Robbi A. Kupfer

Genotyping of 73 UM‐SCC head and neck squamous cell carcinoma cell lines

We established multiple University of Michigan Squamous Cell Carcinoma (UM‐SCC) cell lines. With time, these have been distributed to other labs all over the world. Recent scientific discussions have noted the need to confirm the origin and identity of cell lines in grant proposals and journal articles. We genotyped the UM‐SCC cell lines in our collection to confirm their unique identity.

Biomarkers in Advanced Larynx Cancer

To determine if tumor biomarkers were predictive of outcome in a prospective cohort of patients with advanced larynx cancer treated in a phase II clinical trial.

Spontaneous laryngeal reinnervation following chronic recurrent laryngeal nerve injury

To enhance understanding of spontaneous laryngeal muscle reinnervation following severe recurrent laryngeal nerve injury by testing the hypotheses that 1) nerve fibers responsible for thyroarytenoid muscle reinnervation can originate from multiple sources and 2) superior laryngeal nerve is a source of reinnervation.

Neurogenic vocal fold motion impairment after routine intubation for tonsillectomy in a pediatric patient

OBJECTIVES/HYPOTHESIS Vocal fold motion impairment is a rare complication of general anesthesia and is more common in older patients undergoing longer duration of anesthesia. We present a case of recurrent laryngeal nerve (RLN) axonotmesis in a 16-year-old patient undergoing general anesthesia for tonsillectomy. STUDY DESIGN Case report. METHODS The patient was intubated with a 6-0 oral RAE tube for routine tonsillectomy and was dysphonic postoperatively. Right vocal fold motion impairment was discovered on flexible laryngoscopy, and serial examinations with videostroboscopy were performed. She underwent laryngeal electromyography 3 months postoperatively. RESULTS Initial videostroboscopy demonstrated findings consistent with right RLN injury. Laryngeal electromyography showed severe active denervation of the right thyroarytenoid muscle with signs of early reinnervation, consistent with axonotmesis. Complete recovery was achieved 4 months postoperatively. CONCLUSIONS This case demonstrates RLN axonotmesis after brief routine intubation. The presumed mechanism of injury is compression of the nerve between the thyroid cartilage and the arytenoid or cricoid cartilage. The use of an oral RAE endotracheal tube may have contributed to the injury owing to the short distance between the bend of the tube and the cuff, placing the cuff at a higher level within the airway.

The Relationship between Jugular Bulb–Vestibular Aqueduct Dehiscence and Hearing Loss in Pediatric Patients

Objective. To determine the prevalence of jugular bulb and vestibular aqueduct dehiscence (JBVAD) in pediatric patients undergoing temporal bone computed tomography (CT) scans and to assess the relationship between JBVAD and hearing loss. Study Design. Cross-sectional study with chart review. Setting. Tertiary academic medical center. Subjects and Methods. All patients 18 years of age or younger who had undergone temporal bone CT scans and audiometric testing between 2004 and 2009 were retrospectively reviewed. JBVAD was determined by blinded review of CT images. Hearing loss was determined by review of audiometric data and was correlated with imaging findings. Results. CT images and audiometric data were available for review in 927 patients (1854 ears). Overall prevalence of JBVAD was 8.6%, with a prevalence of 6.6% in right ears and 3.6% in left ears. JBVAD was present in 8.3% and 7.1% of patients with and without sensorineural or mixed hearing loss, respectively (95% confidence interval [CI], -2.3% to 4.6%; P = .51). Similarly, JBVAD was present in 5.5% of ears with and 4.6% of ears without sensorineural or mixed hearing loss (95% CI, -1.1% to 2.9%; P = .37). Conclusion. The prevalence of JBVAD is 8.6% in pediatric patients undergoing temporal bone CT scans, 65% of which occur in the right ear. We were unable to identify any relationship between JBVAD and hearing loss. A major contribution to pediatric sensorineural hearing loss from JBVAD is therefore extremely unlikely.

Anatomic Derkay Score Is Associated with Voice Handicap in Laryngeal Papillomatosis in Adults

Objective The Derkay staging system quantifies recurrent respiratory papillomatosis (RRP) severity based on involvement of laryngeal structures. Despite its broad use in the laryngology literature, the association between Derkay score and voice-related quality of life has not previously been studied. It is hypothesized that Derkay score positively correlates with the Voice Handicap Index–10 (VHI-10). Study Design Case series with chart review. Setting Tertiary medical center. Subjects and Methods Forty-six adult RRP patients treated from 2007 to 2013 at a tertiary medical center were included. Anatomic Derkay scores at the time of each RRP procedure were calculated. VHI-10 scores obtained within 30 days preceding the procedures were used to assess for correlation between Derkay staging system and VHI-10. Results Ninety-three procedures performed on 46 patients met inclusion criteria. Mean Derkay score was 11.9 (range, 2-28), and mean VHI-10 was 18.0 (range, 0-40). There was a significant positive correlation between Derkay score and VHI-10 (Spearman coefficient r = 0.42, P < .0001). Conclusion The anatomic burden of RRP as assessed by Derkay staging system is positively correlated with voice-related quality of life as quantified by the VHI-10.

