Laryngopharyngeal reflux diagnosis: Factors associated with patient satisfaction.

PURPOSE: To examine the patient experience of laryngopharyngeal reflux diagnosis and factors that contributed to perceived difficulty with the process. MATERIALS AND METHODS: A 32-question anonymous survey was administered to individuals over 18 years old who reported a diagnosis of laryngopharyngeal reflux. The survey contained questions regarding demographics and individuals' experiences during the diagnostic workup along with the generic short patient experiences questionnaire. Percentages were calculated for all variables. Kendall rank correlation coefficient was performed to measure the strength and direction of association between laryngopharyngeal reflux workup and perceived difficulty with diagnosis. RESULTS: Of the 232 respondents, 59.9 % reported difficulty with the diagnostic process. Strong positive correlations were found between perceived difficulty with laryngopharyngeal reflux diagnosis and the following factors: total number of physicians seen (τb = 0.483, p < 0.001), time from symptom onset (τb = 0.300, p < 0.001), and time from first physician visit (τb = 0.479, p < 0.001). Results from the generic short patient experiences questionnaire showed moderate negative correlations between perceived difficulty with diagnosis and the following factors: perceived competence of physician (τb = -0.228, p < 0.001), perception that the physician cared for the patient (τb = -0.253, p < 0.001), perceived interest the physician had in the patient (τb = -0.259, p < 0.001), and time interacting with the physician (τb = -0.226, p < 0.001). CONCLUSIONS: Respondents report difficulty being diagnosed with laryngopharyngeal reflux. This correlates with increased time to receive a diagnosis, increased number of physicians seen, and factors related to the patient-physician relationship. Physicians can improve patient experience by focusing on clear communication with interactive patient appointments, and scheduling high yield diagnostic tests.

Dysphagia in COVID-19 Patients on Extracorporeal Membrane Oxygenation.

Patients on extracorporeal membrane oxygenation (ECMO) are infrequently nourished via oral feeding due to aspiration risks. Patients with COVID-19 and on ECMO represent a subpopulation that has additional factors that may affect their swallow function. This study aimed to describe the swallow function and ability to maintain oral feeding in patients with COVID-19 while on ECMO. A retrospective study of patients with COVID-19 who started veno-venous ECMO at the beginning of the COVID-19 pandemic (March 2020 and August 2020) was conducted at a tertiary care hospital. Clinical swallow evaluations and videofluoroscopic swallow studies (VFSS) were analyzed using standardized measurement scales. Pearson's correlation coefficient (r) identified relationships between ECMO and swallowing function at different time points. 19 patients were included; all underwent clinical swallow evaluation and 4 underwent VFSS while on ECMO. Mean age was 43.2 years (standard deviation: 9.2), mean duration of ECMO was 65.7 days (58.7), and mean duration of intubation was 14.4 days (8.6). All patients were able to undergo swallow function evaluation, regain swallow function, and resume oral feeding while cannulated. Duration of ECMO and time to feeding tube removal was positively correlated (r = 0.747, p < 0.001) with patients demonstrating less functional swallowing independence and requiring a more modified diet upon oral diet initiation. Clinical swallow evaluation and videofluoroscopic swallowing evaluation are possible for COVID-19 patients actively on ECMO. Patient swallow function can improve, and oral diet can be achieved while on ECMO, demonstrating benefit of SLP surveillance and swallowing assessment prior to ECMO decannulation.

Granular Cell Tumors of the Larynx: A Systematic Review.

OBJECTIVE: Granular cell tumor of the larynx is an uncommon, typically benign lesion that may be confused for a malignant neoplasm based on histopathology. This review examines cases of granular cell tumor of the larynx in adults to highlight key distinctions in diagnosis/management and demonstrate how misclassification may lead to unnecessary escalations in therapy. DATA SOURCES AND METHODS: A systematic search of PubMed, Ovid, and EBSCO Search Hosts was completed in December 2021. The search yielded 501 articles with 87 full-text articles included in the review. Primary search terms included granular cell, tumor, larynx, and adult. Primary endpoints were patient presentation, primary management, pathological features, and disease course. RESULTS: A systematic review of 87 articles identified 200 patients with granular cell tumors (GCTs) of the larynx. Of the 200 patients, 50.3% were males and 49.7% were females. Of these, 54.0% were reported as white patients, and 46.0% were reported as black patients. The most common presenting symptoms were dysphonia (85.9%) and stridor/dyspnea (14.1%). On examination, the lesions were most commonly polypoid/nodular and firm. Pseudoepitheliomatous hyperplasia (PEH) was identified in 33.5% of cases, and 2% of cases were malignant. GCTs were misdiagnosed as other malignant lesions in 11% of cases. In benign cases, 13.5% of patients underwent additional surgeries beyond simple excision/laryngofissure, including laryngectomy and neck dissection. Less than 2% of lesions reoccurred. CONCLUSION: Granular cell tumors of the larynx are typically benign lesions that may be misdiagnosed with unnecessary escalation of treatment. However, most lesions resolve via primary surgical excision. Laryngoscope, 134:1523-1530, 2024.

