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Pagel JML, Reddy A, Fitzgerald L, Tiouririne M, McGarey PO, Quinn DB, Daniero JJ. The Effect of Laser-Resistant Endotracheal Tube Design on Airflow Dynamics: A Benchtop and Clinical Study. Ann Otol Rhinol Laryngol 2024:34894241238861. [PMID: 38491861 DOI: 10.1177/00034894241238861] [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] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Compare ventilation pressures of 2 endotracheal tube designs used in laser airway surgery in clinical practice and with a benchtop model to elucidate differences and understand the design elements that impact airflow dynamics. METHODS Ventilatory and aerodynamic characteristics of the laser resistant stainless-steel endotracheal tube (LRSS-ET) design and the laser resistant aluminum-wrapped silicone endotracheal tube (LRAS-ET) design were compared. Ventilatory parameters were collected for 32 patients undergoing laser-assisted airway surgery through retrospective chart review. An in vitro benchtop simulation measured average resistance and centerline turbulence intensity of both designs at various diameters and physiological frequencies. RESULTS Baseline patient characteristics did not differ between the 2 groups. Clinically, the median LRAS-ET peak inspiratory pressure (PIP; 21.00 cm H2O) was significantly decreased compared to LRSS-ET PIP (34.67 cm H2O). In benchtop simulation, the average PIP of the LRAS-ET was significantly lower at all sizes and frequencies. The LRSS-ET consistently demonstrated an increased resistance, although no patterns were observed in turbulence intensity data between both designs. CONCLUSION The benchtop model demonstrated increased resistance in the LRSS-ET compared to the LRAS-ET at all comparable sizes. This finding is supported by retrospective ventilatory pressures during laser airway surgery, which show significantly increased PIPs when comparing identically sized inner diameters. Given the equivocal turbulence intensity data, these differences in resistance and pressures are likely caused by wall roughness and intraluminal presence of tubing, not inlet or outlet geometries. The decreased PIPs of the LRAS-ET should assist in following lung protective ventilator management strategies and reduce risk of pulmonary injury and hemodynamic instability to the patient.
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Affiliation(s)
- Jessica M L Pagel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Adithya Reddy
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Lucy Fitzgerald
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Mohamed Tiouririne
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Daniel B Quinn
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
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De La Chapa JS, Webb K, Stadlin C, Reddy A, Schoeff SF, Reed R, McColl LF, Thiele RH, Daniero JJ. Evolving Endotracheal Tube Preferences and Practices: Intensivist Knowledge Gaps and Sex Disparities. Laryngoscope 2023; 133:3080-3086. [PMID: 37191079 DOI: 10.1002/lary.30744] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/03/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The complex management of intubation-related laryngeal injury makes prevention vital. The purpose of this study is to assess endotracheal tube (ETT) practices and preferences among intensivists at our institution. METHODS Chart review of intubated patients and intensivist survey were simultaneously performed in January 2016 and August 2022. A height-to-ETT size ratio (H:ETT) was calculated for each patient in the 2022 cohort. Intubated patients were followed until tracheostomy, extubation, or death occurred. Surveys assessed intensivist preferences for ETT size and management of intubated patients. RESULTS 300 ICU patients were included. The mean ETT size for males decreased from 7.73 ± 0.30 in 2016 to 7.57 ± 0.25 in 2022 (p < 0.001). The average H:ETT of men was higher than females (p = 0.004), indicating that females in this population were intubated with larger ETTs relative to their height compared to males. Whereas the majority (66.7%) of intensivists endorse 7.0 ETTs as the standard for women, the majority (70%) of women at our institution are intubated with a 7.5 ETT or larger. Of intubated patients in the ICU, 23 (19.5%) were intubated for 11 days or longer. CONCLUSIONS Compared to men, women are intubated with larger-than-preferred ETTs relative to height. Additionally, patients in our study were intubated for longer than preferred based on intensivist surveys, putting this population at higher risk for acute laryngeal injury (AlgI)-related laryngotracheal stenosis (LTS). Further studies should seek to identify similar trends and barriers to reducing ALgI-related LTS. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3080-3086, 2023.
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Affiliation(s)
- Julian S De La Chapa
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine Webb
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Cameron Stadlin
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Adithya Reddy
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F Schoeff
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Robert Reed
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Logan F McColl
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Robert H Thiele
- Critical Care, University of Virginia Department of Anesthesiology, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Pruett LJ, Kenny HL, Swift WM, Catallo KJ, Apsel ZR, Salopek LS, Scumpia PO, Cottler PS, Griffin DR, Daniero JJ. De novo tissue formation using custom microporous annealed particle hydrogel provides long-term vocal fold augmentation. NPJ Regen Med 2023; 8:10. [PMID: 36823180 PMCID: PMC9950481 DOI: 10.1038/s41536-023-00281-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 01/25/2023] [Indexed: 02/25/2023] Open
Abstract
Biomaterial-enabled de novo formation of non-fibrotic tissue in situ would provide an important tool to physicians. One example application, glottic insufficiency, is a debilitating laryngeal disorder wherein vocal folds do not fully close, resulting in difficulty speaking and swallowing. Preferred management of glottic insufficiency includes bulking of vocal folds via injectable fillers, however, the current options have associated drawbacks including inflammation, accelerated resorption, and foreign body response. We developed a novel iteration of microporous annealed particle (MAP) scaffold designed to provide persistent augmentation. Following a 14-month study of vocal fold augmentation using a rabbit vocal paralysis model, most MAP scaffolds were replaced with tissue de novo that matched the mixture of fibrotic and non-fibrotic collagens of the contralateral vocal tissue. Further, persistent tissue augmentation in MAP-treated rabbits was observed via MRI and via superior vocal function at 14 months relative to the clinical standard.
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Affiliation(s)
- Lauren J. Pruett
- grid.27755.320000 0000 9136 933XDepartment of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903 USA
| | - Hannah L. Kenny
- grid.27755.320000 0000 9136 933XSchool of Medicine, University of Virginia, Charlottesville, VA 22903 USA
| | - William M. Swift
- grid.27860.3b0000 0004 1936 9684Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616 USA
| | - Katarina J. Catallo
- grid.27755.320000 0000 9136 933XDepartment of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903 USA
| | - Zoe R. Apsel
- grid.27755.320000 0000 9136 933XDepartment of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903 USA
| | - Lisa S. Salopek
- grid.27755.320000 0000 9136 933XDepartment of Plastic Surgery, University of Virginia, Charlottesville, VA 22903 USA
| | - Philip O. Scumpia
- grid.19006.3e0000 0000 9632 6718Department of Medicine, Division of Dermatology and Department of Pathology, Division of Dermatopathology, University of California, Los Angeles, CA 90095 USA
| | - Patrick S. Cottler
- grid.27755.320000 0000 9136 933XDepartment of Plastic Surgery, University of Virginia, Charlottesville, VA 22903 USA
| | - Donald R. Griffin
- grid.27755.320000 0000 9136 933XDepartment of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903 USA ,grid.27755.320000 0000 9136 933XDepartment of Chemical Engineering, University of Virginia, Charlottesville, VA 22903 USA
| | - James J. Daniero
- grid.27755.320000 0000 9136 933XDepartment of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA 22903 USA
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Swift WM, Churnin IT, Hamdi OA, Strumpf AM, Koehn HA, Cottler PS, Daniero JJ. A Simple and Reproducible In Vivo Rabbit Phonation Model for Glottic Insufficiency. Otolaryngol Head Neck Surg 2023; 168:203-209. [PMID: 35763368 DOI: 10.1177/01945998221107813] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation. STUDY DESIGN Nonrandomized controlled animal trial. SETTING Academic medical center. METHODS A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ. RESULTS Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral. CONCLUSION The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.
