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Mills JF, Monaghan NP, Nguyen SA, O'Rourke AK, Halstead LA, Meyer TA. Adult Laryngomalacia: A Scoping Review. Otolaryngol Head Neck Surg 2024; 170:1020-1031. [PMID: 38219735 DOI: 10.1002/ohn.639] [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: 07/15/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE This review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature. DATA SOURCES Studies were identified through CINAHL, Cochrane Review, PubMed, and Scopus published between 1966 and 2023. REVIEW METHODS The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews checklist by 2 independent investigators. A meta-analysis of proportions and continuous measures was conducted. RESULTS Of the 1121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1-88.3) and dyspnea with exertion (83.8%, 64.8-96.3). The most suspected etiology was exercise-induced (86.0%, 69.4-95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0-99.1). Nonsurgical options were attempted in 87.0% (54.0-99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0-91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0-74.6). CONCLUSION Adult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.
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Affiliation(s)
- John F Mills
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical College, Albany, New York, USA
| | - Neil P Monaghan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Munhall CC, Gudipudi R, Nguyen SA, Halstead LA. Work-related musculoskeletal disorders among otolaryngology-head and neck surgery residents. Am J Otolaryngol 2024; 45:104070. [PMID: 37801746 DOI: 10.1016/j.amjoto.2023.104070] [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: 07/24/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Surgical residents are at high risk for work-related musculoskeletal disorders which can impact surgical training and overall quality of life. We sought to assess musculoskeletal symptoms among current United States otolaryngology-head and neck surgery residents. We focused on the upper extremity given fine motor control for microsurgical procedures and increased keyboarding requirements. This study builds on previous research by evaluating setting attribution and attitudes toward ergonomics among otolaryngology residents. MATERIALS AND METHODS A web-based, cross-sectional survey incorporating Nordic Musculoskeletal Questionnaire and ergonomics-related questions was sent to otolaryngology residency program directors in September of 2021. Descriptive statistics, Spearman's correlation, logistic regression, and comparison of proportions were utilized. RESULTS Overall, 148 otolaryngology residents completed the survey; 70 were female (45 %), 83 male (54 %), and 1 non-binary (0.6 %). MSK symptoms were reported in the neck (77.0 %), lower back (45.5 %), and upper back (31.8 %) most frequently. Symptoms were work-related for 80 % of residents, with 84.7 % deemed operating-room-related. Some required treatment (14.5 %) or formal evaluation (11.0 %) of their injury. Injuries prevented residents from working (7.4 %), operating (9.5 %), and performing activities of daily living (27.0 %). Many reported they would use ergonomic equipment (94.2 %), dictation software (74.1 %), and scribes (81.3 %) if available. CONCLUSIONS Despite increased surgical ergonomic awareness, musculoskeletal symptoms are still prevalent among otolaryngology residents. Nearly 1 in 9 residents required evaluation and treatment of their musculoskeletal symptoms, and one third reported lacking various ergonomic measures. Given the high prevalence of work-related musculoskeletal disorders, ergonomic practices for O-HNS trainees should be emphasized by residency programs.
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Affiliation(s)
- Christopher C Munhall
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Rachana Gudipudi
- Department of Anesthesia & Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific Street, BB-1469, Seattle, WA 98195-6540, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
| | - Lucinda A Halstead
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
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Taylor RJ, Lowe SR, Ellis N, Abdullah E, Patel S, Halstead LA. Laryngeal manifestations of cranial nerve IX/X compression at the brainstem. Laryngoscope 2018; 129:2105-2111. [PMID: 30582168 DOI: 10.1002/lary.27678] [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: 04/08/2018] [Revised: 09/09/2018] [Accepted: 10/22/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non-neurosurgical treatments are detailed. STUDY DESIGN Retrospective chart review at a tertiary care academic medical center with follow-up telephone survey. METHODS Baseline demographics, clinical characteristics, quality-of-life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem. RESULTS Forty-nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty-four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near-complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near-complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V-RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow-up 3.0 years, SD 2.0). CONCLUSION Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2105-2111, 2019.