Upper airway and tracheostomy management in patients with COVID-19: A long-term acute care hospital (LTACH).

OBJECTIVE: Describe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting. STUDY DESIGN: Retrospective cohort study. SETTING: Long-term acute care hospital. SUBJECTS AND METHODS: A retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed. RESULTS: Amongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found. CONCLUSION: LTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function.

Inpatient Otolaryngology Consultations and COVID-19: The Surge and Lasting Effects at an Urban, Academic Institution.

Objective: This study aims to examine the lasting effects of the coronavirus disease 2019 (COVID-19) pandemic on inpatient otolaryngology consultations. Methods: In a retrospective analysis, inpatient otolaryngology consultations at an urban, academic tertiary care center were reviewed over the course of 2 years (Jun 2019-Jun 2021). The consultations were categorized by time period based on the local data for COVID-19 hospitalizations and deaths as follows: pre-COVID (Jun 2019-Feb 2020), Surge 1 (Mar 2020-May 2020), Surge 2 (Oct 2020-Jan 2021), and Post Surge (Mar 2021-Jun 2021). Results: A total of 897 patients undergoing an inpatient otolaryngology consultation across all 4 time periods were included for analysis. The average consultations per day was 1.67 ± 0.24 in pre-COVID times, and dropped acutely to 0.86 ± 0.33 consultations per day during Surge 1. The consultation volume was not statistically different from pre-COVID levels during Surge 2 (1.33 ± 0.35) and Post Surge (1.60 ± 0.20). Reason for consultation and procedures performed did not vary significantly between pre-COVID times and Post Surge, except that consultation for postoperative complaint was less frequent in Post Surge (4.8% vs 1.0%, P = .02). More patients had been screened with rapid antigen COVID testing in Post Surge versus Surge 1 (20.1% vs 7.6%, P = .04). Conclusions: Inpatient otolaryngology consultation volumes, indications, and procedures performed at an urban, academic institution returned to pre-COVID levels after being significantly impacted during Surge 1.

Dysphagia outcomes in COVID-19 patients: experiences in long-term acute care hospital (LTACH).

PURPOSE: Long term acute care hospitals (LTACHs) saw a significant increase in COVID-19 patients with prolonged acute illness recovery. Speech language pathologists (SLP) in LTACHs were integral in assessing swallowing and providing rehabilitation for dysphagia, however, there is limited research on LTACHs and dysphagia. Our aim was to describe this unique dysphagia management experience to improve future patient care. METHODS: Retrospective chart reviews were conducted for patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to October 31, 2021. Demographic information, videofluoroscopic swallow study (VFSS) reports with Penetration and Aspiration Scale (PAS) scores and SLP notes were reviewed. Descriptive statistics and chi-square analysis were performed. RESULTS: A total of 213 patients met inclusion criteria. Most patients presented with tracheostomy (93.9%) and were NPO (92.5%) on admission. A strong correlation (p = 0.029) was noted between dependence on mechanical ventilation and significant airway invasion, as indicated by PAS score of 7 or 8 on VFSS. There was a strong association (p = 0.001) between patients who had tracheostomy placed within 33 days of VFSS and recommendation for thin liquids. Upon discharge, the majority of patients (83.57%) transitioned successfully to oral diets, however, a strong association (p = 0.009) between higher age (≥ 62) and NPO at discharge was demonstrated. CONCLUSION: Patients admitted post COVID-19 to LTACH, especially those requiring tracheostomy, demonstrated various degrees of dysphagia and benefited from SLP intervention and instrumental swallow assessments. Most patients admitted to LTACH for COVID-19 were successfully rehabilitated for dysphagia.

