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Lechien JR, Vaezi MF, Chan WW, Allen JE, Karkos PD, Saussez S, Altman KW, Amin MR, Ayad T, Barillari MR, Belafsky PC, Blumin JH, Johnston N, Bobin F, Broadhurst M, Ceccon FP, Calvo-Henriquez C, Eun YG, Chiesa-Estomba CM, Crevier-Buchman L, Clarke JO, Dapri G, Eckley CA, Finck C, Fisichella PM, Hamdan AL, Hans S, Huet K, Imamura R, Jobe BA, Hoppo T, Maron LP, Muls V, O'Rourke AK, Perazzo PS, Postma G, Prasad VMN, Remacle M, Sant'Anna GD, Sataloff RT, Savarino EV, Schindler A, Siupsinskiene N, Tseng PH, Zalvan CH, Zelenik K, Fraysse B, Bock JM, Akst LM, Carroll TL. The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus. Laryngoscope 2024; 134:1614-1624. [PMID: 37929860 DOI: 10.1002/lary.31134] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. METHODS Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. RESULTS After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. CONCLUSION A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. LEVEL OF EVIDENCE 5 Laryngoscope, 134:1614-1624, 2024.
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Affiliation(s)
- Jerome R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium
- Department of Laryngology and Broncho-Esophagology (Anatomy Department), EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacqueline E Allen
- Department of Otolaryngology, Head and Neck Surgery, University of Auckland, Auckland, New Zealand
| | - Petros D Karkos
- Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Sven Saussez
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium
- Department of Laryngology and Broncho-Esophagology (Anatomy Department), EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Kenneth W Altman
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Tareck Ayad
- Department of Otolaryngology-Head Neck Surgery, Montreal Hospital, Montreal, Canada
| | - Maria R Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy
| | - Peter C Belafsky
- Department of Otolaryngology, UC Davis Medical Center, Sacramento, California, USA
| | - Joel H Blumin
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Francois Bobin
- Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinic of Poitiers, Poitiers, France
| | | | - Fabio P Ceccon
- Department of Otolaryngology-Head and Neck Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christian Calvo-Henriquez
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Young-Gyu Eun
- Department of Otolaryngology Head & Neck Surgery, Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, California, USA
| | - Giovanni Dapri
- International School Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, Bergamo, Italy
| | - Claudia A Eckley
- Divisão de Otorrinolaringologia, Fleury Medicina e Saúde Laboratórios de Diagnóstico, São Paulo, Brazil
| | - Camille Finck
- Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Liege, Belgium
| | | | - Abdul-Latif Hamdan
- Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Stephane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Kathy Huet
- Department of Metrology and Langage Science, University of Mons, Mons, Belgium
| | - Rui Imamura
- Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Blair A Jobe
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Toshitaka Hoppo
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lance P Maron
- Netcare Park Lane Hospital, Johannesburg, South Africa
| | - Vinciane Muls
- Department of gastroenterology, CHU Saint-Pierre, Brussels
| | - Ashli K O'Rourke
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paulo S Perazzo
- Department of Otolaryngology, School of Medicine, São Paulo Federal University, Sao Paulo, Brazil
| | - Gregory Postma
- Department of Otolaryngology, Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Vyas M N Prasad
- ENT Centre and Singapore Medical Specialist Centre, Singapore, Singapore
| | - Marc Remacle
- Department of Otolaryngology, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| | - Geraldo D Sant'Anna
- Disciplina de Otorrinolaringologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Nora Siupsinskiene
- Department of Otolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Faculty of Health Sciences, Klaipeda university, Klaipeda, Lithuania
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Craig H Zalvan
- Department of Otolaryngology-New York Medical College, School of Medicine, Valhalla, NY; Institute for Voice and Swallowing Disorders, Sleepy Hollow, NY, USA
| | - Karol Zelenik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas L Carroll
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital and Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Lesh RW, Pai KK, Altman KW. Triological Best Practice: What is the Appropriate Objective Testing for Patients with Suspected Laryngopharyngeal Reflux? Laryngoscope 2024; 134:1493-1495. [PMID: 37837393 DOI: 10.1002/lary.31109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Randy W Lesh
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Kavya K Pai
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
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Pichardo PFA, Desiato VM, Hellums RN, Altman KW, Purdy NC, Haugen T. Depression and anxiety in patients with head and neck cancer undergoing free flap reconstruction. Am J Otolaryngol 2024; 45:104044. [PMID: 37734365 DOI: 10.1016/j.amjoto.2023.104044] [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: 05/17/2023] [Revised: 09/02/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To determine the prevalence and severity of depression and anxiety in patients with head and neck cancer (HNC) undergoing treatment with free-flap (FF) reconstruction. METHODS Participants with HNC undergoing FF reconstruction were given the validated 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder (GAD-7) questionnaire prior to surgery. Patient factors and responses were analyzed. RESULTS Seventy-one patients were included. Mean (SD) pre-operative PHQ-9 was 7.6 (7.04) with 34 % (n = 24) having moderate to severe depression. Mean (SD) pre-operative GAD-7 was 6.5 (6.86) with 30 % (n = 21) having moderate to severe anxiety. CONCLUSION Prevalence of depression and anxiety is high in this cohort and undiagnosed in 22 % and 18 % of patients, respectively. Due to the findings, it is prudent to screen HNC patients at initial diagnosis and offer mental health services.
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Affiliation(s)
- Priscilla F A Pichardo
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Vincent M Desiato
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Ryan N Hellums
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Kenneth W Altman
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Nicholas C Purdy
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Thorsen Haugen
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America.
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Dicpinigaitis PV, Altman KW, Ulger Isci I, Ke X, Blaiss M. Interdisciplinary collaboration in the diagnosis and management of chronic cough: the role and importance of primary care providers. Curr Med Res Opin 2023; 39:1375-1381. [PMID: 37736002 DOI: 10.1080/03007995.2023.2255128] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
Chronic cough (CC) is associated with many conditions, so identifying contributing causes poses a diagnostic challenge. However, guidelines written for US physicians do not explicitly outline suggested roles for primary care providers (PCPs) in the approach to patients with CC, including refractory or unexplained CC. The objective of this review is to describe the role of PCPs in the diagnosis and treatment of CC in adults. This narrative review draws upon literature (identified via a PubMed search performed January 9, 2023, using primary care/disease state-related terms) and expertise from specialist physicians to provide recommendations for CC management in primary care. Cough is one of the top reasons patients seek care from PCPs; accordingly, PCPs are often the first physicians to conduct workup and initiate treatment. Patients with CC often experience a burdensome cough that lasts for years, have high healthcare resource utilization (HCRU), undergo multiple or failed treatment trials, and have limited success finding an etiology. Although specialist referral may be needed for many diagnostic tests, initial aspects of CC workup and management should be completed in primary care. Often more accessible than specialists, real-world evidence on HCRU suggests PCPs are important stakeholders in diagnosing and managing CC, including during initial workup and treatment for the most common causes of CC (i.e. upper-airway cough syndrome, asthma, noneosinophilic asthmatic bronchitis, and gastroesophageal reflux disease). Thorough workup at the primary care level may facilitate earlier identification of CC cause(s), improving patient journey to diagnosis and management.
