Kaalan Johnson

Voice outcomes following adult cricotracheal resection.

Cricotracheal resection (CTR) is an effective treatment for moderate‐to‐severe laryngotracheal stenosis (LTS) in adults. However, one of the potentially significant sequela of this procedure is postoperative dysphonia and permanent voice alteration. The objective of this study is to characterize voice changes in adult patients with subglottic stenosis who have undergone CTR.

Microdebrider vs electrocautery: A comparison of tonsillar wound healing histopathology in a canine model

Objective To evaluate tonsillar wound healing histopathology in a canine model following microdebrider intracapsular and electrocautery tonsillectomy techniques. Study Design Randomized, controlled, single-blinded, paired comparison of histopathology. Subjects and Methods Twelve beagles underwent tonsillectomies by microdebrider on one side and electrocautery on the other. Punch biopsies were taken of the tonsillar fossae on postoperative days 3, 9, and 20. Specimens were graded with a novel mucosal wound healing scale (inter-rater reliability, r = 0.83) and appropriate statistical analysis performed. Results Combined mucosal wound healing scale scores showed significantly faster healing on the microdebrider side when compared to the electrocautery side on postoperative day 3 and day 9 (P > 0.05), which equalized by day 20. Conclusion In a canine model of tonsillar wound healing, microdebrider intracapsular tonsillectomy produced significantly faster healing than electrocautery tonsillectomy in the early postoperative course. The “biologic dressing” theory of intracapsular tonsillectomy wound healing may account for observed differences in healing and suggests a mechanism for improved clinical outcomes.

Simulation to Implement a Novel System of Care for Pediatric Critical Airway Obstruction

OBJECTIVE To implement a novel system of care for pediatric critical airway obstruction. DESIGN Retrospective, observational study of data gathered prospectively during high-fidelity simulations. SETTING Emergency department (ED) and operating rooms (ORs) of a pediatric referral center. SUBJECTS Health care provider simulation participants. MAIN OUTCOME MEASURES Time from ED attending physician request to arrival of an otolaryngologist, participant survey responses, identified latent safety threats, and simulated patient outcomes. METHODS Twelve high-fidelity simulations were conducted: 6 to identify problems with an existing system of care, and 6 to implement a novel system. The simulation scenarios involved a 4-year-old patient with severe respiratory distress after foreign-body aspiration managed solely in the ED or in the ED and OR, depending on stability. RESULTS There were 196 participants in 12 simulations. The mean (SD) time from ED attending physician request to otolaryngologist arrival was 7.8 (1.6) minutes for the existing system simulations and 5.0 (1.1) minutes for the novel system (P = .001). Latent safety threats identified in the simulations included a lack of specialized airway equipment in the ED. Death of the simulated patient occurred in the ED in 2 of 6 existing system simulations; specialized airway equipment was available for neither. For the novel system simulations, specialized airway equipment was available for all 6, no simulated patient deaths occurred. CONCLUSIONS High-fidelity simulation was an effective method to design and implement a novel system of care for pediatric critical airway obstruction. The novel system was associated with more rapid response times and elimination of simulated patient deaths.

Effect of topical dexamethasone versus rimexolone on middle ear inflammation in experimental otitis media with effusion