Prevalence of anxiety during the COVID-19 pandemic in patients diagnosed with subglottic stenosis.

OBJECTIVES: In the wake of the novel coronavirus disease (COVID-19), patients with subglottic stenosis (SGS) have a new, seemingly ubiquitous, respiratory disease to contend with. Whether real or perceived, it is likely that patients with SGS will feel exposed during the current pandemic. This study seeks to determine whether patients with SGS have increased rates of anxiety during the COVID-19 pandemic relative to healthy controls, as well as how much of an impact the pandemic itself plays in the mental health of this population. METHODS: Retrospective review of 10 patients with a confirmed SGS diagnosis and 21 control patients were surveyed via telephone. Patients of all ages that had an in-person or virtual visit within 3 months of the survey start date were included. RESULTS: A total of 30 patients were surveyed in this study, of whom 67.8 % were in the control group and 32.2 % were comprised of patients diagnosed with SGS. SGS patients reported a significantly higher level of anxiety on the GAD-7 scale with severe anxiety in 20 % of patients, moderate anxiety in 50 % of patients, mild anxiety in 20 %, and 10 % reporting no anxiety. Overall, the average reported GAD-7 score of the SGS patients and control patients were 10.8 ± 4.96 and 6.67 ± 2.96 respectively (p < 0.05). CONCLUSIONS: This study is the first of its kind to analyze the rates and causes of anxiety within the context of the COVID-19 pandemic on patients diagnosed with subglottic stenosis. SGS patients were found to have a significantly higher anxiety based on the GAD-7 survey in comparison to patients without SGS. LEVEL OF EVIDENCE: IV.

Voice Outcomes After Bariatric Surgery: A Systematic Review.

OBJECTIVE: Bariatric surgery has been documented to improve comorbidities associated with obesity. Obesity can cause deposition of excess adipose tissue, narrowing of the vocal tract, and decreased lung capacity contributing to reduced vocal quality and increased vocal effort. Limited information is available regarding the impact of bariatric surgery on voice outcomes. This review seeks to examine the role of bariatric surgery on voice outcomes. STUDY DESIGN: Systematic review. METHODS: A systematic review was completed using PubMed and Embase for measures of vocal change before and after bariatric surgery. Studies were reviewed by three authors, and data related to acoustic, aerodynamic, auditory-perceptual, and patient-reported outcome measures were extracted. RESULTS: Forty-nine abstracts were identified with seven meeting criteria for analysis. Voice outcomes pre and postbariatric surgery were measured across 122 individuals. Results revealed increased fundamental frequency (F0) and increased maximum phonation time (MPT) during sustained vowel productions. Correlation coefficients for MPT for /a/ were -0.683 and -0.725 for F0, respectively, indicating a strong negative correlation between body mass index and MPT and F0. Trends toward improved auditory-perceptual ratings and improved patient-reported outcome measures were also noted. However, studies were limited by restricted patient demographics and limited use of standardized and/or comprehensive evaluation techniques. CONCLUSION: Weight loss associated with bariatric surgery can result in improved voice outcomes; however, the mechanism by which it helps is unclear. To better understand this, otolaryngologists and speech-language pathologists may consider advocating for pre- and postsurgery voice evaluation in patients undergoing bariatric surgery.

Anesthesia considerations during management of airway stenosis: A systematic review.

OBJECTIVE: To determine the efficacy of ventilatory techniques by evaluating prevalence of technique failure and intraoperative hypoxia during endoscopic management of airway stenosis. DATA SOURCES: A systematic review was conducted using PubMed and Embase for anesthesia techniques in endoscopic management of airway stenosis. REVIEW METHODS: The primary outcome measured was reports of partial and complete technique failure. The secondary outcome measured was intraoperative hypoxia. RESULTS: We identified 7704 abstracts with 17 meeting criteria for analysis. The reported partial and complete ventilatory technique failures were: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % laryngeal mask airway, 0 % nonocclusive balloon dilator, 4.76 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, and 30.24 % jet ventilation. The reported rate of intraoperative hypoxia was: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, 2.18 % jet ventilation, 3.57 % laryngeal mask airway, and 5 % nonocclusive balloon dilator. CONCLUSION: Evone Flow-Controlled Ventilation with Tritube endotracheal tube had the lowest risk of technique failure and intraoperative hypoxia. Nonocclusive balloon dilator and laryngeal mask airway were also favorable techniques for ventilation. Jet ventilation showed a lower rate of intraoperative hypoxia, but a higher rate of failure. Newer techniques, such as Evone Flow-Controlled Ventilation with Tritube, nonocclusive balloon dilator and spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, may offer promise compared to older techniques like jet ventilation; however, larger studies with more uniform data are needed to determine their efficacy.

