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Conti KR, Zhao A, Hunt E, Jaworek AJ. Practical Application of Culture-Directed Treatment for Chronic Bacterial Laryngitis. Laryngoscope 2024; 134:335-339. [PMID: 37515504 DOI: 10.1002/lary.30906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/25/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND/OBJECTIVES Situated at the center of the upper aerodigestive tract, the larynx often is susceptible to a variety of insults including infection. Manifestations of laryngitis include hoarseness, cough, and sore throat, among others. The purpose of this research is to better understand the clinical presentation and patient characteristics of chronic infectious laryngitis. We aim to better understand when culture-directed therapy should be initiated in patients presenting to the otolaryngologist with suspected chronic infectious laryngitis and how this may influence treatment outcomes. METHODS A single center, retrospective chart review was performed for patients with laryngitis of >3 weeks duration and who had positive laryngeal cultures obtained at a tertiary referral laryngology office from January 2016 through January 2023. RESULTS Twenty-four patients (ages 36-84 years) with 29 positive cultures of the larynx met inclusion criteria. Ninety percent of patients were already on acid suppression therapy prior to culture acquisition. Fifty-five percent were immunocompromised. The most common species of bacterial growth included Klebsiella sp. (27.5%), Staphylococcus sp. (27.5%), and methicillin-resistant staphylococcus sp. (13.7%). Twelve cultures (41.4%) revealed multiple bacterial species, and 10 cultures (34.5%) had concomitant fungal isolates. The average treatment duration was 10 days. Twenty-one patients (72%) experienced improvement or resolution in symptoms after completion of culture-directed therapy. CONCLUSIONS The use of culture-directed therapy for chronic bacterial laryngitis was helpful in the determination of appropriate treatment in these cases. More studies are needed to determine the optimal timing of cultures, duration of treatment, and implications of concomitant fungal laryngitis. LEVEL OF EVIDENCE 4 Laryngoscope, 134:335-339, 2024.
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Affiliation(s)
- Keith R Conti
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, U.S.A
| | - Adelaide Zhao
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Erin Hunt
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, U.S.A
| | - Aaron J Jaworek
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, U.S.A
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Klimza H, Witkiewicz J, Jackowska J, Wierzbicka M. Difficult glottis: Diagnostic dilemma in viewof the clinical presentation. OTOLARYNGOLOGIA POLSKA 2023; 77:53-57. [PMID: 37772377 DOI: 10.5604/01.3001.0053.7263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<br><b>Introduction:</b> The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.</br> <br><b>Aim:</b> The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.</br> <br><b>Material and method:</b> The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.</br> <br><b>Results:</b> Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.</br> <br><b>Conclusions:</b> To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.</br>.
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Affiliation(s)
- Hanna Klimza
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Medical University of Karol Marcinkowski, Poznan, Poland
| | - Joanna Witkiewicz
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Medical University of Karol Marcinkowski, Poznan, Poland
| | - Joanna Jackowska
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Medical University of Karol Marcinkowski, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Medical University of Karol Marcinkowski, Poznan, Poland
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Mohd Ramli SS, Mat Baki M. Glottic Staphylococcus aureus in a patient with systemic lupus erythematosus: videolaryngostroboscopic characteristics. BMJ Case Rep 2022; 15:e245840. [PMID: 35228218 PMCID: PMC8886378 DOI: 10.1136/bcr-2021-245840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
Systemic lupus erythematous (SLE) is an autoimmune disease commonly treated with steroid which leads to immunosuppression and increased susceptibility to infection. Chronic laryngitis with whitish lesion on the true vocal fold in SLE may be caused by opportunistic organisms, such as tuberculous, fungal and Staphylococcus aureus infections. Videolaryngostroboscopy may be helpful in leading to the diagnosis and optimum treatment of glottic S. aureus A woman in her 40s with SLE presented with progressively worsening hoarseness for 2 months, accompanied by sore throat and odynophagia. Videoendoscopy showed erythematous and oedematous bilateral vocal fold with whitish lesion seen at the edge of middle one-third while the videolaryngostroboscopic evaluation showed there was severe asymmetry of the bilateral vocal folds, with severely reduced amplitude during phonation where the vocal cords were not vibrating, aperiodic vibratory cycles and 'always open', incomplete closure of vocal cord pattern. Later, endolaryngeal microsurgery and biopsy of the lesion confirmed of glottic S. aureus Her symptoms and followed up videolaryngostroboscopy showed resolution to normal findings after 6 weeks of cloxacillin. S. aureus infection of the glottis is a differential diagnosis in a chronic laryngitis with leucoplakic lesion in an immunosuppressive patient. Videolaryngostroboscopy has an important role in diagnosis, evaluation and treatment decision.