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Affiliation(s)
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | | | | | - Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Hellums RN, Pichardo PFA, Altman KW, Penn E, Stavrides KP, Purdy NC. Importance of PET/CT in Initial Workup of Head and Neck Squamous Cell Carcinoma. OTO Open 2023; 7:e75. [PMID: 37736120 PMCID: PMC10509648 DOI: 10.1002/oto2.75] [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: 11/15/2022] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023] Open
Abstract
Objective Assess the impact of positron emission tomography/computed tomography (PET/CT) on disease staging at presentation in patients with head and neck squamous cell carcinoma. Study Design Retrospective cross-sectional review. Setting Academic multicenter single institution (Geisinger Health System). Methods All patients who had PET/CT imaging during workup for head and neck squamous cell carcinoma were included in the study. Pre- and post-PET/CT clinical staging were recorded. Statistical analyses were performed for patients with a change in clinical staging or detection of second primary malignancies on PET/CT. Results A total of 292 patients were included in the study, 238 of whom underwent PET/CT imaging as part of their initial workup. Twenty-eight (11.9%) patients were clinically upstaged on PET/CT with 7 patients having treatment alterations based on imaging. Eighteen (7.6%) patients were found to have second primary malignancies on PET/CT. Conclusion The current study further illustrates the importance of PET/CT in the workup of head and neck squamous cell carcinoma. Without the inclusion of PET/CT imaging, 19.3% of patients would have either been staged inappropriately or had second primary malignancies missed, again confirming the necessity of comprehensive functional imaging during the initial pretreatment workup.
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Affiliation(s)
- Ryan N. Hellums
- Department of Otolaryngology–Head and Neck SurgeryFacial Plastic Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA
| | - Priscilla F. A. Pichardo
- Department of Otolaryngology–Head and Neck SurgeryFacial Plastic Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA
| | - Kenneth W. Altman
- Department of Otolaryngology–Head and Neck SurgeryFacial Plastic Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA
| | - Ellen Penn
- Doctor of Medicine ProgramGeisinger Commonwealth School of MedicineScrantonPennsylvaniaUSA
| | - Kevin P. Stavrides
- Department of Otolaryngology–Head and Neck SurgeryFacial Plastic Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA
| | - Nicholas C. Purdy
- Department of Otolaryngology–Head and Neck SurgeryFacial Plastic Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA
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Beydoun AS, Stabenau KA, Altman KW, Johnston N. Cancer Risk in Barrett's Esophagus: A Clinical Review. Int J Mol Sci 2023; 24:ijms24076018. [PMID: 37046992 PMCID: PMC10094310 DOI: 10.3390/ijms24076018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/10/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence and is associated with a poor prognosis. Barrett's esophagus (BE) is a known precursor of esophageal adenocarcinoma. This review aims to explore Barrett's esophagus, esophageal adenocarcinoma, and the progression from the former to the latter. An overview of the definition, diagnosis, epidemiology, and risk factors for both entities are presented, with special attention being given to the areas of debate in the literature. The progression from Barrett's esophagus to esophageal adenocarcinoma is reviewed and the relevant molecular pathways are discussed. The definition of Barrett's esophagus remains debated and without international consensus. This, alongside other factors, has made establishing the true prevalence of Barrett's esophagus challenging. The degree of dysplasia can be a histological challenge, but is necessary to guide clinical management. The progression of BE to EAC is likely driven by inflammatory pathways, pepsin exposure, upregulation of growth factor pathways, and mitochondrial changes. Surveillance is maintained through serial endoscopic evaluation, with shorter intervals recommended for high-risk features.
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Affiliation(s)
- Ahmed Sam Beydoun
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kaleigh A Stabenau
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA 17822, USA
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Stabenau KA, Samuels TL, Lam TK, Mathison AJ, Wells C, Altman KW, Battle MA, Johnston N. Pepsinogen/Proton Pump Co-Expression in Barrett's Esophageal Cells Induces Cancer-Associated Changes. Laryngoscope 2023; 133:59-69. [PMID: 35315085 DOI: 10.1002/lary.30109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 02/02/2023]
Abstract
EDUCATIONAL OBJECTIVE At the conclusion of this presentation, participants should better understand the carcinogenic potential of pepsin and proton pump expression in Barrett's esophagus. OBJECTIVE Barrett's esophagus (BE) is a well-known risk factor for esophageal adenocarcinoma (EAC). Gastric H+ /K+ ATPase proton pump and pepsin expression has been demonstrated in some cases of BE; however, the contribution of local pepsin and proton pump expression to carcinogenesis is unknown. In this study, RNA sequencing was used to examine global transcriptomic changes in a BE cell line ectopically expressing pepsinogen and/or gastric H+ /K+ ATPase proton pumps. STUDY DESIGN In vitro translational. METHODS BAR-T, a human BE cell line devoid of expression of pepsinogen or proton pumps, was transduced by lentivirus-encoding pepsinogen (PGA5) and/or gastric proton pump subunits (ATP4A, ATP4B). Changes relative to the parental line were assessed by RNA sequencing. RESULTS Top canonical pathways associated with protein-coding genes differentially expressed in pepsinogen and/or proton pump expressing BAR-T cells included those involved in the tumor microenvironment and epithelial-mesenchymal transition. Top upstream regulators of coding transcripts included TGFB1 and ERBB2, which are associated with the pathogenesis and prognosis of BE and EAC. Top upstream regulators of noncoding transcripts included p300-CBP, I-BET-151, and CD93, which have previously described associations with EAC or carcinogenesis. The top associated disease of both coding and noncoding transcripts was cancer. CONCLUSIONS These data support the carcinogenic potential of pepsin and proton pump expression in BE and reveal molecular pathways affected by their expression. Further study is warranted to investigate the role of these pathways in carcinogenesis associated with BE. LEVEL OF EVIDENCE NA Laryngoscope, 133:59-69, 2023.
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Affiliation(s)
- Kaleigh A Stabenau
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tina L Samuels
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tina K Lam
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Angela J Mathison
- Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Research, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Clive Wells
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kenneth W Altman
- Department of Otolaryngology, Geisinger Health System, Danville, California, USA
| | - Michele A Battle
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Altman KW, Young AJ, Gupta M, Pichardo PFA, Troup MA, Blank J. Incidence and Prevalence of Cough in a Rural Health System: A 20‐Year Study. Laryngoscope 2022; 133:1191-1196. [PMID: 36054606 DOI: 10.1002/lary.30359] [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: 04/12/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Understanding the cough population is critical to addressing clinical needs and gaps in best practice. We sought to characterize and stratify cough patients with the hypothesis that there are opportunities to improve access to care in our health system and characterize the population. METHODS Following institutional review board exempt status, a retrospective electronic record review was performed on all patients coded with ICD-9 786.2 or ICD-10 is R05 from January 1, 2001 through December 31, 2020 at our health system. Inclusion criteria were one or more visits for cough. The subgroup with more than one visit in each of 2 years was classified as multiple encounters. Patients were characterized by sex, age at first cough encounter, number of cough encounters, smoking status, and insurance status. Results were stratified by year, calculating frequencies, and percentages. RESULTS There were 302,284 unique patients diagnosed with cough, among 1,764,387 patients seen in our health system, representing an average incidence of 3.0% (2.7%-3.7%) and prevalence of 4.9% (3.1%-5.6%). New single encounter cough patients totaled 179,963, and new multiple encounter cough patients totaled 122,321. Of the 39,828,073 total encounters, there were 469,802 for new or existing cough (1.17%-1.73% annually). The age at initial presentation demonstrated 36.5% seen <10 years old, with an even distribution over the remaining decades of life. The majority were seen for cough once, but 23.8% of group two patients had two or more visits for cough in a year. CONCLUSION We demonstrate a lower-than-expected incidence and prevalence of cough in our health population, suggesting challenges with access to care when compared to 10% prevalence and 3% of encounters previously documented in the literature. The study also provides a platform to explore the importance of pediatric cough, as well as population health and the longitudinal journey of cough patients in underserved areas. LEVEL OF EVIDENCE 3 Laryngoscope, 133:1191-1196, 2023.
