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DeVore EK, Adamian N, Jowett N, Wang T, Song P, Franco R, Naunheim MR. Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility. Laryngoscope 2023; 133:2285-2291. [PMID: 36326102 DOI: 10.1002/lary.30473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE (1) To compare maximum glottic opening angle (anterior glottic angle, AGA) in patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI) and normal larynges (NL), and (2) to correlate maximum AGA with patient-reported outcome measures. METHODS Patients wisth BVFI, UVFI, and NL were retrospectively studied. An open-source deep learning-based computer vision tool for vocal fold tracking was used to analyze videolaryngoscopy. Minimum and maximum AGA were calculated and correlated with three patient-reported outcomes measures. RESULTS Two hundred and fourteen patients were included. Mean maximum AGA was 29.91° (14.40° SD), 42.59° (12.37° SD), and 57.08° (11.14° SD) in BVFI (N = 70), UVFI (N = 70), and NL (N = 72) groups, respectively (p < 0.001). Patients requiring operative airway intervention for BVFI had an average maximum AGA of 24.94° (10.66° SD), statistically different from those not requiring intervention (p = 0.0001). There was moderate negative correlation between Dyspnea Index scores and AGA (Spearman r = -0.345, p = 0.0003). Maximum AGA demonstrated high discriminatory ability for BVFI diagnosis (AUC 0.92, 95% CI 0.81-0.97, p < 0.001) and moderate ability to predict need for operative airway intervention (AUC 0.77, 95% CI 0.64-0.89, p < 0.001). CONCLUSIONS A computer vision tool for quantitative assessment of the AGA from videolaryngoscopy demonstrated ability to discriminate between patients with BVFI, UVFI, and normal controls and predict need for operative airway intervention. This tool may be useful for assessment of other neurological laryngeal conditions and may help guide decision-making in laryngeal surgery. LEVEL OF EVIDENCE III Laryngoscope, 133:2285-2291, 2023.
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Affiliation(s)
- Elliana Kirsh DeVore
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nat Adamian
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nate Jowett
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tiffany Wang
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Phillip Song
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ramon Franco
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Matthew Roberts Naunheim
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Talmor G, Tseng C, Nguyen B, Badash I, Lovinescu CD, Benson B, Kaye R. Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes. Laryngoscope 2023; 133:6-14. [PMID: 35253905 DOI: 10.1002/lary.30097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy. METHODS The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded. RESULTS We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated. CONCLUSION Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring. Laryngoscope, 133:6-14, 2023.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ido Badash
- Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Corina Din Lovinescu
- New York Center for Voice and Swallowing Disorders, Mount Sinai St. Luke's Roosevelt, New York, New York, U.S.A
| | - Brian Benson
- Department of Otolaryngology-Head and Neck Surgery, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, U.S.A
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