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Tracy LF, Danis DO, Rodriggs T, Kariveda R, Grillone GA. Laryngotracheal Amyloidosis: Amyloid Airway Center 23-Year Experience. Laryngoscope 2024; 134:1606-1613. [PMID: 37732696 DOI: 10.1002/lary.31049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Localized laryngotracheal amyloidosis (LA) is a rare disease that can impact phonation and respiration. Treatment options include observation, surgery, and radiation therapy (RT). Given the rare incidence of LA, evidence regarding optimal management and long-term outcomes is limited. STUDY DESIGN Retrospective cross-sectional analysis. METHODS All patients with LA presenting to an international amyloid center from 1999 to 2022 were analyzed. Patients were categorized by treatment modality: surgery, RT, or observation. Patient and disease factors including demographics, clinical presentation, and progression with need for additional treatment were evaluated. RESULTS Seventy-one patients (27M:44F) with LA were treated with surgery (n = 40), RT (n = 11), and observation (n = 20). Gender distribution, age at diagnosis, and systemic workup did not differ significantly between treatment cohorts. A correlation was identified between LA location and treatment modality, with higher rate of subglottic/tracheal amyloid in RT patients vs. surgery and observation patients [(90% and 52% respectively), p < 0.005]. Surgery patients had a median of two surgeries for disease management (range: 1-32) and RT patients had median five surgeries prior to RT (range: 0-17). Six patients required tracheotomy: 3/40 surgery, 3/11 RT and 0/20 in observation cohort. Surgery and RT patients had a longer duration of follow-up (mean 6.7 and 11.7 years) compared with the observation cohort (5.7 years). CONCLUSION Laryngotracheal amyloidosis is a rare disease with variable presentation. Selective surgery of involved subsites is the primary treatment, though multiple surgeries may be needed to optimize function. Observation is appropriate for those with minimal symptoms. For recalcitrant disease, and particularly subglottic/tracheal amyloid, radiotherapy can be beneficial. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1606-1613, 2024.
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Affiliation(s)
- Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - D O'Neil Danis
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Timothy Rodriggs
- Department of Otolaryngology-Head and Neck Surgery, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Rohith Kariveda
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Gregory A Grillone
- Department of Otolaryngology-Head and Neck Surgery, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
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Kariveda RR, Tran A, Velu PS, Jabbour N, Pisegna JM, Tracy LF. Impact of Patient Factors on Attendance at Remote Telehealth Swallow Therapy. Dysphagia 2024:10.1007/s00455-023-10654-2. [PMID: 38273158 DOI: 10.1007/s00455-023-10654-2] [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: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
In-person swallow therapy is a primary and effective treatment for dysphagia. However, remote telehealth is now a widely utilized component of healthcare delivery for therapeutic interventions. This study evaluates potential factors influencing attendance at telehealth swallow therapy. Retrospective review of 308 patients referred for telehealth swallow therapy from April 2020-November 2021 included patient referral diagnosis, diagnostic swallowing evaluations, and sociodemographic information including age, race, health insurance, interpreter use, and socioeconomic status. Univariable and multivariable analyses compared patient and appointment factors for those who attended telehealth swallow therapy with those who did not attend. Overall, 71.8% of patients attended at least one telehealth swallow therapy appointment while 28.2% did not attend any. The most common referral diagnoses were "Cancer" (19.2%) and "Dysphagia Unspecified" (19.2%). Patients diagnosed with "Cancer" and "Muscle Tension" were significantly less likely to attend telehealth swallow therapy compared to those with "Dysphagia Unspecified," "Globus," and "Gastroesophageal Reflux Disease/Laryngopharyngeal Reflux" after adjusting for covariates. Lower socioeconomic status (p = 0.023), no interpreter use (p < 0.001), and more diagnostic evaluations (p = 0.001) correlated with higher telehealth swallow therapy attendance. Race and sex did not correlate with attendance. Most patients referred to telehealth swallow therapy attended at least one appointment. Patients with dysphagia associated with cancer and muscle tension, those with higher socioeconomic status, interpreter use, and fewer diagnostic swallowing evaluations were less likely to attend telehealth swallow therapy. Future research should investigate and compare attendance and efficacy of telehealth swallow therapy with in-person therapy.
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Affiliation(s)
- Rohith R Kariveda
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Audrey Tran
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Preetha S Velu
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
| | - Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Jessica M Pisegna
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Lauren F Tracy
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
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Norotsky RL, Dahl KL, Cocroft S, Sauder C, Tracy LF, Stepp CE. Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices? J Voice 2023:S0892-1997(23)00383-1. [PMID: 38065808 DOI: 10.1016/j.jvoice.2023.11.023] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE The purpose of this study was to understand the role of implicit racial bias in auditory-perceptual evaluations of dysphonic voices by determining if a biasing effect exists for novice listeners in their auditory-perceptual ratings of Black and White speakers. METHOD Thirty speech-language pathology graduate students at Boston University listened to audio files of 20 Black speakers and 20 White speakers of General American English with voice disorders. Listeners rated the overall severity of dysphonia of each voice heard using a 100-unit visual analog scale and completed the Harvard Implicit Association Test (IAT) to measure their implicit racial bias. RESULTS Both Black and White speakers were rated as less severely dysphonic when their race was labeled as Black. No significant relationship was found between Harvard IAT scores and differences in severity ratings by race labeling condition. CONCLUSIONS These findings suggest a minimizing bias in the evaluation of dysphonia for Black patients with voice disorders. These results contribute to the understanding of how a patient's race may impact their visit with a clinician. Further research is needed to determine the most effective interventions for implicit bias retraining and the additional ways that implicit racial bias impacts comprehensive voice evaluations.
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Affiliation(s)
- Rachel L Norotsky
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts.
| | - Kimberly L Dahl
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sarah Cocroft
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Lauren F Tracy
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Department of Biomedical Engineering, Boston University, Boston, Massachusetts
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Danis DO, Palmer WJ, Bachrach K, Tracy LF, Levi JR. Racial Disparity in Tympanostomy Tube Placement in Inpatient Pediatric Admissions. Clin Pediatr (Phila) 2023; 62:1531-1536. [PMID: 37060287 DOI: 10.1177/00099228231167685] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
This study aims to evaluate if race and ethnicity affect rates of tympanostomy tube (TT) placement during inpatient pediatric admissions in children with otologic conditions. A review of the 2016 Kids' Inpatient Database was conducted based on the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for common otologic conditions. Among 85 827 weighted pediatric inpatient discharges with ICD-10-CM codes for common otologic conditions, 213 underwent TT placement. Odds ratios (ORs) for children of Hispanic ethnicity and Asian or Pacific Islander race undergoing TT placement when compared to other ethnicities and races were 0.60 (P = .011) and 0.21 (P = .040), respectively. Multiple logistic regression showed Hispanic ethnicity was associated with lower rates of TT placement when compared to non-Hispanic white children (OR = 0.62; 95% confidence interval = 0.40-0.96). Future studies should assess why these differences exist and if these differences are associated with racial/ethnic bias or attributed to patient/family preference.
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Affiliation(s)
- David O'Neil Danis
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Kevin Bachrach
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Lauren F Tracy
- School of Medicine, Boston University, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- School of Medicine, Boston University, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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Marks KL, Díaz Cádiz ME, Toles LE, Buckley DP, Tracy LF, Noordzji JP, Grillone GA, Stepp CE. Automated Creak Differentiates Adductor Laryngeal Dystonia and Muscle Tension Dysphonia. Laryngoscope 2023; 133:2687-2694. [PMID: 36715109 PMCID: PMC10387123 DOI: 10.1002/lary.30588] [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: 09/12/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether automated estimates of vocal creak would differentiate speakers with adductor laryngeal dystonia (AdLD) from speakers with muscle tension dysphonia (MTD) and speakers without voice disorders. METHODS Sixteen speakers with AdLD, sixteen speakers with MTD, and sixteen speakers without voice disorders were recorded in a quiet environment reading aloud a standard paragraph. An open-source creak detector was used to calculate the percentage of creak (% creak) in each of the speaker's six recorded sentences. RESULTS A Kruskal-Wallis one-way analysis of variance revealed a statistically significant effect of group on the % creak with a large effect size. Pairwise Wilcoxon tests revealed a statistically significant difference in % creak between speakers with AdLD and controls as well as between speakers with AdLD and MTD. Receiver operating characteristic curve analyses indicated that % creak differentiated AdLD from both controls and speakers with MTD with high sensitivity and specificity (area under the curve statistics of 0.94 and 0.86, respectively). CONCLUSION Percentage of creak as calculated by an automated creak detector may be useful as a quantitative indicator of AdLD, demonstrating the potential for use as a screening tool or to aid in a differential diagnosis. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2687-2694, 2023.
