Lou Reinisch

Quality-of-life assessment in patients with unilateral vocal cord paralysis

OBJECTIVE: Our objective was to identify the impact of unilateral vocal cord paralysis (UVCP) on an individuals quality of life both before and after thyroplasty. STUDY DESIGN AND SETTING: This was a prospective observational outcome study of consecutive patients presenting to a laryngology clinic with UVCP. Participants received The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36), the Voice Handicap Index (VHI), and the Voice Outcome Survey (VOS). Patients underwent medialization laryngoplasty with silastic, with or without arytenoid adduction. Outcome measures were repeated after surgery. RESULTS: A review of 45 patients at presentation revealed statistically significant reductions in quality of life as measured by each survey. Marked improvements were noted after surgery. CONCLUSIONS: Our preoperative data support a profile of significant general health-related and voice-related limitations caused by UVCP. Patient perceptions improved significantly after the surgical treatment of glottal insufficiency. SIGNIFICANCE: The SF-36, VHI, and VOS provide an important complement to traditional endpoints in the analysis of patients with UVCP.

Inhibition of Subglottic Stenosis with Mitomycin-C in the Canine Model

The objective of this randomized, prospective study was to study the efficacy of topical mitomycin-C in the inhibition of subglottic stenosis in a canine model. Subglottic stenosis was elicited with the carbon dioxide laser in 10 mongrel dogs. Radial incision and serial dilation of the subglottic airway were then carried out. The animals were randomized to receive a topical solution of 1% mitomycin-C to the dilated area for a 5-minute duration or no further treatment. Weekly direct microlaryngoscopy and photodocumentation were performed during the 6-week study. Airway distress developed in 4 of the 5 control dogs, requiring early sacrifice, while all treatment group animals survived the duration of the study (p ≤ .006). Morphometric analysis of the subglottic photographs confirmed a greater than 100% increase in the percentage of relative airway at sacrifice in the treatment group (p ≤ .049). A statistically significant (p ≤ .015) decrease in collagen formation in the subglottic scar of dogs treated with topical mitomycin-C was documented. Mitomycin-C favorably altered the clinical progression of subglottic stenosis, improved quantified airway patency, and reduced the amount of subglottic collagen formation in the canine model.

Comparative histology and vibration of the vocal folds: implications for experimental studies in microlaryngeal surgery.

Objectives/Hypothesis To determine the most suitable animal model for experimental studies on vocal fold surgery and function by a histological comparison of the microflap surgical plane and laryngeal videostroboscopy (LVS) in different species of animals. A second goal was to determine how the layered vocal fold structure in humans and three different animal species affects surgical dissection within the lamina propria.

Preservation of function and histologic appearance in the injured glottis with topical mitomycin-C

Objective: To evaluate the functional and histological effects of a single application of topical mitomycin‐C after laser injury in the posterior canine glottis. Study Design: A prospective, randomized study of 16 canines. Methods: A supersaturated (1%) solution of topical mitomycin‐C was applied to a unilateral, laser‐induced injury near the cricoarytenoid joint in eight dogs. The mitomycin‐soaked pledget was placed immediately after induction of the injury and was left in contact with exposed cartilage for 3 minutes. The opposite side was not injured to provide an internal control. In eight additional dogs, the same laser injury was allowed to heal untreated. After 6 weeks, the animals were sacrificed and their larynges harvested. Arytenoid adduction sutures were placed bilaterally, and the force required to bring the vocal folds to midline was measured for each side using tensiometry. Gross and microscopic histological analysis was performed. Statistical analysis was accomplished using a two‐tailed Student t test of unpaired samples, and the Wilcoxon Signed Rank Test where appropriate. Results: The mitomycin‐C treated larynges demonstrated improved cricoarytenoid joint mobility (P = .007), decreased granulation tissue development (P = .03), and complete prevention of secondary “vocal granuloma” formation (P = .0004) when compared with eight dogs with identical laser injuries allowed to heal untreated. No complications were noted. Conclusions: This study demonstrates functional preservation and improved histological appearance of the injured glottis after a single treatment with topical mitomycin‐C. Potential applications of these findings include prophylactic use of topical mitomycin‐C on glottic insults that commonly progress from granulation tissue formation to scarring and decreased vocal fold function.

Comparison of cortical bone ablations by using infrared laser wavelengths 2.9 to 9.2 μm

The purpose of this study was to compare the ablation of cortical bone at wavelengths across the near and midinfrared region.

Effect of mitomycin-C on vocal fold healing in a canine model.

