Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes.

OBJECTIVE: Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency. METHODS: Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit. RESULTS: 129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only. CONCLUSION: This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:908-913, 2023.

Clinical Cutoff Scores for Acoustic Indices of Vocal Hyperfunction That Combine Relative Fundamental Frequency and Cepstral Peak Prominence.

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.

Automated Relative Fundamental Frequency Algorithms for Use With Neck-Surface Accelerometer Signals.

OBJECTIVE: Relative fundamental frequency (RFF) has been suggested as a potential acoustic measure of vocal effort. However, current clinical standards for RFF measures require time-consuming manual markings. Previous semi-automated algorithms have been developed to calculate RFF from microphone signals. The current study aimed to develop fully automated algorithms to calculate RFF from neck-surface accelerometer signals for ecological momentary assessment and ambulatory monitoring of voice. METHODS: Training a set of 2646 /vowel-fricative-vowel/ utterances from 317 unique speakers, with and without voice disorders, was used to develop automated algorithms to calculate RFF values from neck-surface accelerometer signals. The algorithms first rejected utterances with poor vowel-to-noise ratios, then identified fricative locations, then used signal features to determine voicing boundary cycles, and finally calculated corresponding RFF values. These automated RFF values were compared to the clinical gold-standard of manual RFF calculated from simultaneously collected microphone signals in a novel test set of 639 utterances from 77 unique speakers. RESULTS: Automated accelerometer-based RFF values resulted in an average mean bias error (MBE) across all cycles of 0.027 ST, with an MBE of 0.152 ST and -0.252 ST in the offset and onset cycles closest to the fricative, respectively. CONCLUSION: All MBE values were smaller than the expected changes in RFF values following successful voice therapy, suggesting that the current algorithms could be used for ecological momentary assessment and ambulatory monitoring via neck-surface accelerometer signals.

Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders.

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.

Acoustic Identification of the Voicing Boundary during Intervocalic Offsets and Onsets based on Vocal Fold Vibratory Measures.

Methods for automating relative fundamental frequency (RFF)-an acoustic estimate of laryngeal tension-rely on manual identification of voiced/unvoiced boundaries from acoustic signals. This study determined the effect of incorporating features derived from vocal fold vibratory transitions for acoustic boundary detection. Simultaneous microphone and flexible nasendoscope recordings were collected from adults with typical voices (N=69) and with voices characterized by excessive laryngeal tension (N=53) producing voiced-unvoiced-voiced utterances. Acoustic features that coincided with vocal fold vibratory transitions were identified and incorporated into an automated RFF algorithm ("aRFF-APH"). Voiced/unvoiced boundary detection accuracy was compared between the aRFF-APH algorithm, a recently published version of the automated RFF algorithm ("aRFF-AP"), and gold-standard, manual RFF estimation. Chi-square tests were performed to characterize differences in boundary cycle identification accuracy among the three RFF estimation methods. Voiced/unvoiced boundary detection accuracy significantly differed by RFF estimation method for voicing offsets and onsets. Of 7721 productions, 76.0% of boundaries were accurately identified via the aRFF-APH algorithm, compared to 70.3% with the aRFF-AP algorithm and 20.4% with manual estimation. Incorporating acoustic features that corresponded with voiced/unvoiced boundaries led to improvements in boundary detection accuracy that surpassed the gold-standard method for calculating RFF.

Magnetic Laryngeal Reanimation as a Novel Treatment of Vocal Fold Immobility.

