A Simple and Reproducible In Vivo Rabbit Phonation Model for Glottic Insufficiency.

OBJECTIVE: The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation. STUDY DESIGN: Nonrandomized controlled animal trial. SETTING: Academic medical center. METHODS: A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ. RESULTS: Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral. CONCLUSION: The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.

Public Perception of Ménière's Disease: A Social Media Analysis.

OBJECTIVE: To analyze tweets associated with Ménière's disease (MD), including type of users who engage, change in usage patterns, and temporal associations, and to compare the perceptions of the general public with healthcare providers. METHODS: An R-program code, academictwitterR API, was used to query Twitter. All tweets mentioning MD from 2007 to 2021 were retrieved and analyzed. Valence Aware Dictionary and Sentiment Reasoning was used as a model to assess sentiment of tweets. Two reviewers assessed 1,007 tweets for qualitative analysis, identifying the source and the topic of the tweet. RESULTS: A total of 37,402 tweets were analyzed. The number of tweets per user ranged from 1 to 563 (M = 33.7, SD = 91.1). Quantitative analysis showed no temporal or seasonal association; however, tweeting increased when celebrities were diagnosed with MD. Of the 1007 representative tweets analyzed, 60.6% of tweets came from the general public and were largely of negative sentiment focusing on quality of life and support, whereas healthcare providers accounted for 23% of all tweets and focused on treatment/prevention. Tweets by news sources accounted for the remaining 13% of all tweets and were primarily positive in sentiment and focused on awareness. CONCLUSIONS: MD is commonly tweeted about by the general public, with limited input regarding the disease from healthcare providers. Healthcare providers must provide accurate information and awareness regarding MD, especially when awareness is highest, such as when celebrities are diagnosed. LEVEL OF EVIDENCE: Level IV.Indicate IRB or IACUCNot applicable.

Chronic Laryngotracheal Granulomatous Disease Secondary to Sporothrix schenckii in an Immunocompromised Patient.

OBJECTIVE: To describe a rare presentation of laryngotracheal granulomatous disease secondary to sporotrichosis. METHODS: The authors report a case of laryngeal sporotrichosis in an immunocompromised patient, with accompanying endoscopic images and pathology. RESULTS/CASE: A 72-year-old immunocompromised female with a history of rose-handling presented with a year of hoarseness and breathy voice. Flexible nasolaryngoscopy showed diffuse nodularity; biopsy of the lesions demonstrated granulomatous inflammatory changes, and fungal culture grew Sporothrix schenkii. Long-term itraconazole treatment was initiated, with improvement in dysphonia and few residual granulomas on follow-up examination. CONCLUSION: When evaluating granulomatous disease of the airway, a broad differential including infectious or inflammatory etiologies should be considered, especially in immunocompromised patients. Adequate tissue samples should be collected to facilitate special staining. The current recommendations for laryngeal sporotrichosis include treatment with a prolonged course of itraconazole.

Statin use protective for chronic rhinosinusitis in a nationally representative sample of the United States.

OBJECTIVES/HYPOTHESIS: Statins have long been used in the management of cardiovascular disease for their lipid-lowering properties. However, recent research suggests that statins may also have anti-inflammatory effects via modulation of lipid-containing enzymes and mediators, and therefore may have therapeutic value in the treatment of chronic rhinosinusitis (CRS). STUDY DESIGN: Retrospective database review. METHODS: The 2006 to 2015 National Ambulatory Medical Care Survey (NAMCS) data were queried to analyze the relationship between statin use and rates of CRS. CRS was indicated by the presence of an International Classification of Diseases, Ninth Revision code for CRS in one of the five diagnosis variables. Statin use was indicated by the presence of a statin medication in any of the 30 medication variables using the Multum Lexicon Drug Database, with newly prescribed medications excluded. Relevant demographic, socioeconomic, and comorbid factors were included in a multivariate logistic regression model, which accounted for the complex, stratified, multistage survey design of the NAMCS. RESULTS: There were 390,538 unweighted visit records used in the weighted analysis dataset, corresponding to 9,612,613,668 weighted visits. Statin use was associated with a decreased rate of CRS in both a univariate analysis (odds ratio [OR] = 0.53, P < .001) and the multivariate logistic regression accounting for comorbid, socioeconomic, and demographic factors (OR = 0.79, P = .030). CONCLUSIONS: Statin use is associated with decreased rates of CRS based on a nationally representative sample of outpatient visits in the United States. This supports research that suggests statin medications may have protective properties against CRS, and further research is warranted into their potential therapeutic value for this indication. LEVEL OF EVIDENCE: NA Laryngoscope, 130:848-851, 2020.

Development of a microporous annealed particle hydrogel for long-term vocal fold augmentation.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to develop and provide evidence of a novel permanent injectable biomaterial for vocal fold augmentation with the potential to treat glottic incompetence by evaluating its performance in two animal models. STUDY DESIGN: Animal model. METHODS: Microporous annealed particle (MAP) hydrogel was fabricated using a water-in-oil emulsion method and synthetically tuned to match the stiffness modulus of native vocalis muscle. Thirty-two New Zealand White rabbits were administered unilateral injections of MAP (n = 16), saline (n = 8), and the clinical standard hyaluronic acid (Restylane-L) (n = 8), and evaluated at day 0, and 6-week, 4-month, and 6-month endpoints. Induced vocal fold vibration was recorded with a high-speed camera prior to euthanization, with glottic closure and mucosal wave characteristics assessed both quantitatively and qualitatively by an experienced voice clinician. Histologic analysis was performed to assess scaffold permanence, immunogenicity, and vascularization within the scaffold. RESULTS: Histologic analysis confirmed the MAP gel treatment group maintained its volume without migration for 6 months postimplantation. Immune staining showed minimal to nonexistent immunogenicity over the course of the implant lifetime. Extensive tissue integration and vascularization was observed histologically within the MAP gel group by immunofluorescence staining. Mucosal wave was not impaired by any of the injected materials, including the MAP gel augmentation. CONCLUSIONS: MAP gel is a nonresorbable biostimulatory injectable implant that provides superior tissue integration, stiffness matching, and permanence compared to current injectable implants, with retained biomechanical function, suggesting its potential as a new therapeutic for glottic incompetence. LEVEL OF EVIDENCE: NA Laryngoscope, 130:2432-2441, 2020.

