Laura M. Dominguez

Risk Factors Associated With Unilateral Hearing Loss

OBJECTIVE To analyze the presence of Joint Committee on Infant Hearing (JCIH) risk factors and co-occurring birth defects (CBDs) in children with unilateral hearing loss (UHL). DESIGN Retrospective review. SETTING Statewide registry of universal newborn hearing screen data for all children born in Virginia from 2002 through 2008. PATIENTS The study population comprised 371 children with confirmed UHL. MAIN OUTCOME MEASURES Universal newborn hearing screen status, presence or absence of JCIH risk factors, and CBDs RESULTS Of the 371 children with confirmed unilateral hearing loss, 362 (97.5%) were identified through a failed universal newborn hearing screen. Of these 362 children, 252 (69.6%) had no JCIH risk factors and 110 (30.3%) had 1 or more risk factor reported. Nine children (2.5%) with 1 or more risk factors passed the universal newborn hearing screen but had later-onset UHL. Craniofacial anomaly was the most commonly reported JCIH risk factor in 48 children (43.6%). A family history of permanent childhood hearing loss was present in 24 children (21.8%). Twenty children (18.2%) had stigmata associated with a syndrome including hearing loss. Of the 110 children with UHL and a JCIH risk factor, additional CBDs were identified in 83 (75.5%). An ear-specific anomaly was most prevalent in 37 infants (44.6%), followed by cardiovascular anomalies in 34 infants (41.0%). CONCLUSIONS Thirty percent of children with confirmed UHL had a JCIH risk factor, most commonly craniofacial anomalies, family history of hearing loss, and stigmata of syndromes associated with hearing loss. However, the absence of JCIH risk factors does not preclude the development of UHL. Further studies assessing the etiology of UHL and risk factor associations are warranted.

Genetics of hearing loss: focus on DFNA2

The purpose of this review is to assess the current literature on deafness nonsyndromic autosomal dominant 2 (DFNA2) hearing loss and the mutations linked to this disorder. Hearing impairment, particularly nonsyndromic hearing loss, affects multiple families across the world. After the identification of the DFNA2 locus on chromosome 1p34, multiple pathogenic mutations in two genes (GJB3 and KCNQ4) have been reported. The overwhelming majority of pathogenic mutations linked to this form of nonsyndromic hearing loss have been identified in the KCNQ4 gene encoding a voltage-gated potassium channel. It is believed that KCNQ4 channels are present in outer hair cells and possibly inner hair cells and the central auditory pathway. This form of hearing loss is both phenotypically and genetically heterogeneous and there are still DFNA2 pedigrees that have not been associated with changes in either GJB3 or KCNQ4, suggesting that a possible third gene exists at this locus. Further studies of the DFNA2 locus will lead to a better understanding of progressive hearing loss and provide a better means of early detection and treatment.

Mid-membranous Vocal Fold Webs: Case Series

INTRODUCTION Laryngeal webs are a rare clinical entity, with those in the mid-membranous region occurring even less commonly. This is the first case series describing this condition. CASE REPORT We describe the clinical course of four patients with mid-glottic webs and propose the possible pathophysiology. DISCUSSION Trauma to the vocal folds followed by an inflammatory reaction is the likely event leading to the development of this lesion. Endoscopic division of this type of web has shown good postoperative voice outcomes without any recurrences. CONCLUSION The mid-glottic web is a rare clinical entity for which there is no defined etiology. It is likely that trauma results in an inflammatory reaction and, ultimately, web formation. Further studies are needed to identify risk factors for this condition.

Viral laryngitis: a mimic and a monster - range, presentation, management.

Purpose of reviewThe purpose of this review is to highlight recent literature relating to the diagnosis and treatment of some less common forms of viral laryngitis. The main conditions addressed in this review are chronic cough or postviral vagal neuropathy, varicella zoster infection of the larynx, and a condition increasingly suspected as being virally induced, idiopathic ulcerative laryngitis. Recent findingsDiagnosis of these conditions requires a thorough history and physical exam, and in certain cases referral to other subspecialties such as gastroenterology and pulmonology. Chronic cough due to postviral vagal neuropathy is a diagnosis of exclusion; however, recent literature does suggest that certain studies such as laryngeal electromyography can be of use in reaching a diagnosis. Treatment of this neuropathy has focused on use of neuromodulators. Treatment of laryngeal shingles and idiopathic ulcerative laryngitis has not been well defined because of the rarity of these conditions. SummaryRecent studies regarding these conditions and potential future treatment options will be discussed.