Conclusion. The lipopolysaccharide (LPS)-induced chinchilla otitis media (OM) model was proven useful in screening anti-inflammatory agents for topical use. Both 1% rimexolone and 1% dexamethasone are effective in reducing the volume of middle ear effusion and mucosal thickness compared with control groups. Topical corticosteroid therapy was efficacious in reducing middle ear mucosal inflammation. Objective. OM is one of the most common diseases in the pediatric population. Our previous studies have shown that treatment with systemic antibiotics and corticosteroids was more efficacious than antibiotics alone. The purpose of this study was to determine the effectiveness of topically applied corticosteroids on the outcome of OM. The long-term goal of this study was to develop a better method of OM treatment by demonstrating effectiveness of topically applied anti-inflammatory agents, such as corticosteroids, avoiding systemic side effects. Materials and methods. Three experimental groups were studied in chinchillas. OM with effusion was induced in all groups by injecting LPS. Group 1 consisted of controls in three subgroups as follows. Control-LPS alone, vehicle of dexamethasone (control-dexa), vehicle of rimexolone (control-rimex). Group 2 was treated with dexamethasone and included subgroups of separate concentrations of dexamethasone: 0.1% and 1% suspensions. Group 3 was treated with rimexolone and included subgroups of separate concentrations of rimexolone: 0.1% and 1% suspensions. A total of 58 animals were used: 18 for controls and 40 for experimental groups. All test substances (saline, control-dexa, control-rimex, dexamethasone and rimexolone, 200 µl) were injected at −2, 48 and 60 h; LPS was injected at 0 h. Animals were monitored by daily otomicroscopy. After 4 days, samples of middle ear effusion (MEE) were collected for analysis and temporal bones were harvested for histopathological studies. Results. At the end of 4 days, only in five ears (3/20 with 1% dexamethasone, 1/20 with 1% rimexolone, and 1/20 with 0.1% rimexolone) had the fluid diminished to the point of being unobservable. The volume of MEE, thickness of mucoperiosteum, and the degree of inflammation of middle ear mucosa with 1% dexamethasone and 1% rimexolone was significantly less compared with other groups.

Palliative Aspects of Recurrent Respiratory Papillomatosis

Recurrent respiratory papillomatosis (RRP) is a chronic, frequently debilitating, and potentially life-threatening disease. Therapy for RRP has evolved from simply inserting a tracheotomy to provide an airway and plucking out papillomata with cup forceps to provide some degree of voice to the present-day far more sophisticated approaches, along with preventative measures that may someday offer the potential dramatically to decrease disease prevalence. Family dynamics and support and intentional structuring of office protocols to accommodate the unique nature of RRP are as essential as any operative intervention for saving and prolonging life. This article reviews recent developments in the management of RRP and highlights palliative approaches to case management for those patients who are not easily cured with initial endoscopic interventions.

Endoscopic anterior–posterior cricoid split for pediatric bilateral vocal fold paralysis

Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior–posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI.

Clinically small tonsils are typically not obstructive in children during drug-induced sleep endoscopy

To determine whether the degree of lateral pharyngeal wall (LPW) obstruction on pediatric drug‐induced sleep endoscopy (DISE) correlates with preprocedure tonsillar hypertrophy score on physical examination, and to determine if clinically small tonsils are obstructive.

H1N1 influenza A presenting as bacterial tracheitis.

Six cases of bacterial tracheitis (BT) occurring early in the 2009 flu season have been isolated in conjunction with the H1N1 strain of influenza A (H1N1). No previous H1N1 cases have presented as BT in the literature to date. We would like to discuss viral coinfection in BT patients and how this new strain may affect the rate and type of presentation encountered. The life-threatening potential of BT and the pandemic proportion of H1N1 highlight a possibly dangerous combination that should be recognized by the otolaryngology community. In hospitalized patients with presumed BT, consideration should be given to routine H1N1 testing and the addition of antiviral medication when indicated as this entity is further investigated.

Face, content, and construct validation of a low-cost, non-biologic, sinus surgery task trainer and knowledge-based curriculum.

The purpose of this study was to evaluate face and content validity of a low‐cost, low‐technology, non‐biologic endoscopic sinus surgery (ESS) task trainer and knowledge‐based curriculum followed by construct validation of the task trainer.

Pilot testing of a novel surgical simulator for endoscopic zenker's diverticulotomy

Restrictions on resident work hours and the increasing purview of otolaryngology reduce the efficacy of the traditional surgical training model. With limited case volumes at many institutions and the unique instrumentation of endoscopic Zenkers diverticulotomy (EZD), simulation may be useful to improve training. In this study, a novel surgical simulator for EZD is developed and validated.