Demographics and Clinical Characteristics Associated with the Spread of New-Onset Laryngeal Dystonia.

OBJECTIVES: Adult-onset idiopathic laryngeal dystonia (LD) can be associated with the risk of spread to muscles in the body. Subjects with extralaryngeal onset of dystonia have exhibited spread to the larynx. Previous studies analyze the spread of other dystonias but emphasis has not been placed on LD. The objective was to identify demographic and clinical factors contributing to the spread of dystonia to and from the larynx. METHODS: Data were obtained from the Dystonia Coalition (DC)-patients from 49 international clinical centers. Clinical and demographic data was taken from 143 out of 409 patients with diagnosed LD. Patient criteria included adult-onset LD diagnosed on exam with no co-morbid neurologic conditions and no dystonia in other locations. RESULTS: Among the 143 patients, 94 (65.7%) patients were diagnosed with focal laryngeal onset, with the remainder having extralaryngeal onset. Family history and age at study were statistically significant indicators of a patient developing laryngeal versus extralaryngeal onset of dystonia. Among the laryngeal onset group, 21 cases (22.3%) had an average time of 5.81 ± 5.79 years to spread from diagnosis, most commonly to neck (61.9%). Among extralaryngeal onset patients, mean time of larynx spread was 7.92 ± 7.737 years, most commonly to neck (22.7%). CONCLUSIONS: Our data indicates approximately a quarter of patients with laryngeal-onset dystonia will exhibit spread. There were no demographic or clinical factors that were statistically predictive of the likelihood of spread from larynx. Patients with dystonia elsewhere in the body should be counseled on the possibility of spread to larynx, and vice versa. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2295-2299, 2024.

Update on Clinical Characteristics of Upper Airway Dyspnea: A Mixed Methods Study.

OBJECTIVES: Provide a mixed-methods update on clinical presentation of patients with upper airway dyspnea (UAD). STUDY DESIGN: Prospective, multicenter, mixed-methods study. METHODS: Data were collected from 30 patients presenting to two tertiary ENT clinics with a chief complaint of dyspnea. Exclusionary criteria included abnormal structural laryngeal findings, uncontrolled pulmonary disorders, and medical conditions affecting breathing. Objective data collected included laryngeal exam findings, patient-reported outcome measures and symptom questionnaires, medications, and psychological diagnoses. Patients were categorized into groups based on the chronic or episodic nature of their dyspnea symptoms for comparison. Qualitative data from these groups were collected and analyzed. RESULTS: Laryngeal exams revealed the presence of supraglottic constriction at rest was 26.66% and with phonation 83.33%. Ninety-three percent of patients did not show inappropriate vocal fold motion or adduction. Significant correlations were found between Dyspnea Index (DI) scores and other subjective questionnaires including Voice Handicap Index-10 (r = 0.64, P value = 0.001), Eating Assessment Tool-10 (r = 0.50, P value = 0.004), Cough Severity Index (r = 0.47, P value = 0.008), Vocal Cord Dysfunction Questionnaire (r = 0.59, P value = 0.005), and Somatic Symptom Scale-8 (r = 0.41, P value = 0.021). However, no significant correlation was found between the State-Trait Anxiety Index and DI (r = 0.27, P value = 0.1353). Qualitative analyses identified similar, but non-identical themes for both chronic and episodic dyspnea. CONCLUSIONS: Patients with symptoms of UAD also report other abnormal head and neck and global body symptoms. Most patients with complaints of UAD in this study did not have abnormal vocal fold movements on laryngoscopy. There were differences in qualitative analyses between the chronic and episodic dyspnea groups, but no differences in state or trait anxiety.

A Comparison of Voice Therapy Attendance Rates Between In-Person and Telepractice.

PURPOSE: This study sought to investigate whether a significant difference exists in attendance, cancellations, and no-shows between in-person therapy and telepractice. The authors hypothesized that telepractice no-show and cancellation rates would be less than in-person no-show and cancellation rates. METHOD: This retrospective study manually reviewed and analyzed attendance, no-show, and cancellation data over a 3-month span of in-person-only visits (September 2019-November 2019) and a 3-month span of telepractice visits (September 2020-November 2020) conducted at the Emory Voice Center, a tertiary care practice in urban Atlanta, Georgia. Additionally, data were collected for each patient's full course of therapy outside of the 3-month windows and analyzed for attendance, no-show, and cancellation patterns. RESULTS: Data from 521 patients were available for review from the selected time frame. In 2019 (in-person), 157 patients met inclusion criteria, and in 2020 (telepractice), 176 patients were included. Therapy initiation, therapy attendance, and no-show rates had significant increases in the telepractice year, and cancellations made greater than 24 hr before the appointments had a significant decrease in the telepractice year. Furthermore, the overall course of therapy showed significantly fewer missed appointments and more attended appointments in the telepractice year. CONCLUSIONS: Patients participating in voice therapy via telepractice are more likely to initiate treatment and attend treatment and less likely to cancel sessions compared with patients receiving treatment in person. These data combined with extant data on telepractice treatment efficacy indicate that telepractice should be considered standard of care and offered to all patients seeking treatment, as it removes many reported barriers to treatment.