Laryngopharyngeal Reflux: Effect of Race and Insurance Status on Symptomology.

OBJECTIVES: Laryngopharyngeal reflux (LPR) is an extraesophageal variant of gastroesophageal reflux disease associated with intermittent dysphonia, throat-clearing, and chronic cough. This study aims to evaluate the impact of race and insurance status on symptoms often attributable to LPR. METHODS: Retrospective review of all patients with suspected LPR from 2017 to 2019 was performed at a tertiary care center. The diagnostic criteria comprised evaluation by a fellowship trained laryngologist and Reflux Symptom Index (RSI) scores. Demographics, patient history, and insurance status were recorded. Descriptive statistics were calculated for each parameter using SPSS version 22. RESULTS: A total of 170 patients (96 White, 44 Black, 26 Latinx, 4 Asian) were included in this study. About 57.1% had private insurance, 30.6% had Medicare, and 11.8% had Medicaid. Black and Latinx patients demonstrated higher RSI scores (26.67 ± 8.61, P = .017) when compared to their White and Asian counterparts. RSI scores between all 3 insurance types also varied significantly (P = .035). Medicaid patients reported higher RSI scores (28.65 ± 10.09, P = .028), while private insurance patients reported significantly lower scores (23.75 ± 7.88, P = .03). Controlling for insurance type eliminates the statistically significant association between RSI scores and Black and Latinx patients. Particularly, within the Medicaid group, Black, Latinx, and White patients did not have statistically different RSI scores. CONCLUSIONS: Black and Latinx patients presented with higher RSI scores than White and Asian patients. Similarly, Medicaid patients reported higher RSI scores than the Non-Medicaid cohort. These findings suggest that access to appropriate healthcare, due to varied insurance coverage and socioeconomic, may potentially influence symptoms attributed to LPR.

Gender Disparities in Otolaryngology: A Case Report Reflecting Global Perspectives.

OBJECTIVES: To explore the impact of female sex on the experiences of trainees and surgeons in otolaryngology from LMIC and HIC. METHODS: This study includes perspectives of five consultants and two resident physicians from the United States, United Kingdom, Uganda, Kenya and South Africa. RESULTS: Six themes emerged from these interviews. Overall, LMIC and HIC women shared similar experiences of microaggressions during patients, working along ancillary staff, related to pregnancy, imposter syndrome, difficulties during job search, and unique barriers as consultant. CONCLUSIONS: The findings of this study highlight that gender disparities are present at all levels in Otolaryngology but can present differently depending on context. Laryngoscope, 133:547-551, 2023.

Efficacy of Office-Based Intralesional Steroid Injections in the Management of Subglottic Stenosis: A Systematic Review.

OBJECTIVE: To determine the efficacy of office-based intralesional steroid injections (ILSI) as a management therapy for adult subglottic stenosis (SGS). DATA SOURCES: A systematic review was completed using PubMed and Science Direct for office-based management of SGS due to various etiologies. REVIEW METHODS: The primary end point measured was a change in surgery free interval (SFI) between endoscopic procedures due to office-based serial ILSI. The secondary end point was to determine what percentage of patients did not require further operative intervention for SGS maintenance therapy after changing management to office-based serial ILSI. RESULTS: We identified 187 abstracts, 4 of which were included in the analysis. The total number of participants was 55. The mean age was 50.4, and 78.1% were women. The etiologies were as follows: idiopathic (58.2%), postintubation/tracheotomy (29.1%), and autoimmune (12.7%). The SFI was reported in 3 of the 4 studies. The reported mean pre-ILSI SFI was 362.9 days and the post-ILSI SFI was 582.2 days. The secondary outcome was reported in 3 of the 4 studies. Forty-one of the 55 patients (74.5%) did not require further operative intervention during the duration of the study. CONCLUSION: This review explored office-based ILSI as a potential treatment option for patients with SGS. The limited data presented found ILSI significantly lengthened SFI, potentially reducing surgical burden. In addition, ILSI was found to be safe with few reported side effects.

Trends of Pandemic Parenting in Medical Academia.

