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Chieffe D, Kalos S, Bunting G, Hartnick C. Blue light laser recontouring for pediatric benign fibrovascular vocal fold lesions. Int J Pediatr Otorhinolaryngol 2023; 170:111601. [PMID: 37182361 DOI: 10.1016/j.ijporl.2023.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/09/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Up to 40% of children with hoarseness due to benign fibrovascular vocal fold lesions do not respond to voice therapy and could benefit from further intervention to improve their communication abilities. Currently there are limited surgical options for children too young to comply with post-operative voice rest. We have begun using the 445 nm laser to recontour benign fibrovascular vocal fold lesions without post-operative voice rest in young children with hoarseness due to vocal fold nodules that is unresponsive to voice therapy. This report presents pilot data on the effect of this treatment on pediatric voice-related quality of life. METHODS Pediatric patients with benign fibrovascular lesions and severe subjective dysphonia (per parents or teachers) were given the option of undergoing surgery or continuing voice therapy. Those that opted for surgery underwent 445 nm laser recontouring of their vocal folds. They were discharged home the same day with no voice rest required. Pre- and post-demographic, acoustic measures, auditory perceptual assessments, and validated patient quality of life measures were collected. RESULTS Four patients (ages 3-8y, all male) were selected for surgery. The mean pre- and post-op PVRQOL scores were 59.4 (range: 22.5-80) and 98.1 (range: 97.5-100), respectively (low scores suggest lower voice-related QOL), and a mean change of 38.8 (previously established minimum clinically important difference: 12). Pre- and post-acoustic and aerodynamic measures similarly reflected this improvement. CONCLUSION This pilot case series addresses a commonly seen population (children with benign fibrovascular lesions and significant dysphonia despite voice therapy) where the best practice for timing and types of surgical intervention is unclear. Photoangiolytic lasers (including the 445 nm laser) are gaining popularity for the treatment of benign laryngeal pathologies, and their use may expand treatment possibilities for children with severe dysphonia due to benign vocal fold lesions that do not respond to voice therapy. Further longitudinal investigations are necessary to confirm the safety and efficacy.
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Wu MP, Kaur MN, Feng AL, Pattanaik R, Kammer R, MacLeod B, Farshi AC, Bunting G, Varvares MA, Pusic AL, Klassen AF, Deschler DG. Development and Content Validity of a Novel Patient-Reported Outcome Measure for Total Laryngectomy: The LARY-Q. J Voice 2023:S0892-1997(23)00132-7. [PMID: 37156685 DOI: 10.1016/j.jvoice.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To develop a patient-reported outcomes measure (PROM) for total laryngectomy. STUDY DESIGN Qualitative interviews with a purposive sample of patients with total laryngectomy, followed by cognitive debriefing interviews with patients and expert feedback. METHODS Concept elicitation was performed using in-depth qualitative interviews with a purposive sample of patients who had undergone total laryngectomy. Patients were recruited from head and neck surgery and speech-language pathology clinics as well as via laryngectomy support groups. Interviews were conducted, recorded, transcribed, and coded, resulting in a conceptual framework and item pool. Using the item pool, preliminary scales were drafted. The scales were revised iteratively over 5 rounds using feedback from cognitive interviews with patients and multi-institutional and multi-disciplinary expert feedback. RESULTS A total of 15 patients with total laryngectomy (mean age 68 years, range 57-79) were interviewed resulting in 1555 codes. The codes were used to form a conceptual framework grouped into top-level domains of stoma, function, health-related quality of life, devices, and experience of care. Items were used to form 15 preliminary scales that were revised over five rounds of cognitive debriefing interviews (n = 9 patients) and expert feedback (n = 17 experts). The field-test version of the LARY-Q has 18 scales and 277 items in total. CONCLUSIONS The LARY-Q is a novel PROM designed to assess outcomes associated with total laryngectomy. The next step involves a field test study with a heterogenous sample of patients to assess the psychometric properties of the LARY-Q and perform item reduction.
