Katherine Adams

Longitudinal Voice Outcomes After Type I Gore-tex Thyroplasty for Nonparalytic Glottic Incompetence

Objective: Type I Gore-tex thyroplasty (GTP) for nonparalytic glottic incompetence (GI) results in significantly improved subjective and perceptual voice outcomes. We endeavored to investigate the longitudinal course of voice outcomes measuring the same patients across time points stratified by diagnostic subgroup. Methods: Seventy-five patients with nonparalytic GI treated with GTP in the past 9 years were retrospectively reviewed and grouped according to their primary diagnoses (atrophy, scar, hypomobility, and paresis). Voice outcome measures, Voice-Related Quality of Life (VRQOL), Glottal Function Index (GFI), and GRBAS (grade, roughness, breathiness, asthenia, and strain) for each individual patient and diagnostic subgroup were grouped by time interval following surgery: 0 to 90 days, 3 to 9 months, 9 to 18 months, 18 to 36 months, 3 to 5 years, and 5 to 10 years. Results: Across all diagnoses, statistically significant improvement in VRQOL was maintained at 3 to 5 years (P = .03) and GFI at 5 to 10 years (P = .02). The GRBAS showed statistically significant improvements out to 18 to 36 months (P = .02). In the subgroup analysis, hypomobility/paresis patients maintained significant improvement voice measures longer than patients with other diagnoses. As a group, scar patients did not show statistically significant postoperative improvement in VRQOL or GFI at any of the tested time points. Conclusions: Gore-tex thyroplasty provides durable improvement in subjective and perceptual voice outcomes for patients with nonparalytic GI. Patients treated for hypomobility/paresis have the most durable vocal outcomes followed by atrophy and lastly, scar.

A Pilot Comparison between Caregiver’s and Patient’s Perceived Quality of Life in Chronic Rhinosinusitis

Introduction Chronic rhinosinusitis negatively impacts a patient’s quality of life, but current studies only address the patient’s perception of their disease. Caregivers living with the patient may have an alternative perception of the severity of the quality of life disturbance that patient’s experience with chronic rhinosinusitis. Methods This was a prospective cohort study that enrolled patients with a confirmed chronic rhinosinusitis diagnosis who presented to clinic with a caregiver. At the initial visit, patients completed a Rhinosinusitis Disability Index. The caregiver completed a Rhinosinusitis Disability Index based on their perception of the patient’s symptoms in addition to a Modified Caregiver Strain Index and a Short Form-36 to assess caregiving strain and overall health, respectively. Statistical analyses were performed with significance defined as P < 0.05 a priori. Results A total of 44 total subjects (22 patient and caregiver pairs) were enrolled. Patients reported a total Rhinosinusitis Disability Index of 36.8 (confidence interval: 26.9, 46.6), and caregivers reported a total Rhinosinusitis Disability Index of 50.4 [confidence interval: 38.8, 61.9] (P = 0.02). The principal differences between patient and caregiver scores were noted in the emotional and physical domains (P = 0.01 and P = 0.05, respectively). Only the functional domain was not statistically different (P = 0.20). The patient’s total Rhinosinusitis Disability Index is positively correlated with the caregiver’s total Modified Caregiver Strain Index with a spearman coefficient of .60 (p ≤ 0.005). Conclusions Caregivers experience greater strain as the patient’s quality of life declines. Caregivers perceive patients to have worse quality of life than patients report. Based on these data, caregivers may provide additional insight to the quality of life disturbance of chronic rhinosinusitis. In addition, the societal impact of chronic rhinosinusitis may be underestimated.

Outcomes of Open vs Endoscopic Skull Base Surgery in Patients 70 Years or Older

Importance The use of skull base surgery in patients 70 years or older is increasing, but its safety in this age group has not been evaluated to date. Objectives To describe outcomes in a cohort of patients 70 years or older undergoing skull base surgery and to evaluate whether age, type of disease process, and approach (endoscopic vs traditional open surgery) are associated with increased intraoperative and postoperative complications in this population. Design, Setting, and Participants This retrospective cohort study analyzed a population-based sample of 219 patients 70 years or older from a database of 1720 patients who underwent skull base surgery at University of North Carolina Hospitals, Chapel Hill, a tertiary referral center, between October 2007 and June 2017. Data were collected from June 2016 to July 2017 and analyzed in July 2017 and August 2017. Exposure Skull base surgery. Main Outcomes and Measures Data collected included demographic characteristics, surgical approach, and disease process. Intraoperative findings and postoperative complications were analyzed by age, surgical approach, and malignancy status. Results Of the 219 patients, 166 were aged 70.0 to 79.9 years and 53 patients were older than 80 years (mean [SD] age, 76.4 [4.7] years); 120 (54.8%) were men and 160 (73.7%) were white. There were 161 (73.5%) endoscopic and 58 (26.5%) open operations. The most common pathologic processes among the 219 patients were nonsellar malignant (81 [37.0%]), nonsellar benign (53 [24.2%]), and pituitary (49 [22.4%]) tumors. The most common intraoperative and postoperative complications were intraoperative major bleeding (5 of 219 patients [2.3%]) and postoperative bleeding (9 [4.1%]). Thirty-day mortality was zero. There was no clinically meaningful difference in complications between patients aged 70.0 to 79.9 years vs those older than 80 years, endoscopic vs open surgery, or benign vs malignant neoplasms. Specifically, between the endoscopic and open surgery groups, there was no difference in intraoperative major bleeding (3.9%; 95% CI, −0.7% to 12.9%), postoperative cerebrospinal fluid leak (−0.6%; 95% CI, −3.4% to 5.6%), or postoperative bleeding (1.5%; 95% CI, −3.9% to 10.6%). Conclusions and Relevance Skull base surgery is a safe option in persons 70 years or older, with similar outcomes across age ranges, surgical approaches, and disease processes.

Stricture location predicts swallowing outcomes following endoscopic rendezvous procedures.

Complete pharyngoesophageal strictures may be encountered by the otolaryngologist as a consequence of radiation/chemoradiotherapy therapies for head and neck cancer. A combined anterograde and retrograde dilation procedure (rendezvous procedure) has proven to be a useful surgical intervention in these cases. We assess the long‐term swallowing outcomes of this patient cohort including gastrostomy tube (G‐tube) reliance, swallowing quality of life, and variables that contribute to improved swallowing outcomes.