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Affiliation(s)
- Katherine L Marks
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
| | - Manuel E Díaz Cádiz
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
| | - Laura E Toles
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Daniel P Buckley
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - J Pieter Noordzji
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Gregory A Grillone
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, U.S.A
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Lawlor CM, Graham ME, Owen LC, Tracy LF. Otolaryngology and the Pregnant Patient. JAMA Otolaryngol Head Neck Surg 2023; 149:930-937. [PMID: 37615978 DOI: 10.1001/jamaoto.2023.2558] [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] [Indexed: 08/25/2023]
Abstract
Importance Pregnancy may result in physiologic and pathologic changes in the head and neck. Otolaryngologists may need to intervene medically or surgically with pregnant patients. Careful consideration of risks to both the gravid patient and the developing fetus is vital. Observations Patients may present with otolaryngologic complaints exacerbated by or simply occurring during their pregnancy. Symptoms of hearing loss, vertigo, rhinitis or rhinosinusitis, epistaxis, obstructive sleep apnea, sialorrhea, voice changes, reflux, subglottic stenosis, and benign and malignant tumors of the head and neck may prompt evaluation. While conservative measures are often best, there are medications that are safe for use during pregnancy. When required, surgery for the gravid patient requires a multidisciplinary approach. Conclusions and Relevance Otolaryngologic manifestations in pregnant patients may be managed safely with conservative treatment, medication, and surgery when necessary. Treatment should include consideration of both the pregnant patient and the developing fetus.
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Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - M Elise Graham
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre and Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lynsey C Owen
- Department of Obstetrics and Gynecology, Virginia Hospital Center, Arlington, Virginia
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Chobanian and Avedisian School of Medicine at Boston University, Boston, Massachusetts
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7
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Jabbour N, Mur T, Tracy JC, Tracy LF. Seasonality of head and neck cancers. Am J Otolaryngol 2023; 44:103745. [PMID: 36586316 DOI: 10.1016/j.amjoto.2022.103745] [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: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study is to investigate if the season of diagnosis is associated with patient, tumor, and treatment characteristics within head and neck cancer. MATERIALS AND METHODS 1406 patients with a diagnosis of head and neck cancer (HNC) were identified from a HNC database (1996-2019). Patients were classified as receiving a diagnosis in the winter, spring, summer, or fall by calendar definition. Proportions and chi-squared analysis compared patient, tumor, and treatment factors for all diagnoses. Data was subdivided and analyzed based on the primary site. RESULTS From this cohort, 23 %, 27 %, 25 %, and 25 % of HNC patients were diagnosed in winter, spring, summer, and fall respectively with no statistically significant difference between seasons of diagnosis. When subdivided by primary site, oral cavity cancer was significantly more likely to be diagnosed in spring, salivary gland cancer was more likely to be diagnosed in winter and summer (p = 0.03 and p = 0.01 respectively). No other demographic, clinicopathologic, or management characteristics were associated with the season of diagnosis (p > 0.05 for all). CONCLUSIONS Diagnosis of head and neck cancer does not follow a seasonal pattern. Diagnosis of oral cavity and salivary gland cancer showed a seasonal pattern. The majority of patient, tumor and management characteristics were not associated with the.
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Affiliation(s)
- Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
| | - Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jeremiah C Tracy
- Tufts University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, United States of America
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
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Aaron AS, Abur D, Volk KP, Noordzij JP, Tracy LF, Stepp CE. The Relationship Between Pitch Discrimination and Fundamental Frequency Variation: Effects of Singing Status and Vocal Hyperfunction. J Voice 2023:S0892-1997(23)00010-3. [PMID: 36754684 PMCID: PMC10405643 DOI: 10.1016/j.jvoice.2023.01.008] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between pitch discrimination and fundamental frequency (fo) variation in running speech, with consideration of factors such as singing status and vocal hyperfunction (VH). METHOD Female speakers (18-69 years) with typical voices (26 non-singers; 27 singers) and speakers with VH (22 non-singers; 30 singers) completed a pitch discrimination task and read the Rainbow Passage. The pitch discrimination task was a two-alternative forced choice procedure, in which participants determined whether tokens were the same or different. Tokens were a prerecorded sustained /ɑ/ of the participant's own voice and a pitch-shifted version of their sustained /ɑ/, such that the difference in fo was adaptively modified. Pitch discrimination and Rainbow Passage fo variation were calculated for each participant and compared via Pearson's correlations for each group. RESULTS A significant strong correlation was found between pitch discrimination and fo variation for non-singers with typical voices. No significant correlations were found for the other three groups, with notable restrictions in the ranges of discrimination for both singer-groups and in the range of fo variation values for non-singers with VH. CONCLUSIONS Speakers with worse pitch discrimination may increase their fo variation to produce self-salient intonational changes, which is in contrast to previous findings from articulatory investigations. The erosion of this relationship in groups with singing training and/or with VH may be explained by the known influence of musical training on pitch discrimination or the biomechanical changes associated with VH restricting speakers' abilities to change their fo.
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Affiliation(s)
- Allison S Aaron
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts.
| | - Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Computational Linguistics, Centre for Language and Cognition Groningen, University of Groningen, The Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Kalei P Volk
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Jacob Pieter Noordzij
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Lauren F Tracy
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Biomedical Engineering, Boston University, Boston, Massachusetts
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Rohlfing ML, Kan K, Tierney WS, Plocienniczak MJ, Edwards HA, Tracy LF. Historical Review and Modern Case of Spontaneous Laryngeal Abscess. Ann Otol Rhinol Laryngol 2022:34894221115757. [PMID: 35923122 DOI: 10.1177/00034894221115757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea, syphilis, and tuberculosis. More recent authors have described cases resulting from iatrogenic injury and immunosuppression. This report presents a novel case of laryngeal abscess in the setting of uncontrolled diabetes and a detailed review of modern, reported cases of spontaneous laryngeal abscess. METHODS Report of a single case. Also, PubMed was queried for cases of laryngeal abscess since 1985. CASE REPORT A 58-year-old male with poorly controlled diabetes presented with odynophagia, dysphagia, and dyspnea. He had biphasic stridor, and flexible laryngoscopy showed reduced mobility of bilateral vocal folds and narrowed glottic airway. He was taken urgently for awake tracheostomy and microdirect laryngoscopy. Laryngoscopy demonstrated fullness and fluctuance of the right hemilarynx. The abscess cavity was entered endoscopically via paraglottic incision extending into the subglottis. The patient was treated with an 8-week course of ampicillin-sulbactam with resolution of infection. RESULTS Seven additional cases of spontaneous laryngeal abscesses published after 1985 were identified. In total, 6 of 8 had some form of immunodeficiency (75%). The most common presenting symptoms were dysphonia (8/8, 100%), odynophagia (5/8, 62.5%), and dyspnea/stridor (4/8, 50%). All cases were treated with surgical incision and drainage. CONCLUSIONS Laryngeal abscesses are rare in the era of modern antibiotics. This review confirms that the majority of recent episodes occurred in the setting of immunodeficiency and are caused by non-tubercular bacteria. These infections are commonly associated with impaired vocal fold mobility which may contribute to dyspnea, stridor, and airway compromise. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described context for development of spontaneous laryngeal abscess.
