Andrew D. Palmer

Cricothyroid Approximation to Elevate Vocal Pitch in Male-to-Female Transsexuals: Results of Surgery

Functional changes in voice production, including pitch elevation, may help male-to-female transsexuals assume a new gender identity. To date, there has been a paucity of objective data on the effectiveness of pitch-raising methods. Acoustic data were gathered with regard to preoperative and postoperative changes in pitch, pitch range, and perturbation in 20 patients after cricothyroid approximation. Subjective data were gathered by means of a mailed questionnaire. The mean follow-up time was 22 months. The speaking fundamental frequency was raised by half an octave without any significant changes in perturbation. The lower and upper limits of pitch range both increased by an average of 4 semitones. There was some decline over time of the lower pitch range toward preoperative levels, but the upper pitch range remained elevated. The majority of the patients were satisfied with the results of surgery and felt their voices to be more feminine.

Subjective and Objective Parameters of the Adult Female Voice after Cricotracheal Resection and Dilation

Objectives: We compared the voice outcomes after cricotracheal resection (CTR) and airway dilation in adult women. Methods: We performed long-term comprehensive voice assessments in 23 adult women treated for laryngotracheal stenosis, including acoustic and perceptual measurements of voice, videostroboscopy, the Voice Handicap Index, and an open-ended subjective questionnaire. Results: Voice measures were abnormal in both groups. Objective pitch and loudness measurements were significantly more impaired after CTR than after dilation. Perceptual ratings of voice were worse after CTR than after dilation, particularly with regard to breathiness, pitch, and loudness. The CTR group was more likely to report a voice disorder, reported significantly more voice symptoms, and had higher voice handicap scores. Videostroboscopy was frequently abnormal in both groups, with more evidence of vocal hyperfunction after CTR. Self-ratings of breathing and swallowing were generally high in both groups, but voice satisfaction was rated lower after CTR. Conclusions: Voice was more significantly negatively impacted by CTR than by dilation. Surprisingly, many individuals in both groups reported improvements — A finding that possibly highlights the impact of laryngotracheal stenosis on airflow and vocal function before surgery. The importance of patient selection and preoperative counseling is emphasized, along with the potential need for voice therapy.

How does difficulty communicating affect the social relationships of older adults? An exploration using data from a national survey

UNLABELLED Healthy social relationships are important for maintaining mental and physical health in later life. Less social support, smaller social networks, and more negative social interactions have been linked to depression, poorer immune functioning, lower self-rated health, increased incidence of disease, and higher mortality. Overwhelming evidence suggests that communication disorders adversely affect social relationships. Much less is known about whether some or all aspects of social relationships are negatively affected by a communication disorder. The relative impact of a communication disorder on social relationships, as compared to other kinds of disability, is also poorly understood. Data were analyzed from a representative national sample of community-dwelling adults aged 65 and older living in the continental United States (n=742). Results from multiple regressions indicated that difficulty communicating was significantly associated with several parameters of social relationships even after controlling for age, gender, partnership status, health, functional limitations, and visual impairment. Communication difficulty was a significant predictor of smaller social network size, fewer positive social exchanges, less frequent participation in social activities, and higher levels of loneliness, but was not a significant predictor of negative social exchanges. These findings suggest that communication disorders may place older adults at increased risk for mental and physical health problems because of social isolation, reduced social participation, and higher rates of loneliness. In addition, it appears that communication disorders may have a greater impact on positive, rather than negative, aspects of social relationships. LEARNING OUTCOMES As a result of this activity, the following learning outcomes will be realized: Readers will be able to (1) describe changes in the social relationships of older adults that occur as part of normal aging, (2) identify the aspects of social relationships that were significantly impacted by a communication difficulty, and (3) discuss possible reasons for these findings including potential clinical implications.

Factors associated with supracricoid laryngectomy functional outcomes

Supracricoid partial laryngectomy (SCPL) is an option for laryngeal cancer resection that preserves laryngeal function; however, little information exists regarding factors that are associated with functional outcomes.

Determining the efficacy and cost-effectiveness of the activalve: Results of a long-term prospective trial

To investigate 1) whether the Provox ActiValve results in increased device‐life in individuals with below average device‐life, 2) whether it is cost‐effective, and 3) whether it has any impact on voice‐related quality of life.

Dysphagia after endoscopic repair of Zenker's diverticulum.

Objectives/Hypothesis: To determine whether patient outcomes after endoscopic staple‐assisted diverticulectomy (ESD) were correlated with demographic or disease‐specific patient characteristics.

Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis

Objective: This study aimed to examine the authors’ experience with endoscopic management of idiopathic subglottic stenosis (iSGS), and to identify pulmonary function test (PFT) values that can be used to quantify outcomes. Methods: Retrospective review. Results: Twenty-five patients with a new diagnosis of iSGS were seen between 2006 and 2012. Median age at surgery was 45.3 years (interquartile range [IQR], 38.5-67.0), and median body mass index was 28.7 kg/m2 (IQR, 23.5-32.1). Forty-five procedures were performed. Median preoperative stenosis was 56.8% (Cotton-Myer grade 2). The typical stenosis began 15 mm below the true vocal folds and was 12 mm long. Median follow-up was 21.4 months (IQR, 5.1-43.1). For patients receiving multiple dilations, median time between procedures was 23.7 months. Four PFT parameters demonstrated significant improvement after intervention: (1) PEF (absolute change = 2.54 L/s), (2) PIF (absolute change = 1.57 L/s), (3) FEV1/PEF (absolute change = 0.44), and (4) FIF50% (absolute change = 1.71 L/s). PIF was the only parameter affected by using a larger balloon (P = .047). Conclusion: PEF, PIF, FEV1/PEF, and FIF50% improved significantly after endoscopic incision and dilation of iSGS, and this could potentially be used as a metric by which to evaluate outcomes in the endoscopic management of subglottic stenosis.

The safety and efficacy of endoscopic Zenker's diverticulotomy: A cohort study

To determine whether the application of laser‐assisted techniques for the treatment of Zenkers diverticulum would reduce the failure rate of endoscopic procedures without compromising safety or durability.

A randomized controlled trial of corticosteroids for pain after transoral robotic surgery

To determine if an extended perioperative course of corticosteroids will improve pain control following transoral robotic surgery (TORS).

Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer

Importance In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies. Objective To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT). Design, Setting, and Participants This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital. Main Outcomes and Measures Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients. Results Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, −16.1; 97.5% CI, −29.8 to −2.4) and the TORS-only and TORS+CRT groups (mean difference, −14.6; 97.5% CI, −29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale–Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life–Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3). Conclusions and Relevance Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.