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Affiliation(s)
- Kenneth W. Altman
- Department of Otolaryngology‐Head and Neck Surgery Geisinger Medical Center Danville Pennsylvania U.S.A
| | - Amanda J. Young
- Henry Hood Research Center Geisinger Medical Center Danville Pennsylvania U.S.A
| | - Mudit Gupta
- Henry Hood Research Center Geisinger Medical Center Danville Pennsylvania U.S.A
| | - Priscilla F. A. Pichardo
- Department of Otolaryngology‐Head and Neck Surgery Geisinger Medical Center Danville Pennsylvania U.S.A
| | - Melissa A. Troup
- Henry Hood Research Center Geisinger Medical Center Danville Pennsylvania U.S.A
| | - Jackie Blank
- Henry Hood Research Center Geisinger Medical Center Danville Pennsylvania U.S.A
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Wong J, Quinones W, Altman KW. Progressive Hoarseness and Laryngeal Obstruction in an Elderly Man. JAMA Otolaryngol Head Neck Surg 2022; 148:881-882. [PMID: 35925561 DOI: 10.1001/jamaoto.2022.1945] [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: 11/14/2022]
Affiliation(s)
- Jeff Wong
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - William Quinones
- Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Affiliation(s)
- Kaitlyn C Kishbaugh
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Abstract
Objective This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to consider when managing such patients. Data Sources PubMed/MEDLINE. Review Methods We conducted a detailed review of publications related to vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management focusing specifically on oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques. Conclusions There has been a paradigm shift away from performing “vocal cord stripping” procedures that can cause irreversible hoarseness toward voice preservation surgery while achieving comparable oncologic control. Surgical technical and instrumental developments have been designed to maximally treat superficial disease while preserving underling vibratory mucosa. Recent improvements in histopathological grading systems and advances in biomarker classification may allow for improved oncologic risk stratification. Furthermore, improvements in endoscopic imaging capabilities and contact endoscopy are currently being studied for their potential diagnostic significance. Implications for Practice To optimally manage vocal fold leukoplakia, the otolaryngologist should become familiar with the oncologic implications of the disease and the importance of obtaining pathologic diagnosis to rule out malignancy. In addition, the surgeon should maintain surgical techniques and knowledge of available instruments and lasers that can assist in surgical management while prioritizing the preservation of vibratory tissue and voice quality. Finally, the surgeon and the patient should understand the clinical importance of routine endoscopic surveillance.
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Affiliation(s)
- Joseph C. Park
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kenneth W. Altman
- Department of Otolaryngology–Head and Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | | | | | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Wang BJ, Carter FL, Altman KW. Relationship between Dysarthria and Oral-Oropharyngeal Dysphagia: The present evidence. Ear Nose Throat J 2020:145561320951647. [PMID: 33044841 DOI: 10.1177/0145561320951647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a high prevalence of dysphagia in patients with neuromuscular diseases and stroke, and consequences can be profound. However, the correlation of dysarthria and oral-oropharyngeal dysphagia remains unclear. This review aimed to define the clinical co-presentation of dysarthria and dysphagia in this population. A PubMed search to identify literature on the prevalence of dysarthria and dysphagia was systematically conducted in the English language literature since 1995. Subjective and objective outcomes instruments were identified for both dysarthria and dysphagia. Studies that included prevalence and co-presentation were included. Inclusion and exclusion criteria were applied according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA). Of the 1,056 articles identified in the search, 20 articles met the search criteria. An additional 4 articles were examined for a total of 24 articles for analysis. Dysarthria and dysphagia were found to be highly prevalent among patients with neuromuscular disease (NMD). Overall, there was a higher prevalence of dysarthria than dysphagia. Of those patients with dysphagia, some reports estimate 76-90% of patients with NMD also had dysarthria. Dysarthria is a strong clinical clue to the presence of dysphagia. Existing subjective questionnaires may not reveal the presence of oropharyngeal dysphagia, but objective measures are more revealing. Further study to correlate the degree of dysarthria and severity of oral-oropharyngeal dysphagia are warranted.
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13
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Wan P, Ongkasuwan J, Martinez J, Sandulache V, Deng D, Jiang J, Sikora A, Altman KW. Biomarkers for Malignant Potential in Vocal Fold Leukoplakia: A State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:751-758. [PMID: 32988279 DOI: 10.1177/0194599820957251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore biomarkers that are candidates for understanding potential degeneration to malignancy of vocal fold leukoplakia (VFL), with the goal of guiding future diagnostic and treatment recommendations. DATA SOURCES PubMed and Medline search engines. REVIEW METHODS A systematic review was conducted by searching the following key words: vocal fold or laryngeal, coupled with leukoplakia or dysplasia, and combined with the term prognostic markers. We collated the biomarkers and their significance, followed by observing the power of their evidence by assessing the quality of the studies according to guidelines of tumor marker prognostic studies (REMARK). CONCLUSIONS Prognostic biomarkers in the 16 studies are generally divided into 3 categories according to their biological roles: proliferation (Ki-67, CK-1 RS14024 SNP), cell cycle control (P53, p16, cyclin D1, p57kip2, interleukin-10 [IL-10], miR-10a, and miR-34c), cell adhesion, and invasion (neutrophil-to-lymphocyte ratio, OPN/CD44v6 axis, MMP-1, vascular endothelial growth factor A, MMP-9, serpin peptidase inhibitor 1, plasminogen activator, CTNN/B1, β-catenin, NANOG, HERG1). The prognostic use of these biomarkers is limited due to the variable methodologies, study design, assay methods, and statistical analysis performed. IMPLICATIONS FOR PRACTICE Prognostic factors in vocal fold leukoplakia have important clinical implications regarding the potential for malignant degeneration. Although further study is needed, the currently available evidence suggests that p53, p16, cyclin D1, IL-10, NLR, OPN and CD44v6, CTNNB1, and CTTN and FAK might be of particular interest in determining prognosis of VFL as related to malignancy. Future, large, well-designed, prospective studies are expected to determine the prognostic power of these biomarkers before their implementation in routine clinical practice.