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Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Krystal Kan
- Department of Otolaryngology, University of Illinois Chicago, Chicago, IL, USA
| | - William S Tierney
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Heather A Edwards
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
| | - Lauren F Tracy
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
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Beesley H, Piraquive J, Jaleel Z, Tracy LF. Pharyngesophageal Diverticula Following Anterior Cervical Discectomy and Fusion. Ann Otol Rhinol Laryngol 2022:34894221115745. [PMID: 35915914 DOI: 10.1177/00034894221115745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Development of traction pharyngesophageal diverticula following anterior cervical discectomy and fusion (ACDF) is a rare but morbid cause of dysphagia and the optimal surgical management is unclear. METHODS PubMed, GoogleScholar, Embase database reviews of "traction diverticula/um + anterior cervical/ACDF." Patient demographics, presenting symptoms, surgical technique, and outcomes were compared. RESULTS Seventeen manuscripts reported 21 cases of pharyngesophageal diverticulum (PED) following ACDF (10 F:11 M, mean age 45 years). Presenting symptoms included dysphagia (n = 18), regurgitation (n = 10), and weight loss (n = 6). The average interval to presentation was 4.5 years after ACDF (range: 6 months-18 years) and ACDF levels most commonly involved were C5-C6 and/or C6-C7 (n = 12). Open diverticulectomy with (n = 12) and without (n = 6) cricopharyngeal myotomy was the most common approach and reinforcement with vascularized tissue was used in 6 patients (29%). Attempted endoscopic diverticula repair was successful in 1 patient, was converted to open repair in 5 patients, and 1 patient did not have surgical repair. ACDF hardware was removed in 11 cases (52%) and was routinely removed when concomitant infection was present. Complications following repair were reported in 6 patients (30%). CONCLUSION Traction pharyngesophageal diverticula are a rare cause of dysphagia which occur after a variable interval following ACDF. Open surgical diverticulectomy yields superior outcomes compared to the endoscopic approach. In the setting of infection hardware removal is recommended. Vascularized tissue reinforcement can limit potential esophageal leak; however, the risk of post-operative complications remains high.
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Affiliation(s)
| | - Jacquelyn Piraquive
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Zaroug Jaleel
- Boston University School of Medicine, Boston, MA, USA
| | - Lauren F Tracy
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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11
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Plocienniczak M, Tracy LF. Muscle Tension Dysphonia. JAMA Otolaryngol Head Neck Surg 2022; 148:895. [PMID: 35900756 DOI: 10.1001/jamaoto.2022.1944] [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)
- Michal Plocienniczak
- Boston University School of Medicine, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Lauren F Tracy
- Boston University School of Medicine, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
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12
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Groll MD, Dahl KL, Cádiz MD, Welch B, Tracy LF, Stepp CE. Resynthesis of Transmasculine Voices to Assess Gender Perception as a Function of Testosterone Therapy. J Speech Lang Hear Res 2022; 65:2474-2489. [PMID: 35749662 PMCID: PMC9584127 DOI: 10.1044/2022_jslhr-21-00482] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/22/2021] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The goal of this study was to use speech resynthesis to investigate the effects of changes to individual acoustic features on speech-based gender perception of transmasculine voice samples following the onset of hormone replacement therapy (HRT) with exogenous testosterone. We hypothesized that mean fundamental frequency (f o) would have the largest effect on gender perception of any single acoustic feature. METHOD Mean f o, f o contour, and formant frequencies were calculated for three pairs of transmasculine speech samples before and after HRT onset. Sixteen speech samples with unique combinations of these acoustic features from each pair of speech samples were resynthesized. Twenty young adult listeners evaluated each synthesized speech sample for gender perception and synthetic quality. Two analyses of variance were used to investigate the effects of acoustic features on gender perception and synthetic quality. RESULTS Of the three acoustic features, mean f o was the only single feature that had a statistically significant effect on gender perception. Differences between the speech samples before and after HRT onset that were not captured by changes in f o and formant frequencies also had a statistically significant effect on gender perception. CONCLUSION In these transmasculine voice samples, mean f o was the most important acoustic feature for voice masculinization as a result of HRT; future investigations in a larger number of transmasculine speakers and on the effects of behavioral therapy-based changes in concert with HRT is warranted.
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Affiliation(s)
- Matti D. Groll
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Kimberly L. Dahl
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Manuel Díaz Cádiz
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Brett Welch
- Department of Communication Science and Disorders, University of Pittsburgh, PA
| | - Lauren F. Tracy
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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13
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Kapsner-Smith MR, Díaz-Cádiz ME, Vojtech JM, Buckley DP, Mehta DD, Hillman RE, Tracy LF, Noordzij JP, Eadie TL, Stepp CE. Clinical Cutoff Scores for Acoustic Indices of Vocal Hyperfunction That Combine Relative Fundamental Frequency and Cepstral Peak Prominence. J Speech Lang Hear Res 2022; 65:1349-1369. [PMID: 35263546 PMCID: PMC9499364 DOI: 10.1044/2021_jslhr-21-00466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE This study examined the discriminative ability of acoustic indices of vocal hyperfunction combining smoothed cepstral peak prominence (CPPS) and relative fundamental frequency (RFF). METHOD Demographic, CPPS, and RFF parameters were entered into logistic regression models trained on two 1:1 case-control groups: individuals with and without nonphonotraumatic vocal hyperfunction (NPVH; n = 360) and phonotraumatic vocal hyperfunction (PVH; n = 240). Equations from the final models were used to predict group membership in two independent test sets (n = 100 each). RESULTS Both CPPS and RFF parameters significantly improved model fits for NPVH and PVH after accounting for demographics. CPPS explained unique variance beyond RFF in both models. RFF explained unique variance beyond CPPS in the PVH model. Final models included CPPS and RFF offset parameters for both NPVH and PVH; RFF onset parameters were significant only in the PVH model. Area under the receiver operating characteristic curve analysis for the independent test sets revealed acceptable classification for NPVH (72%) and good classification for PVH (86%). CONCLUSIONS A combination of CPPS and RFF parameters showed better discriminative ability than either measure alone for PVH. Clinical cutoff scores for acoustic indices of vocal hyperfunction are proposed for assessment and screening purposes.
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Affiliation(s)
| | | | - Jennifer M Vojtech
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
| | - Daniel P Buckley
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
| | - Daryush D Mehta
- MGH Institute of Health Professions, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Cambridge, MA
| | - Robert E Hillman
- MGH Institute of Health Professions, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Cambridge, MA
| | - Lauren F Tracy
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
| | - J Pieter Noordzij
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
| | - Tanya L Eadie
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | - Cara E Stepp
- Department of Speech, Language & Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
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14
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Shehan JN, Alwani T, LeClair J, Mahoney TF, Agarwal P, Chaudhry ST, Wang JJ, Noordzij JP, Tracy LF, Edwards HA, Grillone G, Salama AR, Jalisi SM, Devaiah AK. Social determinants of health and treatment decisions in head and neck cancer. Head Neck 2021; 44:372-381. [PMID: 34889486 DOI: 10.1002/hed.26931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study compares select social determinants of health (SDOH) with treatment modality selection and treatment completion in head and neck cancer (HNC) patients, to better understand disparities in health outcomes. METHODS A retrospective cohort study of HNC (n = 1428) patients was conducted. Demographic and disease-specific variables were recorded, including treatment modality selection and completion. Data were analyzed using two-sample t tests, chi-square, and Fisher's exact tests. RESULTS Primary language was significantly associated with treatment choice, where non-English speakers were less likely to choose treatment as recommended by the Tumor Board. Lower mean distance from the hospital (37.38 [48.31] vs. 16.92 [19.10], p < 0.0001) and a county-based higher mean percentage of bachelor degree or higher education (42.16 [8.82] vs. 44.95 [6.19], p < 0.0003) were associated with treatment selection. CONCLUSION Language, distance from the hospital, and education affected treatment selection in this study and may be useful in understanding how to counsel patients on treatment selection for HNC.