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Affiliation(s)
- Michael P Wu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.
| | - Manraj N Kaur
- Department of Surgery (Plastic and Reconstructive Surgery), Brigham and Women's Hospital, Boston, MA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA
| | - Rakasa Pattanaik
- Department of Surgery (Plastic and Reconstructive Surgery), Brigham and Women's Hospital, Boston, MA
| | - Rachael Kammer
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA
| | - Bridget MacLeod
- Voice and Speech Laboratory, Massachusetts Eye and Ear, Boston, MA
| | - Anna Choi Farshi
- Voice and Speech Laboratory, Massachusetts Eye and Ear, Boston, MA
| | - Glenn Bunting
- Voice and Speech Laboratory, Massachusetts Eye and Ear, Boston, MA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA
| | - Andrea L Pusic
- Department of Surgery (Plastic and Reconstructive Surgery), Brigham and Women's Hospital, Boston, MA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA
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Beck AJCC, Retèl VP, Bunting G, Sethi RKV, Deschler DG, van den Brekel MWM, van Harten WH. Cost-effectiveness analysis of using the heat and moisture exchangers compared with alternative stoma covers in laryngectomy rehabilitation: US perspective. Head Neck 2020; 42:3720-3734. [PMID: 32885527 DOI: 10.1002/hed.26442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study aims to evaluate the cost-effectiveness of using heat and moisture exchangers (HMEs) vs alternative stoma covers (ASCs) following laryngectomy in the United States. METHODS A cost-effectiveness and budget impact analysis were conducted including uncertainty analyses using real-world survey data with pulmonary events and productivity loss. RESULTS HME use was more effective and less costly compared with ASCs. Quality-adjusted life years were slightly higher for HME-users. Total costs per patient (lifetime) were $59 362 (HME) and $102 416 (ASC). Pulmonary events and productivity loss occurred more frequently in the ASC-users. Annual budget savings were up to $40 183 593. Costs per pulmonary event averted were $3770. CONCLUSIONS HME utilization in laryngectomy patients was cost-effective. Reimbursement of HME devices is thus recommended. Utilities may be underestimated due to the generic utility instrument used and sample size. Therefore, we recommend development of a disease-specific utility tool to incorporate in future analyses.
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Affiliation(s)
- Ann-Jean C C Beck
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Glenn Bunting
- Department of Otolaryngology-Head and Neck Oncology and Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rosh K V Sethi
- Department of Otolaryngology-Head and Neck Oncology and Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Oncology and Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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Shembel AC, Hartnick CJ, Bunting G, Ballif C, Shaiman S, de Guzman V, Abbott KV. Perceptual Clinical Features in Exercise-Induced Laryngeal Obstruction (EILO): Toward Improved Diagnostic Approaches. J Voice 2019; 33:880-893. [DOI: 10.1016/j.jvoice.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
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Tjoa T, Bunting G, Deschler DG. Injectable Soft-Tissue Augmentation for the Treatment of Tracheoesophageal Puncture Enlargement. JAMA Otolaryngol Head Neck Surg 2019; 144:383-384. [PMID: 29543950 DOI: 10.1001/jamaoto.2017.3422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California at Irvine, Orange
| | - Glenn Bunting
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston
| | - Daniel G Deschler
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston
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Hartnick C, Ballif C, De Guzman V, Sataloff R, Campisi P, Kerschner J, Shembel A, Reda D, Shi H, Sheryka Zacny E, Bunting G. Indirect vs Direct Voice Therapy for Children With Vocal Nodules: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:156-163. [PMID: 29270612 DOI: 10.1001/jamaoto.2017.2618] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Benign vocal fold nodules affect 12% to 22% of the pediatric population, and 95% of otolaryngologists recommend voice therapy as treatment. However, no randomized clinical trials that we are aware of have shown its benefits. Objective To determine the impact of voice therapy in children with vocal fold nodules according to pretherapy and posttherapy scores on the Pediatric Voice-Related Quality