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Affiliation(s)
- Ping Wan
- School of Rehabilitation Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Julina Ongkasuwan
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Julian Martinez
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad Sandulache
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Defeng Deng
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Jack Jiang
- Department of Otolaryngology, University of Wisconsin, Madison, Wisconsin, USA
| | - Andrew Sikora
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth W Altman
- Department of Otolaryngology, Geisinger Health System, Danville, Pennsylvania, USA
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14
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Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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15
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Altman KW, Ha TAN, Dorai VK, Mankidy BJ, Zhu H. Tracheotomy Timing and Outcomes in the Critically Ill: Complexity and Opportunities for Progress. Laryngoscope 2020; 131:282-287. [PMID: 32277707 DOI: 10.1002/lary.28657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/18/2020] [Accepted: 03/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize the effects of tracheotomy timing at our institution on intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. STUDY DESIGN Retrospective cohort study. METHODS A retrospective study was performed at a tertiary care medical center for patients undergoing tracheotomy over 2.5 years from January 1, 2016 through June 30, 2018. Demographics, survival, duration of endotracheal intubation, timing of tracheotomy, and ICU and overall hospital LOS were assessed. Tracheotomy was considered early (ET) if it was performed by day 7 of mechanical ventilation and late (LT) thereafter. Readmission, mortality, and costs were also tabulated for each aggregate group. Nonparametric statistics were used to compare results. RESULTS Of the 536 patients included in the analysis, 160 received tracheotomy early and 376 late. Differences between age and sex were not statistically significant. Duration of total ICU stay was shortened by 65% (12.84 ± 17.69 days vs. 38.49 ± 26.61 days; P < .0001), and length of overall hospital course was reduced by 54% (22.71 ± 26.65 days vs. 50.37 ± 34.20 days; P < .0001) in the early tracheotomy group. Observed/expected (O/E) values standardized results to case mix index and revealed LOS of 1.5 for ET and 2.5 for LT, and mortality of 0.76 for ET and 1.25 for LT, and comparable readmissions of both groups. CONCLUSIONS Early tracheotomy in ICU patients is associated with earlier ICU discharge, decreased length of overall hospital stay, and lower mortality when controlling for case mix index. Opportunities exist to optimize patient outcomes and O/E performance. LEVEL OF EVIDENCE 4 Laryngoscope, 131:282-287, 2021.
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Affiliation(s)
- Kenneth W Altman
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Tu-Anh N Ha
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Vaithianathan K Dorai
- Department of Quality Management, Baylor St. Luke's Medical Center, Houston, Texas, U.S.A
| | - Babith J Mankidy
- Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas, U.S.A
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16
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McCormick CA, Samuels TL, Battle MA, Frolkis T, Blumin JH, Bock JM, Wells C, Yan K, Altman KW, Johnston N. H+/K+ATPase Expression in the Larynx of Laryngopharyngeal Reflux and Laryngeal Cancer Patients. Laryngoscope 2020; 131:130-135. [PMID: 32250454 DOI: 10.1002/lary.28643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/13/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The gastric H+/K+ ATPase proton pump has previously been shown to be expressed in the human larynx, however its contribution to laryngopharyngeal reflux (LPR) signs, symptoms and associated diseases such as laryngeal cancer is unknown. Proton pump expression in the larynx of patients with LPR and laryngeal cancer was investigated herein. A human hypopharyngeal cell line expressing the proton pump was generated to investigate its effects. STUDY DESIGN In-vitro translational. METHODS Laryngeal biopsies were obtained from three LPR and eight LSCC patients. ATP4A, ATP4B and HRPT1 were assayed via qPCR. Human hypopharyngeal FaDu cell lines stably expressing proton pump were created using lentiviral transduction and examined via transmission electron microscopy and qPCR for genes associated with inflammation or laryngeal cancer. RESULTS Expression of ATP4A and ATP4B was detected in 3/3 LPR, 4/8 LSCC-tumor and 3/8 LSCC-adjacent specimens. Expression of ATP4A and ATP4B in FaDu elicited mitochondrial damage and expression of IL1B, PTGS2, and TNFA (P < .0001); expression of ATP4B alone did not. CONCLUSIONS Gastric proton pump subunits are expressed in the larynx of LPR and LSCC patients. Mitochondrial damage and changes in gene expression observed in cells expressing the full proton pump, absent in those expressing a single subunit, suggest that acid secretion by functional proton pumps expressed in upper airway mucosa may elicit local cell and molecular changes associated with inflammation and cancer. LEVEL OF EVIDENCE NA Laryngoscope, 131:130-135, 2021.
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Affiliation(s)
- Caroline A McCormick
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Tina L Samuels
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Michele A Battle
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Talia Frolkis
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joel H Blumin
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Clive Wells
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ke Yan
- Department of Pediatrics Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Kenneth W Altman
- Department of Otolaryngology, Geisinger Health System, Danville, California, U.S.A
| | - Nikki Johnston
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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17
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Altman KW, Lane AP, Irwin RS. Otolaryngology Aspects of Chronic Cough. The Journal of Allergy and Clinical Immunology: In Practice 2019; 7:1750-1755. [DOI: 10.1016/j.jaip.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
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18
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Altman KW. Commentary: Forward to the Special Issue on Cough in Current Otorhinolaryngology Reports. Curr Otorhinolaryngol Rep 2019. [DOI: 10.1007/s40136-019-00243-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Samuels TL, Altman KW, Gould JC, Kindel T, Bosler M, MacKinnon A, Hagen CE, Johnston N. Esophageal pepsin and proton pump synthesis in barrett's esophagus and esophageal adenocarcinoma. Laryngoscope 2019; 129:2687-2695. [DOI: 10.1002/lary.28051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Tina L. Samuels
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin
| | - Kenneth W. Altman
- Department of Otolaryngology–Head and Neck SurgeryBaylor College of Medicine Houston Texas U.S.A
| | - Jon C. Gould
- Department of SurgeryMedical College of Wisconsin Milwaukee Wisconsin
| | - Tammy Kindel
- Department of SurgeryMedical College of Wisconsin Milwaukee Wisconsin
| | - Matthew Bosler
- Department of SurgeryMedical College of Wisconsin Milwaukee Wisconsin
| | | | | | - Nikki Johnston
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin
- Department of Microbiology and ImmunologyMedical College of Wisconsin Milwaukee Wisconsin
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20
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Hill AT, Gold PM, El Solh AA, Metlay JP, Ireland B, Irwin RS, Adams TM, Altman KW, Azoulay E, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Gibson P, Gold P, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lim K, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Moore A, Murad MH, Narasimhan M, Newcombe P, Nguyen HQ, Oppenheimer J, Rosen M, Rubin B, Russell RJ, Ryu JH, Singh S, Smith J, Smith MP, Tarlo SM, Turmel J, Vertigan AE, Wang G, Weinberger M. Response. Chest 2019; 155:1082-1083. [DOI: 10.1016/j.chest.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/14/2019] [Indexed: 10/26/2022] Open
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21
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Ha TAN, Madison MC, Kheradmand F, Altman KW. Laryngeal inflammatory response to smoke and vape in a murine model. Am J Otolaryngol 2019; 40:89-92. [PMID: 30472132 DOI: 10.1016/j.amjoto.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To build a murine model for tobacco smoke and electronic cigarette vapor exposure to characterize the inflammatory and immune responses in the larynx. MATERIALS AND METHODS In this pilot study, twenty-four wild-type C57BL/6 mice were divided into four groups: smoke, vapor with nicotine, vapor without nicotine, and air only. Following daily exposure for 4 months, larynges were dissected and processed with cytokine detection arrays. Each laryngeal cytokine level between the four different groups was analyzed statistically by using statistical analysis software (SAS) to calculate the analysis of variance (ANOVA). RESULTS IL-4 was the only cytokine found to achieve statistically significant different levels in this study, with elevated levels of IL-4 in the tobacco smoke and vapor with nicotine groups compared to the levels found in the vapor without nicotine and air only groups (p = 0.0418). While statistically non-significant, prominent findings revealed up-regulation of TGF-β2 and TGF-β3 in the smoke group, but near-normal levels of TGF-β2 and TGF-β3 and suppression of IL-10 in the vapor groups (p > 0.05). CONCLUSION The potential utility of the murine model is established for studying the inflammatory and immune effects of tobacco smoke and vapor on the mammalian larynx. IL-4 levels in mice larynges were significantly elevated in the tobacco smoke and vapor with nicotine groups.