Association Between Olfactory and Gustatory Dysfunction and Cognition in Older Adults.

BACKGROUND: The association between olfactory dysfunction (OD) and cognitive decline is becoming apparent in the emerging literature. However, the literature demonstrating a similar effect between gustatory dysfunction (GD) and cognition is not well established. OBJECTIVE: To determine whether OD and GD are independently associated with cognitive impairment. METHODS: The 2013-2014 National Health and Nutrition Examination Survey was queried for 1376 older adults, corresponding to a weighted population sample of 50 816 529, to assess olfactory and gustatory status and cognition using univariate and multivariate regression analyses. OD and GD were determined using objective measurements with validated protocols. Participants were stratified as normal or abnormal cognition status using accepted cutoff values as indicated for the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). RESULTS: OD was associated with both mild cognitive impairment (odds ratio [OR] 1.809, P = .004) and dementia (OR 3.173, P < .001) with CERAD testing, abnormal AFT (OR 2.424, P < .001), and abnormal DSST (OR 4.028, P < .001). GD based on 1M NaCl whole mouth taste testing was associated with dementia on CERAD testing (OR 2.217, P = .004). When smell and taste parameters were included together in the regression model, both OD and GD remained significant independent predictors of dementia status based on CERAD testing (OR 3.133, P < .001, OR 1.904, P = .015). CONCLUSIONS: OD and severe GD represent independent predictors of cognitive impairment in a nationally representative sample of older adults.

Treatment of Comorbid Obstructive Sleep Apnea by Upper Airway Stimulation Results in Resolution of Debilitating Symptoms of Restless Legs Syndrome.

ABSTRACT: An association between restless legs syndrome (RLS) and obstructive sleep apnea (OSA) has been suggested for decades but has been questioned in recent years given the apparently similar prevalence of RLS among patients with OSA and the general population. Still, marked improvement in symptoms of RLS has been reported in patients with OSA treated with continuous positive airway pressure (CPAP). Whether the effect of OSA treatment on RLS extends to modalities of OSA treatment other than CPAP remains an open question. Here, we report the case of a patient with OSA and comorbid debilitating RLS who underwent upper airway stimulation device implantation and subsequently experienced near-resolution of her severe RLS symptoms. Upper airway stimulation devices may be an option for patients with OSA and severe RLS intolerant to conventional CPAP modalities.

Association of Resident Duty Hour Restrictions on Mortality of Nervous System Disease and Disorder.

BACKGROUND: The impact of the 2003 residency duty hour reform on patient care remains a debated issue. OBJECTIVE: Determine the association between duty hour limits and mortality in patients with nervous system pathology. METHODS: Via a retrospective cohort study using the Nationwide Inpatient Sample from 2000-2010, the authors evaluated in-hospital mortality status in those with a primary discharge level diagnosis of disease or disorder of the nervous system. Odds ratios were calculated, and Bonferroni corrected P values and confidence intervals were determined to account for multiple comparisons relating in-hospital mortality with teaching status of the hospital by year. RESULTS: The pre-reform (2000-2002) and peri-reform (2003) periods revealed no significant difference between teaching and nonteaching hospital mortality (P > .99). The post-reform period (2004-2010) was dominated by years of significantly higher mortality rates in teaching hospitals compared to nonteaching hospitals: 2004 (P < .001); 2006 (P = .043); 2007 (P = .042); and 2010 (P = .003). However, data for 2005 (P ≥ .99), 2008 (P = .80), and 2009 (P = .09) did not show a significant difference in mortality. CONCLUSIONS: Teaching and nonteaching hospital mortality was similar in patients with nervous system pathology prior to the duty hour reform. While nonteaching institutions demonstrated steadily declining mortality over the decade, teaching hospital mortality spiked in 2004 and declined at a more restricted rate. The timing of these changes could suggest a negative correlation of duty hour restrictions on outcomes of patients with nervous system pathology.

Gender association with postoperative hemorrhage patient safety indicator in the United States from 2000 to 2012.

INTRODUCTION: Postoperative hemorrhage and hematoma (PHH) is a patient safety indicator (PSI) representing a universal complication for all surgical procedures. This study examined the association between gender and the rates of PHH from 2000 to 2012. METHODS: We performed a retrospective cohort study on PHH incidence from 2000 to 2012 using the Healthcare Cost and Utilization Project. Pairwise t tests were performed. Odds ratios and P values were calculated, using a Bonferroni-adjusted α threshold, to examine PHH differences by gender. RESULTS: Our study revealed that males had significantly greater PHH incidence rates compared to females in every year of the study period (P < .001). CONCLUSIONS: Contrary to our results, the current literature on PHH largely identifies females as the gender with the greater risk of PHH. Specific to our study, our definition of PHH excludes pregnancy, childbirth, and puerperium patients. This finding suggests that pregnancy-related bleeding complications have influenced the current literature and males are the higher risk gender for PHH in nonobstetric procedures.