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Affiliation(s)
- Robert J Taylor
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Stephen R Lowe
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Nic Ellis
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Evan Abdullah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Sunil Patel
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Boerner RM, Young DL, Gnagi SH, White DR, Halstead LA. Pyridostigmine for the Reversal of Severe Adverse Reactions to Botulinum Toxin in Children. J Pediatr 2018; 194:241-243. [PMID: 29275924 DOI: 10.1016/j.jpeds.2017.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/17/2017] [Accepted: 11/01/2017] [Indexed: 11/17/2022]
Abstract
Therapeutic botulinum toxin injections are commonly performed in pediatric otolaryngology. Aerodigestive complications from botulinum toxin injections, although rare, may be serious. Oral pyridostigmine is effective in the symptomatic treatment of these complications. We report 2 cases of aerodigestive complications arising from injection of botulinum toxin that were successfully treated with pyridostigmine.
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Affiliation(s)
- Ryan M Boerner
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Medical University of South Carolina, Charleston, SC.
| | - David L Young
- Medical University of South Carolina Medical School, Charleston, SC
| | - Sharon H Gnagi
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Medical University of South Carolina, Charleston, SC; Department of Otolaryngology-Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC
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Isaac MJ, McBroom DH, Nguyen SA, Halstead LA. Prevalence of Hearing Loss in Teachers of Singing and Voice Students. J Voice 2017; 31:379.e21-379.e32. [DOI: 10.1016/j.jvoice.2016.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/05/2016] [Indexed: 11/25/2022]
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Young DL, Moore MM, Halstead LA. The use of the quadrivalent human papillomavirus vaccine (gardasil) as adjuvant therapy in the treatment of recurrent respiratory papilloma. J Voice 2015; 29:223-9. [PMID: 25619468 DOI: 10.1016/j.jvoice.2014.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 04/30/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effect of the quadrivalent human papillomavirus vaccine, Gardasil, on the disease course of patients with recurrent respiratory papillomatosis (RRP). METHODS A retrospective chart review of patients with RRP was conducted and 20 patients were selected who had received the Gardasil vaccine as part of their treatment. Efficacy was assessed by calculating the intersurgical interval (ISI) before and after receiving the vaccine, as well as number of complete and partial remissions. RESULTS Analysis of all patients found a significant increase in the ISI of 3.1 months (95% confidence interval [CI]: 1.02-5.19, P=0.0061). Male patients experienced an increase in the ISI of 4.2 months (95% CI: 1.6-6.7, P=0.0048). Female patients had a nonsignificant increase in ISI of 1.2 months (95% CI: 3.1-5.4, P=0.51). Eight patients (40%; six male and two female) experienced complete remission. Five patients (25%) overall (three male and two female) experienced partial remission. In total, complete or partial remission was achieved in a total of 13 (65%) patients (nine male and four female). CONCLUSIONS The Gardasil vaccine can modulate the severity of RRP and induce remission in some patients. The effect was much greater in males and in females in low estrogen states.
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Affiliation(s)
- David L Young
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Michael M Moore
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lucinda A Halstead
- Department of Otolaryngology-Head & Neck Surgery, MUSC Evelyn Trammell Institute for Voice & Swallowing, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, MUSC Evelyn Trammell Institute for Voice & Swallowing, Medical University of South Carolina, Charleston, South Carolina.