OBJECTIVE: Vocal fold paralysis may result from surgical complications, trauma, tumor, or unknown causes. When both cords are affected, paramedian fixation can lead to life-threatening obstruction. Current treatments, including tracheostomy, cordotomy, and arytenoidectomy, compromise speech and swallow function to maintain a safe airway. To preserve all three critical laryngeal functions, Otolaryngologists need a solution for bilateral vocal fold paralysis that restores motion. This study uses implantable electromagnet technology to create dynamic vocal fold movement in a proof-of-concept, preliminary model. METHODS: A prototype was constructed from a neodymium disk magnet and cylindrical solenoid electromagnet coupled to a battery and 3-way switch. The disk magnet was implanted in an ex vivo porcine larynx model lateral to the arytenoid, affixed with suture. The electromagnet was seated in a window cut in the thyroid cartilage. RESULTS: By driving current in two directions through the electromagnet, the vocal fold was successfully moved towards and away from the electromagnet. The neutral vocal fold opening was 5.8 mm, and the maximal opening was 7.7 mm, representing a 31.4% increase in the cross-sectional area of the glottis. CONCLUSION: This model demonstrated proof of concept of a magnetic laryngeal reanimation device. The full device will include a respiratory effort sensor and implantable processor to time the action of the magnets with respirations. There is currently no effective treatment to re-establish vocal fold motion in patients with vocal fold paralysis. This system has the potential to give patients with bilateral vocal fold paralysis a surgical option to restore vocal fold motion.

Guidelines for Resident Participation in Otolaryngology Telehealth Clinics During the COVID-19 Pandemic.

The practice of otolaryngology has changed drastically since the start of the COVID-19 pandemic. To limit exposure and maintain a reserve of caregivers, residency education ceased most clinical activities and shifted to remote lecture consortiums hosted online across the country in lieu of ambulatory and operative experiences. Many practicing university otolaryngologists have transitioned their clinics to telehealth medicine to maintain access to clinical care during the pandemic. The participation of residents in telemedicine visits has not been described. Here we present guidelines and experience-based suggestions for successful resident involvement in telemedicine. While it is unclear what role telehealth medicine may play within the field of otolaryngology beyond the pandemic, our experiences suggest better patient outreach and access. Expanding residents' skill set with telehealth medicine can enhance their education and better prepare them for future practice.

Vitamin D Status as a Predictor of Postoperative Hypocalcemia after Thyroidectomy.

OBJECTIVE: To determine whether perioperative vitamin D levels are predictive of postoperative hypocalcemia in patients receiving thyroidectomy. STUDY DESIGN: Single center retrospective study. SUBJECTS AND METHODS: This study included all patients receiving total or completion thyroidectomy between January 2007 and March 2017 at a single tertiary care hospital. 25-Hydroxyvitamin D (25[OH]D) levels were measured within 42 days prior to surgery or 1 day postoperatively. Hypocalcemia was defined as an adjusted serum calcium <8.0 mg/dL (based on albumin levels) or symptomatic hypocalcemia. Univariate analysis was performed with a 2-sample t test and chi-square test, while multivariate analysis was performed with logistic regression analysis to determine whether perioperative 25(OH)D level is a predictor of postoperative hypocalcemia. RESULTS: A total of 517 subjects were included in the study, 15.7% (n = 81) of whom experienced postoperative hypocalcemia with a mean ± SD serum calcium level of 7.6 ± 0.5 mg/dL as compared with 8.9 ± 0.5 mg/dL in the normocalcemic population (P < .01). The mean 25(OH)D level for patients with hypocalcemia was 24.4 ± 12.0 ng/mL as compared with 27.5 ± 12.2 ng/mL in patients with normocalcemia (P = .038). Subjects who were hypocalcemic experienced a significantly longer hospital stay (2.9 ± 2.5 vs 1.4 ± 1.1 days, P < .01). After adjusting for preoperative calcium, age, and performance of a neck dissection, subjects with a 25(OH)D level <30 ng/mL were significantly associated with postoperative hypocalcemia (odds ratio, 1.9; P = .041; 95% CI, 1.0-3.3). CONCLUSION: Using a single-center retrospective study design, we demonstrated that 25(OH)D level is a significant predictor of postoperative hypocalcemia after thyroidectomy.

Auditory Feedback Control Mechanisms Do Not Contribute to Cortical Hyperactivity Within the Voice Production Network in Adductor Spasmodic Dysphonia.

