Sunil P. Verma

Implementation of a program for surgical education in laryngology.

To describe the implementation of a program for surgical education in laryngology.

Office-Based Injection Laryngoplasty for the Management of Unilateral Vocal Fold Paralysis

OBJECTIVE Office-based injection laryngoplasty (OBIL) is a common method of addressing glottal insufficiency. This retrospective chart review identifies the demongraphics, laterality, technique, success rate, injectates, and complications of OBIL performed over a 3-year period at a single institution. STUDY DESIGN Retrospective chart review. METHODS All OBILs performed for the management of UVFP by the senior author over 3 years (2007-2009) were identified from billing records. The age, gender, laterality, underlying disease process, augmentation material, route of injection, and complications were recorded. RESULTS Eighty-two OBILs were attempted on 57 patients. The most common route of access was transoral (85.6%). All OBILs were able to be completed. Injectates used were hyaluronic acid derivatives (57.3%), calcium hydroxyapatite (16%), and Cymmetra (16.5%). Three complications (3.7%) occurred. Thirty percent of patients ultimately elected for thyroplasty or ansa reinnervation, 22% found their condition to self-resolve, 14% died, and 25% were lost to follow-up. CONCLUSIONS Using a variety of approaches, OBIL is possible in almost all patients. The single surgeon transoral route using a rigid angled telescope and curved injection needle was the most commonly used approach. Multiple injectates can be used and have good safety records. The final disposition of patients may be variable and warrants further investigation.

Readability and Understandability of Online Vocal Cord Paralysis Materials

Objective Patients use several online resources to learn about vocal cord paralysis (VCP). The objective of this study was to assess the readability and understandability of online VCP patient education materials (PEMs), with readability assessments and the Patient Education Materials Evaluation Tool (PEMAT), respectively. The relationship between readability and understandability was then analyzed. Study Design and Setting Descriptive and correlational design. Method Online PEMs were identified by performing a Google search with the term “vocal cord paralysis.” After scientific webpages, news articles, and information for medical professionals were excluded, 29 articles from the first 50 search results were considered. Readability analysis was performed with 6 formulas. Four individuals with different educational backgrounds conducted understandability analysis with the PEMAT. Fleiss’s Kappa interrater reliability analysis determined consistency among raters. Correlation between readability and understandability was determined with Pearson’s correlation test. Results The reading level of the reviewed articles ranged from grades 9 to 17. Understandability ranged from 29% to 82%. Correlation analysis demonstrated a strong negative correlation between materials’ readability and understandability (r = −0.462, P < .05). Conclusion Online PEMs pertaining to VCP are written above the recommended reading levels. Overall, materials written at lower grade levels are more understandable. However, articles of identical grade levels had varying levels of understandability. The PEMAT may provide a more critical evaluation of the quality of a PEM when compared with readability formulas. Both readability and understandability should be used to evaluate PEMs.

Histologic analysis of pediatric tonsil and adenoid specimens : Is it really necessary?

OBJECTIVE To evaluate the incidence of unexpected histologic findings in routine tonsillectomy and adenoidectomy specimens. METHODS A retrospective medical record review was performed at a tertiary care childrens hospital. The pathology records of 2062 children who underwent tonsil or adenoid surgery were analyzed and the final histologic diagnosis was recorded. RESULTS Four unexpected histologic findings were found on routine tonsil and adenoid specimens. None were clinically significant. A review of the literature shows a very low rate (0.015%) of unexpected clinically significant diagnoses in pediatric adenotonsillectomy specimens. CONCLUSIONS Given rarity of unexpected clinically significant diagnoses in pediatric adenotonsillectomy specimens, the cost and effort of analyzing each specimen histologically is difficult to justify.

A Novel Device for Measurement of Subglottic Stenosis in 3 Dimensions During Suspension Laryngoscopy

IMPORTANCE A challenge in treating subglottic stenosis is assessment of airway caliber before and after management. At present, surgeons lack a simple, efficient, and precise method of measuring subglottic stenosis intraoperatively. We present a novel, easily reproducible tool for measurement of the diameter, location, and length of subglottic stenosis during suspension laryngoscopy. METHODS AND OBSERVATIONS A set of 5 Kirschner wires (30-cm length and 1.6-mm diameter) were bent 90° at both ends to produce a series of 10 short ends designed to measure airway diameter (0.3- to 2.1-cm length with 2-mm intervals). Short, bent ends of the measuring sticks were designed to measure airway diameter. Hash marks at 2-mm intervals were created along the long axis of the measuring sticks to measure subglottic stenosis length and location relative to the vocal cords. The measuring stick was tested in 10 adult patients undergoing suspension microlaryngoscopy for endoscopic treatment of subglottic stenosis between September 2012 and July 2013. The accuracy of the measuring stick was evaluated using an airway phantom. The measuring stick enabled easy and precise quantification of subglottic stenosis diameter (82.5% agreement with reference; interobserver agreement, r = 0.995; P < .001), length (72.5%; r = 0.995; P < .001) and location during suspension laryngoscopy. CONCLUSIONS AND RELEVANCE The measuring stick is inexpensive and simple to construct. It allows for safe, accurate, and practical measurement of subglottic stenosis diameter, length, and location during suspension laryngoscopy.