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Halstead LA, McBroom DM, Bonilha HS. Task-Specific Singing Dystonia: Vocal Instability That Technique Cannot Fix. J Voice 2015; 29:71-8. [DOI: 10.1016/j.jvoice.2014.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Young DL, Halstead LA. Pyridostigmine for Reversal of Severe Sequelae From Botulinum Toxin Injection. J Voice 2014; 28:830-4. [DOI: 10.1016/j.jvoice.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Gullung JL, Halstead LA. Recurrent laryngeal nerve paresis postpneumonectomy contralateral to site of surgery. Ann Thorac Surg 2012; 94:628-30. [PMID: 22818310 DOI: 10.1016/j.athoracsur.2012.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/26/2011] [Accepted: 01/09/2012] [Indexed: 11/24/2022]
Abstract
Recurrent laryngeal nerve (RLN) injury is a serious complication of thoracic surgery that increases morbidity and mortality. It is important to consider the long-term effects of mediastinal shift and the possibility of postpneumonectomy syndrome on RLN function. This report documents a unilateral vocal fold paresis contralateral to the side of pneumonectomy that presents for investigation 6 six years after surgery.
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Affiliation(s)
- Jessica L Gullung
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Abstract
OBJECTIVE To review outcomes after supraglottoplasty for laryngomalacia and identify risk factors for supraglottoplasty failure. STUDY DESIGN Case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS Retrospective case series evaluating patient outcomes after supraglottoplasty at an academic medical center between 2004 and 2010. Surgical failure was defined as need for revision surgery, tracheostomy tube placement, or gastrostomy tube insertion. Multivariable logistic regression was performed to identify risk factors for failure. RESULTS The authors identified 95 children who underwent supraglottoplasty. After excluding patients with inadequate follow-up data, 74 patients were included. On the basis of chart review, 12 (16%) of those patients were defined as failures according to the criteria above. Age, history of prematurity (<34 weeks' gestational age), weight, growth curve percentile, neurologic/developmental problems, genetic syndrome, cardiac abnormality, synchronous airway lesions, and surgical technique were considered in risk factor analysis. Multivariable logistic regression was performed, revealing history of prematurity to be the only independent risk factor for failure (odds ratio = 4.85; 95% confidence interval, 1.07-22.1; P = .041). CONCLUSIONS Outcomes after supraglottoplasty were comparable to previous reports in the literature. History of prematurity should be considered a risk factor for surgical failure.
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Affiliation(s)
- Kristine E Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Ketcham AS, Smith JE, Lee FS, Halstead LA, White DR. Clinical course following endoscopic repair of type 1 laryngeal clefts. Int J Pediatr Otorhinolaryngol 2008; 72:1261-7. [PMID: 18584883 DOI: 10.1016/j.ijporl.2008.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 05/08/2008] [Accepted: 05/09/2008] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Treatment of type I laryngeal clefts (T1LCs) remains controversial. We present our experience with 16 endoscopic T1LC repairs to evaluate the effect of patient characteristics and surgical technique on outcomes. METHODS A retrospective study was performed. Diagnosis of T1LC was made by interarytenoid palpation during operative microlaryngoscopy. Two surgeons performed endoscopic repair using either microflap reconstruction or laser demucosalization and reapproximation. All patients received preoperative and postoperative modified barium swallow (MBS) studies. Improved MBS at 3-5 months determined success of repair. Factors contributing to success of repair were analyzed statistically. RESULTS No intraoperative complications occurred. One T1LC repair dehisced after 3 months. Overall, 11 of 16 repairs (68.8%) were successful. Mean age at repair was 23.3 months. Length of stay for microflap repair was significantly shorter than for laser reapproximation (0.89 days vs. 4.6 days, p<0.001, two-tail t-test). The difference in patient age between failures and successes (21.3 months vs. 24.2 months) was non-significant (p=0.661, two-tail t-test). Success for the nine patients receiving microflap reconstruction (77.8%) vs. the seven receiving laser reapproximation (57.1%) is comparable (p=0.596, Fisher's exact test). No correlation between comorbidities and failure was found (p>0.05, Fisher's exact test). CONCLUSIONS This series matches the largest reported series of endoscopic T1LC repairs. Success rates were lower than in previously reported studies, and comorbidities were higher. However, comorbidities did not contribute to surgical failure. No difference in outcome was seen between the two endoscopic techniques. Microflap repair may require a shorter hospital stay.