Purpose Adductor spasmodic dysphonia (ADSD), the most common form of spasmodic dysphonia, is a debilitating voice disorder characterized by hyperactivity and muscle spasms in the vocal folds during speech. Prior neuroimaging studies have noted excessive brain activity during speech in participants with ADSD compared to controls. Speech involves an auditory feedback control mechanism that generates motor commands aimed at eliminating disparities between desired and actual auditory signals. Thus, excessive neural activity in ADSD during speech may reflect, at least in part, increased engagement of the auditory feedback control mechanism as it attempts to correct vocal production errors detected through audition. Method To test this possibility, functional magnetic resonance imaging was used to identify differences between participants with ADSD (n = 12) and age-matched controls (n = 12) in (a) brain activity when producing speech under different auditory feedback conditions and (b) resting-state functional connectivity within the cortical network responsible for vocalization. Results As seen in prior studies, the ADSD group had significantly higher activity than the control group during speech with normal auditory feedback (compared to a silent baseline task) in three left-hemisphere cortical regions: ventral Rolandic (sensorimotor) cortex, anterior planum temporale, and posterior superior temporal gyrus/planum temporale. Importantly, this same pattern of hyperactivity was also found when auditory feedback control of speech was eliminated through masking noise. Furthermore, the ADSD group had significantly higher resting-state functional connectivity between sensorimotor and auditory cortical regions within the left hemisphere as well as between the left and right hemispheres. Conclusions Together, our results indicate that hyperactivation in the cortical speech network of individuals with ADSD does not result from hyperactive auditory feedback control mechanisms and rather is likely related to impairments in somatosensory feedback control and/or feedforward control mechanisms.

Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study.

OBJECTIVE: To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy. METHODS: All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia. RESULTS: A total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist. CONCLUSIONS: Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.

Clinical scribes and their association with patient experience in the otolaryngology clinic.

OBJECTIVES/HYPOTHESIS: Electronic health records have brought many advantages but also placed a documentation burden on the provider during and after the clinic visit. Some otolaryngologists have countered this challenge by employing clinical scribes. This project aimed to better understand the influence of scribes on patient experience in the otolaryngology clinic. STUDY DESIGN: Retrospective cohort survey study. METHODS: Patients presenting to the otolaryngology clinic for new and follow-up appointments were recruited to complete surveys about their experience. RESULTS: A total of 153 patients completed the survey, and 96 of those patients (62.7%) interacted with a scribe. Patient satisfaction was not significantly associated with participation of the scribe (P = .668). Similarly, patient rating of their physician on a scale of 1 to 10 was not associated with scribe involvement (P = .851). The patients who did interact with a scribe responded that the scribe positively impacted the visit 77.1% of the time. Participation of a resident, primary language other than English, and use of interpreter were associated with lower satisfaction (P = .004, P < .001, and P < .001, respectively). CONCLUSIONS: There are no published data on the effect of scribes on patient experience in the otolaryngology clinic. In other specialties, scribes have been demonstrated as having a positive effect on provider satisfaction, clinical productivity, and patient perception. These data demonstrate that patient satisfaction was neither impaired nor improved by the presence of the scribe in this clinic. In light of benefits demonstrated by prior studies, these findings support the conclusion that scribes are a useful adjunct in providing high-level otolaryngology care. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E134-E139, 2020.

Refining algorithmic estimation of relative fundamental frequency: Accounting for sample characteristics and fundamental frequency estimation method.

Relative fundamental frequency (RFF) is a promising acoustic measure for evaluating voice disorders. Yet, the accuracy of the current RFF algorithm varies across a broad range of vocal signals. The authors investigated how fundamental frequency (fo) estimation and sample characteristics impact the relationship between manual and semi-automated RFF estimates. Acoustic recordings were collected from 227 individuals with and 256 individuals without voice disorders. Common fo estimation techniques were compared to the autocorrelation method currently implemented in the RFF algorithm. Pitch strength-based categories were constructed using a training set (1158 samples), and algorithm thresholds were tuned to each category. RFF was then computed on an independent test set (291 samples) using category-specific thresholds and compared against manual RFF via mean bias error (MBE) and root-mean-square error (RMSE). Auditory-SWIPE' for fo estimation led to the greatest correspondence with manual RFF and was implemented in concert with category-specific thresholds. Refining fo estimation and accounting for sample characteristics led to increased correspondence with manual RFF [MBE = 0.01 semitones (ST), RMSE = 0.28 ST] compared to the unmodified algorithm (MBE = 0.90 ST, RMSE = 0.34 ST), reducing the MBE and RMSE of semi-automated RFF estimates by 88.4% and 17.3%, respectively.

