Melissa McCarty Statham

Quantitative laryngeal electromyography: turns and amplitude analysis.

Laryngeal electromyography (LEMG) is primarily a qualitative examination, with no standardized approach to interpretation. The objectives of our study were to establish quantitative norms for motor unit recruitment in controls and to compare with interference pattern analysis in patients with unilateral vocal fold paralysis (VFP).

Cervical thymic remnants in children

OBJECTIVE Define the clinical presentation, diagnostic value of preoperative imaging, surgical management, and outcomes of treatment of congenital cervical thymic remnants in children. DESIGN Retrospective cohort. SETTING Single tertiary care institution. PATIENTS 20 children who underwent excision of cervical thymic remnant, 1975-2006. MAIN OUTCOMES MEASURED Utility of preoperative imaging to diagnose cervical thymic anomalies; success of surgical treatment of cervical thymic remnants. RESULTS A total of 20 children were identified, with an average age of 6.98+/-5.63 years. All ectopic thymus tissue was found in the embryonic distribution area associated with the third branchial pouch. Fourteen patients underwent excision of a cystic ectopic thymus. Four of these patients exhibited lesions isolated to the cervical region, and 10 patients displayed lesions involving cervicomediastinal areas. Six patients underwent excision of solid ectopic cervical thymus, and each of these was an unanticipated mass encountered during surgical dissection for other procedures. 83% of patients with solid ectopic cervical thymus presented at age 3 or younger. Physical exam and preoperative imaging correctly diagnosed thymic remnants in 15% patients. Resection of thymic remnants was successful in all patients, and there were no recurrences. CONCLUSIONS Though rare, thymic remnants should be considered in the differential diagnosis of masses presenting in locations associated with derivatives of the third branchial pouch. Though preoperative imaging is helpful in identifying the extent of these lesions, congenital thymic remnants prove difficult to diagnosis radiologically. Surgical excision is the diagnostic and therapeutic treatment of choice in the management of cervical thymic remnants.

Actinomycosis of the Temporal Bone With Labyrinthine and Facial Nerve Involvement

Objectives: To demonstrate the clinical, radiologic, and pathologic findings of actinomycosis of the temporal bone.

Serratia marcescens causing cervical necrotizing oropharyngitis

Necrotizing fasciitis is a rare, life-threatening infection. We report a case of necrotizing oropharyngitis caused by Serratia marcescens in a previously immunocompetent 6-year-old male. This necrotizing infection led to a near-total defect of the oropharynx. The wound was managed with daily wound debridement of the patients oropharynx with 3% hydrogen peroxide, carotid artery coverage with Kaltostat, and pharyngeal packing with iodoform ribbon gauze. Our patients resultant nasopharyngeal and hypopharyngeal stenoses present challenges for restoration of form and function for voicing and deglutition. We present our experience of managing this childs hypopharyngeal stenosis with a minimally invasive double-balloon dilatation technique.

Screening and Treatment of Methicillin-Resistant Staphylococcus aureus in Children Undergoing Open Airway Surgery

OBJECTIVES (1) To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in children undergoing open airway surgery using a screening protocol; (2) to examine the rates of postoperative infection in this cohort; and (3) to determine adherence to a MRSA antibiotic protocol. DESIGN Retrospective cohort study. SETTING Tertiary pediatric referral center. PATIENTS The study population comprised 180 children undergoing 197 open airway operations from January 2007 to March 2009 at the Cincinnati Childrens Hospital Medical Center. INTERVENTION Methicillin-resistant Staphylococcus aureus screening and treatment protocol. MAIN OUTCOME MEASURES Prevalence of MRSA colonization, postoperative infection rates, colonization rates by site, and adherence to antibiotic protocol. RESULTS A total of 180 patients who underwent 197 operations were included in the study. The overall prevalence of MRSA was 32.5%. There were no significant differences between MRSA-colonized and noncolonized patients regarding age at surgery, sex, gestational age at birth, or comorbidities. Postoperative infection rates were similar between the 2 groups (16% MRSA colonized; 17% MRSA noncolonized). Three patients who developed postoperative MRSA infections were MRSA negative on preoperative screening. Intraoperative adherence was high in both groups. CONCLUSIONS We describe a MRSA screening and treatment protocol for children undergoing open airway surgery. We found a high prevalence (32.5%) of MRSA colonization in these patients. Treatment of MRSA-colonized patients resulted in postoperative infection rates similar to those in MRSA-noncolonized patients. Treatment of MRSA-colonized patients resulted in no MRSA-associated postoperative infections, graft loss, or dehiscence. MRSA screening and treatment protocols may be helpful in minimizing MRSA-associated postoperative infections in these patients.