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Affiliation(s)
- William M Swift
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Ian T Churnin
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew M Strumpf
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Heather A Koehn
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia, USA
| | - Patrick S Cottler
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Tierney WS, Huang LC, Chen SC, Berry LD, Anderson C, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Makani SS, Maldonado F, Matrka L, McWhorter AJ, Merati AL, Mori M, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rohlfing M, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO, Gelbard A. Comparative Treatment Outcomes for Idiopathic Subglottic Stenosis: 5-Year Update. Otolaryngol Head Neck Surg 2023; 168:1570-1575. [PMID: 36939627 DOI: 10.1002/ohn.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/25/2022] [Revised: 08/18/2022] [Accepted: 09/10/2022] [Indexed: 01/20/2023]
Abstract
The North American Airway Collaborative (NoAAC) previously published a 3-year multi-institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re-enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision-making. Level of evidence: 2-prospective cohort study.
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Affiliation(s)
- William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynn D Berry
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Catherine Anderson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Milan R Amin
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Joel H Blumin
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan M Bock
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Paul F Castellanos
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, Mercy Health-St. Rita's Ear, Nose and Throat, Lima, Ohio, USA
| | - Seth M Cohen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Brianna K Crawley
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Duke University, Durham, North Carolina, USA
| | - Seth H Dailey
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Eric S Edell
- Department of Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, Mercy Health-St. Rita's Ear, Nose and Throat, Lima, Ohio, USA
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Harvard University, Boston, Massachusetts, USA
| | - Catherine Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cheryl Kinnard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander J Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Lentz
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert R Lorenz
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - David G Lott
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Samir S Makani
- Scripps Health, Coastal Pulmonary Associates, Encinitas, California, USA
| | - Fabien Maldonado
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew Mori
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai, New York, New York, USA
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Augusta University Health, Augusta, Georgia, USA
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brent E Richardson
- Department of Otolaryngology-Head and Neck Surgery, Bastian Voice Institute for Voice, Swallowing, and Airway Disorders, Downers Grove, Illinois, USA
| | - Otis B Rickman
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Matthew Rohlfing
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Guri S Sandhu
- Department of Otolaryngology-Head and Neck Surgery, The London Clinic, London, England
| | - Joshua S Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Glenn Todd Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Sigríður Sveinsdóttir
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital of Iceland, Reykjavik, Iceland, UK
| | - David Veivers
- Ear Nose and Throat, University of Sydney, Sydney, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Paul M Weinberger
- Department of Otolaryngology-Head and Neck Surgery, Ark-La-Tex Center for Voice, Airway & Swallowing, Shreveport, Louisiana, USA
| | - Philip A Weissbrod
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - David O Francis
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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De La Chapa JS, Harryman CJ, McGarey PO, Daniero JJ. Clinical Characteristics of the Cervical Inlet Patch: A Case Series. OTO Open 2023; 7:e24. [PMID: 36998556 PMCID: PMC10046733 DOI: 10.1002/oto2.24] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/21/2022] [Accepted: 12/10/2022] [Indexed: 02/19/2023] Open
Abstract
Objective The goal of this study was to characterize the symptoms and outcomes of patients with a symptomatic cervical inlet patch (CIP). Study Design Retrospective case series. Setting Tertiary care laryngology clinic in Charlottesville, Virginia. Methods A retrospective chart review of the patient's demographics, comorbidities, prior workup, interventions, and response to treatment was performed. All patients received flexible nasolaryngoscopy and barium swallow study. The analysis was descriptive. Results Eight patients (6 female) were followed for the management of symptoms related to CIP. The mean age at presentation to our clinic was 64.9 (standard deviation = 15.7). Five out of 8 patients presented with a chief complaint of dysphagia, and the remaining 3 with chronic coughs. Five out of 8 patients demonstrated findings of laryngopharyngeal reflux (LPR) including vocal fold edema, mucosal erythema, or postcricoid edema. Swallow study demonstrated hiatal hernia in 3 of 8 patients, and cricopharyngeal (CP) dysfunction (CP hypertrophy, CP bar, and Zenker's diverticulum) in 3 of 8 patients. One patient presented with a history of Barrett's esophagus. Treatment included increased acid suppression therapy and management of coexisting esophageal pathologies. Ablative procedures were performed in 5 out of 8 cases, with 2 patients requiring repeat procedures. All patients experience subjective symptom improvement. Conclusion CIP tends to present in complex patients with multifactorial dysphagia, with the most common symptoms being dysphagia and cough. Clinical features of CIP overlap with other more common pathologies encountered by otolaryngologists including LPR and CP dysfunction, and future prospective studies in larger populations should seek to clarify these associations.
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Affiliation(s)
- Julian S. De La Chapa
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia USA
| | - Christopher J. Harryman
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia USA
| | - Patrick O. McGarey
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia USA
| | - James J. Daniero
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia USA
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7
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De La Chapa JS, Bellinger JR, Timm AR, Daniero JJ. "Quality, Readability, and Understandability of Online Posterior Glottic Stenosis Information". J Voice 2022:S0892-1997(22)00388-5. [PMID: 36585308 DOI: 10.1016/j.jvoice.2022.11.036] [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] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the quality, readability, and understandability of posterior glottic stenosis (PGS) information available to patients online. METHODS The top 50 Google search results for "posterior glottic stenosis" were categorized based on website affiliation and target audience (patient or provider). Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and the Flesch Reading Ease (FRE) scores. The DISCERN tool was used to assess quality and the Patient Education Assessment Tool for Printed Materials (PEMAT-P) was used to assess understandability and actionability. Simple descriptive statistics were used to analyze the data. RESULTS 36 of the top 50 results were eligible for scoring. 17% (6 of 36) were classified as patient-focused while 83% (30 of 36) were provider-focused. Patient-focused materials had a higher mean FRE score (36.9) than provider-focused materials (15.5) (P < 0.001). Patient-focused materials had an average reading level of 12.5 compared to 15.8 for provider-focused materials (P < 0.001). There was a significant correlation between overall PEMAT-P and DISCERN (r = 0.63, P < 0.001), PEMAT-P understandability and DISCERN (r = 0.63, P < 0.001) and FRES and FKGL (r = -0.67, P < 0.001). From this, we can infer that higher quality sites are easier to understand but not necessarily tailored to a certain reading level. CONCLUSIONS Shared decision making in PGS management is crucial as patients must be aware of how treatment modalities affect airway, voice, and swallowing. However, this study shows that patient targeted PGS information is limited, and the readability, quality, and understandability is generally low. We suggest the development of web pages with PGS information tailored for patient education and search optimization to make this information appear earlier in Google search results. Furthermore, future studies should seek to characterize the link between online health information and socioeconomic-based health disparities.
