Socioeconomic Impact on Swallow Therapy Attendance.

Dysphagia negatively impacts quality of life and increases health care costs. Swallow therapy is the primary and effective treatment for dysphagia of various etiologies, and attendance is critical to success. This study seeks to identify barriers to swallow therapy attendance at a tertiary care, safety-net hospital. A total of 309 patients were referred for swallow therapy from January 1, 2018, to April 30, 2019. Patients were divided into those who "Attended" at least one swallow therapy appointment and those who "Did not Attend" any swallow therapy appointment. Demographics, socioeconomic factors, and diagnosis prompting therapy referral were compared between the two groups. Socioeconomic status (SES) was based on insurance status and income. 177 patients (57%) attended at least one swallow therapy appointment and 132 (43%) did not attend any appointments. Overall, 240 (78%) patients had public insurance and 69 (22%) had private insurance. Analysis of SES status identified 106 (34%) patients as double-low SES, 157 (51%) as low SES, and 43 (14%) as high SES. Referral diagnoses were "Dysphagia-unspecified type" (n = 119, 38%), "Cancer" (n = 66, 21%), "Neurologic" (n = 46, 15%), "Globus" (n = 29, 9%), "Aspiration" (n = 17, 6%), "Reflux" (n = 17, 6%), and "Throat Pain" (n = 15, 5%). No patient demographic factors, SES factors, or referral diagnosis correlated significantly with swallow therapy attendance. Overall, swallow therapy attendance was poor. In this group, socioeconomic and demographic factors did not significantly impact swallow therapy attendance. Future research should focus on identifying barriers to swallow care and strategies to improve attendance.

Impact of Patient Factors on Attendance at Remote Telehealth Swallow Therapy.

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.

Seasonality of head and neck cancers.

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.

Effects of COVID-19 on telemedicine practice patterns in outpatient otolaryngology.

OBJECTIVE: Otolaryngology is considered high risk for Coronavirus Disease 2019 (COVID-19) exposure and spread. This has led to a transition to telemedicine and directly impacts patient volume, evaluation and management practices. The objective of this study is to determine the impact of COVID-19 on patient characteristics in relation to outpatient attendance, ancillary testing, medical therapy, and surgical decision making. METHODS: A retrospective case series at an academic medical center was performed. Outpatient appointments from October 2019 (pre-COVID) and March 16-April 10, 2020 (COVID) were analyzed. Prevalence rates and odds ratios were used to compare demographics, visit characteristics, ancillary tests, medication prescribing, and surgical decisions between telemedicine and in-person visits, before and during COVID. RESULTS: There was a decrease in scheduled visits during the COVID timeframe, for both in-person and telemedicine visits, with a comparable proportion of no-shows. There was a higher overall percentage of Hispanic/Latino patients who received care during the COVID timeframe (OR = 1.43; 95% CI = 1.07-1.90) in both groups, although primary language was not significantly associated with attendance. There were fewer ancillary tests ordered (OR = 0.54) and more medications prescribed (OR = 1.59) during COVID telemedicine visits compared with pre-COVID in-person visits. CONCLUSION: COVID-19 has rapidly changed the use of telemedicine. Telemedicine can be used as a tool to reach patients with severe disease burden. Continued healthcare reform, expanded access to affordable care, and efficient use of resources is essential both during the current COVID-19 pandemic and beyond. LEVEL OF EVIDENCE: IV.

Differential diagnosis and management of adult-onset laryngomalacia.

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.

Oropharyngeal hemorrhage in patients with COVID-19: A multi-institutional case series.

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.

Laryngotracheal Amyloidosis: Amyloid Airway Center 23-Year Experience.

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.

Pharyngesophageal Diverticula Following Anterior Cervical Discectomy and Fusion.

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.

Otolaryngology and the Pregnant Patient.

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.

Racial Disparity in Tympanostomy Tube Placement in Inpatient Pediatric Admissions.

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.

Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices?

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.

The Relationship Between Pitch Discrimination and Fundamental Frequency Variation: Effects of Singing Status and Vocal Hyperfunction.

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.

Historical Review and Modern Case of Spontaneous Laryngeal Abscess.

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.

Automated Creak Differentiates Adductor Laryngeal Dystonia and Muscle Tension Dysphonia.

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.

Resynthesis of Transmasculine Voices to Assess Gender Perception as a Function of Testosterone Therapy.

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.

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.

Geographic Barriers Affect Follow-Up Care in Head and Neck Cancer.

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, 132:1022-1028, 2022.

Social determinants of health and treatment decisions in head and neck cancer.

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.

Herpes simplex laryngitis: Comparison between pediatric and adult patients.

OBJECTIVES: Infection with herpes simplex virus (HSV) typically causes limited oral and genital symptoms, however HSV can also affect the larynx and result in severe aerodigestive symptoms. Due to the rarity of HSV laryngitis, the symptoms and clinical course of are not well understood. This study aims to more completely characterize HSV laryngitis in order to aid clinicians in understanding and recognition of HSV laryngitis. METHODS: Comprehensive literature search of MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews to identify articles relating to HSV laryngitis. Patient demographics, presenting signs and symptoms, treatment and clinical course were extracted from the selected manuscripts. RESULTS: There were 31 studies on HSV laryngitis that identified 36 patients (17 pediatric, 19 adult). The average age for pediatric patients was 11 months (9 M, 8F) and 52 years for adults (11 M, 8F). In the pediatric population, stridor was more common at presentation in comparison to the adult population (p < .01). Adults more commonly presented with dysphagia (p = .03) and dysphonia (p < .01) Adult patients were significantly more likely to undergo tracheotomy than pediatric patients (p = .047). The mean length of inpatient hospital stay was 21.2 days in pediatric patients and 15.8 days for adult patients. CONCLUSION: HSV laryngitis has a unique presentation in pediatrics and adults, but is nonspecific in both populations leading to delays in diagnosis and treatment. HSV laryngitis is associated with significant morbidity including multi-week hospital stay and risk for needing tracheostomy in both adults and pediatric population which demonstrates need for clinical awareness of this complication of HSV infection.

Hey Siri: How Effective are Common Voice Recognition Systems at Recognizing Dysphonic Voices?

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.