INTRODUCTION: The pandemic has been difficult on physicians, with two fifths of doctors in one survey reporting that their mental health is now worse than before the pandemic. It is likely that a significant proportion of these physicians are parents of children necessitating childcare, as approximately 32% of the US workforce has someone in their household under the age of 14. We sought to study the impact of the coronavirus 2019 (COVID-19) pandemic on physician parents in academia. Our goal was to investigate the intersection of professional and personal challenges, as well as perceived impact on domestic life and professional development secondary to the COVID-19 pandemic. METHODS: Using Survey Monkey, we developed a 37-question survey to address the aim of this study. Questions were grouped into four categories: demographics; impact on childcare; impact on care; and impact on mental health/wellness. Most of the questions were multiple choice with a few fill-in-the-blank options to allow participants to provide additional information related to their experiences as physicians during the pandemic. A link to the survey was disseminated via email to physicians at our home institution, Rush University Medical Center (Chicago), via our own intra- and interdepartmental communications, We used private social media accounts such as Facebook physician groups to reach out to physicians at other academic medical centers. Survey responses were voluntary and collected anonymously over an eight-week period, without identifiable data. Inclusion criteria included any physician identifying themselves as working full or full or part time in an academic facility in the US and caregivers for children <18 years. RESULTS: Survey respondents were mostly female (83.2%), practicing in the Midwest (61.2%), and ranked as assistant professor (59.5%). The majority of respondents had two children (65.1%) who were <11 years in age (85.6%). Most respondents worked full time with 72.8% working over 50% clinically. Childcare was disrupted for 171 of 232 respondents (73.7%); 62.9% struggled with balancing work with childcare; 81.9% worried often or very often about fulfilling their responsibilities. A vast majority, 210 of 232 respondents (90.5%) had some degree of concern about feeling overburdened by their roles. More than half (57.3%) worried that their professional advancement was impacted by the pandemic, and 53.9% considered making adjustments to their clinical workload/. Over half (51.6%) thought that increased domestic responsibilities impacted their professional advancement. CONCLUSION: In the survey, which was completed primarily by early-career women physicians practicing in a variety of specialties and geographic regions, we noted that childcare disruption amidst the pandemic was extremely prevalent. The majority of respondents reported full-time equivalent work; thus, it is reasonable to assume that significant workloads and limitations in remote work in combination with childcare constraints resulted in significant burden. A large number felt the challenges were negatively impacting their professional development and felt overburdened by their various roles.

Laryngeal Chondrosarcoma Characteristics and Survival Analysis in the National Cancer Database.

OBJECTIVE: To highlight various patient, tumor, diagnostic, and treatment characteristics of laryngeal chondrosarcoma (LC) as well as elucidate factors that may independently affect overall survival (OS) for LCs. STUDY DESIGN: Retrospective cohort study. SETTING: National Cancer Database (NCDB). METHODS: All LC cases from 2004 to 2016 were extracted from the NCDB. Several demographic, diagnostic, and treatment variables were compared between LC subgroups using χ2 and analysis of variance tests. Univariate and multivariate survival analyses were performed for LCs using univariate Kaplan-Meier analysis and Cox proportional hazards regression models. RESULTS: There were 348 LCs included in the main cohort. LCs were predominantly non-Hispanic white males with similar rates of private and government insurance (49.4% vs 45.4%). Most LCs (81.6%) underwent primary surgery, particularly partial and total laryngectomy. The 1-, 5-, and 10-year survivals for LC were 95.7%, 88.2%, and 66.3%, respectively. On multivariate analysis, lack of insurance (P = .019; hazard ratio [HR], 8.21; 95% CI, 1.40-48.03), high grade (P = .001; HR, 13.51; 95% CI, 3.08-59.26), and myxoid/dedifferentiated histological subtypes (P = .0111; HR, 10.74; 95% CI, 1.71-67.33) correlated with worse OS. No difference in OS was found between partial and total laryngectomy. CONCLUSION: This is the first multivariate survival analysis and largest single cohort study of LCs in the literature. Overall, LCs enjoy an excellent prognosis, with insurance status, grade, and histology as the main predictors of survival.

Patients' Perceptions of Resident Surgeon Involvement in Otolaryngology.