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Affiliation(s)
- Jennifer N Shehan
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Tooba Alwani
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pratima Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Salil T Chaudhry
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judy J Wang
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jacob Pieter Noordzij
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren F Tracy
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather A Edwards
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gregory Grillone
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew R Salama
- Department of Oral Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Scharukh M Jalisi
- Department of Otolaryngology - Head and Neck Surgery, Beth Israel Deaconess, Boston, Massachusetts, USA
| | - Anand K Devaiah
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
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15
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Alwani T, Shehan JN, LeClair J, Mahoney TF, Agarwal P, Chaudhry ST, Wang JJ, Noordzij JP, Tracy LF, Edwards HA, Grillone G, Salama AR, Jalisi SM, Devaiah AK. Geographic Barriers Affect Follow-Up Care in Head and Neck Cancer. Laryngoscope 2021; 132:1022-1028. [PMID: 34762300 PMCID: PMC9007826 DOI: 10.1002/lary.29934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Follow-up care in head and neck cancers (HNC) is critical in managing patient health. However, social determinants of health (SDOH) can create difficulties in maintaining follow-up care. The study goal is to explore how SDOH impacts maintenance of HNC follow-up care appointments. METHODS A systematic retrospective chart review of 877 HNC patients diagnosed in the past 10 years a safety-net tertiary care hospital with systems to help reduce care disparities. Cohort groups were identified and compared against protocols for follow-up. Data were analyzed using analysis of variance, chi-square tests, Fisher's exact tests, two-sample t-tests, and simple linear regression. RESULTS The average length of follow-up time in months and average total number of follow-ups over 5 years were 32.96 (34.60) and 9.24 (7.87), respectively. There was no significant difference in follow-up care between United States (US) versus non-US born and English versus non-English speaking patients. Race/ethnicity, county median household income, insurance status, and county educational attainment were not associated with differences in follow-up. However, living a greater distance from the hospital was associated with lower follow-up length and less frequency in follow-up (P < .0001). CONCLUSION While income, primary language, country of birth, race/ethnicity, insurance status, and markers of educational attainment do not appear to impact HNC follow-up at our safety-net, tertiary care institution, and distance from hospital remains an important contributor to disparities in care. This study shows that many barriers to care can be addressed in a model that addresses SDOH, but there are barriers that still require additional systems and resources. Laryngoscope, 2021.
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Affiliation(s)
- Tooba Alwani
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
| | | | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston MA
| | - Taylor F. Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston MA
| | - Pratima Agarwal
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
| | | | - Judy J. Wang
- Boston University School of Medicine, Boston, MA
| | - J. Pieter Noordzij
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Lauren F. Tracy
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Heather A. Edwards
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Gregory Grillone
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Andrew R. Salama
- Department of Oral Maxillofacial Surgery Boston, Medical Center, Boston MA
| | - Scharukh M. Jalisi
- Department of Otolaryngology – Head and Neck Surgery, Beth Israel Deaconess, Boston, MA
| | - Anand K. Devaiah
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
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16
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Dahl KL, Weerathunge HR, Buckley DP, Dolling AS, Díaz-Cádiz M, Tracy LF, Stepp CE. Reliability and Accuracy of Expert Auditory-Perceptual Evaluation of Voice via Telepractice Platforms. Am J Speech Lang Pathol 2021; 30:2446-2455. [PMID: 34473568 PMCID: PMC9132030 DOI: 10.1044/2021_ajslp-21-00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 05/24/2023]
Abstract
Purpose This study assessed the reliability and accuracy of auditory-perceptual voice evaluations by experienced clinicians via telepractice platforms. Method Voice samples from 20 individuals were recorded after transmission via telepractice platforms. Twenty experienced clinicians (10 speech-language pathologists, 10 laryngologists) evaluated the samples for dysphonia percepts (overall severity, roughness, breathiness, and strain) using a modified Consensus Auditory-Perceptual Evaluation of Voice. Reliability was calculated as the mean of squared differences between repeated ratings (intrarater agreement), and between individual and group mean ratings (interrater agreement). Repeated measures analyses of variance were constructed to measure effects of transmission condition (e.g., original recording, WebEx, Zoom), dysphonia percept, and their interaction on intrarater agreement, interrater agreement, and average ratings. Significant effects were evaluated with post hoc Tukey's tests. Results There were significant effects of transmission condition, percept, and their interaction on average ratings, and a significant effect of percept on interrater agreement. Post hoc testing revealed statistically, but not clinically, significant differences in average roughness ratings across transmission conditions, and significant differences in interrater agreement for several percepts. Overall severity had the highest agreement and strain had the lowest. Conclusion Telepractice transmission does not substantially reduce reliability or accuracy of auditory-perceptual voice evaluations by experienced clinicians.
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Affiliation(s)
- Kimberly L. Dahl
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Hasini R. Weerathunge
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston, University, MA
| | - Daniel P. Buckley
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
| | - Anton S. Dolling
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Manuel Díaz-Cádiz
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren F. Tracy
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
| | - Cara E. Stepp
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
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17
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Baird BJ, Tynan MA, Tracy LF, Heaton JT, Burns JA. Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis. Laryngoscope 2021; 131:2752-2758. [PMID: 34296439 DOI: 10.1002/lary.29717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings. STUDY DESIGN Prospective cohort study. METHODS Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso. RESULTS The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly. CONCLUSION Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Brandon J Baird
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Monica A Tynan
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - James T Heaton
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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18
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Abur D, Subaciute A, Kapsner-Smith M, Segina RK, Tracy LF, Noordzij JP, Stepp CE. Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders. Sci Rep 2021; 11:13123. [PMID: 34162907 PMCID: PMC8222324 DOI: 10.1038/s41598-021-92250-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Hyperfunctional voice disorders (HVDs) are the most common class of voice disorders, consisting of diagnoses such as vocal fold nodules and muscle tension dysphonia. These speech production disorders result in effort, fatigue, pain, and even complete loss of voice. The mechanisms underlying HVDs are largely unknown. Here, the auditory-motor control of voice fundamental frequency (fo) was examined in 62 speakers with and 62 speakers without HVDs. Due to the high prevalence of HVDs in singers, and the known impacts of singing experience on auditory-motor function, groups were matched for singing experience. Speakers completed three tasks, yielding: (1) auditory discrimination of voice fo; (2) reflexive responses to sudden fo shifts; and (3) adaptive responses to sustained fo shifts. Compared to controls, and regardless of singing experience, individuals with HVDs showed: (1) worse auditory discrimination; (2) comparable reflexive responses; and (3) a greater frequency of atypical adaptive responses. Atypical adaptive responses were associated with poorer auditory discrimination, directly implicating auditory function in this motor disorder. These findings motivate a paradigm shift for understanding development and treatment of HVDs.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA.
| | - Austeja Subaciute
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
| | - Mara Kapsner-Smith
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Roxanne K Segina
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
| | - Lauren F Tracy
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
| | - J Pieter Noordzij
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
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19
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Basa K, Jabbour N, Rohlfing M, Schmoker S, Lawlor CM, Levi J, Sobin L, Tracy JC, Tracy LF. Online Reputations: Comparing Hospital- and Patient-Generated Ratings in Academic Otolaryngology. Ann Otol Rhinol Laryngol 2021; 130:1317-1325. [PMID: 33813874 DOI: 10.1177/00034894211005985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study compares hospital-generated online ratings to patient-generated online ratings in academic otolaryngology and evaluates physician factors influencing these results. METHODS Websites of academic otolaryngologists were assessed for inclusion of hospital-generated Press Ganey surveys. Corresponding scores on Healthgrades and Vitals.com were identified via internet search. Hospital ratings were compared with patient-generated ratings, including score, demographics, and number of ratings. All data was collected between July 15th 2019 and August 22nd 2019. RESULTS 742 academic otolaryngologists with hospital-generated ratings were identified. Mean hospital-generated rating was significantly higher ((4.70, 95% CI 4.69-4.72) than patient-generated rating (Vitals:4.26, 95% CI 4.18-4.34, and Healthgrades:4.02, 95% CI 3.87-4.18; P < .001). In patient-generated rating, an increased number of rating scores (>20) was associated with male gender, professor ranking, and >30 years in practice (P < .005). Physician demographics did not impact number of ratings in hospital-generated setting. With patient-generated, lower aggregate score was associated with professor ranking (P = .001). In hospital-generated, lower score was associated with >30+ years in practice (P = .023). Across all platforms, comprehensive otolaryngologists and neurotologists/otologists were rated lower in comparison to other specialties (PGS:P < .001,Vitals:P = .027,Healthgrades:P = .016). CONCLUSION Hospital-generated ratings yield higher mean scores than patient-generated platforms. Between sources, Healthgrades.com scores were lower than those of Vitals.com. Professors with >30 years of practice generated more reviews in patient-generated ratings, and these physicians were generally rated lower. Access to patient-generated ratings is universal and physicians should be aware of variability between online rating platforms as scores may affect referrals and practice patterns.