of Life (PVRQOL) survey; secondary objectives included changes in phonatory parameters. Design, Setting, and Participants For this multicenter randomized clinical trial, 114 children ages 6 to 10 years with vocal fold nodules, PVRQOL scores less than 87.5, and dysphonia for longer than 12 weeks were recruited from outpatient voice and speech clinics. This age range was identified because these patients have not experienced pubertal changes of the larynx, tolerate stroboscopy, and cooperate with voice therapy. Participants were blinded to treatment arm. Interventions Participants received either indirect or direct therapy for 8 to 12 weeks. Indirect therapy focused on education and discussion of voice principles, while direct treatment used the stimulus, response, antecedent paradigm. Main Outcomes and Measures The primary outcome measure was PVRQOL score change before and after treatment. Secondary phonatory measures were also compared. Results Overall, 114 children were recruited for study (mean [SD] age, 8 [1.4] years; 83 males [73%]); with 57 randomized to receive either indirect or direct therapy. Both direct and indirect therapy approaches showed significant differences in PVRQOL scores pretherapy to posttherapy. The mean increase in PVRQOL score for direct therapy was 19.2, and 14.7 for indirect therapy (difference, 4.5; 95.3% CI, -10.8 to 19.8). Of 44 participants in the direct therapy group, 27 (61%) achieved a clinically meaningful PVRQOL improvement, compared with 26 of 49 (53%) for indirect therapy (difference, 8%; 95% CI, -12 to 28). Post hoc stratification showed robust effects in the direct therapy group for older children (Cohen d = 0.50) and the latter two-thirds of participants (Cohen d = 0.46). Vocal fold nodules reduced in size in 31% (22 of 70) and completely resolved in 11% (8 of 70) of participants who consented to a second set of images after going through the recruitment process. Conclusions and Relevance Both direct and indirect voice therapy improved voice-related quality of life in children with vocal fold nodules, although there was no significant difference between approaches. Future studies may focus upon which voice therapy approaches are effective in treating age-defined populations. Trial Registration clinicaltrials.gov Identifier: NCT01255735.
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Affiliation(s)
| | | | | | - Robert Sataloff
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Paolo Campisi
- Hospital for Sick Children, Toronto, Ontario, Canada
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Zenga J, Goldsmith T, Bunting G, Deschler DG. State of the art: Rehabilitation of speech and swallowing after total laryngectomy. Oral Oncol 2018; 86:38-47. [DOI: 10.1016/j.oraloncology.2018.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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Shembel AC, Hartnick CJ, Bunting G, Ballif C, Vanswearingen J, Shaiman S, Johnson A, de Guzman V, Verdolini Abbott K. The Study of Laryngoscopic and Autonomic Patterns in Exercise-Induced Laryngeal Obstruction. Ann Otol Rhinol Laryngol 2018; 127:754-762. [PMID: 30187760 DOI: 10.1177/0003489418796524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES (1) Identify laryngeal patterns axiomatic to exercise-induced laryngeal obstruction (EILO) and (2) investigate the role of autonomic function in EILO. METHODS Twenty-seven athletic adolescents (13 EILO, 14 control) underwent laryngoscopy at rest and exercise. Glottal configurations, supraglottic dynamics, systolic blood pressure responses, and heart rate recovery were compared between conditions and groups. RESULTS Inspiratory glottal angles were smaller in the EILO group than the control group with exercise. However, group differences were not statistically significant ( P > .05), likely due to high variability of laryngeal responses in the EILO group. Expiratory glottal patterns showed statistically greater abductory responses to exercise in the control group ( P = .001) but not the EILO group ( P > .05). Arytenoid prolapse occurred variably in both groups. Systolic blood pressure responses to exercise were higher in the control group, and heart rate recovery was faster in the EILO group. However, no significant differences were seen between the 2 groups on either autonomic parameter ( P > .05). CONCLUSIONS "Paradoxical" inspiratory and blunted expiratory vocal fold pattern responses to exercise best characterize EILO. Group differences were only seen with exercise challenge, thus highlighting the utility of provocation and control groups to identify EILO.