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Affiliation(s)
- Julian S De La Chapa
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia.
| | - Jeffrey R Bellinger
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia
| | - Allyson R Timm
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia
| | - James J Daniero
- University of Virginia Department of Otolaryngology - Head and Neck Surgery, Charlottesville, Virginia
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8
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Duong MN, Strumpf A, Daniero JJ, Jameson MJ, Mattos JL. Redesigning Journal Club to Improve Participant Satisfaction and Education. J Surg Educ 2022; 79:964-973. [PMID: 35241395 DOI: 10.1016/j.jsurg.2022.01.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/08/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Journal clubs are a fundamental part of medical training that allow residents and faculty to critically analyze literature, keep up-to-date with new advancements, and implement evidence-based medicine. The aim of this study was to describe one otolaryngology residency program's efforts towards reformatting its journal club, evaluate how well the re-designed format enabled participants to achieve journal club goals compared to the prior format, and assess faculty and resident qualitative perceptions of both formats. DESIGN An 11-question survey was sent to all department faculty and residents to obtain feedback regarding the original journal club format. The results of this initial survey were then used to redesign the journal club format, which consisted of 3 rotating session types: evidence-based, deep-dive, and landmark. A 6-month pilot program using the redesigned format was implemented, and surveys were sent at the halfway mark and at the conclusion of the pilot to evaluate the effectiveness of these format changes. SETTING A single academic center with an otolaryngology residency program PARTICIPANTS: : Residents and faculty in the department of otolaryngology RESULTS: Compared to the original format, the 6-month pilot demonstrated a more consistent attainment of journal club goals and a near-unanimous preference for the new format. This preference was consistent among both faculty (90.9%) and residents (89%). All respondents agreed that the intended goals of journal club were more frequently met under the revamped format, and statistically significant differences in approval rate were observed in the specific areas of critically assessing the literature, highlighting new findings, and translating forefront knowledge. The overall time required to prepare for sessions was lower for faculty, and higher for residents. CONCLUSIONS The findings from this study help to support programmatic efforts towards redesigning journal clubs with the goals of improving participant satisfaction and educational benefit. With the paucity of data in the literature evaluating journal club format overhauls, this study provides compelling evidence for programs to perform similar assessments and consider redesigns if warranted.
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Affiliation(s)
- Marisa N Duong
- School of Medicine, University of Virginia, Charlottesville, Virgina
| | - Andrew Strumpf
- School of Medicine, University of Virginia, Charlottesville, Virgina; Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - James J Daniero
- School of Medicine, University of Virginia, Charlottesville, Virgina; Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Mark J Jameson
- School of Medicine, University of Virginia, Charlottesville, Virgina; Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Jose L Mattos
- School of Medicine, University of Virginia, Charlottesville, Virgina; Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia.
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9
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Swift WM, Churnin IT, Hamdi OA, Strumpf AM, Koehn HA, Cottler PS, Daniero JJ. A Simple and Reproducible In Vivo Rabbit Phonation Model for Glottic Insufficiency. Otolaryngol Head Neck Surg 2022. [PMID: 35763368 DOI: 10.1177/0194599822110781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation. STUDY DESIGN Nonrandomized controlled animal trial. SETTING Academic medical center. METHODS A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ. RESULTS Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral. CONCLUSION The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.
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Affiliation(s)
- William M Swift
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Ian T Churnin
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew M Strumpf
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Heather A Koehn
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia, USA
| | - Patrick S Cottler
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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10
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Carpenter DJ, Hamdi OA, Finberg AM, Daniero JJ. Laryngotracheal stenosis: Mechanistic review. Head Neck 2022; 44:1948-1960. [PMID: 35488503 PMCID: PMC9543412 DOI: 10.1002/hed.27079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this review article is to summarize the existing literature surrounding wound healing mechanisms in laryngotracheal stenosis. Methods A review of general wound healing pathophysiology, followed by a focused review of iatrogenic laryngotracheal stenosis (iLTS) and idiopathic subglottic stenosis (iSGS) as conditions of aberrant wound healing. Results iLTS is the scarring of the laryngotracheal complex, coming secondary to injury from prolonged intubation. iSGS is a chronic fibroinflammatory scarring and narrowing of the subglottic airway in the absence of any obvious preceding injury or trauma. They are both thought to result from a prolonged and dysregulated wound healing response that promotes the deposition of pathologic scar in the airway. Conclusions Understanding the mechanisms that underlie wound healing will help identify and intervene on the process early in its development and discover future therapies that target individual wound healing mechanisms limiting the incidence of this recalcitrant disease process.
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Affiliation(s)
- Delaney J Carpenter
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ariel M Finberg
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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11
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Hamdi OA, Jonas RH, Daniero JJ. Vocal Fold Paralysis Following COVID-19 Vaccination: Query of VAERS Database. J Voice 2022:S0892-1997(22)00017-0. [PMID: 35193788 PMCID: PMC8784575 DOI: 10.1016/j.jvoice.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Vocal fold paresis or paralysis (VFP) may severely affect quality of life due to dysphonia and respiratory distress. As an increasing percentage of the United States population receives the COVID-19 vaccination, the objective of this study is to determine the correlation of COVID-19 postvaccination recurrent laryngeal neuropathy and resulting VFP. METHODS The Vaccine Adverse Event Reporting System database was queried for patients exhibiting symptoms of VFP following COVID-19 vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, time of diagnosis and laterality. RESULTS Twenty patients were found to have laryngoscopy confirmed VFP following COVID-19 vaccination. Vaccinations for Pfizer-BioNTech, Moderna, and Janssen were reported. Of those reported, 13 patients were female (65.0%) and seven were male (35.0%), with a mean age of 61.8 years. The most common presenting symptom was a hoarse voice (30.0%). A majority of these cases were unilateral in nature (64.0%). Mean time from vaccination to symptom onset was 12.1 days and mean time from vaccination to diagnosis was 37.6 days. CONCLUSION For patients presenting with voice or swallowing complaints after receiving the COVID-19 vaccine, prompt evaluation by an otolaryngologist should occur. However, the potential VFP side effect of vaccination is very rarely cited in the literature and largely outweighed by the benefits of vaccination. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Rachel H Jonas
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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12
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Boles RW, Gao WZ, Johns MM, Daniero JJ, Grant NN, Rubin AD, Bhatt NK, Hapner ER, O'Dell K. Flexible Versus Rigid Laryngoscopy: A Prospective, Blinded Comparison of Image Quality. J Voice 2021; 37:440-443. [PMID: 33775470 DOI: 10.1016/j.jvoice.2021.02.010] [Citation(s) in RCA: 2] [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] [Received: 12/12/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare flexible distal-chip laryngoscopy (FDL) and rigid telescopic laryngoscopy (RTL) in image quality and diagnostic ability. STUDY DESIGN Prospective cohort study; blinded comparison. METHODS Eighteen normal adult subjects were recruited to undergo both FDL and RTL and normalized videos were recorded. Three blinded laryngologists compared the videos for color fidelity, illumination, resolution, and vascularity, and indicated superiority with FDL, RTL, or no difference. Raters also reported if an abnormality was seen and in which video it was better visualized. Videos for two subjects were repeated to assess intra-rater reliability, making 20 video comparisons across 3 raters for a total of 60 ratings. Differences in responses were analyzed via Mann-Whitney U and Pearson Χ2. Inter-rater reliability was assessed via Fleiss' kappa, and intra-rater reliability was assessed via percent agreement. RESULTS RTL was rated superior in all categories of image quality (47 vs 5 vs 8, P < 0.01; 47 vs 7 vs 6, P < 0.01; 51 vs 5 vs 4, P<0.01; 44 vs 9 vs 7, P < 0.01, respectively). An abnormality was seen 33 times with both modalities and 6 times with RTL only. When seen with both modalities, visualization was superior in RTL compared with FDL (29 vs 4, P <0.01). CONCLUSIONS There was significant superiority of RTL in all categories of image quality, with slight inter-rater agreement for color fidelity, resolution, and vascularity. RTL was also significantly better for visualization of abnormalities. These findings suggest superior image quality in RTL compared with FDL, but further research is required to determine if this difference is clinically significant.