OBJECTIVES: To assess patient acceptance of resident involvement in otolaryngologic procedures and to evaluate the impact of a written preoperative educational pamphlet. STUDY DESIGN: Prospective cohort study. METHODS: This is a prospective survey study at a large tertiary care academic center. In addition to standard perioperative instructions and informed consent, 87 out of 183 patients received a pamphlet with information on the role of the otolaryngology resident. RESULTS: Greater than 90% of all patients surveyed recognized that resident physicians are directly involved in delivering care at teaching hospitals and may have assisted in their surgical procedure. Ninety percent of patients receiving educational pamphlets were aware residents may have performed portions of their procedure versus 71% in the control group (P = .001). Ninety-seven percent of patients receiving pamphlets wanted to know how much of their procedure was performed by a resident versus 71% of the control group (P < .001), and patients undergoing single-surgeon procedures were less likely to want to know how much was performed by a resident (P < .05). Ninety-six percent in the pamphlet group agreed that residents improved the quality of their care versus 79% of the control group (P = .001). DISCUSSION: Resident surgeons are well received by the large majority of otolaryngology patients. Structured perioperative information regarding surgical training facilitates an honest and open informed consent discussion between the patient and surgeon and helps to establish a solid foundation of trust. CONCLUSION: Implementation of this practice is simple and inexpensive. It should be considered for any clinical practice with a focus on surgical education. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2448-2454, 2021.

The Association Between Upper Airway Patency and Speaking Valve Trial Tolerance for Patients With Tracheostomy: A Clinical Retrospective Study and an In Vitro Study.

Purpose Upper airway patency is crucial in a patient's ability to tolerate a one-way speaking valve (SV). Traditional assessment of airway patency is mainly subjective. We developed four noninvasive methods to assess patency (leak volume, transtracheal pressure [TTP], end-tidal CO2, and Mallampati score) in our institution. This study was aimed to evaluate the effectiveness of the four methods and explore the relationship between the patient's upper airway patency and SV trial tolerance. Method A retrospective cohort study was conducted to enroll adult patients with tracheostomies eligible for an SV trial from April 2019 through January 2020. An in vitro study was also implemented to explore the relationship between upper airway patency and noninvasive measurements. Results Forty patients (22 men and 18 women) were included; 16 used SV in-line with mechanical ventilation. Twenty-four patients tolerated an SV trial of > 10 min; they had lower TTP (3.0 [2.0-9.0] vs. 15.0 [9.3-21.3] cm H2O, p < .001), higher leak volume (268.5 ± 177.2 vs. 88.6 ± 99.6 ml, p = .038), and lower percentage of patients with Mallampati Classification IV (16.7 vs. 50.0%, p = .035), compared to the 16 patients who did not tolerate an SV trial. Twenty-two patients with a TTP of ≤ 9 cm H2O had higher percentage tolerating an SV trial than those with a TTP of > 9 cm H2O (86.4 vs. 35.3%, p = .002). The in vitro study demonstrated a strong correlation between upper airway patency and TTP, peak inspiratory flow, and tidal volume inhaled from the upper airway. Conclusions TTP, Mallampati classification, and leak volume can be used to assess upper airway patency for adult patients with tracheostomies undergoing an SV trial. A TTP of ≤ 9 cm H2O might indicate adequate upper airway patency to tolerate the SV trial.

Voice-related quality of life: Relation to objective spirometry measures in subglottic stenosis.

OBJECTIVES: The current study seeks to identify the correlation between in-office spirometry data and voice-related quality of life in patients with subglottic stenosis (SGS). METHODS: Patients with SGS of any etiology were included when in-office spirometric data was available in addition to voice-related patient-reported outcomes (PROM) data in the form of the Voice Handicap Index-10 (VHI-10) and/or the Voice-Related Quality of Life (V-RQOL) survey. Overall survey scores and individual question responses were assessed for degree of correlation to spirometric data. RESULTS: Twenty-nine patients were included in the final analysis. Overall mean total VHI-10 scores totaled 7.15 (SD 9.11), while mean overall V-RQOL scores totaled 78.41 (SD 16.45). Both PEF and PIF rates correlated to total scores on the VHI and V-RQOL surveys. This correlation was stronger with PIF than with PEF, and with the V-RQOL than with the VHI. Questions related to breathlessness most closely correlated with spirometric data. CONCLUSION: Voice-related QOL is impacted in patients with SGS in a predictable way. Breathlessness while speaking may be more impactful than inability to produce speech in this population.

Occult Lymph Node Metastasis in Early-Stage Glottic Cancer in the National Cancer Database.

