Stratos Achlatis

Morbidity and Patient Perception of Flexible Laryngoscopy

Objectives: The recently published Clinical Practice Guideline: Hoarseness (Dysphonia) revealed major deficits in the literature regarding relatively routine clinical decision-making. One of the more controversial points in the Guideline regarded the utility and timing of laryngeal visualization via flexible laryngoscopy, potentially because of sparse literature regarding the risks and potential morbidity. We sought to prospectively address this issue in order to optimize evaluation protocols. Methods: Two-hundred fifty consecutive patients with a variety of complaints completed a survey after undergoing flexible laryngoscopy. The survey queried 1) demographics; 2) discomfort of pretreatment anesthesia and scope placement in the nose and pharynx; 3) fear of future examinations; and 4) patient perception and past experience. Concurrently, the laryngoscopist reported the complications and anatomic variations encountered. Results: The discomfort and pain ratings from both the anesthetic spray and the scope placement were low. No statistically significant differences were observed with regard to sex; however, women reported greater fear associated with examinations (p = 0.0001). Anatomic abnormalities were observed in 14.4% of patients, and these patients reported greater discomfort, pain, and fear regarding the examination. No adverse events were observed. Conclusions: Flexible laryngoscopy was well tolerated, with little to no risk. The presence of nasal anatomic abnormalities predicted increased discomfort.

Incidence of underlying laryngeal pathology in patients initially diagnosed with laryngopharyngeal reflux

To characterize the videoendoscopic laryngeal findings in patients with a prior established diagnosis of laryngopharyngeal reflux disease (LPR) as the sole etiology for their chief complaint of hoarseness. We hypothesized that many, if not all, of these patients would present with discrete laryngeal pathology, divergent from LPR.

Risk factors for adult‐onset recurrent respiratory papillomatosis

To evaluate risk factors strongly associated with adult‐onset recurrent respiratory papillomatosis (AO‐RRP).

Patient‐based outcomes of in‐office KTP ablation of vocal fold polyps

Recent data have suggested that in‐office potassium titanyl phosphate (KTP) laser treatment for benign vocal fold lesions yields significant reduction in lesion size with favorable effects on both mucosal wave and glottic closure. However, these previous studies omitted voice‐related outcomes. We sought to compliment these previous data with voice‐related outcomes in a cohort of patients undergoing KTP ablation of vocal fold polyps.

Dynamic Magnetic Resonance Imaging of the Pharynx during Deglutition

Objectives: We utilized dynamic magnetic resonance imaging to visualize the pharynx and upper esophageal segment in normal, healthy subjects. Methods: A 3-T scanner with a 4-channel head coil and a dual-channel neck coil was used to obtain high-speed magnetic resonance images of subjects who were swallowing liquids and pudding. Ninety sequential images were acquired with a temporal resolution of 113 ms. Imaging was performed in axial planes at the levels of the oropharynx and the pharyngoesophageal segment. The images were then analyzed for variables related to alterations in the area of the pharynx and pharyngoesophageal segment during swallowing, as well as temporal measures related to these structures. Results: All subjects tolerated the study protocol without complaint. Changes in the area of the pharyngeal wall lumen and temporal measurements were consistent within and between subjects. The inter-rater and intra-rater reliabilities for the measurement tool were excellent. Conclusions: Dynamic magnetic resonance imaging of the swallow sequence is both feasible and reliable and may eventually complement currently used diagnostic methods, as it adds substantive information.

Temporal Measurements of Deglutition in Dynamic Magnetic Resonance Imaging versus Videofluoroscopy

Objectives: We undertook to provide data regarding temporal measurements of swallow function obtained by dynamic magnetic resonance imaging in a midsagittal plane and to compare these values to normative fluoroscopy data. Methods: Seventeen healthy female volunteers with no swallowing complaints underwent turbo-fast low-angle-shot magnetic resonance imaging with a 3-T scanner while swallowing liquid and pudding boluses delivered via syringe. Ninety sequential images were acquired with a temporal resolution of 113 ms per frame for each swallow. The imaging was performed in the midsagittal plane. The analyses focused on oral and pharyngeal transit times. Results: All subjects tolerated the protocol without complaints or adverse events. The mean (±SD) oral transit times for liquids and pudding were measured as 0.25 ± 0.09 second and 0.25 ± 0.13 second, respectively. This difference was not statistically significant (p = 0.74). The mean pharyngeal transit times for liquids and pudding were measured as 0.84 ± 0.16 second and 1.11 ± 0.21 seconds, respectively. This difference achieved statistical significance (p < 0.0001). The intrarater and inter-rater reliabilities for the measurements were excellent. Conclusions: This sequence provided a high degree of temporal resolution of deglutition in the midsagittal plane. Furthermore, the temporal measurements acquired with dynamic magnetic resonance imaging were reliable and were relatively consistent with those of previous studies done with videofluoroscopy.