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Affiliation(s)
- Roger W Boles
- Keck School of Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, District of Columbia
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nazaneen N Grant
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical School, Washington, District of Columbia
| | - Adam D Rubin
- Lakeshore Ears, Nose, Throat Center, St. Clair Shores, Michighan
| | - Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Edie R Hapner
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California.
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13
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Lee J, Huang LC, Berry LD, Anderson C, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Chen SC, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Hussain LK, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Lowery AS, Makani SS, Maldonado F, Mannion K, Matrka L, McWhorter AJ, Merati AL, Mori M, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Van Daele DJ, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO, Gelbard A. Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis. Ann Otol Rhinol Laryngol 2021; 130:1116-1124. [PMID: 33629608 DOI: 10.1177/0003489421995283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients. METHODS Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence. RESULTS The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression. CONCLUSIONS Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.
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Affiliation(s)
- Jaclyn Lee
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Lynn D Berry
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joel H Blumin
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan M Bock
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul F Castellanos
- Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheau-Chiann Chen
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brianna K Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Seth H Dailey
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - C Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth A Guardiani
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Lena K Hussain
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Cheryl Kinnard
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Alexander J Langerman
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Robert J Lentz
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Robert R Lorenz
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samir S Makani
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA, USA
| | - Fabien Maldonado
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA
| | - Andrew J McWhorter
- Department of Otolaryngology, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, USA
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Matthew Mori
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY USA
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Guri S Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joshua S Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Northwest Clinic for Voice and Swallowing, Portland, OR, USA
| | - G Todd Schneider
- Department of Otolaryngology, University of Rochester, Rochester, NY, USA
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City, UT, USA
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Douglas J Van Daele
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - David Veivers
- Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Paul M Weinberger
- Departments of Otolaryngology, Molecular and Cellular Physiology, Feist-Weiller Cancer Center, LSU Shreveport, LA, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - David O Francis
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Gelbard A, Anderson C, Berry LD, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Chen SC, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fernandes-Taylor S, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Huang LC, Hussain LK, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Lowery AS, Makani SS, Maldonado F, Mannion K, Matrka L, McWhorter AJ, Merati AL, Mori MC, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Van Daele DJ, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO. Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2021; 146:20-29. [PMID: 31670805 PMCID: PMC6824232 DOI: 10.1001/jamaoto.2019.3022] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Question What are the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS)? Findings In this cohort study of 810 patients with iSGS who underwent 1 of the 3 most common surgical treatments, 23% of patients underwent a recurrent surgical procedure during the 3-year study period, but recurrence differed by modality (cricotracheal resection, 1%; endoscopic resection with adjuvant medical therapy, 12%; and endoscopic dilation, 28%). Among successfully treated patients, those who underwent cricotracheal resection reported the highest quality of life but the greatest perioperative risk and worst long-term voice outcomes. Meaning These results show the feasibility of integrating an engaged rare disease community with a network of surgeons to facilitate rapid and nuanced treatment comparisons; findings may help inform treatment decision-making in iSGS. Importance Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, Setting, and Participants In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main Outcomes and Measures The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score–matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and Relevance In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catherine Anderson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynne D Berry
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Milan R Amin
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joel H Blumin
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Jonathan M Bock
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul F Castellanos
- Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Sheau-Chiann Chen
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver
| | - Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brianna K Crawley
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Seth H Dailey
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - C Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth A Guardiani
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Li-Ching Huang
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Lena K Hussain
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Cheryl Kinnard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor
| | - Alexander J Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert R Lorenz
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samir S Makani
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura Matrka
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Medical Center, Columbus
| | - Andrew J McWhorter
- Department of Otolaryngology, Louisiana State University Health Sciences Center-New Orleans, New Orleans
| | - Albert L Merati
- Department of Otolaryngology-Head & Neck Surgery, University of Washington Medical Center, Seattle
| | - Matthew C Mori
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Guri S Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare National Health System Trust, London, United Kingdom
| | - Joshua S Schindler
- Department of Otolaryngology-Head & Neck Surgery, Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - G Todd Schneider
- Department of Otolaryngology, University of Rochester, Rochester, New York
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marshall E Smith
- Division of Otolaryngology-Head & Neck Surgery, The University of Utah, Salt Lake City
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Douglas J Van Daele
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - David Veivers
- Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Paul M Weinberger
- Departments of Otolaryngology, Molecular and Cellular Physiology, Feist-Weiller Cancer Center, Louisiana State University, Shreveport
| | - Philip A Weissbrod
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego, San Diego
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Shyr
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - David O Francis
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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McGarey PO, Simpson CB, Daniero JJ. Practice Patterns and Barriers in Botulinum Toxin Injection for the Treatment of Voice Disorders. J Voice 2020; 36:113-118. [PMID: 32467003 DOI: 10.1016/j.jvoice.2020.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/05/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
Laryngeal botulinum toxin injection is an important treatment modality for spasmodic dysphonia and other laryngeal disorders. We sought to compare usage patterns of laryngeal botulinum toxin injections for voice disorders and to identify and quantify inefficiencies and barriers in providing this treatment. A 26 item survey was written and approved for distribution by the American Academy of Otolaryngology-Head and Neck Surgery and the National Spasmodic Dysphonia Association. It was distributed to Otolaryngologists who perform laryngeal botulinum toxin injections via the e-mail lists of the National Spasmodic Dysphonia Association provider database, American Academy of Otolaryngology-Head and Neck Surgery Voice Committee and the American Laryngological Association Neurolaryngology Study Group. There were 81 survey participants who collectively reported performing >1700 laryngeal botulinum toxin injections for voice disorders monthly (Mean = 21.5 pts/month). Regarding botulinum toxin A (BtxA) vial use, 54% of participants reported using multiple doses per vial for different patients during a single clinic day, while 14% reported using pharmacy predrawn single use aliquots. A combination of usage practices was reported by 7% of participants. Using an individual vial per patient and discarding the unused remainder was reported by 26% of participants with an associated annual cost in wasted BtxA of $84,300 per physician. There is wide variation in injection practices regarding management of BtxA vials and adherence to an individual vial per patient policy is associated with significant waste of health care resources. Alternative approaches to BtxA vial use could positively impact health care resource utilization.
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Affiliation(s)
- Patrick O McGarey
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
| | - C Blake Simpson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama - Birmingham, Birmingham, Alabama
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
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Carpenter DJ, Ferrante S, Bakos SR, Clary MS, Gelbard AH, Daniero JJ. Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2019; 145:21-26. [PMID: 30383170 DOI: 10.1001/jamaoto.2018.2717] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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 Because of the recurrent nature of idiopathic subglottic stenosis, routine follow-up is necessary for monitoring progression of stenosis. However, no easily accessible, standardized objective measure exists to monitor disease progression. Objective To determine whether peak expiratory flow (PEF) can be used as a reliable and easily accessible biometric indicator of disease progression relative to other validated spirometry measures in patients with idiopathic subglottic stenosis. Design, Setting, and Participants Prospectively collected data on PEF, expiratory disproportion index (EDI), and total peak flow (TPF) from 42 women with idiopathic subglottic stenosis without comorbid lower airway or parenchymal lung disease who were treated at a single tertiary referral center between 2014 and 2018 were analyzed. The mean follow-up period was 18.2 months (range, 2-40 months). Ten patients initially screened were not included in the analysis owing to comorbid glottic or supraglottic stenosis or nonidiopathic etiology. Main Outcomes and Measures Measurements of PEF, EDI, and TPF were taken at preoperative visits and at all other visits. Results Forty-two women (mean age, 51.5 years; 98% white [n = 41]) met the inclusion criteria. The area under the curve for PEF was 0.855 (95% CI, 0.784-0.926). The optimal cutoff value was 4.4 liters per second (264 L/min), with a sensitivity and specificity of 84.4% and 82.0%, respectively. The area under the curve for EDI was 0.853 (95% CI, 0.782-0.925). For TPF, this was 0.836 (95% CI, 0.757-0.916). Conclusions and Relevance This study provides evidence supporting the use of PEF as a simple, efficient, and accessible way of monitoring progression of idiopathic subglottic stenosis and predicting receipt of surgical intervention. Sensitivity and specificity of PEF were comparable to those of the more complex measures of TPF and EDI.