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Affiliation(s)
- Amy S Ketcham
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, United States
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Skinner ML, Halstead LA, Rubinstein CS, Atz AM, Andrews D, Bradley SM. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130:1293-301. [PMID: 16256781 DOI: 10.1016/j.jtcvs.2005.07.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 06/06/2005] [Accepted: 06/08/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to evaluate the incidence and significance of recurrent laryngeal nerve and swallowing dysfunction after a Norwood procedure compared with that after biventricular aortic arch reconstruction. METHODS From April 2003 through December 2004, 36 neonates underwent a Norwood procedure; 33 of 36 had postoperative fiberoptic laryngoscopy and modified barium swallow. Study results were used to guide the transition from nasogastric tube to oral feeding and placement of gastrostomy tubes. During the same time period, 18 neonates underwent aortic arch reconstruction as part of a biventricular repair. RESULTS After a Norwood procedure, laryngoscopy showed left true vocal fold (cord) paralysis in 3 (9%) of 33 patients. The results of a modified barium swallow were abnormal in 16 (48%) of 33 patients, with aspiration in 8 (24%) of 33 patients. Of the 3 patients with vocal fold paralysis, 2 had a normal modified barium swallow result, and 1 had aspiration. Gastrostomy tubes were placed in 6 (18%) of 33 patients, all with an abnormal modified barium swallow result. Hospital stay was longer in patients with an abnormal modified barium swallow result: 34 +/- 13 versus 22 +/- 7 days (P < .01). After biventricular repair with aortic arch reconstruction, left true vocal fold paralysis occurred in 4 (25%) of 16 patients; results of a modified barium swallow were abnormal in 10 (59%) of 17 patients, with aspiration in 6 (35%) of 17 patients (all nonsignificant vs patients undergoing the Norwood procedure). Follow-up laryngoscopy in 4 patients with vocal fold paralysis showed no change in 3 of 4 patients and improvement in 1 patient. Follow-up modified barium swallow showed resolution of aspiration in 11 (85%) of 13 patients. Hospital survival was 32 (89%) of 36 patients for the Norwood procedure and 18 (100%) of 18 patients for biventricular repair. There has been 1 sudden death before second-stage palliation. CONCLUSIONS After a Norwood procedure, swallowing dysfunction occurs in 48% of patients, with aspiration in 24%, and results in increased length of hospital stay. Left recurrent laryngeal nerve injury, seen in 9% of patients, is an uncommon cause of swallowing dysfunction. Postoperative aspiration generally resolves over time, whereas vocal fold paralysis does not. Systematic evaluation of swallowing function allows appropriate tailoring of feeding regimens and might contribute to decreased hospital and interstage mortality.
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Affiliation(s)
- Margaret L Skinner
- Evelyn Trammell Institute of Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
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Halstead LA. Extraesophageal manifestations of GERD: diagnosis and therapy. Drugs Today (Barc) 2005; 41 Suppl B:19-26. [PMID: 16200228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Extraesophageal manifestations of gastroesophageal reflux disease (GERD) can include upper airway disorders, asthma and chronic cough. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux (EER) in such disorders is underdiagnosed due to the often silent symptoms and difficult confirmation of diagnosis. Laryngeal examination and quantitative evaluation of findings using the reflux finding score are essential to diagnosis and treatment. Long-term high-dose proton pump inhibitor therapy is the first-line approach to controlling symptoms. Use of treatment algorithms is necessary to manage and accurately diagnose the cause of nonresponse to treatment.
