation with professional voice use and disease duration. In multiple linear regression (R2 = 0.178, P < 0.001), age, HADS anxiety, female gender, and CAPE-V were significant. CONCLUSIONS Older age, higher anxiety levels, female gender, and clinician-perceived dysphonia are associated with higher levels of patient-perceived hoarseness in SD patients. Hoarseness is a very personal symptom. Multiple factors determine its self-perception.

Impact of patient-related factors on the outcomes of office-based injection laryngoplasty

In‐office percutaneous injection laryngoplasty (IL) is a common treatment for glottal insufficiency. The objective of this prospective study was to determine if voice outcomes from IL are affected by age, gender, or initial disease severity.

Disease-Specific Self-Efficacy in Spasmodic Dysphonia Patients

Objective Self-efficacy (SE) is an optimistic self-belief that one can perform a novel task. This concept involves empowerment, self-esteem, and adaptation to a stressful situation. SE is a strong predictor of health behaviors. Our objectives were to study SE in spasmodic dysphonia (SD) and to develop a disease-specific SE-SD scale. Study Design Prospective study. Setting Academic hospital. Subject and Methods Disease-specific SE-SD items were developed with laryngologists, speech pathologists, and SD patients. These items, General SE Scale, Voice Handicap Index-10 (VHI-10), Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), and Hospital Anxiety and Depression Scale (HADS), were administered to SD patients who presented for botulinum toxin injections. Results One hundred forty-five SD patients (mean age 59.5 ± 13.6 years) had a general SE score (Cronbach’s α = 0.894) of 33.4 ± 5.2 out of 40. This was negatively correlated with HADS-A (r = −0.42, P < 0.001) and HADS-D (r = −0.42, P < .001), but not correlated with VHI-10 (r = −0.098, P = .243) and CAPE-V (r = −0.047, P = .57). Factor analysis selected 8 items from the general SE scale and 5 disease-specific SE-SD items to generate a 13-item disease-specific SE-SD scale (Cronbach’s α = 0.907). Disease-specific SE-SD score was 42.1 ± 6.9 out of 52 and was negatively correlated with VHI-10 (r = −0.19, P = .005), HADS-A (r = −0.43, P < .001), and HADS-D (r = −0.57, P < .001), but not correlated with CAPE-V (r = −0.024, P = .60). Conclusion SD patients established on botulinum toxin injections have high degrees of general and disease-specific SE. Patients with higher SE-SD demonstrate lower vocal handicap and lower levels of anxiety and depression. A 13-item disease-specific SE-SD scale has been developed.

Sulcus Vocalis (Type III): Prevalence and Strobovideolaryngoscopy Characteristics.

OBJECTIVES The reported prevalence of sulcus vocalis (SV)/type III, a pathologic groove in the vibratory margin of the vocal fold, varies greatly in the literature. Difficulties in visualizing the defect and a variety of descriptions have complicated the evaluation of SV. The objective of this study was to determine the prevalence of SV by reviewing strobovideolaryngoscopy (SVL) examinations in subjects with and without dysphonia. STUDY DESIGN Retrospective chart review. METHODS Charts and SVL images were reviewed for subjects with and without dysphonia and analyzed using standard statistical techniques. RESULTS SVL images were reviewed for 94 nondysphonia subjects and 100 dysphonia subjects. For all subjects, 19.6% had type I, 2.1% had type II, and 5.7% had type III/SV. Per vocal fold, 14.7% had type I, 1.3% had type II, 3.1% had type III/SV and 13.1% had scar. The prevalence of SV per subject was not significantly different between the two groups (8% of dysphonia subjects, 3.2% of nondysphonia subjects). Male gender, decreased amplitude, decreased waveform, and hypodyamic motion were significantly higher in the dysphonia SV subjects compared with the non-SV subjects. All other SVL characteristics were not significantly different in subjects with SV compared with non-SV subjects. CONCLUSIONS We report a prevalence of SV/type III at 3.1% (per vocal fold) and 5.7% (per subject). Higher frequencies of male gender and waveform abnormalities were seen in the dysphonia SV subjects only. There were no significant differences in nondysphonia subjects with or without SV.

Readability Assessment of Online Tracheostomy Care Resources

Objective To assess the readability of online tracheostomy care resources. Study Design Cross-sectional study. Setting: Academic center. Subjects and Methods A Google search was performed for “tracheostomy care” in January 2014. The top 50 results were categorized into major versus minor websites and patient-oriented versus professional-oriented resources. These websites were evaluated with the following readability tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG). Results Readability scores for the websites were FRES 57.21 ± 16.71 (possible range = 0-100), FKGL 8.33 ± 2.84 (possible range = 3-12), SMOG 11.25 ± 2.49 (possible range = 3-19), and GFOG 11.43 ± 4.07 (possible range = 3-19). There was no significant difference in all 4 readability scores between major (n = 41) and minor (n = 9) websites. Professional-oriented websites (n = 19) had the following readability scores: FRES 40.77 ± 11.69, FKGL 10.93 ± 2.48, SMOG 13.29 ± 2.32, and GFOG 14.91 ± 3.98. Patient-oriented websites (n = 31) had the following readability scores: FRES 67.29 ± 9.91, FKGL 6.73 ± 1.61, SMOG 10.01 ± 1.64, and GFOG 9.30 ± 2.27. Professional-oriented websites had more difficult readability scores than patient-oriented websites for FRES (P < .00), FKGL (P < .00), SMOG (P < .00), and GFOG (P < .00). Conclusion Online tracheostomy care resources were written at a level more difficult than the recommended fourth- to sixth-grade level for written health information. There was no significant difference in readability between major and minor websites. Professional-oriented websites were more difficult to read than patient-oriented websites.