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Affiliation(s)
- Delaney J Carpenter
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | | | - Stephen R Bakos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver
| | - Alexander H Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
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Pruett L, Koehn H, Martz T, Churnin I, Ferrante S, Salopek L, Cottler P, Griffin DR, Daniero JJ. Development of a microporous annealed particle hydrogel for long‐term vocal fold augmentation. Laryngoscope 2019; 130:2432-2441. [DOI: 10.1002/lary.28442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Lauren Pruett
- Department of Biomedical Engineering University of Virginia Charlottesville Virginia U.S.A
| | - Heather Koehn
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia U.S.A
| | - Teresa Martz
- School of Medicine University of Virginia Charlottesville Virginia U.S.A
| | - Ian Churnin
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia U.S.A
| | - Sergio Ferrante
- School of Medicine University of Virginia Charlottesville Virginia U.S.A
| | - Lisa Salopek
- Department of Plastic Surgery University of Virginia Charlottesville Virginia U.S.A
| | - Patrick Cottler
- Department of Plastic Surgery University of Virginia Charlottesville Virginia U.S.A
| | - Donald R. Griffin
- Department of Biomedical Engineering University of Virginia Charlottesville Virginia U.S.A
| | - James J. Daniero
- Department of Otolaryngology–Head and Neck Surgery University of Virginia Charlottesville Virginia U.S.A
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Affiliation(s)
- Abel P David
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Stephen R Bakos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
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McGarey PO, Martz TG, Daniero JJ. Arytenoid Expectoration After Radiotherapy: A Rare Complication of Laryngeal Chondronecrosis. Ear Nose Throat J 2019; 99:181-182. [PMID: 30955369 DOI: 10.1177/0145561319840104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Patrick O McGarey
- Division of Laryngology and Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Teresa G Martz
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - James J Daniero
- Division of Laryngology and Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
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Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT. Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction: Proceedings of the North American Airway Collaborative (NoAAC). JAMA Otolaryngol Head Neck Surg 2019; 143:609-613. [PMID: 28418443 DOI: 10.1001/jamaoto.2016.4126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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Teague WG, Lawrence MG, Shirley DAT, Garrod AS, Early SV, Payne JB, Wisniewski JA, Heymann PW, Daniero JJ, Steinke JW, Froh DK, Braciale TJ, Ellwood M, Harris D, Borish L. Lung Lavage Granulocyte Patterns and Clinical Phenotypes in Children with Severe, Therapy-Resistant Asthma. J Allergy Clin Immunol Pract 2019; 7:1803-1812.e10. [PMID: 30654199 DOI: 10.1016/j.jaip.2018.12.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with severe asthma have frequent exacerbations despite guidelines-based treatment with high-dose corticosteroids. The importance of refractory lung inflammation and infectious species as factors contributing to poorly controlled asthma in children is poorly understood. OBJECTIVE To identify prevalent granulocyte patterns and potential pathogens as targets for revised treatment, 126 children with severe asthma underwent clinically indicated bronchoscopy. METHODS Diagnostic tests included bronchoalveolar lavage (BAL) for cell count and differential, bacterial and viral studies, spirometry, and measurements of blood eosinophils, total IgE, and allergen-specific IgE. Outcomes were compared among 4 BAL granulocyte patterns. RESULTS Pauci-granulocytic BAL was the most prevalent granulocyte category (52%), and children with pauci-granulocytic BAL had less postbronchodilator airflow limitation, less blood eosinophilia, and less detection of BAL enterovirus compared with children with mixed granulocytic BAL. Children with isolated neutrophilia BAL were differentiated by less blood eosinophilia than those with mixed granulocytic BAL, but greater prevalence of potential bacterial pathogens compared with those with pauci-granulocytic BAL. Children with isolated eosinophilia BAL had features similar to those with mixed granulocytic BAL. Children with mixed granulocytic BAL took more maintenance prednisone, and had greater blood eosinophilia and allergen sensitization compared with those with pauci-granulocytic BAL. CONCLUSIONS In children with severe, therapy-resistant asthma, BAL granulocyte patterns and infectious species are associated with novel phenotypic features that can inform pathway-specific revisions in treatment. In 32% of children evaluated, BAL revealed corticosteroid-refractory eosinophilic infiltration amenable to anti-TH2 biological therapies, and in 12%, a treatable bacterial pathogen.
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Affiliation(s)
- W Gerald Teague
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
| | - Monica G Lawrence
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Debbie-Ann T Shirley
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Andrea S Garrod
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Stephen V Early
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Jackie B Payne
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Julia A Wisniewski
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Peter W Heymann
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - James J Daniero
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - John W Steinke
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Deborah K Froh
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Thomas J Braciale
- Beirne Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va
| | - Michael Ellwood
- University Physicians Group, University of Virginia School of Medicine, Charlottesville, Va
| | - Drew Harris
- Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Larry Borish
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va; Beirne Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va; Department of Microbiology, University of Virginia School of Medicine, Charlottesville, Va
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Ferrante SS, Wang L, Kurant D, Daniero JJ. Laryngeal Immunoglobulin G4-Related Disease Resulting in Severe Airway Obstruction. JAMA Otolaryngol Head Neck Surg 2018; 143:426-427. [PMID: 28097297 DOI: 10.1001/jamaoto.2016.3931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | - Lexie Wang
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond
| | - Danielle Kurant
- Department of Pathology, University of Virginia Health System, Charlottesville
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
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Affiliation(s)
- Teresa G Martz
- University of Virginia School of Medicine, Charlottesville
| | - Patrick O McGarey
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
| | - James J Daniero
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
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McGarey PO, Barone NA, Freeman M, Daniero JJ. Comorbid Dysphagia and Dyspnea in Muscle Tension Dysphonia: A Global Laryngeal Musculoskeletal Problem. OTO Open 2018; 2:2473974X18795671. [PMID: 31535069 PMCID: PMC6737875 DOI: 10.1177/2473974x18795671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/20/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To characterize the associated symptoms of dysphagia and dyspnea among patients presenting with muscle tension dysphonia (MTD). Study Design Retrospective chart review performed over a 14-month period from October 2014 to December 2015. Setting Voice and swallowing center of a tertiary academic medical center. Subjects and Methods Thirty-eight patients with MTD were included for analysis. Clinical data were collected and analyzed, including perceptual voice evaluation and patient-reported outcomes measures. Results Among patients with a diagnosis of MTD, the incidence of reported dysphagia during clinical history and examination was 44.7%. Among patients with MTD, 60.5% had an EAT-10 (10-item Eating Assessment Tool) score ≥3 (ie, abnormal). Patients who reported dysphagia and/or had abnormal EAT-10 score (≥3) had significantly greater voice impairment than that of patients without dysphagia (P = .02). Patients who reported dysphagia also had significantly higher Clinical COPD Questionnaire scores than those of patients who reported only dysphonia (P = .002). Conclusions Patients presenting for dysphonia who are diagnosed with MTD have a high rate of comorbid dysphagia. Patients who reported dysphagia had significantly higher self-reported voice impairment and greater severity of breathing dysfunction as measured by the Clinical COPD Questionnaire. The coincidence of these symptoms in this patient cohort may suggest an underlying pathophysiology that has yet to be elucidated. Further prospective studies are needed to clarify the underlying cause of dysphagia and breathing dysfunction in the setting of MTD and to investigate diagnostic and therapeutic paradigms.