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Affiliation(s)
- Siti Sarah Mohd Ramli
- Department of Otorhinolarynology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolarynology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
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4
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Toyoshima H, Yamada H, Tanigawa M, Sakabe S. Chronic Bacterial Laryngitis: A Diagnostic Pitfall for Clinicians. Intern Med 2022; 61:597-598. [PMID: 34544943 PMCID: PMC8907767 DOI: 10.2169/internalmedicine.7796-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hirokazu Toyoshima
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Japan
| | - Hiroyuki Yamada
- Department of Otorhinolaryngology, Head and Neck Surgery, Japanese Red Cross Ise Hospital, Japan
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Japan
| | - Shigetoshi Sakabe
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, Japan
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Michael A, Vesole AS, Diekema DJ, Stegall H, Hoffman HT. Use of a transnasal flexible laryngoscope tip for laryngeal culturing: A novel in-office technique. Laryngoscope Investig Otolaryngol 2022; 7:197-201. [PMID: 35155798 PMCID: PMC8823174 DOI: 10.1002/lio2.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In-office culture of the larynx using a flexible laryngoscope tip can help identify laryngeal pathogens in cases of laryngitis. OBJECTIVE This retrospective case series aimed to investigate the feasibility of in-office laryngoscope tip culture to identify laryngeal pathogens and help guide medical treatment. METHODS This case series consists of 8 patients who underwent 11 in-office laryngeal cultures using the tip of the flexible laryngoscope. Concurrent nasal cultures were performed on two patients to assess for possible nasal contamination of these laryngoscope tip cultures. RESULTS Nine patients underwent laryngeal culture with laryngoscope tip in-office, with two patients undergoing repeat swabs for a total of eleven swabs. Then, 8 of 11 swabs (73%) grew methicillin-sensitive Staphylococcus aureus, while 1 of 11 (9.1%) swabs grew methicillin-resistant S. aureus. Three of eleven swabs (27%) grew Candida species. Concurrent culture was performed of the contralateral nasal cavity in two patients to assess for the possibility of nasal contamination of laryngoscope tip cultures. Concurrent contralateral nasal cultures grew distinct pathogens compared to the laryngeal cultures, suggesting that nasal contamination did not occur. CONCLUSION In-office laryngoscope tip culture allows safe identification of laryngeal pathogens in an ambulatory setting. In-office laryngoscope tip culture can help guide medical treatment of laryngeal infections. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alexander Michael
- Department of Otolaryngology Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Adam S. Vesole
- University of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Daniel J. Diekema
- Department of Internal Medicine, Infectious DiseasesUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Helen Stegall
- Department of Otolaryngology Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Henry T. Hoffman
- Department of Otolaryngology Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Abstract
Hintergrund Die prolongierte ulzerierende Laryngitis ist eine seltene, gutartige, über Monate andauernde entzündliche Veränderung des Larynx. Der lupenlaryngoskopische Befund lässt einen malignen Prozess vermuten und kann somit eine Herausforderung für den behandelnden Hals-Nasen-Ohren-Arzt (HNO-Arzt) darstellen. Fragestellung Darstellung der aktuellen Datenlage, um einen für den klinischen Alltag hilfreichen Überblick über Ätiologie, Verlauf und Therapieoptionen zu geben. Material und Methoden Präsentation von 3 Fallbeispielen aus der Abteilung für Phoniatrie und Klinische Logopädie der ORL-Klinik des Universitätsspitals Zürich. Analyse und Diskussion der aktuellen Studienlage und von Einzelfallberichten aus der englischsprachigen Literatur. Ergebnisse Ätiologie und prädisponierende Faktoren sind unklar. Ein vorangegangener Atemwegsinfekt mit Husten und Heiserkeit scheint die häufigste Ursache zu sein. Die Erkrankung weist einen selbstlimitierenden Krankheitsverlauf ohne strukturell dauerhafte Folgen auf. Biopsien sollten vermieden werden. Schlussfolgerung Der typische laryngoskopische Befund zeigt umschriebene korrespondierende lanzettförmige Ulzerationen im mittleren Stimmlippendrittel. Der Krankheitsverlauf scheint selbstlimitierend zu sein und ohne strukturell dauerhafte Folgen abzulaufen. Deswegen sollten eine gute Patientenaufklärung und engmaschige laryngoskopische Kontrollen vorgenommen werden.
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Affiliation(s)
- S Reetz
- Abteilung Phoniatrie und Klinische Logopädie, Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, UniversitätsSpital Zürich, Universität Zürich, Frauenklinikstr. 24, 8091, Zürich, Schweiz.
| | - M Brockmann-Bauser
- Abteilung Phoniatrie und Klinische Logopädie, Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, UniversitätsSpital Zürich, Universität Zürich, Frauenklinikstr. 24, 8091, Zürich, Schweiz
- Universität Zürich, Rämistr. 71, 8006, Zürich, Schweiz
| | - J E Bohlender
- Abteilung Phoniatrie und Klinische Logopädie, Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, UniversitätsSpital Zürich, Universität Zürich, Frauenklinikstr. 24, 8091, Zürich, Schweiz
- Universität Zürich, Rämistr. 71, 8006, Zürich, Schweiz
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Zainal Abidin SS, Kew TY, Azman M, Mat Baki M. Pseudomonas laryngeal perichondritis: unexpected diagnosis. BMJ Case Rep 2020; 13:13/12/e237129. [PMID: 33370978 PMCID: PMC7757453 DOI: 10.1136/bcr-2020-237129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months' duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa The patient made a good recovery following treatment with oral ciprofloxacin.