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Affiliation(s)
- Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
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Abstract
Gastroesophageal reflux (GER) plays a causative role in the development of subglottic stenosis (SGS) in children. This study examined the impact of aggressive antireflux therapy on the clinical outcomes of 35 children. Since 1994, 25 children were treated aggressively with omeprazole and cisapride before endoscopic surgical repair of their stenoses, which ranged from Cotton grades 1 to 3. Nine patients became asymptomatic on antireflux therapy alone. Endoscopic repair was performed in 16 patients. Endoscopic repair failed in only 1, who required tracheotomy. Before 1994, all children undergoing endoscopic repair of SGS were treated perioperatively for reflux. Endoscopic repair failed in 10 of the 57 children, and all required tracheotomy. The clinical outcome of these 10 patients after aggressive antireflux therapy is described. Five of the 10 have been decannulated. The role of double pH probe testing and the importance of the pharyngeal probe for monitoring the response to antireflux medication are described. The probe data suggest that in some instances GER may be limited to perioperative stress, but in many cases, especially in premature infants with SGS, GER can persist unabated for years and is not outgrown as the patient matures.
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Affiliation(s)
- L A Halstead
- Department of Otolaryngology, Medical University of South Carolina, Charleston 29425, USA
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15
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Abstract
Gastroesophageal reflux (GER) into the laryngopharynx causes or contributes significantly to a variety of upper respiratory problems in children. The pH probe, laryngeal examinations, and broncholveolar lavage results for children with subglottic stenosis, recurrent croup, apnea, chronic cough, laryngomalacia, recurrent choanal stenosis, vocal fold nodules, and chronic sinusitis/otitis/bronchitis were reviewed in an effort to quantify the role of GER in each of these disorders. This review suggests that GER plays a causative role in subglottic stenosis, recurrent croup, apnea, and chronic cough. It is an important inflammatory cofactor in laryngomalacia and possibly in true vocal cord nodules and problematic recurrent choanal stenosis. GER is also an important inflammatory cofactor in chronic sinusitis/otitis/bronchitis but may be the result of chronic illness in the older patients.
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Affiliation(s)
- L A Halstead
- Department of Otolaryngology and Communicative Sciences, Medical University of South Carolina, Charleston 29425, USA
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Halstead LA. Gastroesophageal Reflux: A Critical Factor in Pediatric Subglottic Stenosis. Otolaryngol Head Neck Surg 1997. [DOI: 10.1016/s0194-59989780045-9] [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: 01/11/2023]
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Halstead LA. 11:08 AM: The Role of Gastroesophageal Reflux in Pediatric Upper Airway Disorders. Otolaryngol Head Neck Surg 1996. [DOI: 10.1016/s0194-5998(96)80590-0] [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: 11/30/2022]
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Affiliation(s)
- C C Alpert
- Department of Anesthesiology, Medical University of South Carolina, Charleston 29425
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Halstead LA, Bowles JT. Management of post-intubation and post-traumatic airway stenosis. J S C Med Assoc 1989; 85:447-9. [PMID: 2796302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
We have reviewed 50 cases of Wegener's granulomatosis, seen at the New England Medical Center Hospital between 1970 and 1984, and were impressed that 10 (20%) of these patients were under 25 years of age, with ages ranging from 13 to 23 years. Closer examination of this younger group revealed striking differences in their presenting symptoms and organ involvement when compared to the older group of patients. The presentation of these young patients was varied, with no single predominant symptom. Patients presented with otalgia and otitis media or hearing loss, fulminant sinusitis, arthralgias, and even corneal ulcers. Only one patient had "typical" rhinitis and nasal congestion. This group also had a disproportionate number of patients with involvement of the oral cavity, skin, and trachea. Biopsy of these sites frequently demonstrated necrotizing vasculitis. Three of our 50 patients had intracranial involvement, leading to transient hemiplegia in the first, permanent hemiplegia in the second, and a seizure disorder in the third. Two of these patients were in the younger age group. The proportion of patients with limited and generalized Wegener's granulomatosis was the same in both the younger and older age groups. All the younger patients, however, had manifestations of the disease in the head and neck, while four of the older patients had no symptoms in the upper respiratory tract. The number of young patients in our study emphasizes the fact that Wegener's granulomatosis, indeed, occurs in the younger patient and with a greater frequency than previously supposed. This study suggests that in the teenager and young adult, with an unusual constellation of symptoms of the head and neck and accompanying systemic problems, a diagnosis of Wegener's granulomatosis should be seriously considered.
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