Histological Bulbar Manifestations in the ALS Rat

Background: Almost all patients with amyotrophic lateral sclerosis (ALS) develop bulbar symptoms; therefore, it is important to have valid animal models that accurately reflect these features. While the SOD1-G93A rat is extensively used as an ALS model, bulbar symptoms in this model are not well characterized. Objective: In the present study, we aimed to better characterize bulbar dysfunction in terms of histology to determine whether the SOD1-G93A rat is a useful model for bulbar-onset ALS. Methods: Sixty-day-old SOD1-G93A rats on a Sprague-Dawley background and age-matched wild-type controls were assessed weekly for global motor function, facial nerve function, and vagal nerve function. The study endpoint was determined when an SOD1-G93A rat could not right itself within 30 s of being placed on its side. At that point, neuronal counts were assessed in different brainstem cranial nerve nuclei. In addition, the masseter muscle, posterior belly of the digastric muscle, and tongue muscle were evaluated for intact neuromuscular junctions. Results: Our data demonstrate decreases in the number of motor neurons in the trigeminal, facial, and hypoglossal nuclei, as well as compromised neuromuscular junction integrity in the muscles they innervate. Conclusion: These findings suggest that, from a histological standpoint, the SOD1-G93A rat is a valid model of ALS bulbar symptoms.

Implementation of a novel otolaryngology clinic for indigent patients

This study was designed to describe the implementation, utilization, and outcomes of an otolaryngology clinic for indigent patients employing a novel design.

Medialization Laryngoplasty for Odynophonia

IMPORTANCE Medialization laryngoplasty (ML) remains the gold standard for the long-term treatment of hoarseness related to glottal insufficiency. Odynophonia is a less common manifestation of glottal insufficiency related to vocal fold motion impairment (VFMI), and ML is hypothesized to relieve pain associated with this condition. OBJECTIVE To evaluate whether patients with VFMI and a chief complaint of odynophonia may achieve pain relief with ML, regardless of the degree of vocal impairment. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective review of medical records for 8 patients with VFMI and a chief complaint of odynophonia who were treated at 2 tertiary care laryngology centers over a 2-year period. INTERVENTIONS All patients underwent ML. MAIN OUTCOMES AND MEASURES Patient-reported relief of pain, preoperative and postoperative Voice Handicap Index 10 (VHI-10) scores, and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores were obtained. RESULTS All eight patients (5 women and 3 men; mean age, 42 years) had durable relief of their discomfort postoperatively (average follow-up, 14 months). Mean VHI-10 scores improved significantly from 17.9 preoperatively to 6.3 postoperatively (P = .001), while perceptual voice parameters as measured by CAPE-V were unchanged. There were no complications. CONCLUSIONS AND RELEVANCE In select cases of VFMI, ML can relieve pain related to voice use, even in the absence of significant hoarseness.

Office-Based vs Traditional Operating Room Management of Recurrent Respiratory Papillomatosis: Impact of Patient Characteristics and Disease Severity

Importance Management of recurrent respiratory papillomatosis (RRP) in adults has evolved to include office-based laser techniques. Objective To determine whether demographic or disease characteristics differ between patients undergoing office-based (office group) vs traditional operating room (OR group) surgical approaches for RRP. Design, Setting, and Participants This study was a medical record review of adult patients with RRP treated between January 2011 and September 2013 at a tertiary care center. Patients were divided into 2 groups according to the setting in which the patient had the most procedures during the past 2 years. Main Outcomes and Measures Demographic and disease characteristics were compared between patients receiving predominantly office-based vs predominantly OR management. Results Of 57 patients (47 male and 10 female, with a mean [SD] age of 53.5 [16.4] years) treated during the 2-year period, 34 patients underwent predominantly office-based management and 23 patients underwent predominantly OR management. Sex, age, and weight were not statistically significantly different between the 2 groups. Patients in the OR group had a younger age at RRP diagnosis (mean [SD], 28.7 [22.0] years in the OR group and 45.5 [20.5] years in the office group), with a mean difference of 16.8 years (95% CI, −28.3 to −5.4 years). Patients in the OR group also had a significantly higher Derkay score (mean [SD], 15.1 [5.7] in the OR group and 10.7 [5.0] in the office group), with a mean difference of 4.4 (95% CI, 1.6-7.3). No statistically significant differences in comorbidities were observed between the 2 groups except for type 1 or 2 diabetes, which was more common in the OR group. There were 5 patients (22%) with diabetes in the OR group and 1 patient (3%) with diabetes in the office group, with a mean difference of 19% (95% CI, 2.7%-35%). In a subanalysis that excluded patients with juvenile-onset RRP, Derkay score (mean [SD], 13.9 [4.5] in the OR group and 10.8 [5.1] in the office group), with a mean difference of 3.1 (95% CI, 0.5-6.1), and the incidence of diabetes (25% [4 of 16] in the OR group and 3% [1 of 31] in the office group), with a mean difference of 22% (95% CI, 3%-40%), remained significantly higher in the OR group, while age at diagnosis of RRP was no longer statistically significant (mean [SD], 40.2 [15.6] years in the OR group and 49.6 [16.4] years in the office group), with a mean difference of 9.4 years (95% CI, −19.4 to −0.7 years). Conclusions and Relevance There were no sex or age differences between patients with RRP treated in the office compared with those treated in the OR. Patients with earlier age at diagnosis of RRP and greater disease severity were more likely to be managed in the OR.