Automated high-level disinfection of nonchanneled flexible endoscopes: Duty cycles and endoscope repair†‡§

Guidelines issued by the Association of Operating Room Nurses and the Association of Professionals in Infection Control and Epidemiology recommend high‐level disinfection (HLD) for semicritical instruments, such as flexible endoscopes. We aim to examine the durability of endoscopes to continued use and automated HLD. We report the number of duty cycles a flexible endoscope can withstand before repairs should be anticipated.

Intraoperative PTH: Effect of sample timing and vitamin D status

Objective To assess the effect of timing of intraoperative parathormone (iPTH) samples and 25-hydroxyvitamin D (25-OHD) status on decision-making during parathyroidectomy. Methods A total of 77 patients with primary hyperparathyroidism and iPTH levels (preincision, preremoval, 5 (T5) and 10 (T10) minutes postremoval) performed during parathyroidectomy were reviewed. Results Forty-one percent of patients were 25-OHD insufficient. We noted a significant correlation between preoperative 25-OHD and preincision iPTH (P = 0.002) but not iPTH at postremoval levels (T5, P = 0.89; T10, P = 0.42). When compared with preincision iPTH, the use of either the higher preincision or preremoval iPTH baseline significantly improves the assay sensitivity from 83% to 93% at T5 (P = 0.01) and 87% to 97% at T10 (P = 0.02). Surgical cure was obtained in 98% of patients. Conclusion Obtaining preremoval iPTH allowed earlier decision with respect to operative completion in 38% of cases. 25-OHD status does not appear to significantly affect interpretation of iPTH levels. Significance Obtaining both baseline levels significantly improves sensitivity in iPTH monitoring.

Pediatric Laryngology: Innovations and Updates

Program Description: Pediatric laryngology has experienced tremendous growth with increased focus on voice issues. This miniseminar incorporates viewpoints of several clinicians and will focus on clinically relevant matters for general and specialty otolaryngologists, including diagnosis, common pathologies, and operative and non-operative approaches and techniques. Pathology includes benign vocal lesions, vocal fold paralysis, recurrent respiratory papillomatosis (RRP), laryngeal webs, and subglottic stenosis. Non-operative innovations will be discussed, including voice therapy, laryngeal electromyography, botulinum toxin, and fillers. Operative innovations include laser, techniques for vocal fold paralysis, and augmentations to standard open techniques. Differing practical approaches will be discussed in a panel format with presentations of challenging cases. Educational Objectives: 1) Illustrate the diagnostic approach of pediatric laryngology and give practical advice towards successful techniques. 2) Describe various diagnostic challenges in pediatric laryngological diseases and illustrate approaches towards proper diagnosis and treatment. 3) Elucidate newer innovative techniques in pediatric laryngology through case discussion and panel discussion.

Updates and Innovations in Pediatric Laryngology

Program Description: The field of pediatric laryngology has experienced tremendous growth in the past few years; the increased focus on voice-related quality of life issues in pediatric airway is a prime example of this. Much in the development of pediatric laryngology reflects the complementary efforts of laryngologists and pediatric otolaryngologists supported by key technological advancements. This miniseminar incorporates the viewpoints of several clinicians experienced in the management of pediatric laryngeal disorders, particularly those related to voice. The presenters will focus on clinically relevant matters for both general and specialty otolaryngologists, including diagnosis, common pathologies, as well as both operative and non-operative approaches and techniques. The anatomical and physiological basis for pediatric laryngology care will be reviewed. Specific components of the interactive session will include addressing these questions: What is the role of videostroboscopy in children? What is the role of FEES and FEESST testing in children? What is the role of in-office tracheobronchoscopy? Who should be referred for these tests? Fundamental pathologies impacting pediatric laryngology will be reviewed, including benign vocal lesions, RRP, laryngeal webs, subglottic stenosis, and hemangioma. Non-operative innovations will be discussed including propanolol, mitomycin, steroids, Botulinum toxin, and fillers. Operative innovations will include the use of cold versus laser technique for benign lesions, a brief discussion of open techniques, and recent augmentations to standard open techniques. Differing practical approaches for operative and non-operative techniques will be discussed in a panel format with presentations of challenging cases after the initial diagnostic, pathological, and interventional options have been discussed in a lecture format. Educational Objectives: 1) Understand the clinical role of specific diagnostic tests in pediatric laryngology. 2) Approach clinical issues in pediatric laryngology and address them with practical non-operative and operative solutions. 3) Understand the clinical advantages and disadvantages of individual non-operative and operative solutions.

09:20 AM: Intraoperative PTH: Effect of Sample Timing & Vitamin D

treatment both in vitro and in vivo. SIGNIFICANCE: The presenters demonstrate a mechanism for therapeutic synergism with celecoxib and radiation therapy, and provide a basis for further studies combining these treatments for patients with SCCHN. For the first time NSAID drugs are demonstrated to be distinctly toxic to cells with the S phase of the cell cycle. These data will be the basis for a clinical trial combining celecoxib with radiation therapy for patients with laryngeal cancer at the University of Iowa.