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22
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Altman KW. President's address: Integrity, unity, and our common sense of purpose with the ALA. Laryngoscope 2018; 128:1507-1509. [PMID: 29683505 DOI: 10.1002/lary.27102] [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] [Received: 11/27/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Kenneth W Altman
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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23
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Wang BJ, Carter FL, Altman KW. Relationship between dysarthria and oral-oropharyngeal dysphagia: The current evidence. Ear Nose Throat J 2018; 97:E1-E9. [PMID: 29554404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
There is a high prevalence of dysphagia among patients with neuromuscular diseases and cerebrovascular diseases, and its consequences can be profound. However, the correlation between dysarthria and oral-oropharyngeal dysphagia remains unclear. We conducted a literature review to define the clinical presentation of both dysarthria and dysphagia in patients with neuromuscular and cerebrovascular diseases. We performed a systematic PubMed search of the English-language literature since 1995. Objective and subjective outcomes instruments were identified for both dysarthria and dysphagia. Studies that included the incidence of concomitant presentations were included. Inclusion and exclusion criteria were applied according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1,056 articles we reviewed, we selected 24 for analysis. We found that dysarthria and dysphagia were common among patients with neuromuscular and cerebrovascular diseases. Overall, there was a higher prevalence of dysarthria than dysphagia. Of those patients with dysphagia, some reports found that 76 to 90% of patients with neuromuscular disease also had dysarthria. Dysarthria is a strong clinical clue to the presence of dysphagia. Existing subjective questionnaires may not reveal the presence of oropharyngeal dysphagia; objective measures are obviously more revealing. Further studies to correlate the degree of dysarthria and the severity of oral-oropharyngeal dysphagia are warranted.
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Affiliation(s)
- Brandon J Wang
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, One Baylor Plaza, NA-102, Houston, TX 77030, USA
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24
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Irwin RS, French CL, Chang AB, Altman KW. Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest 2018; 153:196-209. [PMID: 29080708 PMCID: PMC6689094 DOI: 10.1016/j.chest.2017.10.016] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/21/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful? METHODS We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. RESULTS With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian countries. The subjects resided on four continents: North America, South America, Europe, and Asia. CONCLUSIONS Although the quality of evidence was low, the published literature since 2006 suggests that CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe. These same algorithms have been updated to reflect the advances in cough management as of 2017.
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Affiliation(s)
| | | | - Anne B Chang
- Menzies School of Health Research and Respiratory Department, Lady Cilento Children's Hospital, Qld Uni of Technology Queensland, Australia
| | - Kenneth W Altman
- Institute for Voice and Swallowing, Baylor College of Medicine, Houston, TX
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25
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Akst LM, Haque OJ, Clarke JO, Hillel AT, Best SR, Altman KW. The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice. Ann Otol Rhinol Laryngol 2017; 126:229-235. [DOI: 10.1177/0003489416686586] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives: The National Ambulatory Medical Care Survey (NAMCS) database was utilized to understand evolving national trends in diagnosis and management of reflux. Methods: The NAMCS database was queried for visits related to gastroesophageal reflux diagnosis and management. Analysis performed for time periods 1998-2001, 2002-2005, and 2006-2009 was weighted to provide national estimates of care. Results were compared to previously reported time periods from 1990 to 2001 to evaluate patterns in overall visits, age and ethnicity of patients, provider type, and prescriptions provided. Results: The number of ambulatory visits for reflux increased from 8 684 000 in 1998-2001 to 15 750 000 in 2006-2009. Visits increased across each time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, absolute visits increased from 1998-2001 to 2002-2005 but decreased in 2006-2009; difference between these time periods did not reach statistical significance. From 1998-2001 to 2006-2009, reflux medication use increased 233%, with continuing trends toward increased proton pump inhibitor use. Conclusions: Reflux visits have increased across all demographic subgroups studied. Knowledge of these trends may inform further paradigm shifts in diagnosis and management of reflux.
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Affiliation(s)
- Lee M. Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - John O. Clarke
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexander T. Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Simon R.A. Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kenneth W. Altman
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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26
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Kahrilas PJ, Altman KW, Chang AB, Field SK, Harding SM, Lane AP, Lim K, McGarvey L, Smith J, Irwin RS. Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report. Chest 2016; 150:1341-1360. [PMID: 27614002 PMCID: PMC6026249 DOI: 10.1016/j.chest.2016.08.1458] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/21/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We updated the 2006 ACCP clinical practice guidelines for management of reflux-cough syndrome. METHODS Two population, intervention, comparison, outcome (PICO) questions were addressed by systematic review: (1) Can therapy for gastroesophageal reflux improve or eliminate cough in adults with chronic and persistently troublesome cough? and (2) Are there minimal clinical criteria to guide practice in determining that chronic cough is likely to respond to therapy for gastroesophageal reflux? RESULTS We found no high-quality studies pertinent to either question. From available randomized controlled trials (RCTs) addressing question #1, we concluded that (1) there was a strong placebo effect for cough improvement; (2) studies including diet modification and weight loss had better cough outcomes; (3) although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, proton pump inhibitors (PPIs) demonstrated no benefit when used in isolation; and (4) because of potential carryover effect, crossover studies using PPIs should be avoided. For question #2, we concluded from the available observational trials that (1) an algorithmic approach to management resolved chronic cough in 82% to 100% of instances; (2) cough variant asthma and upper airway cough syndrome (UACS) (previously referred to as postnasal drip syndrome) from rhinosinus conditions were the most commonly reported causes; and (3) the reported prevalence of reflux-cough syndrome varied widely. CONCLUSIONS The panelists (1) endorsed the use of a diagnostic/therapeutic algorithm addressing causes of common cough, including symptomatic reflux; (2) advised that although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, PPIs demonstrated no benefit when used in isolation; and (3) suggested that physiological testing be reserved for refractory patients being considered for antireflux surgery or for those in whom there is strong clinical suspicion warranting diagnostic testing.