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Affiliation(s)
- Siti Salwa Zainal Abidin
- Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Thean Yean Kew
- Department of Radiology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Abstract
Chronic laryngitis is an inflammatory process of at least 3 weeks duration and affects phonation, breathing, and swallowing. This article describes the infectious, inflammatory, and autoimmune causes of chronic laryngitis. Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy.
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Casazza G, Graham ME, Nelson D, Chaulk D, Sandweiss D, Meier J. Pediatric Bacterial Tracheitis-A Variable Entity: Case Series with Literature Review. Otolaryngol Head Neck Surg 2018; 160:546-549. [PMID: 30348058 DOI: 10.1177/0194599818808774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the presentation and treatment of children diagnosed with bacterial tracheitis at our institution and to review the available literature focusing on key presenting symptoms and clinical outcomes of children diagnosed with bacterial tracheitis. STUDY DESIGN Case series with literature review. SETTING Tertiary children's hospital and available literature. SUBJECTS AND METHODS Case series of children with bacterial tracheitis retrospectively reviewed at a tertiary children's hospital. Those with a tracheostomy or those who developed bacterial tracheitis as a complication of prolonged intubation were excluded. RESULTS Thirty-six children were identified (mean ± SD age, 6.7 ± 4.5 years). The most common presenting symptom was cough (85%), followed by stridor (77%) and voice changes/hoarseness (67%). A concurrent viral illness was found for 55%, and the most common bacteria cultured was methicillin-sensitive Staphylococcus aureus. Pediatric intensive care admission occurred for 69%, and 43% required intubation. No patient required tracheostomy. One patient (2.7%) died secondary to airway obstruction and subsequent respiratory arrest. Four patients had recurrence of bacterial tracheitis 4 to 12 months following their initial presentation. CONCLUSION Bacterial tracheitis is an uncommon condition with an atypical presentation and variable clinical course but serious consequences if left unrecognized. Staphylococcus is the most common bacteria identified, and many patients will have a prodromal viral illness. Changes in patient epidemiology and presentation may have occurred over time.
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Affiliation(s)
- Geoffrey Casazza
- 1 Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.,2 Primary Children's Hospital, Salt Lake City, Utah, USA
| | - M Elise Graham
- 1 Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.,2 Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Douglas Nelson
- 2 Primary Children's Hospital, Salt Lake City, Utah, USA.,3 Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - David Chaulk
- 2 Primary Children's Hospital, Salt Lake City, Utah, USA.,3 Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - David Sandweiss
- 2 Primary Children's Hospital, Salt Lake City, Utah, USA.,3 Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Meier
- 1 Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.,2 Primary Children's Hospital, Salt Lake City, Utah, USA
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Tachibana T, Orita Y, Makino T, Komatsubara Y, Matsuyama Y, Naoi Y, Nakada M, Sato Y, Nishizaki K. Prognostic factors and importance of recognition of adult croup. Acta Otolaryngol 2018; 138:579-583. [PMID: 29310492 DOI: 10.1080/00016489.2017.1422140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Croup, or laryngotracheobronchitis, is a common disease in childhood. On the other hand, to our knowledge, there are only 14 cases in six English literatures describing adult croup (AC). The clinical features of AC have not been well known. METHODS We conducted a retrospective analysis of medical records of 18 patients with AC during the period from 2008 to 2016. RESULTS None of the 18 patients required an urgent airway intervention. Univariate analysis indicated that the duration of symptoms was significantly longer in patients with cough (p < .01) and younger patients (age < 60, p = .037). The duration of subglottic edema was significantly longer in female (p = .035), patients with high levels of CRP (≥1 mg/dL, p = .049), and patients with cough symptom (p = .035). CONCLUSIONS Female, young age (<60 years), the symptom of cough, and high levels of CRP should be recognized as signs of prolonged AC. It is important to confirm the diagnosis of AC by laryngoscopic examination, which also help to avoid airway intervention.
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Affiliation(s)
- Tomoyasu Tachibana
- Department of Otolaryngology, Himeji Red Cross Hospital, Himeji City, Japan
| | - Yorihisa Orita
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto City, Japan
| | - Takuma Makino
- Department of Otolaryngology, Himeji Red Cross Hospital, Himeji City, Japan
| | | | - Yuko Matsuyama
- Department of Otolaryngology, Himeji Red Cross Hospital, Himeji City, Japan
| | - Yuto Naoi
- Department of Otolaryngology, Himeji Red Cross Hospital, Himeji City, Japan
| | | | - Yasuharu Sato
- Pathology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
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Carpenter PS, Kendall KA. MRSA chronic bacterial laryngitis: A growing problem. Laryngoscope 2017; 128:921-925. [DOI: 10.1002/lary.26955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/10/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Patrick S. Carpenter
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
| | - Katherine A. Kendall
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery; University of Utah Health System; Salt Lake City Utah U.S.A
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