Overlapping otolaryngologic surgery: Safety and efficacy.

BACKGROUND: Surgical procedures scheduled staggered between two operating rooms increase efficiency by eliminating turnover time. However, the practice might increase the surgeon's fatigue. Overlapping surgery has been assumed to be safe because no critical portions of procedures are performed simultaneously in two rooms, but there is little evidence in the literature to support that assumption for otolaryngologic surgery, and there is no evidence comparing non-overlapping and overlapping surgical outcomes for a single surgeon with all confounding factors controlled. METHODS: Retrospective cohort study that included a consecutive sample of adult subjects who underwent otolaryngologic laryngeal or otologic surgery between June 2013 and March 2016. All procedures were performed by the same surgical team and surgeon who had block time with 2-rooms every other week and 1-room on alternate weeks. The incidence of surgical complications was assessed in the perioperative period. Duration of surgery and time-in-room also were evaluated, as were surgical outcomes. RESULTS: A total of 496 surgeries were assigned to either overlapping-surgery (n = 346) or non-overlapping-surgery (n = 150) cohorts. Overlapping-surgery was a significant predictor for increased time-in-room on multivariate analysis but was not a significant predictor for surgery duration. Rate of complications, hospital readmission, emergency department visit, reoperation, mortality, and patient satisfaction did not differ significantly between cohorts. CONCLUSIONS: Overlapping surgery does not hinder patient safety or functional outcomes in patients undergoing otolaryngologic operations such as voice or ear surgery.

An Exploration of the Risk Factors, Severity, and Sequelae of Vocal Fold Hemorrhage in a Population of Voice Patients Before and After Diagnosis.

BACKGROUND: Vocal fold hemorrhage (VFH) is the rupture (usually acute) of a blood vessel within the true vocal fold. The long-term sequelae of VFH on the mucosal wave (MW) and glottic gap on video stroboscopy remain understudied. The primary objective of this study was to investigate the short-term and long-term consequences of VFH through measured and rated analysis of the mucosal wave and glottic gap. METHODS: The presence of VFH and its extent (limited/moderate vs. extensive VFH) were identified. The primary outcome of this study was mucosal wave, which was assessed on an ordinal scale by three blinded raters pre and posthemorrhage. Only patients who had undergone strobovideolaryngoscopy before sustaining VFH were included. Mucosal wave and glottic gap also were measured using image pixel analysis using the open-access tool, ImageJ (NIH, Bethesda, MD). RESULTS: Twenty-three subjects were included in this study (mean age 39.78 ± 15.54). Intra-rater reliability for MW ratings was 81.48% ± 6.150% (minimum 77.78%) for all evaluators (κ = 0.519 [0.267-0.772], P < 0.001). Inter-rater reliability analysis revealed 75.56% agreement between evaluators (κ = 0.524 [0.425-0.623], P < 0.001). MWMeasured extrapolated from ImageJ methodology correlated significantly with MWRated (n = 70, r = 0.448, P < 0.001). ΔMWMeasured from baseline to follow-up evaluation were compared for both the initial follow-up visit (FU1) and the second follow-up visit (FU2) [-4.135 ± 31.01 vs. 36.50 ± 39.97, P = 0.025]. Hence, ΔMWMeasured was significantly better by FU2 than FU1, with the larger positive change from baseline representing a greater improvement in the measured mucosal wave. Additionally, there were significant differences in ΔMWRated between those with limited/moderate VFH and those with extensive VFH at FU1. Duration of absolute voice rest correlated significantly with time to VFH resolution. Long-term change in mucosal wave after hemorrhage was assessed using both ΔMWMeasured and MWRated. Based on ΔMWRater, 35.0% of subjects demonstrated ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. Based on ΔMWMeasured, 50.0% of the subjects showed ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. CONCLUSION: Overall long-term restrictions in MW after hemorrhage were present in 35.0% of the subjects based on ratings and 50.0% of the patients based on the measured MW using ImageJ, demonstrating the importance of ongoing study into this pathology and how to prevent it, especially in PVU and professional singers. Patients presenting with extensive hemorrhage were at risk for more prominent, detectable changes in mucosal wave compared to those with limited/moderate hemorrhage in the short-term, defined by a mean FU time of 3 months, but not long-term, characterized by a mean FU time 6 months or greater. Whether the severity of VFH is a true indicator of mucosal wave alterations requires additional study, as does the reliability and validity of ImageJ mucosal wave and glottic gap measurement techniques.

Postoperative Voice Surgical Outcomes in Professional Singers vs Non-Singers.

OBJECTIVES: Professional singers often are described as vocal athletes, and just as professional athletes get injured, injuries to professional singers can occur during practice and performances. In other fields of medicine, research has shown that competitive sports athletes recover more quickly after orthopedic surgical procedures compared to non-athletes. The purpose of this study was to determine whether similar differences occur with voice patients by comparing voice surgical outcomes between professional singers and non-singers. METHODS: A retrospective cohort study was conducted that included a consecutive sample of 194 adult subjects who underwent voice surgical procedures in the operating room. All surgeries were performed by the same surgeon, the senior author of this study (RTS). Data were reviewed for patients with medical records between January 1, 2010 to February 1, 2022. Subjects who reported receiving income from singing or reported studying voice at a collegiate level or higher were classified as professional singers. Subjects reporting careers in all other professions, including unpaid avocational singers or singers without formal training, were assigned to the non-singer control group. The data were analyzed using SPSS statistical software. Statistical significance was determined using independent samples t test for continuous variables and Fisher's exact test or binary logistic regression for binary outcomes. RESULTS: There were 194 subjects included in this study (43.81% male/56.19% female). The average age was 42.60 ± 15.17. Ninety subjects were professional singers and 104 were non-singers. Revision of surgical plan was significantly different for professional singers compared to non-singers (14.44% versus 0%, P < 0.001). The rate of postoperative complications did not differ significantly between the singer and non-singer groups, even when adjusting for other factors. Professional singers presented with slightly more severe vocal fold hemorrhages on the first postoperative visit compared to non-singers (1.73 ± 0.73 versus 1.32 ± 0.65, P = 0.003), but there was no difference by the second visit. Following surgery, professional singers adhered to a longer duration of voice rest. However, both groups participated equally in voice therapy postoperatively. CONCLUSIONS: No differences were found in operative complications between professional singers and non-singers. This study describes outcomes and considerations in patient care for professional singers. It also provides insight into potentially modifiable factors, such as voice rest, that could impact patient care postoperatively.