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Affiliation(s)
- Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | | | - Matthew Rohlfing
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | | | - Claire M Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, DC, USA
| | - Jessica Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Lindsay Sobin
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeremiah C Tracy
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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20
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Ghodke A, Tracy LF, Hollis A, Adams K, Shah RN, Buckmire RA. Combined Transverse Cordotomy- Anteromedial Arytenoidectomy for Isolated Glottic Stenosis. Laryngoscope 2021; 131:2305-2311. [PMID: 33577090 DOI: 10.1002/lary.29438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Glottic stenosis is a discrete cause of airway compromise. We aimed to determine the surgical outcomes of transverse cordotomy with anteromedial arytenoidectomy (TCAMA), performed in the setting of isolated glottic stenosis resulting from two discrete etiologies: bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS). STUDY DESIGN Retrospective, analytic cohort study. METHODS Twenty-six patients with isolated glottic stenosis were treated with TCAMA between 2006 and 2019. A retrospective analysis determined decannulation rates and intervals, voice outcomes, swallowing outcomes, and reoperation rates postoperatively. Outcomes between the two etiologic cohorts were compared. RESULTS Of the 26 patients, 16/26 patients were diagnosed with PGS and 10/26 with BVFP. Eighteen patients required tracheotomies during their clinical course (11/16 PGS, and 7/10 BVFP), and 100% were ultimately decannulated. The PGS cohort required two-sided interventions more frequently than the BVFP cohort (45.5% vs. 0%, P = .066). Trach-dependent PGS patients required a longer time to achieve decannulation than BVFP patients by a factor of 2.38, although the difference was not statistically significant (102.3 days vs. 42.9 days, respectively, P = .113). Patients demonstrated a significant change in maximum phonation time but no statistically significant differences with preoperative versus postoperative voice outcomes like voice-related quality of life. All patients ultimately returned to their baseline swallow function postoperatively. CONCLUSION TCAMA is an effective treatment for surgical rehabilitation of glottic stenosis caused by both BVFP and PGS. Patient-reported outcomes of postoperative vocal function remain consistent following surgical intervention. Additional, prospective studies with greater power are warranted to validate the contrasting outcomes observed when applying this discrete surgical technique across two distinct diagnostic cohorts in this retrospective study. LEVEL OF EVIDENCE 4. Laryngoscope, 2021.
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Affiliation(s)
- Ameer Ghodke
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Alison Hollis
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Katherine Adams
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Robert A Buckmire
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
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21
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Zambare WV, Sobin L, Messner A, Levi JR, Tracy JC, Tracy LF. Gender Representation in Otolaryngology–Head and Neck Surgery Recognition Awards. Otolaryngol Head Neck Surg 2020; 164:1200-1207. [DOI: 10.1177/0194599820970958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The proportion of women in otolaryngology–head and neck surgery (OHNS) has steadily increased in recent years. This study examines gender representation in recognition awards given by OHNS societies between 2009 and 2019. Study Design Retrospective analysis of recognition awards given by 10 OHNS societies between 2009 and 2019. Setting Retrospective review of web-based, public records. Methods Data from 19 awards were analyzed for recipient gender ratio, society, subspecialty, award type (research, achievement, or humanitarian), and change over time. Results Of 184 awards given by societies in otolaryngology–head and neck surgery, 59 (28%) were given to women. Women received 49 (28%) research awards, 9 (31%) humanitarian awards, and 1 (2.8%) achievement award. Women represented 31% of award winners in rhinology/skull base, 30% of award winners in head and neck surgery, 8% in neurotology, and 6% in facial plastic surgery. The American Head and Neck Society Prevention and Early Detection award had the highest representation of women at 43%. Some awards had no female awardees over the past decade. No temporal trends were observed. Conclusion From 2009 to 2019, women received recognition awards at a higher percentage than overall gender representation in OHNS. Comparison of research, humanitarian, and achievement awards revealed the disparity of women receiving fewer achievement awards relative to men. Gender representation of award recipients varied by subspecialty, which may be partially determined by gender distribution within the fields.
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Affiliation(s)
- Wini V. Zambare
- Boston University School of Medicine, Boston Massachusetts, USA
| | - Lindsay Sobin
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Anna Messner
- Division of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck Surgery, Tufts University Medical Center, Boston Massachusetts, USA
| | - Lauren F. Tracy
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Mulcahy CF, Ghulam-Smith M, Mamidi IS, Thakkar PG, Edwards H, Tummala N, Tracy LF. Oropharyngeal hemorrhage in patients with COVID-19: A multi-institutional case series. Am J Otolaryngol 2020; 41:102691. [PMID: 32890807 PMCID: PMC7435325 DOI: 10.1016/j.amjoto.2020.102691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 who are intubated and require mechanical ventilation have been observed to have oropharyngeal bleeding necessitating otolaryngology intervention. Methods We report five cases of oropharyngeal hemorrhage in COVID-19 patients on mechanical ventilation requiring evaluation by otolaryngologists at George Washington University Hospital (GWUH) and Boston Medical Center (BMC) from March to April 2020. Institutional Review Board at both institutions exempted this study from informed consent because there were no identifiable patient characteristics, photographs, or imaging studies included. Results All five patients were managed conservatively; four required packing with Kerlix gauze by an otolaryngologist. Two patients had the additional requirement of extracorporeal membrane oxygenation (ECMO) and associated anticoagulation. Three patients improved with oropharyngeal packing; two had persistent bleeding. Three patients expired. Endotracheal tubes were repositioned less frequently due to the COVID-19 pandemic. Conclusions Intubated patients with COVID-19 may have an increased risk of oropharyngeal hemorrhage. This may be due to anticoagulation, prolonged intubation, or decreased frequency of endotracheal tube repositioning. Otolaryngologists should wear appropriate PPE when managing this hemorrhagic complication.
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Mur TA, Pellegrini WR, Tracy LF, Levi JR. Laryngeal granular cell tumors in children: A literature review. Int J Pediatr Otorhinolaryngol 2020; 138:110193. [PMID: 32705988 DOI: 10.1016/j.ijporl.2020.110193] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Granular cell tumors of the larynx are exceedingly rare in the pediatric population. The purpose of this review is to further characterize features of these tumors and trends in their management. METHODS A search of the PubMed, Ovid Medline and Cochrane Collaboration databases was undertaken using the terms: pediatric, child, laryngeal, larynx, granular cell tumor, granular cell myoblastoma, benign mass. RESULTS A total of 38 children with laryngeal granular cell tumor were identified. Their ages ranged from 4 to 16 years. The most common presenting symptom was dysphonia. Five patients were previously treated for asthma. Within the laryngeal subsites, 49% presented with subglottic tumors, while 43% were found at the level of the glottis. Subglottic tumors were found anteriorly 42% of the time and posteriorly 53% of the time. Multifocal disease was present in four patients. Around half of patients were treated by cold steel excision and/or CO2 laser, 31% through laryngofissure, and two required laryngectomy. There were four documented cases of recurrence ranging from 4 months to 3 years after treatment. CONCLUSIONS Laryngeal granular cell tumor during childhood occurs most commonly in the subglottis. Posterior laryngeal tumors were more frequent than anterior tumors. Patients should be carefully evaluated for multifocal disease. Long-term surveillance for recurrence is recommended.
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Affiliation(s)
- Taha A Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | | | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Lim KWR, Zambare W, Rubin BR, Tracy LF. Barriers to Voice Therapy Attendance in a Language-Diverse Population. Laryngoscope 2020; 131:1835-1839. [PMID: 33001456 DOI: 10.1002/lary.29149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice therapy is an effective treatment for many voice disorders, but success depends on attendance and adherence. Many factors hinder treatment attendance, and language discordance with the provider may present an additional obstacle to attending therapy. This study evaluates factors associated with voice therapy attendance at a language-diverse, safety-net hospital. STUDY DESIGN Retrospective chart review. METHODS Retrospective review of adult patients referred to speech language pathology for treatment of voice disorders from January, 2018 to April, 2019. Primary spoken language, interpreter collaboration, and patient demographics were obtained from medical records. Multivariate analysis compared patient factors with voice therapy attendance versus nonattendance. RESULTS Of 422 patients, 219 (52%) attended at least one therapy session, whereas 203 (48%) did not attend (n = 120) or schedule therapy (n = 83). In multivariate analysis, only the association between public insurance and nonattendance was statistically significant (P = .016). After adjusting for interpreter use and interval between referral and first appointment, patients with private health insurance were 2.35 times more likely to attend therapy compared to those with public insurance (95% confidence interval: 1.18-4.71). Non-English language; interpreter collaboration; distance from hospital; and patient demographics, including age, gender, ethnicity, and birthplace, did not significantly correlate with attendance. CONCLUSIONS In a culturally and language-diverse cohort of dysphonic patients, individuals with public health insurance were significantly less likely to attend voice therapy. Language-discordant therapy and interpreter collaboration was not a statistically significant barrier to therapy attendance. Additional investigation is warranted to optimize allocation of voice therapy resources for those with public health insurance and for diverse speakers of all languages. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1835-1839, 2021.
