Assessment of Postoperative Pain and Opioid Consumption Following Laryngeal Surgery: A Pilot Study.

The epidemic of opioid use in the United States has been declared a national public health crisis due to the rapid increase in drug overdose mortality. Physician overprescribing has been identified as one of many contributing factors, with most patients receiving excess opioid pain medication. Furthermore, there is a significant correlation between prescribed opioid dosage and mortality. Postoperative pain is a well-recognized clinical problem, but little has been done to advance or standardize pain management protocols. The purpose of this study was to determine the expected postoperative pain severity and quantity of opioid analgesic required for adequate pain management after laryngeal surgery. METHODS: Adult voice center patients who had recently undergone laryngeal surgery were included in this retrospective review. Tylenol #3 had been prescribed for all patients for pain management and they had been instructed to take additional over-the-counter acetaminophen as needed. In the senior author's (RTS) practice, patients are asked routinely to report pain severity and analgesic use during postoperative visits. All patients who had this information available were included in the cohort. Opioid medication consumed, over-the-counter medication consumed, and pain level (scale of 0-10 with 10 being most severe) were analyzed over the first week postoperatively. RESULTS: There were 43 patients (19 male, 24 female) included in the retrospective cohort (average age = 46.8 ± 18.6, range = 18-82). Procedures performed included vocal fold mass excision (48.8%), type I thyroplasty (27.9%), laser vaporization of vascular lesions (11.6%), laser stenosis resection (9.3%), and VF medialization injection with abdominal fat harvest (7.0%). Overall, voice surgery patients reported mild to moderate pain (2.1-4.7 out of 10). An average of 13.2 ± 2.8 T3 tablets were prescribed for pain management (range = 10-20), and no patient required more T3 tablets than the number provided. Sixteen patients (37.2%) supplemented or substituted their T3 medication for it with OTC acetaminophen. No patients used non-steroidal anti-inflammatory drugs (NSAIDs) for supplemental pain management. Consumption of both T3 pain medication (r = 0.444) and OTC acetaminophen (r = 0.274) was correlated significantly with postoperative pain severity (P < 0.001). When stratified by type of surgical procedure performed, one-way ANOVA (F = 2.749, P = 0.043) and post-hoc Games-Howell test revealed that the patients who underwent type I thyroplasty reported a significantly higher (P = 0.041) pain severity score than patients who underwent vocal fold mass excision (4.7 versus 2.1, respectively). No significant differences in pain severity existed between other procedures (P > 0.05). There were no significant differences between type of procedure performed for number of T3 tablets prescribed, number of T3 tablets taken, or number of OTC tablets taken (P > 0.05). Younger age was correlated significantly with a higher number of OTC tablets consumed (r = -0.316, P = 0.039). Women consumed more OTC pain medications than men. CONCLUSIONS: Most patients in this study reported mild to moderate postoperative pain. Adequate pain management was achieved using less pain medication tablets than the number prescribed. Type I thyroplasty was associated with more severe pain than other surgeries. Women used more OTC pain medications than men with no significant difference in reported pain level.

Socioeconomic Variables of Patients with Spasmodic Dysphonia: A Preliminary Study.

OBJECTIVES/HYPOTHESIS: To characterize socioeconomic status (SES) variables of spasmodic dysphonia (SD) patients and determine their impact on voice outcomes after treatment with botulinum toxin. STUDY DESIGN: Retrospective review. MATERIALS AND METHODS: SD patients treated with botulinum toxin for the past 10 years (July 2007-July 2017) for whom sufficient SES and outcome data were available were included. Spearman rho nonparametric correlation coefficients were calculated to determine if SES variables were significantly associated with self-perceived vocal quality. Voice Handicap Index-10 was recorded. Patients were asked at each visit to rate their best voice quality during the period of previous botulinum toxin injection on a scale of 1-10, with 10 being the best. RESULTS: Fifty SD patients were included. Average age was 60.3 ± 11.4 years, with men representing 24% of patients. Ethnicity was 74% Caucasian and 26% non-Caucasian. Median household income was $76,564 ± $24,782. Sixty-six percent of patients were employed. Adductor SD was diagnosed in 82% of patients and abductor SD in 12%. Best voice out of 10 was 7.23 ± 2.0. Mean Voice Handicap Index-10 score was 25.14 ± 9.4. Patients were treated with botulinum toxin for 165.9 ± 101.9 months. Age, gender, median household income, ethnicity, and employment status were not significantly associated with self-perceived vocal quality. Patients with longer disease duration self-reported a better voice (P = 0.02, r = 0.387). CONCLUSIONS: SES variables were not associated with voice outcomes for SD patients treated with botulinum toxin. Patients self-reported improved voice with longer duration of disease.

The Effect of Microphone Type on Acoustical Measures of Synthesized Vowels.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to compare microphones of different directionality, transducer type, and cost, with attention to their effects on acoustical measurements of period perturbation, amplitude perturbation, and noise using synthesized sustained vowel samples. STUDY DESIGN: This was a repeated measures design. METHOD: Synthesized sustained vowel stimuli (with known acoustic characteristics and systematic changes in jitter, shimmer, and noise-to-harmonics ratio) were recorded by a variety of dynamic and condenser microphones. Files were then analyzed for mean fundamental frequency (fo), fo standard deviation, absolute jitter, shimmer in dB, peak-to-peak amplitude variation, and noise-to-harmonics ratio. Acoustical measures following recording were compared with the synthesized, known acoustical measures before recording. RESULTS: Although informal analyses showed some differences among microphones, and analyses of variance showed that type of microphone is a significant predictor, t-tests revealed that none of the microphones generated different means compared with the generated acoustical measures. CONCLUSION: In this sample, microphone type, directionality, and cost did not have a significant effect on the validity of acoustic measures.

Evaluating the role of single-photon emission computed tomography in the assessment of neurotologic complaints.

We conducted a retrospective study to reexamine the value of single-photon emission computed tomography (SPECT) in the evaluation of patients with neurotologic complaints, and to assess the intra- and inter-radiologist variability of SPECT readings. Our study population was made up of 63 patients--23 men and 40 women, aged 34 to 91 years (mean: 59)--who had presented to a tertiary care otolaryngology practice and university hospital for evaluation of head trauma, sensorineural hearing loss, tinnitus, and/or vertigo. All patients had undergone brain scanning with SPECT during their evaluation, and almost all had also undergone magnetic resonance imaging (MRI) and standard computed tomography (CT). We compared the findings of all three imaging modalities in terms of their ability to detect neurotologic abnormalities. We found that detection rates were very similar among the three modalities; abnormalities were found in 24% of SPECT scans, 26% of MRIs, and 23% of CTs. Nevertheless, we did find that among 60 patients who underwent all three types of imaging, 13 (22%) exhibited areas of cerebral hypoperfusion on SPECT while their MRIs and CTs were read as either normal or nonspecific. In all, 18 of these 60 patients (30%) exhibited normal or nonspecific findings on all three types of imaging. In addition, when SPECT scans were read by the same radiologist at different times, different results were reported for 17 of the 63 scans (27%). Likewise, when SPECT scans were read by different radiologists, different results were reported for 21 of 63 scans (33%). We conclude that SPECT may be a valuable complementary diagnostic modality for making a comprehensive neurotologic evaluation and that it may detect abnormalities in some patients whose other imaging is read as normal. However, we did not find that SPECT was the most sensitive of the three modalities in neurotologic evaluation, as we had previously found in a preliminary study that the senior author (R.T.S.) published in 1996. In addition, with respect to our radiologists, both their intra- and inter-reader reliability was low, and we recommend additional study on this matter.