Debbie A. Mouadeb

Validity and Reliability of the Eating Assessment Tool (EAT-10):

Objectives: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10). Methods: The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses. Results: A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (±SD) EAT-10 score of the normal cohort was 0.40 ± 1.01. The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia, 23.10 ± 12.22 for those with oropharyngeal dysphagia, 9.19 ± 12.60 for those with voice disorders, 22.42 ± 14.06 for those with head and neck cancer, and 11.71 ± 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p < 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment (p < 0.001). Conclusions: The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

Antiphospholipid Inner Ear Syndrome

Objective: This study was initiated to clarify the possible association between antiphospholipid antibodies, mediators of microthrombus formation, and sensorineural hearing loss (SNHL) of unknown origin in a large cohort of patients.

In-office laryngeal surgery with the 585nm pulsed dye laser (PDL)

OBJECTIVES: The 585nm pulsed dye laser (PDL) is a promising tool for in-office laryngeal surgery. Data with respect to the safety and efficacy of the PDL for office laryngeal use is sparse. The purpose of this study is to review our experience with unsedated office PDL surgery. METHODS: Records of individuals undergoing in-office PDL between September 1, 2004, and September 1, 2006 were abstracted from a clinical database. RESULTS: Forty-seven patients underwent 117 treatments. The most common indications were recurrent respiratory papillomatosis (RRP), Reinkes edema, and vocal fold polyps. One hundred and four of 117 procedures were felt to be a success ablating all disease. Thirteen treatments requred early termination. The most common factor responsible for termination was an inability to achieve a comfortable level of anesthesia. One patient with Reinkes edema developed postprocedure stridor that required a 3-day hospital admission for observation and corticosteroids. There was no incidence of any vocal fold scarring, web formation, or other complications. CONCLUSIONS: The 585nm PDL is a promising tool for in-office treatment of various laryngeal disorders. Complications are rare.

Utilization of the LifeStat Emergency Airway Device

Objectives: Management of the airway in an emergency may be a harrowing experience. The equipment necessary to perform this procedure is often inaccessible. The LifeStat emergency airway is a portable device approved by the US Food and Drug Administration in 1997 for emergency cricothyrotomy. It is small enough to secure to a keychain, thus allowing instantaneous access at all times. We present a retrospective case series to report the experience of clinicians who have used the LifeStat device. Methods: A survey instrument was sent to a convenience sample of health-care professionals who purchased the LifeStat emergency airway. The survey queried device use, user demographics, and the success, ease, complications, and location of use. Results: One thousand surveys were distributed, and 100 individuals responded. Fifteen percent (15 of 100) reported use of the device on 17 occasions. The LifeStat was used successfully in all 17 cases. Eighty-two percent (14 of 17) of emergency use was in hospitals. In all cases the device was positioned successfully on the first attempt. No complications were reported. Conclusions: The LifeStat device provides a relatively safe and effective means of performing emergency cricothyrotomy. The majority of emergency situations in which the device was deployed occurred in hospital settings.

Esophageal pathology in patients after treatment for head and neck cancer

OBJECTIVE: To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA). STUDY DESIGN: Case series with planned data collection. SETTING: Academic medical practice. SUBJECTS AND METHODS: Subjects comprised HNCA survivors. Esophagoscopy was prospectively performed on 100 patients at least three months after treatment for HNCA. Patient demographics including cancer stage, cancer treatment, use of reflux medications, symptoms surveys, and esophageal findings were prospectively determined. RESULTS: The mean age of the cohort was 64 (± 10) years; 75 percent were male. The mean time between the end of treatment and endoscopy was 40 (± 51) months. Eighty-one percent of HNCA was advanced stage (3 or 4). The distribution of site of the primary HNCA was as follows: oropharynx (38%), larynx (33%), oral cavity (17%), unknown primary (10%), hypopharynx (1%), and nasopharynx (1%). Treatment modalities included surgery alone (15%), surgery with radiation (34%), radiation alone (6%), chemoradiation alone (24%), and chemoradiation with surgery (20%). The findings on esophagoscopy included peptic esophagitis (63%), stricture (23%), candidiasis (9%), Barrett metaplasia (8%), gastritis (4%), and carcinoma (4%). Only 13 percent had a normal esophagoscopy. CONCLUSION: Esophageal pathology is extremely common in patients treated for HNCA. These findings support routine esophageal screening after HNCA treatment.

