Brad W. deSilva

Role of the Physician Versus the Patient in the Detection of Recurrent Disease Following Treatment for Head and Neck Cancer

Objectives/Hypothesis: Objective evidence supporting current National Comprehensive Cancer Network guidelines regarding surveillance of patients treated for head and neck cancer is presently lacking. The study examines the relative role of current surveillance methods on disease detection in this patient population.

Exercise-induced paradoxical vocal fold motion disorder: diagnosis and management.

To review our experience with the diagnosis and treatment of exercise‐induced paradoxical vocal fold motion disorder (EPVFMD).

Paradoxical vocal fold motion disorder in the elite athlete: Experience at a large division I university

To review our experience at a large division I university with the diagnosis and management of paradoxical vocal fold motion disorder (PVFMD) in elite athletes.

Gore-Tex medialization laryngoplasty for treatment of dysphagia.

Objective: Gore-Tex medialization laryngoplasty is a well described procedure for the management of glottal incompetence with associated phonatory disturbance. Limited literature exists describing the use of this procedure in the management of dysphagia. We describe our experience with Gore-Tex medialization laryngoplasty and the treatment of dysphagia. Study Design: Case series with chart review. Setting: Tertiary referral center. Subjects and Methods: Between April 2000 and September 2008, 189 Gore-Tex medialization laryngoplasties were performed on 180 patients by the senior author. Complete records and analysis were available for and performed on 121 procedures for 113 patients. The main outcome measures were discontinuation of gastrostomy tube (g-tube) use or avoidance of g-tube, as well as clinical subjective improvement in swallowing function. Results: Fifty-seven of 113 (50%) patients had complaints of dysphagia at presentation, with 47 of 57 (82%) having an objective swallowing evaluation. Thirty-two of 47 (68%) had documented penetration and/or aspiration. Twenty of 57 (35%) patients with dysphagia required g-tubes for alimentation. Eleven of 20 (55%) patients were able to discontinue g-tube use after Gore-Tex medialization laryngoplasty, and an additional five patients with aspiration were able to avoid need for g-tubes with Gore-Tex medialization laryngoplasty and swallowing therapy. Conclusions: Gore-Tex medialization laryngoplasty is a well tolerated and well described treatment for the management of glottal incompetence. The procedure is an appropriate adjunct in dysphagia management for the appropriate patient population.

The use of ultrasound imaging in evaluation of peritonsillar infections

The objectives of this study were to evaluate safety and patient tolerance of intraoral ultrasound and to evaluate efficacy of intraoral ultrasound in the diagnosis of peritonsillar infections.

Irritant-Induced Paradoxical Vocal Fold Motion Disorder: Diagnosis and Management.

Objectives To review our experience with the diagnosis and treatment of irritant-induced paradoxical vocal fold motion disorder (IPVFMD). Study Design Retrospective chart review. Setting Tertiary academic referral center. Subjects and Methods Thirty-four cases that met IPVFMD criteria and 76 cases of non-IPVFMD were selected from a database of patients with paradoxical vocal fold motion disorder—the diagnosis of which was made on the basis of flexible fiberoptic laryngoscopy and augmented by an odor challenge. Clinical charts were reviewed to document history of environmental allergies, pulmonary disease, gastroesophageal reflux, psychiatric disorder, fibromyalgia, tobacco use, alcohol use, dysphonia, cough, dysphagia, and treatment outcomes. Results There were no statistical differences between the IPVFMD and non-IPVFMD groups. Of the patients who were assigned and attended laryngeal control therapy, 13 (65%) reported improvement of symptoms. Symptom improvement increased to 100% in those patients who attended at least 2 laryngeal control therapy sessions. Conclusions IPVFMD should be considered in patients presenting with respiratory symptoms after irritant exposure. Sensitivity of diagnosis can be improved via a standardized approach consisting of a careful history and physical examination, including laryngoscopy in the presence of triggers. Laryngeal control therapy is a well-tolerated and effective method of managing IPVFMD.

Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use

To determine whether diagnosis and treatment of paradoxical vocal fold movement disorder (PVFMD) leads to decreased asthma medication use. Secondary objectives include determining initial rate of asthma medication use, characterizing symptom improvement, and correlating with pulmonary function testing (PFT).

Spontaneous MRSA postcricoid abscess: a case report and literature review.

Laryngeal abscesses are rare but potentially life‐threatening infections due to potential airway obstruction. Most abscesses occur in the epiglottis or preepiglottic space as a sequela of acute supraglottitis. Abscesses in the posterior larynx are extremely rare and typically due to instrumentation or trauma. Appropriate workup and management of the airway are essential for optimizing outcomes in these patients. We present an interesting case and our management of a spontaneous posterior laryngeal abscess due to methicillin‐resistant Staphlococcus aureus. Laryngoscope, 124:2583–2585, 2014

Risk Factors for Posttracheostomy Tracheal Stenosis

Objective To determine the incidence of posttracheostomy tracheal stenosis and to investigate variables related to the patient, hospitalization, or operation that may affect stenosis rates. Study Design A combined retrospective cohort and case-control study. Setting Tertiary care academic medical center. Subjects and Methods A total of 1656 patients who underwent tracheostomy at a tertiary care medical center from January 2011 to November 2016 were reviewed for evidence of subsequent tracheal stenosis on airway endoscopy or computed tomography. Forty-three confirmed cases of posttracheostomy tracheal stenosis (PTTS) were compared with a subgroup of 319 controls. Factors including medical comorbidity, type and setting of tracheostomy, and hospitalization details were analyzed. Results Five-year incidence of PTTS was 2.6%. Obesity was the sole demographic factor associated with stenosis. Hospitalization-related variables associated with stenosis included tracheostomy after 10 days of orotracheal intubation and endotracheal tube cuff pressure ≥30 mm H2O. The surgical variables associated with higher rates of stenosis included percutaneous technique and insertion of an initial tracheostomy tube size >6. Bjork flap creation was negatively associated with stenosis. In multivariable analysis, obesity and insertion of tracheostomy tube size >6 were identified as risk factors. Conclusion Greater than 10 days of orotracheal intubation prior to tracheostomy and endotracheal tube cuff pressure ≥30 mm H2O were associated with greater rates of subsequent tracheal stenosis. The only patient-related factor associated with tracheal stenosis was obesity. Surgical variables associated with increased rates of subsequent stenosis included placement of a tracheostomy tube size >6, use of percutaneous technique, and failure to create a Bjork flap.

Current and future management of recurrent respiratory papillomatosis: RRP Management

Recurrent respiratory papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the human papillomavirus (HPV), in particular low‐risk HPV6 and HPV11, and aggressiveness varies among patients. RRP remains a chronic disease that is difficult to manage. This review provides perspectives on current and future management of RRP.