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Affiliation(s)
- Adrianna C Shembel
- 1 Department of Otolaryngology, NYU Langone Medical Center, Voice Center, New York, New York, USA.,2 Massachusetts Eye and Ear, Pediatric Airway, Voice, and Swallowing Center, Division of Pediatric Otolaryngology, Boston, Massachusetts, USA.,3 School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher J Hartnick
- 2 Massachusetts Eye and Ear, Pediatric Airway, Voice, and Swallowing Center, Division of Pediatric Otolaryngology, Boston, Massachusetts, USA
| | - Glenn Bunting
- 4 Massachusetts Eye and Ear, Voice and Speech Laboratory, Boston, Massachusetts, USA
| | - Catherine Ballif
- 4 Massachusetts Eye and Ear, Voice and Speech Laboratory, Boston, Massachusetts, USA
| | - Jessie Vanswearingen
- 3 School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Shaiman
- 3 School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aaron Johnson
- 1 Department of Otolaryngology, NYU Langone Medical Center, Voice Center, New York, New York, USA
| | - Vanessa de Guzman
- 2 Massachusetts Eye and Ear, Pediatric Airway, Voice, and Swallowing Center, Division of Pediatric Otolaryngology, Boston, Massachusetts, USA
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Infusino SA, Diercks GR, Rogers DJ, Garcia J, Ojha S, Maurer R, Bunting G, Hartnick CJ. Establishment of a Normative Cepstral Pediatric Acoustic Database. JAMA Otolaryngol Head Neck Surg 2015; 141:358-63. [DOI: 10.1001/jamaoto.2014.3545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Scott A. Infusino
- Division of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | - Gillian R. Diercks
- Division of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | - Derek J. Rogers
- Division of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | - Jordan Garcia
- Division of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | | | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Glenn Bunting
- Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston
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Affiliation(s)
- Joseph Rohrer
- Department of Otolaryngology, San Antonio Military Medical Center, San Antonio, Texas
| | - Stephen Maturo
- Department of Otolaryngology, San Antonio Military Medical Center, San Antonio, Texas
| | - Courtney Hill
- Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston3Department of Otolaryngology and Laryngology, Harvard Medical School, Boston, Massachusetts
| | - Glenn Bunting
- Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston
| | - Cathy Ballif
- Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston
| | - Christopher Hartnick
- Department of Otolaryngology and Laryngology, Harvard Medical School, Boston, Massachusetts4Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Hill CA, Ojha S, Maturo S, Maurer R, Bunting G, Hartnick CJ. Consistency of Voice Frequency and Perturbation Measures in Children. Otolaryngol Head Neck Surg 2013; 148:637-41. [DOI: 10.1177/0194599813477829] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Evaluate normal pediatric voice frequency and perturbation measures with Voice Evaluation Suite (VES) and Multi Dimensional Voice Program (MDVP), determine the consistency of these measures over time, and understand which measures might be most useful for evaluating children with voice disorders. Study Design Prospective, longitudinal study of normal voices of 50 children aged 4 to 17 years. Setting Pediatric otolaryngology clinic within tertiary hospital. Subjects and Methods Two tests of sustained utterances from each child were evaluated by 2 computerized voice analysis programs for frequency and perturbation. Intraclass correlation coefficient (ICC) was used to assess the reliability between the samples. Results Children (male/female, 1.08:1) with a mean age of 8.34 years were tested on an average of 54.2 minutes apart. Each test included 4 utterances; 1 was analyzed by MDVP, and 3 grouped utterances were averaged and evaluated by VES. Fundamental frequency had excellent reliability (ICC = 0.95) in both VES and MDVP. Jitter, shimmer, and noise to harmonic ratio were poorly reliable (ICC ≤0.4) in MDVP but had good to excellent reliability (ICC 0.66-0.8) in VES. Conclusion Single, sustained utterances in children provide consistent measures of frequency. Perturbation is not reliably measured by such testing, but averaging multiple samples yields improved consistency. Evaluating acoustic measure stability in spontaneous speech and in sustained utterances cued by a tuning frequency can provide further insight on pediatric voice consistency.
