Laryngeal disorders in people living with HIV.

OBJECTIVES: Several studies have shown that HIV infected individuals are at higher risk compared to the general population of developing non-AIDS defining conditions such as some types of cancer, kidney disease, liver disease and others. In this case-control study, we compared the incidence of laryngeal disorders between a treatment-seeking HIV-positive population and uninfected controls. We aimed to investigate whether there are any laryngeal disorders that are overrepresented in HIV-positive individuals. METHODS: This was a case-control study based on retrospective chart review, comparing the incidence of laryngeal, airway, and swallowing disorders in sixty-nine HIV positive individuals and 4178 HIV negative controls treated between January 1, 2016 and December 31, 2017, at the Johns Hopkins Voice Center. RESULTS: A majority of HIV-infected patients (59.4%) had at least one diagnosis belonging to the Vocal cord pathology category compared to 48.2% of controls (OR 1.57, p = 0.065). Compared to the entire treatment-seeking population, HIV patients were more likely to present with laryngeal cancer (15.9% vs. 3.4% in controls, OR 5.43, p < 0.001) and chronic laryngitis (17.4% vs. 4.2%, OR 4.79, p < 0.001). Fungal and ulcerative laryngitis were also overrepresented in HIV-positive individuals (OR 9.45, p < 0.001 and 6.29, p < 0.001, respectively). None of the diagnoses categorized as functional voice disorders, swallowing, or airway problems showed a significant difference between groups. Laryngeal papillomatosis, which is an HPV-dependent disease, had similar prevalence in both groups. CONCLUSIONS: Treatment-seeking HIV-positive patients presenting to a laryngology clinic suffer significantly more often from laryngeal squamous cell carcinoma as well as chronic, fungal, and ulcerative laryngitis compared to HIV-negative individuals. LEVEL OF EVIDENCE: 4.

Dysphonia and dysphagia as early manifestations of autoimmune inflammatory myopathy.

PURPOSE: While dysphagia is a recognized manifestation of autoimmune inflammatory myopathy, a relationship between myositis and dysphonia or laryngeal pathology is not well-documented. We therefore sought to describe the spectrum of laryngeal disorders present in myositis patients, evaluate whether any specific conditions are overrepresented among these patients compared to a large treatment-seeking population, and examine the clinical course and outcomes of these symptoms. MATERIALS AND METHODS: This was a retrospective chart review, including all patients seen at the Johns Hopkins Voice Center between January 2016 and December 2017. Demographic data, comorbidities, and laryngeal diagnoses were extracted from the electronic medical record. The charts of patients with myositis were reviewed further to ascertain details of their laryngeal symptoms and myositis disease course. Associations between myositis and dysphonia/dysphagia were evaluated using binary regression and multinomial logistic regression models to adjust for age, sex, race, and smoking status. RESULTS: Of 4252 patients, sixteen had myositis. Compared to 4236 controls, these patients had significantly higher odds of presenting with muscular voice disorders (adjusted odds ratio (OR*) = 4.503, p* = 0.005) and dysphagia (OR* = 6.823, p* < 0.001). A majority (64.3%, CI:35.6-93.0%) of myositis patients had laryngeal pathology among the presenting symptoms of their myositis. Across all diagnostic categories, there was a non-significant trend towards better outcomes in patients receiving specific interventions for their laryngeal symptoms. CONCLUSIONS: Muscular voice disorders and dysphagia are significantly overrepresented in myositis patients presenting to a laryngology clinic, and in these patients, both are frequently among the presenting symptoms of myositis.

Long-term Functional Outcomes of Trabeculectomy Revision Surgery.

PURPOSE: To describe the long-term results of revision surgery for complications from trabeculectomy in a case series from an academic glaucoma service. DESIGN: Retrospective case series. PARTICIPANTS: A total of 310 eyes (310 individuals) who underwent revision of trabeculectomy at the Wilmer Eye Institute between 2007-2015. METHODS: Retrospective study of patients who underwent revision of trabeculectomy at the Wilmer Eye Institute between 2007-2015. MAIN OUTCOME MEASURES: Success of revision, defined as maintenance of long-term intraocular pressure (IOP) control at or below target, no further glaucoma-related reoperations, no major complications during revision surgery, and no dysfunctional hypotony; need for additional surgery after revision; change in visual acuity (VA) between original trabeculectomy; revision surgery; and last follow-up visit. RESULTS: The mean time between original surgery and revision was 3.1±4.0 years, and the mean follow-up from revision to last examination was 4.4±2.9 years. The overall successes at 1, 2, 5, and 8 years after revision were 76%, 68%, 57%, and 50%, respectively (Kaplan-Meier). The success was similar among revision indications (P = 0.43). The 5-year Kaplan-Meier survival was 60% for eyes undergoing revision for hypotony, 57% for bleb leak, 63% for dysesthesia, and 44% for uncontrolled IOP. Revisions in which the original surgery was performed by surgeons other than present Wilmer faculty were 5 times more likely to fail than cases in which the original surgery was performed by the Wilmer surgeon performing the most trabeculectomy and revision surgeries (P = 0.04). Further surgery after revision was required in 30% of cases during follow-up. Approximately half were additional IOP-lowering procedures, and half were further revisions. Duration of symptoms before revision was not consistently associated with the loss of VA between original surgery and last follow-up. Eyes that lost the most VA before revision surgery for hypotony tended to be the same eyes that regained the most vision after revision; eyes that underwent revision for hypotony with shorter duration of symptoms showed a greater improvement of VA between revision surgery and last follow-up (P = 0.01). CONCLUSIONS: Revision of trabeculectomy provided successful resolution of complications associated with trabeculectomy surgery in many cases.