Quantifying the cepstral peak prominence, a measure of dysphonia.

OBJECTIVE: The purpose of this study is to establish normative values for the smoothed cepstral peak prominence (CPPS) and its sensitivity and specificity as a measure of dysphonia. STUDY DESIGN: Prospective cohort study. METHODS: Voice samples of running speech were obtained from 835 patients and 50 volunteers. Eight laryngologists and four speech-language pathologists performed perceptual ratings of the voice samples on the degree of dysphonia/normality using an analog scale. The mean of their perceptual ratings was used as the gold standard for the detection of the presence or absence of dysphonia. CPPS was measured using the CPPS algorithm of Hillenbrand, and the cut-off value for positivity that has the highest sensitivity and specificity for discriminating between normal and severely dysphonia voices was determined based on ROC-curve analysis. RESULTS: The cut-off value for normal for CPPS was set at 4.0 or higher, which gave a sensitivity of 92.4%, a specificity of 79%, a positive predictive value of 82.5%, and a negative predictive value of 90.8%. The area under the receiver operating characteristic (ROC) curve was 0.937 (P < 0.05). CONCLUSIONS: CPPS is a good measure of dysphonia, with the normal value of CPPS (Hillenbrand algorithm) of a running speech sample being defined as a value of 4.0 or higher.

Office-based pulsed-dye laser surgery for laryngeal lesions: a retrospective review.

OBJECTIVES: The 585-nm pulsed-dye laser (PDL) is used for in-office treatment of recurrent respiratory papillomatosis (RRP), premalignant/early malignant lesions, vascular lesions, and proliferative lesions of the larynx. Reported advantages of this technique include avoidance of general anesthesia, improved efficiency, lower overall cost, and treatment of the anterior commissure with minimal web formation. Our objective was to review our experience with office-based PDL procedures for laryngeal lesions. STUDY DESIGN: Retrospective review. METHODS: A chart review of patients undergoing office-based PDL procedures of laryngeal lesions from the years 2005 to 2012. RESULTS: Of 33 patients, 32 (97%) tolerated the procedure without complication. One patient experienced an anxiety attack and the procedure was aborted. There were no complications. The following pathologies were treated: vascular lesions (n = 10), RRP (n = 8), granuloma (n = 5), premalignant lesions (n = 5), benign mass (n = 2), amyloidosis (n = 1), and anterior web (n = 1). Six (19%) patients, all with vascular lesions, were treated successfully with the in-office PDL and no operating room (OR) procedures. All six patients reported complete resolution of symptoms at 6 months posttreatment. Twenty-six (81%) patients were treated with a combination of in-office PDL and OR procedures, most commonly for RRP (n = 8). Seventeen patients had complete resolution of their symptoms with in-office PDL and OR procedures. CONCLUSIONS: PDL treatment is a safe, well-tolerated, effective, adjunctive therapy and may function as monotherapy in the treatment of selected laryngeal lesions.

Coblation of the canine vocal fold: a histologic study.

Controlled ablation (coblation) is a radiofrequency bipolar method of tissue ablation, which destroys tissue at very low temperatures. It has been used in a variety of clinical settings and is most frequently used by the otolaryngologist for tonsillectomy. In this study, we have examined the effect of coblation on the canine larynx by applying coblation to the vocal fold and harvesting the larynx on postoperative days (PODs) 0, 4, and 7. Histologic examination was performed with a variety of stains to examine the healing process. Coblation injury demonstrated complete epithelialization by POD 7. No injury to the underlying vocalis muscle was seen. The inflammatory response demonstrates less inflammation than previously reported with CO(2) laser injury. Coblation is a viable method for removal of tissue from the vocal fold resulting in minimal scar formation and a controlled depth of injury. Further studies should be performed to determine clinical utility in the removal of lesions such as respiratory papillomatosis.

Neuroendocrine adenoma of the middle ear (NAME).

Neuroendocrine adenoma of the middle ear (NAME) is a rare tumor. We report a case of NAME, the clinical and pathologic findings of which illustrate the biologic behavior of adenomatous tumors of the middle ear and their relationship with rare carcinoid tumors of the middle ear. A 29-year-old man presented with a history of recurrent otitis media, right conductive hearing loss, and aural fullness. The tumor was removed in its entirety. Otolaryngologists should be familiar with this unusual but important entity.

Bilateral occult mucosal bridges of the true vocal folds.

A mucosal bridge of the true vocal fold is a rare, benign anatomical finding that can cause dysphonia. It has been described by some in the literature as "occult" as it is often not visibly evident on flexible nasopharyngolaryngoscopy or strobovideolaryngoscopy, but mistakenly diagnosed as a sulcus vocalis (Sataloff RT, Rosen C, Hawkshaw M. Occult mucosal bridge of the vocal fold. Ear Nose Throat J. 1997; 76(12):850).(2) Final diagnosis is usually not made until microscopic direct laryngoscopy is performed and palpation of the true vocal fold reveals the mucosal bridge (Tanaka S, Hirano M, Umeno H, Tanaka Y. Mucosal bridge of the vocal fold [Japanese].(4)Nippon Jibiinkoka Gakkai Kaiho. 1991; 94(12):1853-1856). We describe a case of a 15-year-old boy complaining of long-standing hoarseness and found to have bilateral mucosal bridges of the true vocal folds. Previous reports cite cases of a unilateral mucosal bridge. We believe this is the first reported case of bilateral mucosal bridges.