Magnetic Resonance Imaging of the Effortful Swallow

Objective: The effortful swallow was designed to improve posterior mobility of the tongue base and increase intraoral pressures. We characterized the effects of this maneuver via dynamic magnetic resonance imaging (dMRI) in healthy patients. Methods: A 3-T scanner was used to obtain dMRI images of patients swallowing pudding using normal as well as effortful swallows. Ninety sequential images were acquired at the level of the oropharynx in the axial plane for each swallow; 3 series were obtained for each swallow type for each patient. Images were acquired every 113 ms during swallowing. The images were analyzed with respect to oropharyngeal closure duration, anteroposterior and transverse distance between the oropharyngeal walls, and oropharyngeal area before and after closure. Results: Preswallow reduced pharyngeal area was observed (P = .02; mean = 212.61 mm2 for effortful, mean = 261.92 mm2 for normal) as well as prolonged pharyngeal closure during the swallow (P < .0001; mean = 742.18 ms for effortful, mean = 437.31 ms for normal). No other differences were noted between swallow types. Interrater and intrarater reliability of all measurements was excellent. Conclusion: This preliminary investigation is the first to evaluate the effects of effortful swallows via dMRI. In our cohort, consistent physiologic changes were elicited, consistent with clinical dogma regarding this maneuver.

Concurrent oral human papilloma virus infection in patients with recurrent respiratory papillomatosis: A preliminary study

To determine oral human papilloma virus (HPV) colonization in patients with adult‐onset recurrent respiratory papillomatosis (AO‐RRP) and their long‐term partners.

Factors Associated With the Use of Postoperative Analgesics in Patients Undergoing Direct Microlaryngoscopy

Objective: Morbidity associated with suspension laryngoscopy has been well documented. However, standard of care with regard to postoperative analgesia has not been described, and anecdotal evidence suggests wide variability with regard to postoperative narcotic and non-narcotic recommendations. We sought to quantify the postoperative course following suspension microlaryngoscopy by relating patient-based and intraoperative measures with analgesic use. Methods: Body mass index (BMI), Friedman tongue position (FTP), and Mallampati scores as well as laryngoscope type, number of attempts required for optimal visualization, and suspension time were documented in 50 consecutive patients undergoing routine suspension microlaryngoscopy. Postoperative symptoms and analgesic use was queried on postoperative days 1, 3, and 10. Results: In this cohort, 62.5% employed postoperative analgesia. However, only 20% required narcotics. No difference in suspension time was identified in those taking analgesics (33.0 vs 37.3 minutes, P = .44). In addition, no relationship between procedure type and the need for analgesia was noted. The majority of patients (76%) described sore throat persisting for 3 postoperative days; 36% reported sore throat persisting beyond postoperative day 3. Conclusions: The majority of patients undergoing microlaryngoscopy reported discomfort, but symptoms were largely ameliorated with over-the-counter analgesics. Routine prescription of narcotics following routine suspension laryngoscopy may be unnecessary.

Allergic reaction to ortho‐phthalaldehyde following flexible laryngoscopy

Flexible laryngoscopes are common outpatient surveillance tools. Cleansing of these scopes between patients must be quick, effective, and safe. One sterilant that largely meets these criteria is ortho‐phthalaldehyde (OPA); however, infrequently, patients may develop allergic reactions to it. We present three cases of patients who developed significant allergic reactions following repeated laryngoscopic examinations. Subsequent intradermal allergy testing confirmed sensitivity to OPA. In addition, we reviewed the current literature, which includes 17 similar reactions reported in nine patients across disciplines. Allergic reaction to OPA is uncommon, but a potentially under‐reported severe complication of repeated endoscopy. Laryngoscope, 125:2349–2352, 2015