Voice Outcomes of Lipoinjection Versus Medialization Laryngoplasty for Nonparalytic Glottic Insufficiency: Lipoinjection Versus Medialization Laryngoplasty

To compare voice outcomes of autogenous fat injection versus medialization laryngoplasty in patients with glottic insufficiency due to vocal fold paresis or atrophy.

Treatment of chronic neurogenic cough with in-office superior laryngeal nerve block

Neurogenic cough is believed to result from a sensory neuropathy involving the internal branch of the superior laryngeal nerve (SLN). We present our outcomes for the treatment of neurogenic cough with localized blockade of the internal branch of the SLN.

Inflammatory reaction to hyaluronic acid: A newly described complication in vocal fold augmentation

To establish the rate of inflammatory reaction to hyaluronic acid (HA) in vocal fold injection augmentation, determine the most common presenting signs and symptoms, and propose an etiology.

Impact of Perioperative Voice Therapy on Outcomes in the Surgical Management of Vocal Fold Cysts

INTRODUCTION Vocal fold cysts are benign mid-membranous lesions of the true vocal fold, classified as mucus retention or epidermal inclusion cysts. Treatment is surgical excision with or without postoperative voice therapy. METHODS A retrospective review was performed of the demographics, treatment approach, and outcomes of patients treated for vocal fold cysts between 2009 and 2014. Voice Handicap Index (VHI)-10 scores before and after treatment were compared using the Wilcoxon Rank-Sum test and the two-tailed Students t test. Videostroboscopy examinations were reviewed for posttreatment changes in vibratory characteristics of the vocal folds. RESULTS Twenty-five patients were identified, and one was excluded for incomplete records. Mean age was 41.9 years (66.7% female), and mean follow-up time was 5.58 months. Microflap excision was pursued by 21/24 (87.5%) patients, with 14 patients (58.3%) undergoing perioperative voice therapy. One cyst recurred. Two patients elected for observation, and their cysts persisted. VHI-10 decreased from 23.8 to 6.6 (P < 0.001) overall. There was a statistically significant reduction in VHI-10 in patients undergoing surgery with and without postoperative voice therapy (P < 0.004 and 0.001), but there was no significant difference between these two groups. Mucosal wave was classified as normal or improved in the majority. Cysts were characterized as mucus retention cysts in 19/21 (90%) and as epidermal inclusion cysts in 2/21 (10%). CONCLUSIONS Vocal fold cysts impact mucosal wave and glottic closure. Surgical excision resulted in low rates of recurrence, and in improvement in the mucosal wave and VHI-10. Perioperative voice therapy did not offer a significant benefit. Mucus retention cysts were the majority, in contrast to other published studies.

Treatment Outcomes of In-Office KTP Ablation of Vocal Fold Granulomas

Objective: To determine the effectiveness of in-office potassium-titanyl-phosphate (KTP) treatment of vocal fold granulomas and identify any predictors of complete lesion resolution. Methods: A retrospective review of patients who underwent in-office KTP ablation of vocal fold granulomas between 2007 and 2016 was performed. Medical records were reviewed for use of acid suppression medication, prior surgical treatment, voice therapy, laser settings, number of treatments, follow-up time, and Voice Handicap Index-10 (VHI-10) scores. Results: Twenty-six patients underwent a total of 43 laser treatments. Eighty percent of patients were previously on acid suppression medication, and 42.3% had failed previous endoscopic treatments. Patients underwent a mean number of 1.65 ± 1.16 in-office treatments with decrease in size in 96.2% of cases. The VHI-10 was not significantly affected. Complete resolution occurred in 73.1% of cases with follow-up time ranging from 1 to 86 months (median = 9.5 months). No recurrences occurred in patients with complete resolution. Other than undergoing a single KTP treatment, no variable was found to be predictive of complete lesion resolution. Granuloma etiology was not predictive of lesion resolution but did correlate with symptom improvement. Conclusion: In-office pulsed KTP laser is an effective treatment option for vocal fold granulomas as the lesion resolves in the majority of cases.

Neurolaryngology: In-office Diagnosis and Treatment

The purpose of this review is to highlight recent literature relating to the diagnosis and treatment of neurologic disorders of the larynx. The three main conditions of interest in this review are spasmodic dysphonia, essential tremor, and Parkinson’s disease. Diagnosis of these disorders requires a thorough history, complete physical exam, and a neurology consultation in most cases. While diagnostic tools have not changed much over the past year, recent studies proposing new treatment methods for these conditions will be reviewed.