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Affiliation(s)
- Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nicholas A Barone
- Curry School of Education, Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Gelbard A, Shyr Y, Berry L, Hillel AT, Ekbom DC, Edell ES, Kasperbauer JL, Lott DG, Donovan DT, Garrett CG, Sandhu G, Daniero JJ, Netterville JL, Schindler JS, Smith ME, Bryson PC, Lorenz RR, Francis DO. Treatment options in idiopathic subglottic stenosis: protocol for a prospective international multicentre pragmatic trial. BMJ Open 2018; 8:e022243. [PMID: 29643170 PMCID: PMC5898326 DOI: 10.1136/bmjopen-2018-022243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Idiopathic subglottic stenosis (iSGS) is an unexplained progressive obstruction of the upper airway that occurs almost exclusively in adult, Caucasian women. The disease is characterised by mucosal inflammation and localised fibrosis resulting in life-threatening blockage of the upper airway. Because of high recurrence rates, patients with iSGS will frequently require multiple procedures following their initial diagnosis. Both the disease and its therapies profoundly affect patients' ability to breathe, communicate and swallow. A variety of treatments have been advanced to manage this condition. However, comparative data on effectiveness and side effects of the unique approaches have never been systematically evaluated. This study will create an international, multi-institutional prospective cohort of patients with iSGS. It will compare three surgical approaches to determine how well the most commonly used treatments in iSGS 'work' and what quality of life (QOL) trade-offs are associated with each approach. METHODS AND ANALYSIS A prospective pragmatic trial comparing the 'Standard of Care' for iSGS at multiple international institutions. Patients with a diagnosis of iSGS without clinical or laboratory evidence of vasculitis or a history of endotracheal intubation 2 years prior to symptom onset will be included in the study. Prospective evaluation of disease recurrence requiring operative intervention, validated patient-reported outcome (PRO) measures as well as patient-generated health data (mobile peak flow recordings and daily steps taken) will be longitudinally tracked for 36 months. The primary endpoint is treatment effectiveness defined as time to recurrent operative procedure. Secondary endpoints relate to treatment side effects and include PRO measures in voice, swallowing, breathing and global QOL as well as patient-generated health data. ETHICS AND DISSEMINATION This protocol was approved by the local IRB Committee of the Vanderbilt University Medical Center in July 2015. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and directly to patient with iSGS via social media-based support groups. TRIAL REGISTRATION NUMBER NCT02481817.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynne Berry
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Alexander T Hillel
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric S Edell
- Department of Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Donald T Donovan
- Department Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - C. Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Guri Sandhu
- Department of Otolaryngology, Imperial College Healthcare NHS, London, UK
| | - James J Daniero
- Department Otolaryngology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James L Netterville
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Josh S Schindler
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA
| | - Marshall E Smith
- Department of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - Paul C Bryson
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio, USA
| | - David O Francis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Rousseau B, Kojima T, Novaleski CK, Kimball EE, Valenzuela CV, Mizuta M, Daniero JJ, Garrett CG, Sivasankar MP. Recovery of Vocal Fold Epithelium after Acute Phonotrauma. Cells Tissues Organs 2017. [PMID: 28647731 DOI: 10.1159/000472251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/26/2022] Open
Abstract
We investigated the timeline of tissue repair of vocal fold epithelium after acute vibration exposure using an in vivo rabbit model. Sixty-five New Zealand white breeder rabbits were randomized to 120 min of modal- or raised-intensity phonation. After the larynges were harvested at 0, 4, 8, and 24 h, and at 3 and 7 days, the vocal fold tissue was evaluated using electron microscopy and quantitative real-time polymerase chain reaction. There was an immediate decrease in the microprojection depth and height following raised-intensity phonation, paired with upregulation of cyclooxygenase-2. This initial 24-h period was also characterized by the significant downregulation of junction proteins. Interleukin 1β and transforming growth factor β1 were upregulated for 3 and 7 days, respectively, followed by an increase in epithelial cell surface depth at 3 and 7 days. These data appear to demonstrate a shift from inflammatory response to the initiation of a restorative process in the vocal fold epithelium between 24 h and 3 days. Despite the initial damage from raised-intensity phonation, the vocal fold epithelium demonstrates a remarkable capacity for the expeditious recovery of structural changes from transient episodes of acute phonotrauma. While structurally intact, the return of functional barrier integrity may be delayed by repeated episodes of phonotrauma and may also play an important role in the pathophysiology of vocal fold lesions.
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Affiliation(s)
- Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Affiliation(s)
- James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
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Francis DO, Daniero JJ, Hovis KL, Sathe N, Jacobson B, Penson DF, Feurer ID, McPheeters ML. Voice-Related Patient-Reported Outcome Measures: A Systematic Review of Instrument Development and Validation. J Speech Lang Hear Res 2017; 60:62-88. [PMID: 28030869 PMCID: PMC5533561 DOI: 10.1044/2016_jslhr-s-16-0022] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/28/2016] [Accepted: 07/20/2016] [Indexed: 05/24/2023]
Abstract
PURPOSE The purpose of this study was to perform a comprehensive systematic review of the literature on voice-related patient-reported outcome (PRO) measures in adults and to evaluate each instrument for the presence of important measurement properties. METHOD MEDLINE, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument databases were searched using relevant vocabulary terms and key terms related to PRO measures and voice. Inclusion and exclusion criteria were developed in consultation with an expert panel. Three independent investigators assessed study methodology using criteria developed a priori. Measurement properties were examined and entered into evidence tables. RESULTS A total of 3,744 studies assessing voice-related constructs were identified. This list was narrowed to 32 PRO measures on the basis of predetermined inclusion and exclusion criteria. Questionnaire measurement properties varied widely. Important thematic deficiencies were apparent: (a) lack of patient involvement in the item development process, (b) lack of robust construct validity, and (c) lack of clear interpretability and scaling. CONCLUSIONS PRO measures are a principal means of evaluating treatment effectiveness in voice-related conditions. Despite their prominence, available PRO measures have disparate methodological rigor. Care must be taken to understand the psychometric and measurement properties and the applicability of PRO measures before advocating for their use in clinical or research applications.