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Affiliation(s)
- Courtney A. Hill
- Section of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shilpa Ojha
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Maturo
- Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Catalyst, The Harvard Clinical and Translational Science Center, Boston, Massachusetts, USA
| | - Glenn Bunting
- Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Christopher J. Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Maturo S, Hill C, Bunting G, Ballif C, Maurer R, Hartnick C. Establishment of a Normative Pediatric Acoustic Database. ACTA ACUST UNITED AC 2012; 138:956-61. [DOI: 10.1001/2013.jamaoto.104] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Maturo S, Hill C, Bunting G, Baliff C, Ramakrishna J, Scirica C, Fracchia S, Donovan A, Hartnick C. Pediatric paradoxical vocal-fold motion: presentation and natural history. Pediatrics 2011; 128:e1443-9. [PMID: 22123871 DOI: 10.1542/peds.2011-1003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe (1) a cohort of children with paradoxical vocal-fold motion (PVFM) who were referred to a multidisciplinary airway center and (2) the outcomes of various treatment modalities including speech therapy, gastroesophageal reflux disease treatment, and psychiatric treatment. PATIENTS AND METHODS This was a case series with chart review of children younger than 18 years with PVFM evaluated at a tertiary care pediatric airway center over a 36-month period. RESULTS Fifty-nine children with PVFM were evaluated. The cohort had a mean age of 13.64 years (range: 8-18 years) and a female-to-male ratio of 3:1. Speech therapy as an initial treatment resulted in a 63% (24 of 38) success rate after an average of 3.7 treatment sessions. Speech therapy was a more successful treatment than antireflux therapy (P = .001). Ten percent (6 of 59) of the children presented with a known psychiatric diagnosis, and 30% (18 of 59) of children in the cohort were ultimately diagnosed with a psychiatric condition. Children with inspiratory stridor at rest had a lower initial success rate with speech therapy (56%), a higher rate of underlying psychiatric disorders (75%), and a high rate of success after psychiatric treatment (100%) that required, on average, 3 sessions over a 2-month period. CONCLUSIONS To our knowledge, this is the largest study to date on pediatric PVFM. The majority of children with PVFM improve with speech therapy. Children with PVFM at rest may be better treated with psychiatric therapy than speech therapy. Furthermore, children who present with symptoms at rest may have a higher likelihood of underlying psychiatric disease.
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Affiliation(s)
- Stephen Maturo
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Maturo S, Hill C, Bunting G, Ballif C, Maurer R, Hartnick C. Pediatric laryngeal diadochokinetic rates: establishing a normative database. Otolaryngol Head Neck Surg 2011; 146:302-6. [PMID: 22027868 DOI: 10.1177/0194599811426259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Laryngeal diadochokinetic (L-DDK) rate is a measure of laryngeal neural integrity. The objectives for this study included the following: (1) establish the first comprehensive pediatric normative database for L-DDK rates (DDK) using the Voice Evaluation Suite, a computerized voice analysis program; and (2) analyze normal L-DDK rates for age and gender differences. STUDY DESIGN Cross-sectional study with planned data collection. SETTING Outpatient pediatric otolaryngology clinic. SUBJECTS AND METHODS Three hundred seven children aged 4 to 18 with normal voices. L-DDK rates were collected during a 6-month period. Main outcome measures included age, gender, and L-DDK rates. RESULTS Three hundred seven children (151 girls and 156 boys) were evaluated. There was no statistically significant difference between the overall mean L-DDK rate of boys (2.69 syllables/s) compared to girls (2.55 syllables/s; P > .05). Further analysis of all individual age groups did not reveal any statistical significance between boys and girls. There was a statistically significant difference among children aged 4 to 11 compared to those 12 to 18 years old. Among boys aged 4 to 11, the mean rate was 2.49 syllables per second, whereas among 12- to 18-year-olds, the rate was 2.95 syllables per second (P < .01). The mean rate was 2.40 syllables per second among girls aged 4 to 11 and 2.74 syllables per second for those aged 12 to 18 (P < .01). CONCLUSION This is the largest normative pediatric L-DDK analysis in the English literature. The findings suggest that neurolaryngeal development approaches adult maturation at the beginning of the teenage years. These data have the potential application for objective measurement of neurolaryngeal coordination in children with neurologic impairment and also in children who have undergone nerve reinnervation procedures.