Vitamin D deficiency and its relationship to cancer stage in patients who underwent thyroidectomy for papillary thyroid carcinoma.

PURPOSE: As imaging technology improves and more thyroid nodules and malignancies are identified, it is important to recognize factors associated with malignancy and poor prognosis. Vitamin D has proven useful as a prognostic tool for other cancers and may be similarly useful in thyroid cancer. This study explores the relationship of Vitamin D to papillary thyroid carcinoma stage while accounting for socioeconomic covariates. MATERIALS AND METHODS: The medical records of all patients who underwent thyroidectomy at one institution between 2000 and 2015 were reviewed. Subjects with non-papillary thyroid cancer pathology, prior malignancy, and without Vitamin D levels were excluded. The remaining 334 patient records were examined for cancer stage, Vitamin D levels, Vitamin D deficiency listed in history, and demographic and comorbid factors. RESULTS: Vitamin D laboratory values showed no significant relationship to cancer stage (p = 0.871), but patients with Vitamin D deficiency documented in the medical record were more likely to have advanced disease (28.6% versus 14.7%; p = 0.028). The patients with documented Vitamin D deficiency also had lower 25-hydroxyvitamin D nadirs (21.5 ng/mL versus 26.5 ng/mL, p = 0.008) and were more likely to be on Vitamin D supplementation (92.6% versus 41.8%, p < 0.001). CONCLUSIONS: The results suggest that Vitamin D deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because Vitamin D deficiency is modifiable. While different racial subgroups had different rates of Vitamin D deficiency, neither race nor socioeconomic status showed correlation with cancer stage.

The fork in the road: A laryngeal filter airway foreign body.

OBJECTIVE: Upper aero-digestive tract foreign body management can be complicated and life threatening in both adult and pediatric populations. The variation seen with foreign bodies including shape, material, and duration of ingestion can impact clinical decision making and management. The objective of this report is to demonstrate a complicated case of upper airway obstruction by a plastic fork. METHOD: This case report presents an adult with ingestion of an intact plastic fork with acute laryngeal and cervical esophageal obstruction. The position of the fork precluded intubation as it was blocking the laryngeal inlet. RESULTS: The report illustrates successful nasolaryngoscopy pre-operative evaluation, multi-disciplinary team airway management and subsequent operative airway management and fork removal. CONCLUSION: Despite various concerns by both the Otolaryngology and Anesthesia services for airway establishment, sedation allowing for spontaneous ventilation through the fork prongs and adequate analgesia for direct laryngoscopy yielded successful removal of a plastic fork from the upper airway.

Diagnostic flexible pharyngo-laryngoscopy: development of a procedure specific assessment tool using a Delphi methodology.

PURPOSE: Proper training and assessment of skill in flexible pharyngo-laryngoscopy are central in the education of otorhinolaryngologists. To facilitate an evidence-based approach to curriculum development in this field, a structured analysis of what constitutes flexible pharyngo-laryngoscopy is necessary. Our aim was to develop an assessment tool based on this analysis. METHODS: We conducted an international Delphi study involving experts from twelve countries in five continents. Utilizing reiterative assessment, the panel defined the procedure and reached consensus (defined as 80% agreement) on the phrasing of an assessment tool. RESULTS: FIFTY PANELISTS COMPLETED THE DELPHI PROCESS. THE MEDIAN AGE OF THE PANELISTS WAS 44 YEARS (RANGE 33-64 YEARS). MEDIAN EXPERIENCE IN OTORHINOLARYNGOLOGY WAS 15 YEARS (RANGE 6-35 YEARS). TWENTY-FIVE WERE SPECIALIZED IN LARYNGOLOGY, 16 WERE HEAD AND NECK SURGEONS, AND NINE WERE GENERAL OTORHINOLARYNGOLOGISTS. AN ASSESSMENT TOOL WAS CREATED CONSISTING OF TWELVE DISTINCT ITEMS.: Conclusion The gathering of validity evidence for assessment of core procedural skills within Otorhinolaryngology is central to the development of a competence-based education. The use of an international Delphi panel allows for the creation of an assessment tool which is widely applicable and valid. This work allows for an informed approach to technical skills training for flexible pharyngo-laryngoscopy and as further validity evidence is gathered allows for a valid assessment of clinical performance within this important skillset.