For evaluation of the effect of topical mitomycin-C on vocal fold healing and return of function after surgical excision of mucosa, 6 dogs underwent suspension microlaryngoscopy with bilateral microflap excision of vocal fold mucosa. Topical mitomycin-C, a chemotherapeutic agent and a fibroblast inhibitor, was applied randomly to one side, with the contralateral side serving as the control. Laryngeal videostroboscopy (LVS) was performed on each animal before the operation, at 2 weeks, and before sacrifice at 4 weeks. Both functional analysis with LVS and histologic analysis were performed in a blinded fashion to determine the effect of mitomycin-C on healing. Histologic analysis was augmented with computer morphometries. The LVS revealed diminished mucosal wave vibration in the vocal folds treated with mitomycin-C, as well as a more atrophic appearance to the vibratory surface. The vocal folds treated with mitomycin-C showed fewer fibroblasts and less collagen within the superficial layer of the lamina propria than the control vocal folds (p < .05, Students f-test, paired analysis). Inflammatory infiltrate was not significantly different between the two sides. Consistent with the known suppression of fibroblast proliferation by mitomycin-C, the treated vocal folds showed less connective tissue response to the surgical injury. In contrast to the reported positive effects of mitomycin-C on tracheal and glottic stenosis, the observed decrease in the healing response in the present study had negative consequences on the vocal fold vibratory pattern.

Laser treatment of solar elastosis with epithelial preservation

Background and Objective: Laser resurfacing has gained wide acceptance for the treatment of actinic facial skin. However, postoperative care of the face is reasonably complicated and prolonged erythema is common. To simplify the postoperative care and to possibly reduce the duration of the erythema, we investigated a laser treatment that spares the epithelium.

Radiofrequency Tissue Ablation of the Inferior Turbinates Using a Thermocouple Feedback Electrode

Objective: The objective of this clinical trial was to assess the safety and efficacy of radiofrequency (RF) tissue ablation of the inferior turbinates in the treatment of nasal obstruction using an RF energy delivery system with a thermocouple feedback electrode.

Laryngotracheal reconstruction in the adult : A ten year experience

The purpose of this study is to retrospectively analyze our experience with airway reconstruction, to outline a new staging system for laryngotracheal (LT) stenosis, and to identify preoperatively those patients likely to fail reconstruction. We reviewed 41 patients who underwent 46 LT reconstructions over the past 10 years. Success was judged by the ability to decannulate patients within 1 year postoperatively. Of our patients, 63% were treated successfully, and an additional 17% had intermediate success. The techniques used for laryngotracheoplasty with augmentation grafting and tracheal resection are reviewed. Major complications, thoracic complications, and wound complications are presented. Each patient was staged by the McCaffrey staging system and Cotton grades. We propose a new staging system based on the extent of the stenosis throughout the glottis, subglottis, and trachea. It is logical and easy to use. Applied to our cases of LT stenosis retrospectively, the new system predicts clinical success (χ2, p = .05). Using contingency tables and χ2 testing for statistical evaluation, we found that diabetics have a significantly higher failure rate (χ2, p = .0002). Further, we identified a group of patients who in addition to the airway stenosis also had comorbid medical conditions that frequently necessitate a tracheostomy. These patients have a significantly higher failure rate (χ2, p = .009). Using this information and applying the staging system prior to reconstruction, we can identify patients likely to fail.

Histomorphometric and laryngeal videostroboscopic analysis of the effects of corticosteroids on microflap healing in the dog larynx

The histologic and functional effects of unilateral, layered corticosteroids on lateral microflap healing in 15 dogs were analyzed. Histologic sections of steroid-treated vocal folds (VFs) were studied with computer morphometry to examine differences in the tissue healing response. Paired analysis revealed increases in the inflammatory infiltrate around the microflap in the steroid-treated VFs at 2,4, and 6 weeks (6.3%, 30.6%, and 34.9%, all with p < .02). The neovascular response in the steroid-treated VFs was less at 2 weeks (–20.9%, p < .005) but greater at 4 and 6 weeks (16.3% and 4.3%, p < .005). To better characterize the effect of steroids on the healing process, a normal, time-dependent distribution was applied to the histologic data and demonstrated a delay in the steroid-treated VF tissue response of 12 days for the inflammatory infiltrate and 21 days for the neovascular response. Qualitative and quantitative analysis of in vivo laryngeal videostroboscopy (LVS) samples taken preoperatively and at sacrifice could not identify significant differences in appearance, amplitude, mucosal wave, or suppleness between the 2 VFs. Therefore, although corticosteroids cause a delay in wound healing, LVS does not discern differences in microflap characteristics between healing steroid-treated and control VFs at 2, 4, or 6 weeks. If steroids are used, the surgeon should account for a probable delay in wound healing, but should not expect an overall difference in functional outcome.