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Affiliation(s)
- Steve Maturo
- Department of Otolaryngology Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Lackland AFB, Texas, USA
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Abstract
Objective: 1) Establish the first comprehensive pediatric normative database for diadochokinetic rates (DDK) using the Voice Evaluation Suite, a computerized voice analysis program. 2) Analyze normal DDK rates for age and gender differences. Method: Observational design analyzing DDK rates on 335 children ages 4 to 18 years with normal voices. Data was collected over a 6-month period from July to December 2010 in a pediatric otolaryngology clinic. Main outcome measures included age, gender, Pediatric Voice Related Quality of Life screening, and DDK rates. Results: The mean DDK rates of each age and gender are presented. There was no statistically significant difference between boys and girls of the same age ( P < .05). There was a statistically significant difference in children ages 4 to 11 years when compared with children ages 12 to 18 years ( P < .001). Conclusion: Pediatric DDK rate is similar between boys and girls of the same age. Faster DDK rates are seen in children over 12 years of age, regardless of gender, when compared with those children younger than 12 years. The normative data presented represents the most comprehensive DDK database in the English language.
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Fink DS, Bhatnagar S, Song P, Bunting G. The Effect of Singing on Laryngopharyngeal Reflux. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811416318a135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: While there has been widespread conjecture regarding the role of laryngopharyngeal reflux in singing, there remains no objective data demonstrating that voice use causes increased reflux. We attempted to objectively analyze pharyngeal pH changes during singing to better understand how it is affected by singing. Method: Eight singers underwent 24-hour pharyngeal pH probe testing with the Restech Dx-pH measurement systemTM, one hour of which was spent singing. The mean pH and number of pH drops were recorded. A one-tailed t test was used to compare the mean pH of the time singing with the 2 control values. Results: The mean pH for the control time was 6.8347, for the control time without the time supine was 6.9164, and for the time singing was 7.0286. We were thus able to reject the null hypothesis that singing decreases laryngeal pH ( P = .035). There was an increase in mean pH during the time singing as compared with the 2 control groups. Conclusion: While singers may have increased reflux complaints, our data suggest that the singing itself does not cause an increase in acid exposure to the laryngopharynx.
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Deschler DG, Emerick KS, Lin DT, Bunting G. Simplified Technique of Tracheoesophageal Prosthesis Placement at the Time of Secondary Tracheoesophageal Puncture. Laryngoscope 2011. [DOI: 10.1002/lary.21985] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hillman R, DeLassus Gress C, Hargrave J, Walsh M, Bunting G. The Efficacy of Speech-Language Pathology Intervention: Voice Disorders. Semin Speech Lang 2008. [DOI: 10.1055/s-2008-1064259] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Disruption of the normal viscoelastic properties of the superficial lamina propria (SLP) results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to determine whether stroboscopy is a reliable method for 1) differentiating invasive glottic carcinoma from intraepithelial atypia or 2) determining the depth of cancer invasion. An analysis was done on the preoperative vocal fold vibration characteristics of 62 keratotic (intraepithelial, 45; cancer, 17) lesions that were subsequently resected by means of microlaryngoscopy. Histopathology and intraoperative mapping were used to specify the depth of invasion. A panel of 4 blinded judges was used to assess the amplitude of vocal fold vibration and the magnitude of mucosal wave activity in the region of the lesion from videostroboscopic recordings. The final comparative data set comprised only those ratings that achieved at least 75% interjudge agreement. Of the 28 intraepithelial lesions that could be reliably evaluated for amplitude of vocal fold vibration, only 2 were normal, with the amplitude reduced in 24 and absent in 2. Of the 30 intraepithelial lesions in which mucosal wave activity could be reliably assessed, only 2 were normal, with the wave reduced in 24 and absent in 4. Furthermore, amplitude of vocal fold vibration and magnitude of mucosal wave propagation were absent in 2 of 4 carcinomas in which the depth of microinvasion did not reach the vocal ligament. According to the findings herein, reduced amplitude of vocal fold vibration and/or mucosal wave propagation associated with keratosis did not reliably predict the presence of cancer or the depth of cancer invasion into the laminae propriae. However, the presence of a flexible mucosal wave probably indicates that there is not extensive vocal ligament invasion. Reductions in the amplitude of vocal fold vibration and in mucosal wave magnitude were usually noted in intraepithelial atypia, despite the fact that there was no invasion into the SLP. The reduced epithelial pliability could be due to bulky keratosis and/or alteration of the SLP occurring as a result of inflammation or fibrovascular scarring.