Persistent buccopharyngeal membrane: Report of a case and review of the literature

A persistent buccopharyngeal membrane is a rare entity with 23 reported cases in the literature. Patients often present at birth in airway distress with diagnosis initially unrecognized. The otolaryngologist is frequently consulted in the delivery room to establish a secure airway after attempts at direct laryngoscopy are unsuccessful. Historically, definitive treatment has proved challenging. This article presents a new case and thoroughly reviews the literature for previous cases. Embryology, presentation, and treatment options are outlined.

Soot and house dust mite allergen cause eosinophilic laryngitis in an animal model

Chronic laryngitis (CL) is common and costly. One of the most common causes of CL is thought to be laryngopharyngeal reflux, although a significant percentage of individuals fail to get better with acid suppressive therapy. The role of other potential causes of CL such as allergy and environmental pollution has not been thoroughly investigated.

Ambulatory Laryngopharyngeal Surgery: Evaluation of the National Survey of Ambulatory Surgery

OBJECTIVES To determine the demographics and perioperative outcomes of ambulatory laryngopharyngeal surgery in the United States and to investigate potential changes over a 10-year period. DESIGN Cross-sectional, population-based study of representative US ambulatory surgery data. SETTING The National Survey of Ambulatory Surgery (NSAS). PATIENTS The study included all patient records from the 1996 and 2006 National Survey of Ambulatory Surgery databases with at least 1 surgery performed on the pharynx or larynx. By definition, the surgeries were outpatient and did not require an overnight stay within the facility. MAIN OUTCOME MEASURES Data regarding sex, age, facility type, principal payer, anesthesia type and administration, diagnosis, type of surgery, frequency of reported complications, and patient disposition were extracted and analyzed. RESULTS In 1996 and 2006, a total of 176 305 (95% CI, 146 954-205 657; mean [SD] age, 37 [26] years) and 189 930 (95% CI, 135 827-244 003; mean [SD] age, 45 [22] years) patients, respectively, underwent ambulatory laryngopharyngeal surgery. No significant changes were noted in the number, demographics, and outcomes of the patients during the 10-year period. The patients were more likely to be men aged 45 to 64 years and to have their surgery performed in a hospital under general anesthesia. The unexpected admission rate after laryngopharyngeal surgery was less than 4%. While minor complications were present in approximately 9% of all surgeries, no serious adverse events occurred in this representative population. CONCLUSIONS Despite the growth in the US population, the number of patients who underwent ambulatory laryngopharyngeal surgery did not change significantly during the study period. The complication rates of ambulatory laryngopharyngeal surgeries are relatively low, demonstrating the safety of these procedures.

Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography.

Objectives: To determine the feasibility of long-range optical coherence tomography (LR-OCT) as a tool to intraoperatively image and measure the subglottis and trachea during suspension microlaryngoscopy before and after endoscopic treatment of subglottic stenosis (SGS). Methods: Long-range optical coherence tomography of the adult subglottis and trachea was performed during suspension microlaryngoscopy before and after endoscopic treatment for SGS. The anteroposterior and transverse diameters, cross-sectional area (CSA), distance from the vocal cords, and length of the SGS were measured using a MATLAB software. Pre-intervention and postintervention airway dimensions were compared. Three-dimensional volumetric airway reconstructions were generated using medical image processing software (MIMICS). Results: Intraoperative LR-OCT imaging was performed in 3 patients undergoing endoscopic management of SGS. Statistically significant differences in mean anteroposterior diameter (P < .01), transverse diameter (P < .001), and CSA (P < .001) were noted between pre-intervention and postintervention data. Three-dimensional airway models were viewed in cross-sectional format and via virtual “fly through” bronchoscopy. Conclusions: This is the first report of intraoperative LR-OCT of the subglottic and tracheal airway before and after surgical management of SGS in humans. Long-range optical coherence tomography offers a practical means to measure the dimensions of SGS and acquire objective data on the response to endoscopic treatment of SGS.

The Changing Landscape of Total Laryngectomy Surgery

Objective To determine if the number of total laryngectomies (TL) performed in California has changed over a 15-year period from 1996 to 2010. We also sought to investigate if the location of surgery, length of stay, use of rotational/free flaps, cost, and complications changed over this period. Study Design Cross-sectional. Setting California Hospital Inpatient Discharge Data sets. Subjects and Methods All patient records enlisting International Classification of Diseases, Ninth Revision, Clinical Modification procedural codes for total/radical laryngectomy were extracted from 1996 to 2010 data sets. Patients’ demographics were evaluated. Hospitals were coded as university medical centers (UMCs) vs others. Population-adjusted surgery rates, percentage of surgeries with rotational/free flap and/or percutaneous endoscopic gastrostomy (PEG), length of stay, total charges, and disposition status were then analyzed and compared between UMCs and non-UMCs. Results A total of 4145 TLs were performed in California during 1996 to 2010. The overall number of surgeries declined from 1.3 to 0.6 per 100,000 California residents (P < .001). The number of surgeries performed in non-UMCs dropped by 70% during this period (P < .001). The median length of stay increased from 10 to 12 days, and the median total charges increased from