Matthew S. Clary

Surgical Treatment of Subperiosteal Orbital Abscess

OBJECTIVE To determine the factors influencing the surgical approach to a pediatric subperiosteal orbital abscess (PSPOA), more specifically, comparing external (E) vs transnasal endoscopic (TNE) surgical approaches. DESIGN A retrospective medical chart review. SETTING Childrens National Medical Center in Washington, DC. PATIENTS All pediatric patients who underwent surgical treatment of PSPOA from 2004 to 2007. MAIN OUTCOME MEASURES Age at presentation, presentation duration of periorbital edema before presentation, white blood cell count and temperature at initial presentation, preoperative radiographic location of abscess, and number of extraocular muscles displaying radiographic abnormalities. RESULTS Thirteen patients, 10 boys and 3 girls, were identified (mean age, 8.7 years [range, 6 weeks to 13 years]). Five patients were successfully treated with only a TNE approach, whereas 8 patients required an E approach. Location of PSPOAs and radiographic changes of extraocular muscles differentiated the patients in TNE and E groups. All patients had eventual resolution of their disease without any surgical complications. CONCLUSIONS Factors influencing the choice of surgical approach for the treatment of PSPOAs extend beyond surgeon preference. Patient clinical presentation and radiographic findings may help guide the physician in choosing an appropriate surgical approach.

Efficacy of large‐diameter dilatation in cricopharyngeal dysfunction

To investigate patient outcomes with large‐diameter bougienage in isolated cricopharyngeal dysfunction and understand how esophageal dilatation can be used as an effective diagnostic and therapeutic modality in treating dysphagia.

Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery

Exercise-induced laryngeal obstruction (E-ILO) causes exertional dyspnoea. There is no standardised methodology which characterises laryngeal obstruction in relation to exercise or links laryngeal obstruction and dyspnoea severity. Continuous laryngoscopy during exercise (CLE) may improve diagnostic sensitivity by enabling laryngeal visualisation at peak work capacity in patients with rapidly resolving obstruction. The time course of laryngeal obstruction across exercise and recovery has not been quantitated until this report. Adolescents and young adults referred for CLE were laryngoscopically monitored across rest, maximal cycle ergometry exercise, and recovery. Three reviewers, blinded to time sequencing, rated inspiratory glottic and supraglottic obstruction during 10 windows of 15-s corresponding to rest, 25%, 50%, 75%, 90% and 100% of individual symptom-limited peak work capacity (expressed in Watts), and four consecutive recovery windows. 85 patients were screened and 71 included. Over 96% of time windows were interpretable. Laryngeal obstruction severity reached observed maximal levels at peak work capacity, and rapidly resolved. A spectrum of observed maximal obstruction was measured. CLE provides interpretable data demonstrating laryngeal obstruction in patients with suspected E-ILO that is more severe at peak work capacity than during rest, submaximal exercise, or recovery. Observed maximal obstruction was infrequently severe and rapidly resolved. Maximal laryngeal obstruction occurs at peak work capacity in suspected exercise-induced laryngeal obstruction http://ow.ly/pHER300eiU9

Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue

This study investigated financial and treatment implications of a speech‐language pathologist (SLP) performing a voice evaluation at the initial laryngologic visit.

Office-based vocal fold injection with the laryngeal introducer technique

There are numerous techniques for awake laryngeal injection, each with its limitations and technical challenges. We demonstrate a modification to the thyrohyoid approach for injection that stabilizes needle introduction and allows for consistent placement in a wide variety of larynges.

Glottic configuration in patients with exercise‐induced stridor: A new paradigm

Paradoxical vocal fold motion and exercise‐induced paradoxical vocal fold motion (EIPVFM) are two related conditions that do not have definitive diagnostic criteria. Much of the EIPVFM literature describes patients with characteristic physiologic findings of severe upper airway obstruction or obvious airflow limitation in the clinical context of exertional dyspnea with audible stridor. The objective of this study was to highlight a group of patients who demonstrate important clinical findings of EIPVFM (exertional dyspnea with audible stridor) without simultaneously definitive physiologic findings (mild glottic adduction and normal flow volume loops).

Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights

Abstract Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise--ILO can impair one’s ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care. It is characterized by episodic shortness of breath and noisy breathing that generally occurs at high work rates. The present diagnostic gold standard for all types of ILO is laryngoscopic visualization of inappropriate glottic or supraglottic movement resulting in airway narrowing during a spontaneous event or provocation challenge. A number of different behavioral techniques, including speech therapy, biofeedback, and cognitive-behavioral psychotherapy, may be appropriate to treat individual patients. A consensus nomenclature, which will allow for better characterization of patients, coupled with new diagnostic techniques, may further define the epidemiology and etiology of ILO as well as enable objective evaluation of therapeutic modalities.

Development of Procedures and Techniques for the Office

This article presents the evolution of current office-based surgery of the larynx, focusing on the development of the tools and techniques for these ambulatory procedures, including laryngoscopy, bronchoscopy, esophagoscopy, and current office-based interventions. Additionally, a historical timeline is presented for the development of office-based laryngology within the context under which laryngology, as a subspecialty, has evolved over the past 200 years, with questions posed to the reader regarding what further developments may arise and how those will affect the practice.

Automatic registration of large set of microscopic images using high-level features

In this paper, we present a novel method for automatic registration of large set of microscopic images by automatically match high-level region features via finding cyclic structures in a matching graph. The use of high-level features (e.g., regions, landmarks, objects) significantly reduced the computation and provides accurate initialization, which further allows fast convergence of the maximum mutual information algorithm. The scheme is a universal one as it works for other types of high-level features and the matching process is very computationally efficient. We have applied our method in 3-D reconstruction of a unique human cochlear sample and are also applying it to two other set of large microscopic images

A low-cost transcervical laryngeal injection trainer

To develop a low‐cost, easy‐to‐construct model for education in transcervical laryngeal injection techniques. To validate the simulator among both fellowship‐trained laryngologists and otolaryngology resident learners.