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Affiliation(s)
- Peter J Kahrilas
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Kenneth W Altman
- Bobby R. Alford Department of Otolaryngology, Baylor College of Medicine, Houston, TX
| | - Anne B Chang
- Menzies School of Health, Research and Respiratory Department, Lady Cilento Children's Hospital, Queensland University of Technology, Queensland, Australia
| | - Stephen K Field
- Division of Respiratory Medicine, Department of Medicine, Cummings School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Susan M Harding
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew P Lane
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kaiser Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, Rochester, MN
| | - Lorcan McGarvey
- Department of Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Jaclyn Smith
- Department of Medicine, University of Manchester and University Hospital of South Manchester, England
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Del Signore AG, Shah RN, Gupta N, Altman KW, Woo P. Complications and Failures of Office-Based Endoscopic Angiolytic Laser Surgery Treatment. J Voice 2016; 30:744-750. [DOI: 10.1016/j.jvoice.2015.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 10/20/2022]
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Tarlo SM, Altman KW, Oppenheimer J, Lim K, Vertigan A, Prezant D, Irwin RS. Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report. Chest 2016; 150:894-907. [PMID: 27521735 DOI: 10.1016/j.chest.2016.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. METHODS MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. RESULTS The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. CONCLUSIONS Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future.
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Affiliation(s)
- Susan M Tarlo
- Division of Respiratory Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX
| | - John Oppenheimer
- Division of Allergy and Immunology, University of Medicine and Dentistry of New Jersey-Rutgers University, Newark, NJ
| | - Kaiser Lim
- Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Mayo College of Medicine, Rochester, MN
| | | | - David Prezant
- Fire Department of the City of New York, Brooklyn, NY
| | - Richard S Irwin
- Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
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Abstract
Objectives: The H+/K+-ATPase proton pump has been demonstrated in human laryngeal submucosal glands, and is not solely present in the parietal cells of the stomach. Although proton secretion is present in the lung, a variety of mechanisms have been elucidated. The hypothesis of this study is that the H+/K+-ATPase proton pump is one additional pathway of proton secretion in the human lung. Methods: Fourteen surgical lung specimens from 10 subjects were retrospectively obtained after approval from our Human Subjects Committee. Banked human stomach tissue was used for comparative positive and negative controls. Sections were immunostained with 2 monoclonal antibodies selectively reactive with alpha or beta subunits of the H+/K+-ATPase proton pump. Results: In the human lung, consistent staining for both subunits was present in the mucous gland cells and ducts in all specimens in which mucous glands were present (6 specimens from 5 subjects). Overall, weak to strong staining was present in focal areas within the multicellular mucous glands. There was only scant focal staining in the respiratory epithelium in 4 specimens. Stomach parietal cells exhibited strongly positive staining for both subunits of the proton pump. There was no staining in stomach cells that were not morphologically consistent with parietal cells. Conclusions: The H+/K+-ATPase proton pump is present in mucous cells and ducts in the human lung, with some variable expression noted. Proton pump inhibitor pharmacotherapy may have a site of action in the human lung, explaining some of the controversies otherwise attributable to interrelatedness of aerodigestive tract disease.
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Affiliation(s)
- Kenneth W Altman
- Dept of Otolaryngology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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Abstract
An ever-increasing number of adult and pediatric disorders have been shown to be influenced or caused by airway reflux. This has become a controversial and complicated aspect of medicine that requires a multidisciplinary approach. Evidence indicates that it is not only the acidic components of gastric refluxate that injure extraesophageal tissues but also the nonacidic components, such as pepsin and bile. There is a realization that proton pump inhibitors will not be effective when nonacidic components of refluxate are causing the problem. New in vitro and in vivo models for the study of airway reflux and new therapeutic and surgical approaches are discussed in this review article.
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Affiliation(s)
- Nikki Johnston
- Departments of Otolaryngology and Communication Sciences, and Microbiology and Molecular Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Frank Ondrey
- Department of Otolaryngology and Masonic Cancer Center, University of Minnesota School of Medicine, Duluth, Minnesota
| | - Rachel Rosen
- Department of Gastroenterology and Nutrition, Boston's Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bryan P Hurley
- Department of Pediatrics, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jon Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jacquie Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John DelGaudio
- Department of Otolaryngology, Emory University, Atlanta, Georgia
| | - Kenneth W Altman
- Department of Otolaryngology - Head & Neck Surgery, Baylor College of Medicine, Houston, Texas
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Affiliation(s)
- Kershena S Liao
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Sarah A Gitomer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Kenneth W Altman
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Saini AT, Parasher AK, Kass JI, Altman KW, Miles BA. Intraoral midline mandibulotomy improves laryngeal access for transoral resection of laryngeal cancer. Am J Otolaryngol 2016; 37:95-8. [PMID: 26954859 DOI: 10.1016/j.amjoto.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Intraoral midline mandibulotomy is a technique that can be used to increase exposure for transoral endoscopic laser microsurgery (TLS). We describe the case of a 51 year old male with persistent T1 glottic carcinoma. At initial diagnosis, he had been referred for curative radiotherapy as laryngeal access was not sufficient for TLS. For treatment of his recurrence, we describe the technique of performing a midline mandibular osteotomy to improve access to the larynx allowing for safe and effective transoral endoscopic laser microsurgery. Surgical access to the larynx was greatly improved, and we were able to perform TLS in a case that would have otherwise not been amenable to TLS. An intraoral midline mandibulotomy can improve access to the larynx and allow for successful transoral resection of laryngeal cancer in patients with otherwise inaccessible tumors.
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Gibson P, Wang G, McGarvey L, Vertigan AE, Altman KW, Birring SS. Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report. Chest 2016; 149:27-44. [PMID: 26426314 DOI: 10.1378/chest.15-1496] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/09/2015] [Accepted: 08/12/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Unexplained chronic cough (UCC) causes significant impairments in quality of life. Effective assessment and treatment approaches are needed for UCC. METHODS This systematic review of randomized controlled trials (RCTs) asked: What is the efficacy of treatment compared with usual care for cough severity, cough frequency, and cough-related quality of life in patients with UCC? Studies of adults and adolescents aged > 12 years with a chronic cough of > 8 weeks' duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the American College of Chest Physicians organization methodology. RESULTS Eleven RCTs and five systematic reviews were included. The 11 RCTs reported data on 570 participants with chronic cough who received a variety of interventions. Study quality was high in 10 RCTs. The studies used an assortment of descriptors and assessments to identify UCC. Although gabapentin and morphine exhibited positive effects on cough-related quality of life, only gabapentin was supported as a treatment recommendation. Studies of inhaled corticosteroids (ICS) were affected by intervention fidelity bias; when this factor was addressed, ICS were found to be ineffective for UCC. Esomeprazole was ineffective for UCC without features of gastroesophageal acid reflux. Studies addressing nonacid gastroesophageal reflux disease were not identified. A multimodality speech pathology intervention improved cough severity. CONCLUSIONS The evidence supporting the diagnosis and management of UCC is limited. UCC requires further study to establish agreed terminology and the optimal methods of investigation using established criteria for intervention fidelity. Speech pathology-based cough suppression is suggested as a treatment option for UCC. This guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge as well as areas for future research.