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Affiliation(s)
- David O. Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN
- Center for Surgical Quality and Outcomes Research, Nashville, TN
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
| | - James J. Daniero
- Center for Voice and Swallowing, University of Virginia, Charlottesville
| | | | - Nila Sathe
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
- Vanderbilt University Medical Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Barbara Jacobson
- Department of Hearing and Speech Sciences, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN
| | - David F. Penson
- Center for Surgical Quality and Outcomes Research, Nashville, TN
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Departments of Urology and Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research and Education Coordination Center, Veteran's Administration Tennessee Valley Health System, Geriatric Research and Education Coordination Center, Nashville, TN
| | - Irene D. Feurer
- Center for Surgical Quality and Outcomes Research, Nashville, TN
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa L. McPheeters
- Vanderbilt Evidence-Based Practice Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
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Gelbard A, Katsantonis NG, Mizuta M, Newcomb D, Rotsinger J, Rousseau B, Daniero JJ, Edell ES, Ekbom DC, Kasperbauer JL, Hillel AT, Yang L, Garrett CG, Netterville JL, Wootten CT, Francis DO, Stratton C, Jenkins K, McGregor TL, Gaddy JA, Blackwell TS, Drake WP. Idiopathic subglottic stenosis is associated with activation of the inflammatory IL-17A/IL-23 axis. Laryngoscope 2016; 126:E356-E361. [PMID: 27296163 DOI: 10.1002/lary.26098] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 01/18/2016] [Revised: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Idiopathic subglottic stenosis (iSGS) is a rare and devastating extrathoracic obstruction involving the lower laryngeal and upper tracheal airway. It arises without known antecedent injury or associated disease process. Persistent mucosal inflammation and a localized fibrotic response are hallmarks of the disease. Despite the initial clinical description of iSGS more than 40 year ago, there have been no substantive investigations into the pathogenesis of this enigmatic and progressive airway obstruction. In these studies, we present the initial characterization of the molecular pathogenesis underlying the fibrosing phenotype of iSGS. METHODS Utilizing 20 human iSGS and healthy control specimens, we applied histologic, immunohistochemical, molecular, and immunologic techniques. RESULTS We demonstrate significant activation of the canonical IL-23/IL-17A pathway in the tracheal mucosa of iSGS patients, as well as identify γδ T cells as the primary cellular source of IL-17A. CONCLUSION Our results suggest that aberrant mucosal immune activation is a component in of the pathogenesis of iSGS. Most critically, our work offers new targets for future therapeutic intervention. LEVEL OF EVIDENCE NA Laryngoscope, 126:E356-E361, 2016.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee.
| | | | - Masanobu Mizuta
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Dawn Newcomb
- Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee
| | - Joseph Rotsinger
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - James J Daniero
- Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Eric S Edell
- Department of Medicine, Division of Pulmonary & Critical Care, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Liying Yang
- Department of Medicine, New York University School of Medicine, New York, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | | | | | - David O Francis
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Charles Stratton
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Kevin Jenkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Tracy L McGregor
- Department of Pediatrics, Division of Medical Genetics, Vanderbilt University, Nashville, Tennessee
| | - Jennifer A Gaddy
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee.,Veterans Affairs Tennessee Valley Healthcare Services, Nashville, Tennessee
| | - Timothy S Blackwell
- Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee.,Veterans Affairs Tennessee Valley Healthcare Services, Nashville, Tennessee
| | - Wonder P Drake
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee
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Gelbard A, Katsantonis NG, Mizuta M, Newcomb D, Rotsinger J, Rousseau B, Daniero JJ, Edell ES, Ekbom DC, Kasperbauer JL, Hillel AT, Yang L, Garrett CG, Netterville JL, Wootten CT, Francis DO, Stratton C, Jenkins K, McGregor TL, Gaddy JA, Blackwell TS, Drake WP. Molecular analysis of idiopathic subglottic stenosis for Mycobacterium species. Laryngoscope 2016; 127:179-185. [PMID: 27295947 PMCID: PMC5156582 DOI: 10.1002/lary.26097] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/25/2016] [Indexed: 01/22/2023]
Abstract
Objectives/Hypothesis Idiopathic subglottic stenosis (iSGS) is an unexplained obstruction involving the lower laryngeal and upper tracheal airway. Persistent mucosal inflammation is a hallmark of the disease. Epithelial microbiota dysbiosis is found in other chronic inflammatory mucosal diseases; however, the relationship between tracheal microbiota composition and iSGS is unknown. Given the critical role for host defense at mucosal barriers, we analyzed tissue specimens from iSGS patients for the presence of microbial pathogens. Methods Utilizing 30 human iSGS, 20 intubation‐related tracheal stenosis (iLTS), and 20 healthy control specimens, we applied molecular, immunohistochemical, electron microscopic, immunologic, and Sanger‐sequencing techniques. Results With unbiased culture‐independent nucleic acid, protein, and immunologic approaches, we demonstrate that Mycobacterium species are uniquely associated with iSGS. Phylogenetic analysis of the mycobacterial virulence factor rpoB suggests that, rather than Mycobacterium tuberculosis, a variant member of the Mycobacterium tuberculosis complex or a closely related novel mycobacterium is present in iSGS specimens. Conclusion These studies identify a novel pathogenic role for established large airway bacteria and provide new targets for future therapeutic intervention. Level of Evidence NA Laryngoscope, 127:179–185, 2017
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | | | - Masanobu Mizuta
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Dawn Newcomb
- Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee
| | - Joseph Rotsinger
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - James J Daniero
- Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Eric S Edell
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Liying Yang
- Department of Medicine, New York University School of Medicine, New York, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | | | | | - David O Francis
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Charles Stratton
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Kevin Jenkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Tracy L McGregor
- Department of Pediatrics, Division of Medical Genetics, Vanderbilt University, Nashville, Tennessee
| | - Jennifer A Gaddy
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee.,Veterans Affairs Tennessee Valley Healthcare Services, Nashville, Tennessee
| | - Timothy S Blackwell
- Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, Tennessee.,Veterans Affairs Tennessee Valley Healthcare Services, Nashville, Tennessee
| | - Wonder P Drake
- Department of Medicine, Division of Infectious Disease, Vanderbilt University, Nashville, Tennessee
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Yawn RJ, Daniero JJ, Gelbard A, Wootten CT. Novel application of the Sonopet for endoscopic posterior split and cartilage graft laryngoplasty. Laryngoscope 2015; 126:941-4. [DOI: 10.1002/lary.25596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Robert J. Yawn
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University; Nashville Tennessee
| | - James J. Daniero
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia; Charlottesville Virginia U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University; Nashville Tennessee
| | - Christopher T. Wootten
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University; Nashville Tennessee
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Gelbard A, Donovan DT, Ongkasuwan J, Nouraei SAR, Sandhu G, Benninger MS, Bryson PC, Lorenz RR, Tierney WS, Hillel AT, Gadkaree SK, Lott DG, Edell ES, Ekbom DC, Kasperbauer JL, Maldonado F, Schindler JS, Smith ME, Daniero JJ, Garrett CG, Netterville JL, Rickman OB, Sinard RJ, Wootten CT, Francis DO. Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. Laryngoscope 2015; 126:1390-6. [PMID: 26536285 DOI: 10.1002/lary.25708] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS Idiopathic subglottic stenosis (iSGS) is a rare and potentially life-threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes. STUDY DESIGN Medical record abstraction. METHODS Utilizing an international, multi-institutional collaborative, we collected retrospective data on patient characteristics, treatment, and clinical outcomes. We investigated variation between and within open and endoscopic treatment approaches and assessed therapeutic outcomes; specifically, disease recurrence and need for tracheostomy at last follow-up. RESULTS Strikingly, 479 iSGS patients across 10 participating centers were nearly exclusively female (98%, 95% confidence interval [CI], 96.1-99.6), Caucasian (95%, 95% CI, 92.2-98.8), and otherwise healthy (mean age-adjusted Charlson Comorbidity Index 1.5; 95% CI, 1.44-1.69). The patients presented at a mean age of 50 years (95% CI, 48.8-51.1). A total of 80.2% were managed endoscopically, whereas 19.8% underwent open reconstruction. Endoscopic surgery had a significantly higher rate of disease recurrence than the open approach (chi(2) = 4.09, P = 0.043). Tracheostomy was avoided in 97% of patients irrespective of surgical approach (95% CI, 94.5-99.8). Interestingly, there were outliers in rates of disease recurrence between centers using similar treatment approaches. CONCLUSION Idiopathic subglottic stenosis patients are surprisingly homogeneous. The heterogeneity of treatment approaches and the observed outliers in disease recurrence rates between centers raises the potential for improved clinical outcomes through a detailed understanding of the processes of care. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1390-1396, 2016.