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Affiliation(s)
- D Colden
- Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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Freeman R, Oliver M, Bunting G, Kirk J, Saunderson W. Addressing children's oral health inequalities in Northern Ireland: a research-practice-community partnership initiative. Public Health Rep 2001; 116:617-25. [PMID: 12196622 PMCID: PMC1497385 DOI: 10.1093/phr/116.6.617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Northern Ireland has a high prevalence of childhood dental caries, reflecting heavy consumption of cariogenic snack foods. To develop a policy to promote and facilitate healthier eating, researchers, practitioners, and the school community formed a partnership, together creating the Boost Better Breaks (BBB) school-based policy. The policy was developed with and supported by dieticians, health promotion officers, teachers, school meal advisors, and local suppliers of school milk. Eighty percent of primary schools and preschool groups within the Southern Health and Social Services Board are involved in the program, which permits the consumption of only milk and fruit at break time. METHODS The authors assessed the effectiveness of the partnership using data from its first two years. RESULTS Results of the first two years of evaluation are positive. Initial findings indicate that the program had a positive effect in increasing the mean number of sound teeth in children attending schools in areas in which socioeconomic conditions are poor. CONCLUSION This initiative suggests that collaboration can facilitate improvement in children's dental health and that careful targeting of the policy to schools in poor areas has the potential to narrow disparities.
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Affiliation(s)
- R Freeman
- Dental Public Health, School of Dentistry, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BP, Northern Ireland.
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McLean-Muse A, Montgomery WW, Hillman RE, Varvares M, Bunting G, Doyle P, Eng J. Montgomery Thyroplasty Implant for vocal fold immobility: phonatory outcomes. Ann Otol Rhinol Laryngol 2000; 109:393-400. [PMID: 10778895 DOI: 10.1177/000348940010900410] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Forty-three patients with a diagnosis of unilateral vocal fold immobility underwent thyroplasty type I with the Montgomery Thyroplasty Implant System. Preoperative and postoperative evaluations were completed by means of videostroboscopic, acoustic, and aerodynamic measures. Clinicians' perceptions of vocal quality and patients' satisfaction with the surgery and vocal quality were determined. Improvements after surgery were observed for glottal closure, vocal fold amplitude, mucosal wave activity, average intensity, maximum intensity range, maximum phonation time, glottal airflow, average sound pressure, and subglottal pressure. Average postsurgical fundamental frequency values fell within normal limits and did not display significant changes relative to presurgical values. The clinicians' perceptual evaluations indicated an improvement in voice quality for most patients. A majority of patients expressed satisfaction with the surgery and resulting voice quality. The results of the present study, in combination with the surgical advantages that have been described for the Montgomery Thyroplasty Implant System, support the view that this approach offers an attractive alternative for treating unilateral vocal fold immobility.
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Affiliation(s)
- A McLean-Muse
- Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston, USA
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Bunting G. Contracting out. A not so sterile exercise. Health Serv J 1987; 97:960-1. [PMID: 10283396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bunting G. Why nursing is so special. Nurs Mirror 1981; 152:32. [PMID: 6907997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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