C. Blake Simpson

Randomized double-blind study of botulinum toxin type B for sialorrhea in ALS patients

Twenty ALS patients with sialorrhea refractory to medical therapy were enrolled in this double‐blind, randomized study to receive either 2,500 U of botulinum toxin type B (BTxb) or placebo into the bilateral parotid and submandibular glands using electromyographic guidance. Patients who received BTxb reported a global impression of improvement of 82% at 2 weeks compared to 38% of those who received placebo (P < 0.05). This significant effect was sustained at 4 weeks. At 12 weeks, 50% of patients who received BTxb continued to report improvement compared to 14% of those who received placebo. There were no significant adverse events, including dysphagia, in the BTxb group, and there was no significant increase in the rate of decline of vital capacity. Muscle Nerve 39: 137–143, 2009

Complications of thyroid and parathyroid surgery

Today most complications of thyroid and parathyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerves. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Although the principal goal of thyroid and parathyroid surgery is the prevention of these complications, prompt recognition and intervention will minimize morbidity and provide the patient with the best chance of a satisfactory outcome.

Cough and paradoxical vocal fold motion

OBJECTIVES: The differential diagnosis and treatment of patients with chronic cough, paradoxical vocal fold motion, and disordered breathing can be a challenge to most practicing otolaryngologists. Tracheobronchial (ie, asthma, bronchitis, and tracheal stenosis), laryngeal (ie, vocal fold paralysis and neoplasms), and rhinologic (ie, allergies and rhinosinusitis) etiologies are commonly diagnosed and treated effectively. However, occasionally one is faced with patients who are refractory to medical treatment and have no obvious rhinologic, laryngeal or pulmonary cause. STUDY DESIGN AND SETTING: We conducted a review of the literature. METHODS: We present a thorough review of the current medical literature exploring the complex neurologic mechanisms involved in the production of cough and the relationship between gastroesophageal reflux disease, vagal neurapathy, and paradoxical vocal fold motion. RESULTS: The diagnosis and successful treatment of chronic cough can be complex. It requires a thorough understanding of the neurologic mechanisms behind cough excitation and suppression. Successful treatment strategies include aggressive management of the patients reactive airway disease, gastroesophageal reflux disease, and, in select cases, paradoxical vocal fold motion. This may involve a well-coordinated effort among pulmonologists, otolaryngologists, gastroenterologists, and speech pathologists. CONCLUSION: Gastroesophageal reflux disease, vagal neuropathy, and paradoxical vocal fold motion are additional causes of chronic cough and disordered breathing that need to be considered, in the absence of obvious laryngotracheal and/or rhinologic pathology. A high index of suspicion is essential in making the diagnosis and formulating an effective multidisciplinary treatment plan for these patients.

Laryngeal Pseudosulcus as a Predictor of Laryngopharyngeal Reflux

Objectives/Hypothesis Laryngeal pseudosulcus is an accurate prognostic indicator of laryngopharyngeal reflux (LPR) disease.

The efficacy of mitomycin-C in the treatment of laryngotracheal stenosis.

Objective: The purpose of this study is to evaluate whether the addition of topical mitomycin‐C (MMC) application to the wound site after endoscopic treatment of laryngotracheal stenosis (LTS) resulted in measurable improvement in clinical outcomes.

Advances in office-based diagnosis and treatment in laryngology.

No abtracts.

Airway complications from topical mitomycin-c

OBJECTIVE: Topical application of mitomycin C appears to be a useful adjunct in reducing cicatricial scarring of the airways. Human and animal studies have demonstrated the efficacy and safety of mitomycin C topically in the treatment of airway stenosis at concentrations ranging from 0.4 mg/mL to 10 mg/mL. Although no reports of mitomycin C toxicity have been reported in the otolaryngology literature, the ophthalmologic literature has documented serious, vision-threatening complications resulting from the use of topical mitomycin C. The purpose of this study is to report complications related to mitomycin C use in the treatment of glottic and subglottic stenosis. Risk factors associated with these complications are identified. STUDY DESIGN AND SETTING: A retrospective chart review of all patients treated by the senior author for laryngotracheal stenosis with endoscopic CO2 laser incisions/dilation and adjuvant topical mitomycin C was performed to determine the incidence of complications. Variables studied included patient age and gender, location and severity of stenosis, medical comorbidities, length of procedure, postoperative instrumentation of the airway, and mitomycin C concentration. RESULTS: Eighty-five cases of adjuvant topical mitomycin C use after CO2 laser endoscopic treatment and dilation for upper airway stenosis were identified in a total of 44 patients. Complications that were believed to be caused by the local toxicity of mitomycin C occurred in 4 cases out of 85 (or 4.7%), manifested by accumulation of fibrinous debris at the operative site, resulting in partial airway obstruction and the need for emergent airway intervention. CONCLUSIONS: Caution should be exercised when topical mitomycin C is used in the treatment of airway stenosis. EBM RATING: B-3

A nomenclature paradigm for benign midmembranous vocal fold lesions

There is a significant lack of uniform agreement regarding nomenclature for benign vocal fold lesions (BVFLs). This confusion results in difficulty for clinicians communicating with their patients and with each other. In addition, BVFL research and comparison of treatment methods are hampered by the lack of a detailed and uniform BVFL nomenclature.

Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis

Objectives: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared. Methods: The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained. Results: Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively. Conclusions: Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.

Pachydermia is not diagnostic of active laryngopharyngeal reflux disease

Objective: To determine the change in pachydermia/posterior commissure hypertrophy in patients with laryngopharyngeal reflux disease (LPR) on long‐term acid‐suppressive therapy.