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Affiliation(s)
| | - Wini Zambare
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Batsheva R Rubin
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center; Boston University School of Medicine, Boston, Massachusetts, U.S.A
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Rohlfing ML, Buckley DP, Piraquive J, Stepp CE, Tracy LF. Hey Siri: How Effective are Common Voice Recognition Systems at Recognizing Dysphonic Voices? Laryngoscope 2020; 131:1599-1607. [PMID: 32949415 DOI: 10.1002/lary.29082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Interaction with voice recognition systems, such as Siri™ and Alexa™, is an increasingly important part of everyday life. Patients with voice disorders may have difficulty with this technology, leading to frustration and reduction in quality of life. This study evaluates the ability of common voice recognition systems to transcribe dysphonic voices. STUDY DESIGN Retrospective evaluation of "Rainbow Passage" voice samples from patients with and without voice disorders. METHODS Participants with (n = 30) and without (n = 23) voice disorders were recorded reading the "Rainbow Passage". Recordings were played at standardized intensity and distance-to-dictation programs on Apple iPhone 6S™, Apple iPhone 11 Pro™, and Google Voice™. Word recognition scores were calculated as the proportion of correctly transcribed words. Word recognition scores were compared to auditory-perceptual and acoustic measures. RESULTS Mean word recognition scores for participants with and without voice disorders were, respectively, 68.6% and 91.9% for Apple iPhone 6S™ (P < .001), 71.2% and 93.7% for Apple iPhone 11 Pro™ (P < .001), and 68.7% and 93.8% for Google Voice™ (P < .001). There were strong, approximately linear associations between CAPE-V ratings of overall severity of dysphonia and word recognition score, with correlation coefficients (R2 ) of 0.609 (iPhone 6S™), 0.670 (iPhone 11 Pro™), and 0.619 (Google Voice™). These relationships persisted when controlling for diagnosis, age, gender, fundamental frequency, and speech rate (P < .001 for all systems). CONCLUSION Common voice recognition systems function well with nondysphonic voices but are poor at accurately transcribing dysphonic voices. There was a strong negative correlation with word recognition scores and perceptual voice evaluation. As our society increasingly interfaces with automated voice recognition technology, the needs of patients with voice disorders should be considered. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1599-1607, 2021.
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Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Daniel P Buckley
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
| | - Jacquelyn Piraquive
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A
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Tracy LF, Segina RK, Cadiz MD, Stepp CE. The Impact of Communication Modality on Voice Production. J Speech Lang Hear Res 2020; 63:2913-2920. [PMID: 32762517 PMCID: PMC7890225 DOI: 10.1044/2020_jslhr-20-00161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 06/11/2023]
Abstract
Purpose Communicating remotely using audio and audiovisual technology is ubiquitous in modern work and social environments. Remote communication is increasing in medicine and in voice therapy delivery, and this evolution may have an impact on speakers' voices. This study sought to determine whether these communication modalities impact the voice production of typical speakers. Method The speech acoustics of 12 participants with healthy voices were recorded as they held standardized conversations with a single investigator using three communication modalities: in-person, remote-audio, and remote-audiovisual. Participants rated their vocal effort on a 100-mm visual analog scale. Results Compared to in-person communication, self-ratings of vocal effort were statistically significantly increased for remote-audiovisual communication; vocal effort during remote-audio and in-person communication were not significantly different. In comparison to in-person communication, vocal intensity and smoothed cepstral peak prominence (CPPS) were statistically significantly higher during remote-audio and remote-audiovisual communication. Effect sizes for CPPS changes were larger than for sound pressure level (SPL), and changes in CPPS and SPL between in-person and remote-audiovisual communication were not significantly correlated. Conclusions Vocal effort and SPL were increased when using remote-audio and remote-audiovisual communication in comparison to in-person communication. Voice quality was also impacted by technology use, with changes in CPPS that were consistent with, but not fully explained by, increases in SPL. This may impact the telepractice delivery of voice therapy, and further investigation is warranted.
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Affiliation(s)
- Lauren F. Tracy
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
| | - Roxanne K. Segina
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Manuel Diaz Cadiz
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
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Sulibhavi A, Kaufmann MR, Shetty KR, Wulu JA, Tracy LF, Levi JR. Factors Associated With Distribution of Female Otolaryngology Residents in United States. Laryngoscope 2020; 131:E367-E372. [PMID: 32681748 DOI: 10.1002/lary.28746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/08/2019] [Revised: 03/12/2020] [Accepted: 04/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The gender balance within medicine, and specifically within otolaryngology, is equalizing. It is important to determine the factors that impact the distribution of female residents among otolaryngology programs in the United States to better understand factors that may affect these changing trends. STUDY DESIGN Retrospective Study. METHODS Cross-sectional analysis was performed using data from 2018 of otolaryngology residents at 90 programs across the United States. Each program's website was searched for a current resident roster. Data of geography, number of female faculty, number of female physicians in leadership positions, program setting, and program size were obtained. Statistical comparison of these factors with number of female residents was performed with P < .05 as significant. RESULTS There was a significant association between programs having a higher-than-average female faculty representation and a greater representation of female residents (P < .001). Larger residency programs were more likely to have greater female representation (P = .010). There was a slight predominance of both female residents and female faculty at urban programs (odds ratio [OR] = 1.27, P = .04; OR = 1.28, P = .03). Geographic location, presence of a female chairperson, and presence of a female residency program director were not associated with higher female-to-male resident ratio. CONCLUSION Availability of female role models in faculty, along with program setting and size, may be more likely to promote greater female representation. Focusing on gender equality in the workplace can help promote diversity in the workforce and improve patient outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 131:E367-E372, 2021.
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Affiliation(s)
- Anita Sulibhavi
- Department of Otolaryngology Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew R Kaufmann
- Department of Otolaryngology Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Kunal R Shetty
- Department of Otolaryngology Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Jacqueline A Wulu
- Department of Otolaryngology Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Department of Otolaryngology Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
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Ferri GM, Prakash Y, Levi JR, Tracy LF. Differential diagnosis and management of adult-onset laryngomalacia. Am J Otolaryngol 2020; 41:102469. [PMID: 32278471 DOI: 10.1016/j.amjoto.2020.102469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Adult-onset laryngomalacia is a rare clinical entity that has been infrequently reported. This study aims to evaluate the clinical presentation, diagnosis, and management of adult-onset laryngomalacia through literature review and report of a case. METHODS PubMed and Google Scholar databases were queried for articles published from 1960 to 2019 including only patients aged 18 years and older. Included keywords were: 'laryngomalacia', 'adult laryngomalacia', 'acquired laryngomalacia', 'idiopathic laryngomalacia', 'laryngeal obstruction', 'floppy epiglottis', 'floppy epiglottis', and 'epiglottis prolapse'. Data extracted from literature included clinical presentation, diagnostic workup, surgical management, and follow-up care. SOURCES PubMed and Google Scholar. RESULTS A total of 21 articles reported 41 cases of adult-onset laryngomalacia. Within these cases, 5 etiologies were identified: neurologic (n = 14), exercise-induced (n = 9), post-operative (n = 7), idiopathic (n = 7), and age-related (n = 4) laryngomalacia. Anterior prolapse of arytenoids and aryepiglottic folds was the most common laryngoscopic finding (n = 21), followed by posterior epiglottic prolapse (n = 20). Management included supraglottoplasty (n = 14), epiglottidectomy (n = 8) or epiglottopexy (n = 2). Neurologic etiology required tracheotomy more often than the other etiologies (n = 5, 36% vs. 15%). Three patients were managed expectantly without surgical intervention and reported symptom resolution. CONCLUSION Adult laryngomalacia is a rare diagnosis comprising a spectrum of disease. This diagnosis may be overlooked, but association with neurologic injury or trauma should encourage consideration. In comparison to pediatric laryngomalacia, patients often require surgical intervention. Surgical decision is based on the direction of supraglottic collapse, where supraglottoplasty and partial epiglottidectomy are effective interventions. LEVEL OF EVIDENCE N/A.