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Affiliation(s)
- Peter Gibson
- Hunter Medical Research Institute, New South Wales, Australia.
| | - Gang Wang
- Sichuan University, West China Hospital, Chengdu, China
| | | | | | | | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, England
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Tarlo SM, Altman KW, French CT, Diekemper RL, Irwin RS. Evaluation of Occupational and Environmental Factors in the Assessment of Chronic Cough in Adults. Chest 2016; 149:143-60. [DOI: 10.1378/chest.15-1877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/30/2015] [Accepted: 09/30/2015] [Indexed: 11/01/2022] Open
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French CT, Diekemper RL, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning BJ, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Feinstein A, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lim K, Malesker MA, Mazzone P, Mazzone S, McCrory DC, McGarvey L, Molasiotis A, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Vertigan AE, Wang G, Weinberger M, Weir K. Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult: CHEST Guideline and Expert Panel Report. Chest 2015; 148:32-54. [PMID: 25764280 DOI: 10.1378/chest.15-0164] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators. METHODS We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology. RESULTS A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48). CONCLUSIONS Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.
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Vertigan AE, Murad MH, Pringsheim T, Feinstein A, Chang AB, Newcombe PA, Rubin BK, McGarvey LP, Weir K, Altman KW, Weinberger M, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning BJ, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Feinstein A, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lim K, Malesker MA, Mazzone P, Mazzone S, McCrory DC, McGarvey L, Molasiotis A, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Vertigan AE, Wang G, Weinberger M, Weir K, Wiener RS. Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report. Chest 2015; 148:24-31. [PMID: 25856777 DOI: 10.1378/chest.15-0423] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. METHODS We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. RESULTS The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. CONCLUSIONS Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.
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Altman KW. Physician integrity, unity, and our common sense of purpose. Ear Nose Throat J 2015; 94:300-301. [PMID: 26322444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Kenneth W Altman
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
BACKGROUND Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system. METHODS A retrospective review of the health system's hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated. RESULTS There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was ∼ 18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed. CONCLUSIONS There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.
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Affiliation(s)
- Kenneth W Altman
- Department of Otolaryngology, Baylor College of Medicine , Houston, TX , USA
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Affiliation(s)
- Kenneth W. Altman
- Department of Otolaryngology-Head & Neck Surgery; Baylor College of Medicine; Houston Texas
| | - J. Pieter Noordzij
- Department of Otolaryngology-Head & Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Clark A. Rosen
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Seth Cohen
- Division of Otolaryngology-Head & Neck Surgery; Duke University Medical Center; Durham North Carolina
| | - Lucian Sulica
- Department of Otolaryngology-Head & Neck Surgery; Weill Cornell Medical College; New York New York
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Richards AL, Sugumaran M, Aviv JE, Woo P, Altman KW. The utility of office-based biopsy for laryngopharyngeal lesions: Comparison with surgical evaluation. Laryngoscope 2014; 125:909-12. [DOI: 10.1002/lary.25005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/14/2014] [Accepted: 10/07/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Amanda L. Richards
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine, Mount Sinai Hospital; New York New York U.S.A
| | - Manikandan Sugumaran
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine, Mount Sinai Hospital; New York New York U.S.A
| | - Jonathan E. Aviv
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine, Mount Sinai Hospital; New York New York U.S.A
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine, Mount Sinai Hospital; New York New York U.S.A
| | - Kenneth W. Altman
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine, Mount Sinai Hospital; New York New York U.S.A
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Lewis SZ, Diekemper RL, French CT, Gold PM, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning B, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lewis SZ, Lim K, Malesker MA, Mazzone P, McCrory DC, McGarvey L, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Turner RB, Vertigan A, Weir K, Wiener RS. Methodologies for the Development of the Management of Cough. Chest 2014; 146:1395-1402. [DOI: 10.1378/chest.14-1484] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Haydour Q, Alahdab F, Farah M, Barrionuevo P, Vertigan AE, Newcombe PA, Pringsheim T, Chang AB, Rubin BK, McGarvey L, Weir KA, Altman KW, Feinstein A, Murad MH, Irwin RS. Management and diagnosis of psychogenic cough, habit cough, and tic cough: a systematic review. Chest 2014; 146:355-372. [PMID: 24833061 DOI: 10.1378/chest.14-0795] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology. METHODS We conducted a systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic, and habit cough. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched from the earliest inception of each database to September 2013. Content experts were contacted, and we searched bibliographies of included studies to identify additional references. RESULTS A total of 18 uncontrolled studies were identified, enrolling 223 patients (46% male subjects, 96% children and adolescents). Psychogenic cough was the most common descriptive term used (90% of the studies). Most of the patients (95%) had no cough during sleep; barking or honking quality of cough was described in only eight studies. Hypnosis (three studies), suggestion therapy (four studies), and counseling and reassurance (seven studies) were the most commonly used interventions. Hypnosis was effective in resolving cough in 78% of the patients and improving it in another 5%. Suggestion therapy resolved cough successfully in 96% of the patients. The greatest majority of improvements noted with these forms of therapy occurred in the pediatric age group. The quality of evidence is low due to the lack of control groups, the retrospective nature of all the studies, heterogeneity of definitions and diagnostic criteria, and the high likelihood of reporting bias. CONCLUSIONS Only low-quality evidence exists to support a particular strategy to define and treat psychogenic, habit, and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.
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Affiliation(s)
- Qusay Haydour
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN.
| | - Fares Alahdab
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
| | - Magdoleen Farah
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
| | - Patricia Barrionuevo
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
| | - Anne E Vertigan
- John Hunter Hospital, Department of Speech Pathology, Newcastle, NSW, Australia
| | - Peter A Newcombe
- University of Queensland, School of Psychology, Brisbane, QLD, Australia
| | | | - Anne B Chang
- Royal Children's Hospital and Menzies School of Health Research, Charles Darwin University, Brisbane, Brisbane, QLD, Australia
| | - Bruce K Rubin
- Children's Hospital of Richmond and Virginia Commonwealth University, Richmond, VA
| | - Lorcan McGarvey
- Centre for Infection and Immunity, The Queen's University of Belfast, Belfast, Northern Ireland
| | - Kelly A Weir
- Royal Children's Hospital Department of Speech Pathology and Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Mohammad Hassan Murad
- Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN
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Abstract
PURPOSE Over 4.5 million people in North America had a diagnosis of dementia in the year 2000, and more than half had advanced disease with potential aspiration risk. There is much controversy regarding the use and timing of enteral feeding support in these patients with dysphagia. The management of dysphagia is far more complex when considering quality of life, "comfort care" hand feeding, the use of percutaneous endoscopic gastrostomy tube (PEG), and associated mortality rates. This study seeks to critically review the literature that evaluates PEG placement in this population. METHODS A systematic literature review of PubMed, from 1995-2012, was conducted to identify studies relating to PEG placement in dementia patients with dysphagia. The principal outcomes and related survival rates for this population were compared. RESULTS In total, 100 articles were identified in the search. Of these, ten met the search criteria and were analyzed. There was one study with a 2b level of evidence, one with 3b, and the remainder had level 4. All studies discussed long-term survival in the PEG versus non-PEG populations. No studies showed definitive evidence to suggest long-term survival rates improved in patients who underwent PEG placement as compared to those who did not. Two studies documented median survival worse in patients over age 80 with dementia and PEG placement. CONCLUSION There is presently no evidence to suggest long-term survival rates improved in patients with advanced dementia who underwent PEG placement for dysphagia. Relevance to quality of life, need for nutrition and hydration, and ethical considerations in the decision process are discussed.