Laryngeal Manipulation for Dysphagia with Muscle Tension Dysphonia.

The purpose of the article is to describe the use of laryngeal manipulation as a treatment for dysphagia resulting from excessive paralaryngeal muscle tension and to identify the patients likely to have symptomatic improvement. This is a retrospective single-center case series. A retrospective review identified patients from 2007 to 2013 with laryngeal manipulation for muscle tension dysphagia in an academic Otolaryngology practice. Subjects with dysphagia not attributable to an anatomic cause who attended therapy at least one time were included in the study. The primary outcome of the study was subjective improvement in dysphagia symptoms (yes/no) during follow-up. Symptoms, demographic information, treatment, and response to therapy were recorded. The Kruskal-Wallis test was used for analysis of continuous variables, while a Chi-squared test or fisher's exact test was used for analysis of all categorical variables. Forty-four subjects were included, consisting of 37 women and 7 men. Subjective improvement in dysphagia was seen in 34 subjects (77.3%). No significant differences were seen in improvement based on gender (p = 0.3223), race (p = 0.4317), number of sessions with a speech pathologist (p = 0.3198), or presenting symptoms including hoarseness (p = 0.0853), pain (p = 1.000), globus (p = 0.2834), and cough (p = 1.000). We found subjective improvement with laryngeal manipulation as reported during follow-up visits to clinic among individuals with muscle tension dysphagia. Patient age, presenting symptoms, and number of therapy sessions were not found to be significantly associated with resolution of symptoms.

Validation of an Algorithm for Semi-automated Estimation of Voice Relative Fundamental Frequency.

OBJECTIVES: Relative fundamental frequency (RFF) has shown promise as an acoustic measure of voice, but the subjective and time-consuming nature of its manual estimation has made clinical translation infeasible. Here, a faster, more objective algorithm for RFF estimation is evaluated in a large and diverse sample of individuals with and without voice disorders. METHODS: Acoustic recordings were collected from 154 individuals with voice disorders and 36 age- and sex-matched controls with typical voices. These recordings were split into training and 2 testing sets. Using an algorithm tuned to the training set, semi-automated RFF estimates in the testing sets were compared to manual RFF estimates derived from 3 trained technicians. RESULTS: The semi-automated RFF estimations were highly correlated ( r = 0.82-0.91) with the manual RFF estimates. CONCLUSIONS: Fast and more objective estimation of RFF makes large-scale RFF analysis feasible. This algorithm allows for future work to optimize RFF measures and expand their potential for clinical voice assessment.

The Benefits and Limitations of Targeted Training in Flexible Transnasal Laryngoscopy Diagnosis.