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Abstract
OBJECTIVE Laryngopharyngeal reflux (LPR) and associated symptoms can be refractory to treatment with acid suppressing medication. We investigated the role and evidence for complementary and alternative medicine (CAM) for LPR in this systematic review. REVIEW METHODS Complementary and alternative treatment was defined in this systematic review as any non-acid suppressing medication, treatment, or therapy. A literature search was performed by two authors in consultation with a medical librarian using controlled vocabulary for "complementary and alternative medicine" and "laryngopharyngeal reflux" in the databases PubMed and EMBASE, with supplemental searches with Google Scholar. RESULTS Twenty articles were included in this review for the modalities: alginate, diet modification, prokinetics, respiratory retraining, voice therapy, rikkunshito (RKT), hypnotherapy, and sleep positioning. The studies were analyzed for bias based on the Cochrane criteria for RCTs and Methodological Index for non-RCT (MINORS) criteria for all other studies. For each modality a level of evidence was assigned to the current body of evidence using the GRADE approach. CONCLUSION There is mixed evidence with a high degree of bias and heterogeneity between studies for the modalities presented in the paper. Based on this review, an anti-reflux diet is recommended for all patients and there is some low-quality evidence to support alkaline water. For patients with predominant vocal symptoms there is evidence that supports voice therapy. There is insufficient evidence to recommend prokinetics at this time. For patients with predominant globus symptoms, alginate, RKT, and relaxation strategies may be used in conjunction with acid suppressing medications for symptom relief.
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Affiliation(s)
| | | | - Chase I Kahn
- Boston University School of Medicine, Boston, MA, USA
| | - Lauren F Tracy
- Boston University School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, MA, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, MA, USA
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Abstract
Tracheotomy in the pediatric population creates unique challenges for parents. Parents often feel underprepared to provide adequate tracheostomy care. Social media is used as a resource for many medical conditions. We looked at Facebook use among parents of children with a tracheostomy to determine how this resource is used as support and to assess common concerns that require improved education prior to discharge. We joined 8 Facebook groups focused on children with a tracheostomy, analyzed the posts for how the groups were used, and identified recurring content. The primary focus of the groups was parental support and general information about tracheostomy care. A common theme identified was patients not receiving medical supplies on time, and groups provided a forum to obtain supplies. Groups also provided general advice about how to travel with a tracheostomy and medical advice, such as when to worry about blood in the tracheostomy tube.
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Affiliation(s)
| | - Chase I. Kahn
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Lauren F. Tracy
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jessica R. Levi
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Tracy LF, Jabbour N, Rubin BR, Sobin LB, Lawlor CM, Basa KC, Levi JR, Tracy JC. Satisfaction in Academic Otolaryngology: Do Physician Demographics Impact Press Ganey Survey Scores? Laryngoscope 2019; 130:1902-1906. [DOI: 10.1002/lary.28335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Lauren F. Tracy
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Nicolette Jabbour
- Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Batsheva R. Rubin
- Boston Medical Center Boston University School of Medicine Boston Massachusetts
- Boston University School of Public Health Boston Massachusetts
| | - Lindsay B. Sobin
- Department of Otolaryngology–Head and Neck Surgery University of Massachusetts Amherst Massachusetts
| | - Claire M. Lawlor
- Department of Otolaryngology–Head and Neck Surgery Children's National Health System, George Washington University Washington DC
| | - Krystyne C. Basa
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck Surgery University of Massachusetts Amherst Massachusetts
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Tracy LF, Kobler JB, Van Stan JH, Burns JA. Carbon debris and fiber cleaving: Effects on potassium-titanyl-phosphate laser energy and chorioallantoic membrane model vessel coagulation. Laryngoscope 2019; 129:2244-2248. [PMID: 30908661 DOI: 10.1002/lary.27948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Photoangiolytic precision afforded by the 532-nm potassium-titanyl-phosphate (KTP) laser relies on predictable energy delivery. Inadequate energy output can cause vessel rupture, and excessive energy can cause thermal damage. The quality of the cleaved surface and carbon deposits from ablated tissue are two factors that could negatively impact fiber performance. The effects of these on energy output and blood vessel coagulation were assessed using a chorioallantoic membrane (CAM) model. STUDY DESIGN Comparative analysis. METHODS Laser fibers with carbon debris, optimal fiber cleaving, and suboptimal cleaving were inspected at three times magnification, and the light dispersion pattern of each fiber was rated. The average energy output from consecutive pulses through each fiber configuration was recorded. The effect of these fiber conditions on clinical efficacy was estimated by measuring vessel coagulation versus rupture in the CAM model. Repeated measures analysis of variance compared results. RESULTS Carbon debris and suboptimal cleaving resulted in decreased energy output in comparison to optimal cleaving ([-Δ244 mJ, d = 4.31, P < .001] and [-Δ195 mJ, d = 6.04, P < .001]). Optimal cleaving resulted in immediate coagulation of vessels. Fibers with suboptimal cleaving and carbon debris had unpredictable outcomes, requiring multiple pulses for coagulation or causing vessel rupture. CONCLUSIONS KTP laser fiber function is significantly affected by fiber tip condition. Carbon debris and suboptimal cleaving create significant attenuation of energy, which results in an unpredictable angiolytic effect, as demonstrated by increased vessel rupture in the CAM model. Optimal recleaving of KTP laser fibers restores prior energy output and predictable coagulation. Care should be taken to avoid carbon debris on laser-fiber tips and to cleave fibers properly. LEVEL OF EVIDENCE NA Laryngoscope, 129:2244-2248, 2019.
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Affiliation(s)
- Lauren F Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - James B Kobler
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Jarrad H Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Tracy LF, Basu S, Shah PV, Frank-Ito DO, Das S, Zanation AM, Kimbell JS. Impact of endoscopic craniofacial resection on simulated nasal airflow and heat transport. Int Forum Allergy Rhinol 2019; 9:900-909. [PMID: 30861326 DOI: 10.1002/alr.22328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/02/2018] [Revised: 01/27/2019] [Accepted: 02/20/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endoscopic craniofacial resections (CFR) are performed for extensive anterior skull base lesions. This surgery involves removal of multiple intranasal structures, potentially leading to empty nose syndrome (ENS). However, many patients remain asymptomatic postoperatively. Our objective was to analyze the impact of CFR on nasal physiology and airflow using computational fluid dynamics (CFD). This is the first CFD analysis of post-CFR patients. METHODS Three-dimensional sinonasal models were constructed from 3 postoperative images using MimicsTM . Hybrid computational meshes were created. Steady inspiratory airflow and heat transport were simulated at patient-specific flow rates using shear stress transport k-omega turbulent flow modeling in FluentTM . Simulated average heat flux (HF) and surface area where HF exceeded 50 W/m2 (SAHF50) were compared with laminar simulations in 9 radiographically normal adults. RESULTS Three adults underwent CFR without developing ENS. Average HF (W/m2 ) were 132.70, 134.84, and 142.60 in the CFR group, ranging from 156.24 to 234.95 in the nonoperative cohort. SAHF50 (m2 ) values were 0.0087, 0.0120, and 0.0110 in the CFR group, ranging from 0.0082 to 0.0114 in the radiographically normal cohort. SAHF50 was distributed throughout the CFR cavities, with increased HF at the roof and walls compared with the nonoperative cohort. CONCLUSION Average HF was low in the CFR group compared with the nonoperative group. However, absence of ENS in most CFR patients may be due to large stimulated mucosal surface area, commensurate with the nonoperative cohort. Diffuse distribution of stimulated area may result from turbulent mixing after CFR. To better understand heat transport post-CFR, a larger cohort is necessary.
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Affiliation(s)
- Lauren F Tracy
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Saikat Basu
- Department of Mechanical Engineering, South Dakota State University, Brookings, SD
| | - Parth V Shah
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dennis O Frank-Ito
- Division of Otolaryngology, Head and Neck Surgery, Duke University Medical Center, Durham, NC
| | - Snigdha Das
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Julia S Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Tracy LF, Patel SN, Buckmire RA, Shah RN. Laryngeal reconstruction for recurrent desmoid tumor using three-dimensional modeling: A unique approach for a rare tumor. Laryngoscope 2018; 129:1989-1992. [PMID: 30585331 DOI: 10.1002/lary.27756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
Desmoid tumors are exceedingly rare within the larynx and cause significant morbidity due to their locally aggressive and infiltrative nature. Surgery is the mainstay of treatment with previous reports describing total and near-total laryngectomy for cure. We present a case of recurrent glottic desmoid tumor managed with hemilaryngectomy and reconstructed with temporoparietal free tissue, rib, and buccal grafts. Three-dimensional modeling was utilized to optimize aerodigestive function after laryngeal reconstruction. Laryngoscope, 129:1989-1992, 2019.