OBJECTIVES: Early-stage glottic cancer (cT1-T2 cN0) may be treated by primary surgery or radiation. Elective treatment of the neck in clinically N0 disease is usually not performed due to low rates of regional lymph node metastasis. This study examines the role of elective neck dissection (END) and rate of occult nodal metastasis in cT1-T2 cN0 glottic cancer treated with primary surgery. STUDY DESIGN: Retrospective cohort study. METHODS: The National Cancer Database was used to identify patients treated for early-stage glottic cancer. Demographic variables, disease characteristics, and overall survival were compared between the subgroups of patients who did and did not receive END. Factors predictive of occult lymph node metastasis were also identified using a multivariate logistic regression model. RESULTS: Thirty-eight percent of the 991 patients in this cohort underwent END. Younger age, treatment at an academic facility, advanced T-stage, and higher tumor grade were associated with receiving END. Sixteen percent of the 372 patients undergoing END had occult nodal metastasis. Higher tumor histopathologic grade was associated with occult metastasis (P = .004). While undergoing END did not affect significantly survival, those with occult metastasis had poorer survival (P < .001). CONCLUSIONS: END should be considered in cT1-T2 N0 glottic cancers with poorly differentiated or undifferentiated tumor histopathology. While END itself may not improve overall survival, identification of occult nodal metastasis is an important finding for prognostication. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 131:E1139-E1146, 2021.

Identifying Type III Sulcus: Patient Characteristics and Endoscopic Findings.

OBJECTIVE: Type III sulcus is a pathologic structural deformity of the vocal folds that is challenging to accurately diagnose without endoscopic examination under anesthesia. This study aims to further define the clinical presentation and examination features shared among a patient cohort intraoperatively diagnosed with type III sulcus. STUDY DESIGN: Case series with chart review. SETTING: Tertiary laryngology practice. SUBJECTS AND METHODS: All patients diagnosed intraoperatively with type III sulcus from 2002 to 2014 at a tertiary laryngology practice were included. Clinical history of presenting symptoms, videostroboscopy, and intraoperative and histologic findings were reviewed. RESULTS: Twenty-two patients were included in the study. A majority were female (77%) and had a mean age of 32.4 years. All patients endorsed hoarseness, and 86% were defined as professional voice users. Endoscopic examination revealed bilateral type III sulcus in 23% of patients. The most common preoperative stroboscopic findings included decreased mucosal wave (100%), dilated vessel (95%), phase asymmetry (91%), additional benign lesion (91%), and cyst (82%). Histology revealed epithelial changes of atypia and keratosis. CONCLUSION: Both the severity of dysphonia and the difficulty observing structural malformations of the vocal folds make type III sulcus challenging to preoperatively diagnose. This study reports the clinical and endoscopic features seen within a cohort of patients with type III sulcus.

Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence.

OBJECTIVE: To determine if rapid implementation of simulation training for anticipated COVID-19 tracheostomy procedures can increase physician confidence regarding procedure competency and use of enhanced personal protective equipment (PPE). METHODS: A brief simulation training exercise was designed in conjunction with the development of a COVID-19 Tracheostomy Protocol. The simulation training focused primarily on provider safety, pre and post-surgical steps and the proper use of enhanced PPE. Simulation training was performed in the simulation lab at the institution over 2 days. Pre and post self-evaluations were measured using standardized clinical competency questionnaires on a 5-point Likert Scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent." RESULTS: Physicians self-reported a significant increase in knowledge and competency immediately after completing the training exercise. Resident physicians increased from a mean score of 3.00 to 4.67, p-value 0.0041, mean increase 1.67 (CI 95% 0.81 to 2.52). Attending physicians increased from a mean score of 2.89 to 4.67, p-value 0.0002, mean increase 1.78 (CI 95% 1.14 to 2.42). Overall, all participants increased from a mean score of 3.06 to 4.71, p-value 0.0001, mean increase 1.65 (CI 95% 1.24 to 2.05). DISCUSSION: Implementation of this simulation training at our institution resulted in a significant increase in physician confidence regarding the safe performance of tracheostomy surgery in COVID-19 patients. IMPLICATIONS FOR PRACTICE: Adoption of standardized COVID-19 tracheostomy simulation training at centers treating COVID-19 patients may result in improved physician safety and enhanced confidence in anticipation of performing these procedures in real-life scenarios.