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Affiliation(s)
- Leanne S Goldberg
- Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY, USA
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Akst LM, Haque OJ, Hillel AT, Best SR, Altman KW. The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice: An Updated Study. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a29] [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
Objectives: (1) Understand evolving national trends in diagnosis and management of reflux disease. (2) Be able to analyze these by provider specialty. Methods: National Ambulatory Medical Care Survey (NAMCS) data for time periods 1998-2001, 2002-2005, and 2006-2009 were reviewed for number of visits, provider type, and prescriptions provided. Results: Addition of 2 more 4-year periods to previously reported data demonstrates increasing ambulatory visits for reflux across all races, sexes, and age groups. In 2006-2009, there were 15,750,000 visits for reflux, representing 6.9 visits per 100 people on a population basis. Overall visits increased across each sequential time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, reflux visits increased from 1998-2001 to 2002-2005 but then decreased in 2006-2009; percentage of reflux visits to otolaryngologists fell from 4.4% in 2002-2005 to 2.9% in 2006-2009. Approximately two-thirds of reflux visits were among internal medicine and family practice providers. Among the 3 study periods, number of reflux prescriptions increased 233% with continuing trends toward increased proton pump inhibitor and reduced H2 antagonist use. Conclusions: Number of ambulatory visits for reflux continues to increase over time, across all demographic subgroups studied. Otolaryngologists are the only specialty who saw a decrease in overall reflux visits from 2002-2005 through 2006-2009; this may reflect real change in practice patterns, change in coding strategies or uncertainty in firmly establishing a reflux diagnosis. Understanding trends in this increasingly prevalent disease may focus attention on more precise diagnosis and improved treatment.
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Altman KW, Krouse JH, Luong AU, Lane AP, Carroll TL, Rosen CA. Challenging Cough Cases: A Protocolized Approach. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a21] [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
Program Description: Chronic cough is an increasingly important public health concern, accounts for a large number of ambulatory care visits, and often involves a protracted clinical course. Otolaryngologists play a critical role in the care of these patients because of our interdisciplinary approach to the aerodigestive tract and our mastery of many procedures used to evaluate and treat related conditions. This miniseminar will present challenging cases with panel discussion and audience participation to emphasize evidence-based practice and the “state-of-the-art” for patients with chronic cough. Controversial areas will include prioritization, the use of evidence-based protocols, and the importance of early diagnosis in value-based health care. Educational Objectives: (1) Describe evidence-based treatment guidelines in the evaluation and treatment of chronic cough. (2) Use the spectrum of common and uncommon causes of chronic cough with an appreciation of the underlying physiology. (3) Evaluate these complex patients, perform objective testing when indicated, and prescribe appropriate pharmacotherapy for patients with chronic cough.
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Stachler RJ, Bock JM, Cohen SM, Altman KW. Cough: Contemporary Challenges. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Program Description: The purpose of this miniseminar is to present the contemporary management of cough. This miniseminar will thoroughly cover the most common etiologies of cough and its current management. A description of the sensory receptors, hyperexcitability related to neuropathy (including postviral), pharmacologic suppression of hyperexcitability, and management of pertussis (whooping cough) will be presented. If time allows, a few difficult cases will be presented that highlight the current management strategies. Educational Objectives: (1) Explain the multiple etiologies for cough and its management. (2) Examine the complex relationship between the cough receptors and the larynx. (3) Illustrate pertussis resurgence and contemporary management.
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Akst LM, Altman KW, Burns JA, Califano J, Quon H, Remacle MJ. Vocal Fold Leukoplakia: Controversies in Evaluation and Treatment. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Program Description: This miniseminar comprehensively reviews evaluation and management of laryngeal leukoplakia. Although white vocal fold lesions are common, management remains challenging. Doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia. Within a framework balancing oncologic with functional outcomes, and using case-based presentations, this miniseminar highlights challenges, controversies, and emerging paradigms in laryngeal leukoplakia care. Perspectives from laryngology, head and neck oncology, and radiation oncology will discuss innovations such as narrow-band imaging, optical coherence tomography, potassium titanyl phosphate (KTP) and CO2 laser, chemotherapy, radiotherapy, and photodynamic therapy as they apply to current and future state-of-the-art management. Educational Objectives: (1) Understand the risk of progression of laryngeal leukoplakia to carcinoma and need to balance oncologic efficacy with functional outcomes in leukoplakia care. (2) Review current and emerging techniques for accurate diagnosis, staging, and surveillance of laryngeal leukoplakia. (3) Discuss treatment alternatives for laryngeal leukoplakia, emphasizing surgical techniques of KTP, CO2, and cold-instrument phonosurgery and including potential roles of radiotherapy, photodynamic therapy, and chemotherapy.
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Abstract
BACKGROUND Chronic rhinosinusitis (CRS) consists of a constellation of symptoms, including facial pressure/pain, hyposmia, rhinorrhea, and nasal congestion. On histopathological evaluation, the disease can be divided into pathophysiologically distinct subgroups. This study systematically reviews the literature regarding the unique histopathological findings of the various subtypes of CRS to determine the potential diagnostic value of performing tissue analysis of CRS specimens beyond routine hematoxylin and eosin (H&E) staining. METHODS A PubMed search was untaken to identify articles that evaluated the histopathological features of CRS. Six hundred fifty-four relevant articles were identified and after application of specific exclusion criteria, 71 articles were further reviewed in detail. RESULTS All articles included analysis of tissue samples from in-office biopsies or intraoperative specimens of patients who underwent sinus surgery. CRS was often further divided into subgroups and compared with each other and with a control group. The subgroups included CRS with and without nasal polyps, asthmatic and nonasthmatic patients, and with and without eosinophilia. Distinct inflammatory mediators were found for the different subgroups. Twenty-eight articles evaluated these inflammatory markers for their potential value as prognostic indicators. CONCLUSION CRS is a heterogeneous disease based on its histopathological findings. Information that is obtainable from light microscopy, but typically goes unreported, can serve as valuable prognostic indictors. However, routine H&E staining is suboptimal in distinguishing among the various subgroups of CRS. Assessment of specific inflammatory mediators in sinus mucosa specimens may help provide prognostic information and guide more tailored treatment for the individual patient.
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Affiliation(s)
- Nancy Jiang
- Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York, USA
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Abstract
With a growing interest in value-based health care, there is an emphasis on establishing best practice, measuring outcomes, and improving clinical efficiencies. Best practice is a challenging concept with our growing knowledge base, and clinical practice guidelines (CPGs) help establish an approach to prioritize care and reduce practice variation. New challenges are emerging with a larger population of insured patients and a mandate to coordinate care with a shared electronic health record, and these are coupled with a massive growth in computing power. Care pathways (also called critical or clinical pathways) structure the implementation of CPGs, stratify high-risk patients, and provide the opportunity to achieve improved value. These are dynamic processes that are supervised by interdisciplinary teams and have the potential to evolve with new information gathered from each of the steps. As we emerge from single to group medical practices and hospitals to health systems, care pathways will be critically needed for optimal population management in health care.
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Affiliation(s)
- Kenneth W. Altman
- Department of Otolaryngology–Head & Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA
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50
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Affiliation(s)
- Kenneth W. Altman
- Associate Professor of Otolaryngology, Department of Otolaryngology; The Icahn School of Medicine at Mount Sinai; New York New York
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