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Affiliation(s)
- Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
| | - Samip N Patel
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
| | - Robert A Buckmire
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
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Tracy LF, Kwak PE, Bayan SL, Van Stan JH, Burns JA. Vocal Fold Motion Recovery in Patients With Iatrogenic Unilateral Immobility: Cervical Versus Thoracic Injury. Ann Otol Rhinol Laryngol 2018; 128:44-49. [DOI: 10.1177/0003489418808306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Prognostic information about the return of vocal fold mobility in patients with iatrogenic unilateral vocal fold immobility (UVFI) can help with informed decisions about temporary and permanent treatment options. Although many variables can influence the likelihood of recovery, clinical experience suggests that cervical versus thoracic injury is a determining factor. The purpose of this study was to compare recovery rates from UVFI between cervical and thoracic injuries. Methods: A retrospective review of the medical record was performed on all adult patients diagnosed with complete iatrogenic UVFI from 2005 to 2015 (n = 923). Patients with incomplete data and etiologies of idiopathic, malignancy, or stenosis were excluded, leaving a study cohort of 502 patients who were categorized as having UVFI after cervical (n = 329) or thoracic (n = 173) injury. Data regarding site of iatrogenic injury (cervical vs thoracic), mobility status, and time interval to recovery or surgical intervention were recorded and compared using χ2 analyses. Results: Overall, 15% of patients recovered vocal fold mobility at a median of 4.1 months. Patients with cervical injury (65 of 329 [20%]) were significantly more likely to recover mobility than patients with thoracic injury (11 of 173 [6.4%]) (odds ratio, 3.63). The cervical cohort contained more women (68% vs 31%) and was younger (mean age, 60.4 ± 13.8 vs 64.1 ± 16.1 years; Cohen’s D = 0.25). Conclusions: Patients with cervical injuries resulting in UVFI are 4 times more likely to recover mobility than patients with thoracic injuries. This information can be valuable in counseling patients with UVFI and may affect clinical decision making.
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Affiliation(s)
- Lauren F. Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Paul E. Kwak
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Semirra L. Bayan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Jarrad H. Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Communication Sciences and Disorders, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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Tracy LF, Hron TA, Van Stan JH, Burns JA. Wound healing after transoral angiolytic laser surgery for early glottic carcinoma. Laryngoscope 2018; 129:435-440. [PMID: 30194756 DOI: 10.1002/lary.27283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Wound healing after transoral angiolytic laser surgery for early glottic carcinoma was analyzed to identify factors influencing healing and clinical significance of persistent granulation tissue. STUDY DESIGN Retrospective review. METHODS A retrospective review of 100 consecutive patients undergoing endoscopic angiolytic laser surgery for T1 and T2 glottic carcinoma was performed. Patients with prior radiation or incomplete data were excluded. Postoperative endoscopic images were analyzed for time to healing, size and location of wound, and presence of granulation tissue. Three blinded, independent raters graded wound appearance and presence of granulation tissue. RESULTS Seventy-nine patients healed without need for intervention at a median of 3.5 months. Two patients had office-based ablation of granulation without biopsy and healed. The remaining 19 patients had biopsy for granulation tissue. Wounds that underwent biopsy at >3 months were more likely to contain carcinoma (5/6 patients, 83%) than wounds that were biopsied <3 months (2/13 patients, 15%) (P = .004). Presence of granulation significantly correlated with resection involving anterior commissure (P = .01), > 75%vocal fold length (P = .006), and depth into muscle (P = .001). Delayed healing (>3 months) correlated with T2b tumors (P = .02), depth into ligament (P = .002) and anterior commissure involvement (P = .04). T1a carcinomas more commonly healed in <3 months (P = .005). CONCLUSIONS Many vocal fold wounds heal completely within 3.5 months after angiolytic laser surgery for early glottic carcinoma. Larger and deeper wounds are more likely to heal with granulation tissue. Granulation can resolve without surgical intervention; however, granulation present > 3 months warrants biopsy due to increased risk of malignancy. LEVEL OF EVIDENCE 4 Laryngoscope, 129:435-440, 2019.
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Affiliation(s)
- Lauren F Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Tiffiny A Hron
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Jarrad H Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.,Department of Communication Sciences and Disorders, Massachusetts General Hospital Institute of Health Professions, Charlestown, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Burns JA, Adlard SD, Kobler JB, Tynan MA, Petrillo RH, Tracy LF. A Comparison of Laser-Protected Endotracheal Tubes. Otolaryngol Head Neck Surg 2018; 159:871-878. [PMID: 30130457 DOI: 10.1177/0194599818796106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the physical characteristics of 3 laser-protected endotracheal tubes (LPETs) commonly used in endoscopic laser surgery. To report potential intraoperative problems related to LPET use and suggest practical solutions. STUDY DESIGN Comparative analysis. SETTING Academic laboratory. SUBJECTS AND METHODS Physical characteristics of the Mallinckrodt Laser-Flex (MTL), Medtronic Laser-Shield II (ML-II), and Rusch LaserTubus (RL) were compared. The effect of bending LPETs on airflow resistance was estimated with a pressure transducer. The force required to pull each tube through the glottis and the pressure exerted during this maneuver were measured in a fresh cadaveric human larynx. RESULTS The design features and physical characteristics of LPETs differ, including varying balloon-tip lengths. Bending LPETs to acute angles caused significant pressure increase within the RL tube (Δ 3.42 cm H2O) and minimal change within the ML-II (Δ 0.12 cm H2O) and MTL (Δ 0.21 cm H2O) tubes. The average force required to pull the RL (48.12 g, P = .003) and MTL (282.4 g, P = .001) tubes through the glottis was 7.6× and 44.5× greater than that for the ML-II (6.39 g). When pulled through the vocal folds, the ML-II cuff exerted no detectable pressure, whereas higher pressures were measured for the RL (2.2 cm H2O) and MTL (6.5 cm H2O) tubes. CONCLUSION The ML-II tube had the most favorable characteristics, with minimal pressure during extubation and resistance to kinking. The RL tube kinks readily with a resultant increase in resistance to airflow. The MTL tube extends farther into the trachea due to a relatively elongated balloon-tip configuration. Future LPET designs should incorporate features that avoid intraoperative difficulties related to airway protection and ventilation.
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Affiliation(s)
- James A Burns
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen D Adlard
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James B Kobler
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Monica A Tynan
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert H Petrillo
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren F Tracy
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Tracy LF, Gomez G, Overton LJ, McClain WG. Hypovolemic shock after labial and lingual frenulectomy: A report of two cases. Int J Pediatr Otorhinolaryngol 2017; 100:223-224. [PMID: 28802376 DOI: 10.1016/j.ijporl.2017.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022]
Abstract
Lingual and labial frenulectomy are commonly performed as an outpatient procedure, either in an office setting or under general anesthesia. Frenulectomy is generally regarded by both otolaryngologists and dentists as a straightforward and low-risk procedure with limited evidence-based indications and similarly few contraindications. We describe two cases of hypovolemic shock occurring after outpatient frenulectomy requiring emergent interventions of cardiopulmonary resuscitation and blood transfusion. These rare, but life-threatening outcomes warrant recognition as potential complications for the presumed benign labial and lingual frenulectomy. We additionally briefly review indications for upper labial and lingual frenulectomy.
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Affiliation(s)
- Lauren F Tracy
- University of North Carolina, Department of Otolaryngology/Head and Neck Surgery, 101 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Gabriel Gomez
- University of North Carolina, Department of Pediatric Otolaryngology, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Lewis J Overton
- University of North Carolina, Department of Otolaryngology/Head and Neck Surgery, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Wade G McClain
- University of North Carolina, Department of Pediatric Otolaryngology, 101 Manning Drive, Chapel Hill, NC 27599, USA
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