Importance: Targeted laryngoscopy training can be used successfully in de novo learners. Objective: To determine the value of targeted laryngoscopy education in interns. Design, Setting, and Participants: This prospective study of fiberoptic laryngoscopy interpretations enrolled 13 participants in an academic hospital setting from August 1 to December 31, 2015. Participants included 10 postgraduate year 1 emergency and otolaryngology interns and 3 board-certified otolaryngology attending physicians. Interventions: Participants viewed 25 selected and digitally recorded fiberoptic laryngoscopies and were asked to rate 13 items relating to abnormalities in the pharynx, hypopharynx, larynx, and subglottis; the level of concern; and confidence with the diagnosis. A laryngoscopy teaching video was then administered to the interns before rating a second set of 25 videos. Improvement in diagnosis and intraclass correlation coefficients (ICC) were calculated for each question and compared between the first and second administration. Main Outcomes and Measures: Improvement in correct diagnosis of abnormalities in recorded laryngoscopies. Results: All 13 participants completed the interventions. The ICCs for all questions were generally low for the intern groups and higher for the attending group. For vocal cord mobility, a preintervention ICC of 0.25 (95% CI, 0.16-0.37) improved to 0.47 (95% CI, 0.36-0.59) among interns after the intervention. The ICCs for vocal cord mobility were higher among attendings for the preintervention (0.89; 95% CI, 0.84-0.93) and postintervention (0.89; 95% CI, 0.83-0.93) assessments. Minimal improvement was observed in intern scores for base of tongue abnormalities, subglottic stenosis, vocal cord abnormalities, level of comfort, level of concern, pharyngeal abnormalities, or laryngeal, pharyngeal, and hypopharyngeal masses. Conclusions and Relevance: Learning of flexible laryngoscopy can be improved with the use of a teaching video; however, additional interventions are needed to attain competence in accurately diagnosing upper airway lesions. Clinicians who seek to perform flexible laryngoscopy require robust training.

Utility of Allergy Testing in Patients with Chronic Laryngopharyngeal Symptoms: Is It Allergic Laryngitis?

OBJECTIVE: To determine the utility of allergy evaluation in patients with chronic refractory laryngeal symptoms. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. SUBJECTS: All patients who underwent in vitro allergy testing at a single institution from 2006 to 2010, for a total of 998 patients. METHODS: Charts of patients who underwent in vitro allergy testing were identified. The charts were reviewed for the primary indication for allergy testing, as categorized into rhinitis complaints, chronic sinusitis, otitis media, and refractory laryngeal symptoms (globus, cough, throat clearing, increased secretions, and hoarseness). Results of allergy tests and comorbid conditions were analyzed and compared among groups. RESULTS: The positive yield of allergy testing in patients with primary laryngeal indications was 51.8%, 63.3% for rhinitis, 60.9% for sinusitis, and 33.3% for otitis media. The odds ratio of having a positive test was not statistically different for patients with laryngeal symptoms, rhinitis, or sinusitis. Patients with chronic laryngeal symptoms and positive allergy testing were most often sensitized to dust mites (63%) and least often sensitized to molds (1.3%). CONCLUSIONS: Allergy testing in patients with chronic laryngeal symptoms yields positive results in equivalent proportion to patients with other common presenting symptoms. Dust mites sensitization is the most common sensitization in patients with allergic laryngitis.

Voice Relative Fundamental Frequency Via Neck-Skin Acceleration in Individuals With Voice Disorders.

PURPOSE: This study investigated the use of neck-skin acceleration for relative fundamental frequency (RFF) analysis. METHOD: Forty individuals with voice disorders associated with vocal hyperfunction and 20 age- and sex-matched control participants were recorded with a subglottal neck-surface accelerometer and a microphone while producing speech stimuli appropriate for RFF. Rater reliabilities, RFF means, and RFF standard deviations derived from the accelerometer were compared with those derived from the microphone. RESULTS: RFF estimated from the accelerometer had slightly higher intrarater reliability and identical interrater reliability compared with values estimated with the microphone. Although sensor type and the Vocal Cycle × Sensor and Vocal Cycle × Sensor × Group interactions showed significant effects on RFF means, the typical RFF pattern could be derived from either sensor. For both sensors, the RFF of individuals with vocal hyperfunction was lower than that of the controls. Sensor type and its interactions did not have significant effects on RFF standard deviations. CONCLUSIONS: RFF can be reliably estimated using an accelerometer, but these values cannot be compared with those collected via microphone. Future studies are needed to determine the physiological basis of RFF and examine the effect of sensors on RFF in practical voice assessment and monitoring settings.