Thyrohyoid vocal fold augmentation with calcium hydroxyapatite

Objectives To review the clinical results of the thyrohyoid approach for in-office vocal fold augmentation with calcium hydroxyapatite. Study Design Retrospective chart review. Methods The charts of all persons who underwent in-office thyrohyoid vocal fold augmentation between June 1, 2005 and June 1, 2007 were reviewed. Information with respect to patient demographics, indications, complications, and clinical outcome was abstracted. Results Fifty-one thyrohyoid vocal fold augmentations were performed in 33 patients (26 men; mean age, 66 years). Six (13%) procedures were aborted as a result of an inability to achieve an appropriate injection angle. Two (6%) self-limited complications included a vasovagal episode and a small ulcer near the petiole of the epiglottis. Pre- and postprocedure data were available for 62.5%. The mean 10-item Voice Handicap Index improved from 27.9 (±8.40) preprocedure to 13.5 (±10.52) postprocedure (P < 0.001). Conclusion In-office vocal fold augmentation with the use of the thyrohyoid approach demonstrates excellent clinical results. It has become our technique of choice for vocal fold medialization with the patient under local anesthesia in the office setting. Complications are rare.

The effects of allergens and tobacco smoke on the laryngeal mucosa of guinea pigs.

Objective: The purpose of this study was to investigate the effects of environmental tobacco smoke (ETS) and house dust mite allergen (HDMA) on the laryngeal mucosa of guinea pigs. Study Design: Prospective, controlled animal study. Subjects and Methods: Sixteen juvenile guinea pigs were randomly assigned to one of four treatment groups: (1) filtered air, (2) HDMA, (3) ETS, and (4) ETS and HDMA. The mucosal response of retrieved larynges was measured by eosinophil grade and stored mucin index. Results: HDMA exposure increased eosinophil grade in the supraglottis. The mean eosinophil grade in the supraglottis was 1.25 (±1.26) in the filtered air group. The grade increased to 3.60 (±0.89) in the HDMA group (P = 0.021) and 3.00 (±1.16) in the ETS/HDMA group (P = 0.078). HDMA and ETS exposure was associated with increased mucin index in the subglottis. The grade increased from 1.50 (±1.73) in the control group to 3.25 (±0.50) in the ETS, 2.80 (±1.64) in the HDMA, and 3.25 (±0.50) in the ETS/HDMA group (P < 0.05). Conclusion: Exposure to HDMA was associated with eosinophilia in the supraglottis. Exposure to HDMA and ETS was associated with elevated mucin in the subglottis. These results provide further evidence that ETS and inhaled allergens may play a role in the development of chronic laryngitis.

Effect of Allergens and Tobacco Smoke on Laryngeal Mucosa

Problem Environmental factors such as second hand smoke and allergens are known to play an important part in the development of lower airway disease, specifically asthma. The effect of these common exposures on the larynx has been neglected. The purpose of this investigation was to investigate the effects of environmental tobacco smoke (ETS) and allergens on laryngeal mucosa. Methods Seventeen guinea pigs were exposed by inhalation to: 1) air and saline, 2) air and house dust mite allergen (HDMA), 3) ETS and saline 4) HDMA and ETS. Exposures began at 3 weeks of age and lasted 10 weeks. Histology was evaluated in different subsets of the larynx for eosinophils and mucin, markers of inflammation. Results Eosinophils in the supraglottis were elevated in the air/HDMA and ETS/HDMA groups (p<0.05). Animals exposed to HDMA were 4 times more likely to have > 10 eosinophils per HPF in the supraglottis than control animals (95% CI = 0.74, 20). Trends towards mucin hypersecretion in the subglottis of the ETS/air and ETS/HDMA groups were noted. Animals exposed to ETS and HDMA were 3.8 times more likely to have 25% of the subglottic epithelium stain PAS positive for mucin (95% CI = .59, 23.66). Conclusion The data suggest that environmental tobacco smoke and inhaled allergens contribute to the pathogenesis of laryngeal inflammation. Significance Environmental tobacco smoke and allergen exposure may play a role in the development of chronic laryngitis.