Medical history in voice professionals.

A careful and thoughtful history is extremely important in helping to elucidate the cause of a patient's voice complaints. An understanding of the patient's performance and rehearsal environment and demands is also important in guiding the treatment process. A thorough history helps the clinician understand the vocal problem and how to interpret findings on physical examination that may be contributing to the pathophysiology of the vocal complaint.

Physical examination of voice professionals.

Comprehensive physical examination is essential when evaluating patients. Often it includes objective voice assessment and measures along with strobovideolaryngoscopy. In all cases physical examination involves a thorough examination of the ears, nose, throat, neck, posture, cranial nerve function (usually), and assessment of the patient's general (systemic) physical condition. Performance assessment usually should be included for professional voice.

Voice surgery.

There have been many advances in microsurgery for voice professionals over the last three decades. Driven by a greater understanding of the anatomy and physiology of phonation, most of the advances provide greater surgical precision through improved exposure and more delicate instrumentation. Laryngologists who perform laryngoscopic surgery should be familiar with the current state-of-the-art and should use the latest techniques and technology for all voice patients and particularly for voice professionals. Video procedures for surgical management of voice disorders accompany this content online.

Diagnosis and management of laryngopharyngeal reflux disease.

PURPOSE OF REVIEW: The recent findings and up-to-date practice guidelines for diagnosing, evaluating, and treating gastro-esophageal reflux disease are discussed. RECENT FINDINGS: The patient complaints for reflux disease are crucial in diagnosis. Although physical examination findings may correlate with laryngopharyngeal reflux, these findings may not improve after an adequate course of treatment. Behavioral modifications are a critical part of improving reflux; however, weight loss has not been shown to improve laryngopharyngeal reflux disease. Patients who used proton-pump inhibitors and histamine blockers were shown to have increased risk of developing Clostridium difficile infections. Laryngopharyngeal reflux has been shown to be a better predictor of Barrett's esophagus than gastroesophageal reflux, although specific screening recommendations have not been determined. SUMMARY: Current studies in laryngopharyngeal reflux demonstrate that improvements in physical examination findings are not a reliable way of determining patient improvement. An empiric trial of therapy is the best diagnostic test for laryngopharyngeal reflux. Future studies will examine the role of transnasal esophagoscopy in the screening of the laryngopharyngeal reflux patient for Barrett's esophagus.

Postoperative tonsillectomy bleed: coblation versus noncoblation.

OBJECTIVE: To examine the incidence of postoperative bleeding after coblation and noncoblation tonsillectomy and to use postoperative bleeding as an outcome measure to determine the presence of a learning curve with this new surgical technique. STUDY DESIGN: A retrospective review of records from January 1999 to April 2003 to determine type of tonsillectomy performed and the presence of postoperative bleeding. A chi-square analysis was used to determine a statistical difference between the postoperative bleed rate of coblation and noncoblation procedures. The examined time period was divided into 3-month intervals, and the coblation postoperative bleeds were tallied for each interval. The Cochraine-Armitage test of linear trend was used to assess change in the postoperative bleeds. RESULTS: One thousand seven hundred sixty-two tonsillectomies were performed. The postoperative bleed rate for noncoblation tonsillectomy was 6.1% (74/1,216). The bleeding rate for coblation tonsillotomy was 5.9% (18/303) and 5.4% (13/239) for coblation tonsillectomy. There was no statistical difference (P = .93) between bleed rates for coblation versus noncoblation techniques. There was no difference in the need for operative intervention to control postoperative bleeding: 16.2% (12/74) for noncoblation technique and 25.85 (8/31) for coblation procedures (P = .25). The postoperative coblation bleed rates for the 3-month periods did not reveal an increasing or decreasing trend in the postoperative bleed rate (P = .49). CONCLUSION: Coblation is a safe procedure for performing tonsil surgery with no significant difference in postoperative bleeding from previous techniques and no increased need for operative intervention to control postoperative bleeding. A learning curve could not be identified when using postoperative bleeding as an outcome measure for coblation tonsillectomy.

Mixed myxoid/round cell liposarcoma of the scalp.

Liposarcoma of the head and neck is rare. Only 12 cases of scalp liposarcoma have been previously reported. In this report, we describe a case of myxoid/round cell liposarcoma in the scalp of a 28-year-old woman. This case report highlights a histologic pattern rarely reported in the head and neck but consistent with the evolving classification of liposarcomas.