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Affiliation(s)
- Alexander Gelbard
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
| | - Donald T Donovan
- Baylor College of Medicine Dept. of Otolaryngology, Houston, Texas
| | | | - S A R Nouraei
- Imperial College Healthcare NHS Trust Dept. of Otolaryngology, London, United Kingdom
| | - Guri Sandhu
- Imperial College Healthcare NHS Trust Dept. of Otolaryngology, London, United Kingdom
| | | | - Paul C Bryson
- Cleveland Clinic Dept. of Otolaryngology, Cleveland, Ohio
| | | | | | | | | | - David G Lott
- Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota
| | - Eric S Edell
- Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota
| | - Dale C Ekbom
- Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota
| | - Jan L Kasperbauer
- Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota
| | - Fabien Maldonado
- Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota
| | - Joshua S Schindler
- Oregon Health and Science University Dept. of Otolaryngology, Portland, Oregon
| | - Marshall E Smith
- University of Utah School of Medicine Dept. of Otolaryngology, Salt Lake City, Utah
| | - James J Daniero
- University of Virginia Health System Dept. of Otolaryngology, Charlottesville, Virginia, U.S.A
| | - C Gaelyn Garrett
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
| | - James L Netterville
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
| | - Otis B Rickman
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
| | - Robert J Sinard
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
| | - Christopher T Wootten
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
| | - David O Francis
- Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee
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Boon MS, Daniero JJ, Saxena S, Balceniuk M. Tubeless tracheotomy for survival airway surgery in the leporine model. Laryngoscope 2014; 125:680-4. [PMID: 25290079 DOI: 10.1002/lary.24965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/11/2014] [Revised: 09/03/2014] [Accepted: 09/16/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The ideal animal experimental tracheostomy technique is one that is 1) safe and easy to perform, 2) requires no tracheostomy tube, and 3) requires minimal cleaning or suctioning to maintain patency. The leporine model for airway injury has been well established and offers an inexpensive and practical animal model for experimental evaluation. However, previous research has demonstrated a high mortality rate with survival airway surgery in rabbits. This study demonstrates the feasibility of airway management in the leporine model using a simple maturing suture tracheostomy that avoids a tracheostomy tube. STUDY DESIGN Tracheostomy was performed in six New Zealand white rabbits in the setting of survival surgery over a 2-week study period. METHODS A vertical tracheal incision was made from the second to the sixth tracheal ring. The anterior portion of the tracheal rings was removed and the skin surrounding the stoma was sutured down to the tracheal wall. The lateral tracheal wall was then suspended to the soft tissue in the lateral neck. RESULTS All six rabbits survived the study period with minimal care and maintained stoma patency until sacrifice. Granulation tissue and edema were noted during the first week and largely resolved by the second week. An average of 5-mm-diameter stoma was measured 14 days after surgery without intraluminal stenosis or laryngeal edema. CONCLUSIONS This method meets the defined criteria for the ideal experimental tracheostomy, demonstrating potential benefit in a laryngotracheal stenosis model and a rabbit model of evoked phonation.
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Affiliation(s)
- Maurits S Boon
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Daniero JJ, Spiegel JR, Brody RM, Fickes MG. Ultrasonic surgical aspirator-assisted phonosurgery: A novel technique for laryngeal cartilage dissection. Laryngoscope 2014; 124:1909-11. [DOI: 10.1002/lary.24421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/11/2013] [Accepted: 08/23/2013] [Indexed: 12/19/2022]
Affiliation(s)
- James J. Daniero
- Department of Otolaryngology-Head & Neck Surgery (J.J.D., J.R.S.); Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Joseph R. Spiegel
- Department of Otolaryngology-Head & Neck Surgery (J.J.D., J.R.S.); Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Robert M. Brody
- Jefferson Medical College (R.M.B., M.G.F.); Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Michael G. Fickes
- Jefferson Medical College (R.M.B., M.G.F.); Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
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Abstract
Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes.
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Affiliation(s)
- James J Daniero
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center ; Center for Surgical Quality & Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center
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Daniero JJ, Chu JS, O'Hara BJ, Pribitkin EA. Value-based analysis of routine pathologic septal and inferior turbinate specimens. Otolaryngol Head Neck Surg 2013; 148:509-12. [PMID: 23314161 DOI: 10.1177/0194599812472656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens. STUDY DESIGN Case series with chart review. SETTING Tertiary care academic medical center. SUBJECTS AND METHODS A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, or directed septal biopsies were excluded from review. RESULTS A total of 1194 pathology reports were reviewed from 1172 individual patients. This included histopathologic evaluation of 1194 septal cartilage and bone specimens and 714 inferior turbinate specimens. None of the patients had unanticipated histopathologic findings that were clinically significant. CONCLUSION Many surgeons obtain histopathologic diagnoses on all tissue removed from a patient. Based on our institutional case series, histopathology of the septum and inferior turbinates in routine sinonasal cases may not be necessary. A value-based approach to processing grossly unremarkable septal and turbinate tissue by waiving histologic processing and subsequent microscopic evaluation could provide significant cost savings.
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Affiliation(s)
- James J Daniero
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Chu J, Daniero JJ, Pribitkin EA. Value-Based Analysis of Septoplasty and Turbinate Specimens. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451438a7] [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: 11/16/2022]
Abstract
Objective: 1) Determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery. 2) Evaluate the necessity for histopathologic processing of septal cartilage, bone, and inferior turbinate specimens during routine sinonasal surgery. Method: A retrospective review of histopathologic reports on all adult patients undergoing sinonasal surgery at a tertiary care hospital during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, or directed septal biopsies were excluded from review. Results: A total of 1198 pathology reports were reviewed from 1175 individual patients. This included histopathologic evaluation of 1194 septal cartilage and bone specimens and 715 inferior turbinate specimens. None of the patients had an unanticipated histopathology finding other than squamous metaplasia and inflammation. Conclusion: Many surgeons obtain histopathologic diagnoses on all tissue removed from a patient. Based on our extensive review, histopathology of the septum and inferior turbinates in routine sinonasal cases may not be necessary. In the current era of cost-containment in medicine, using a value-based approach to processing routine tissue by waiving histopathologic evaluation could provide significant cost savings.
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Daniero JJ, Clary MS, O'Reilly RC. Complications of otitis media. Infect Disord Drug Targets 2012; 12:267-70. [PMID: 22338586 DOI: 10.2174/187152612801319294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 11/07/2011] [Accepted: 12/08/2011] [Indexed: 11/22/2022]
Abstract
Otitis media is the most common reason for antibiotic prescription in the United States. Whether due to disease virulence or growing antimicrobial resistance, complications of otitis media seem to be seen more frequently. These complications may be difficult to identify and treat. This article focuses on the pathophysiology of these complications and address medical and surgical approaches to safe treatment.
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Affiliation(s)
- James J Daniero
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA
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Clary MS, Daniero JJ, Keith SW, Boon MS, Spiegel JR. Efficacy of large-diameter dilatation in cricopharyngeal dysfunction. Laryngoscope 2011; 121:2521-5. [DOI: 10.1002/lary.22365] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 06/24/2011] [Accepted: 06/28/2011] [Indexed: 11/07/2022]
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Mark MSJ, Roseman JT, Caperton RL, Daniero JJ, Frontini M, Snaman JM. International volunteer medicine. JAMA 2006; 296:652; author reply 652-3. [PMID: 16896105 DOI: 10.1001/jama.296.6.652-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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