Assessing Candidacy for Conversation Training Therapy: The Role of Patient Perception.

OBJECTIVE: Voice therapy is the primary treatment modality for voice rehabilitation. Specific patient-ability factors beyond patient-characteristic factors (eg, disorder diagnosis, age, etc.), that influence individual patient responses to voice treatment remain largely unknown. The goal of the current study was to determine the relationship between patient-perceived improvements in both the sound and feel of voice during stimulability assessment and voice therapy outcomes. STUDY DESIGN: Prospective Cohort study. METHODS: This study was a single-arm, single-center, prospective study. Fifty patients with primary muscle tension dysphonia and benign vocal fold lesions were enrolled. Patients read the first four sentences of the Rainbow Passage and were asked if they experienced a change in the feel or sound of their voice following the stimulability prompt. Patients then completed four sessions of conversation training therapy (CTT) voice therapy and followed up one-week and three-months after their last therapy session, for a total of six time-points. Demographic data were collected at baseline, and voice handicap index 10 (VHI-10) scores were collected at each follow-up time-point. The primary exposure variables were CTT intervention and patient perception of voice change to stimulability probes. The primary outcome was change in VHI-10 score. RESULTS: On average, VHI-10 scores improved for all participants following CTT treatment. All participants heard a change in the sound of voice with stimulability prompts. Descriptively, patients who reported a positive change in the feel of their voice after stimulability testing recovered faster (ie, experienced a sharper decline in VHI-10) compared to those who did not note a change in feel of voice during stimulability testing. However, the rate of change over time was not significantly different between groups. CONCLUSION: Patient self-perception of a change in the sound and feel of voice in response to stimulability probes during initial evaluation is an important factor in treatment outcomes. Patients who perceive an improved feel of their voice production after stimulability probes may respond to voice therapy more quickly.

Trends Following Implementation of an Otolaryngology Hospitalist Model in a Tertiary Care Setting.

OBJECTIVES: The otolaryngology hospitalist (OH) model is an emerging paradigm for inpatient and acute patient care. This study presents encounter volume before and after the implementation of an OH service. Postimplementation trends are evaluated. STUDY DESIGN: Retrospective administrative and clinical database review. SETTING: Tertiary care university hospital. METHODS: This review includes 2 distinct time frames (2008-2012, 2014-2018), representing periods before and after OH implementation. The number of billed patient encounters is compared between these 2 periods using the hospital data warehouse. Additional data is evaluated for the postimplementation period, using a clinical database. Encounter type, the reason for consultation, procedures, and requesting service/location are described. RESULTS: After the OH implementation, there was a 451% increase in evaluation and management encounters submitted for billing. Since the OH model inception, there was an overall increase in encounters (849-910), procedures performed (319-345), and operative cases (46-54) per year. Each inpatient consultation request generates one or more procedures on average. Common reasons for consultation include sinonasal pathology (20.3%), dysphonia/dysphagia (17.5%), and airway evaluation (15%). Critical Care (24%), Emergency Medicine (21%), and Hospital Medicine (21%) requested most of the Otolaryngology consults. Most consults were seen on the inpatient medical/surgical floor (46%), with the ICU (27%) and the Emergency Department (22%) being the next most common locations. CONCLUSIONS: The OH model is an evolving paradigm that is viable and offers timely, specialized care for patients in a hospital or acute care setting.

An Evaluation of the Content of Canadian Plastic Surgery Residency Websites.

Background: Plastic surgery residency program websites are an important source of information to prospective applicants, especially given the ongoing COVID-19 pandemic and resulting suspension of all visiting electives and in-person interviews. This study aimed to analyze the online content of Canadian plastic surgery residency program websites. Methods: The content of all accredited Canadian plastic surgery residency websites was evaluated using 77-point criteria in the following 10 domains: recruitment, faculty, residents, research and education, surgical program, clinical work, benefits and career planning, wellness, environment, and gender of faculty leadership. Results: All accredited Canadian plastic surgery residency programs (n = 13) were identified using Canadian Resident Matching Service and had their dedicated program websites available for analysis. On average, residency program websites obtained a score of 33.5 (standard deviation = 13.7). The majority of programs did not score differently on the criteria by geographical distribution (P > .05) nor by ranking (P > .05). Conclusions: Most Canadian plastic surgery residency program websites are lacking content relevant to prospective applicants. Addressing inadequacies in online content may support programs to inform and recruit strong applicants into residency programs.

Historique: Les sites Web des programmes de résidence en chirurgie plastique sont une source d'information importante pour les candidats potentiels, notamment en contexte de pandémie de COVID-19 et de suspension de tous les séjours pour cours facultatifs et des entrevues en personne. La présente étude visait à analyser le contenu des sites Web des programmes canadiens de résidence en chirurgie plastique. Méthodologie: Les chercheurs ont évalué le contenu de tous les sites Web canadiens de résidence en chirurgie plastique d'après des critères en 77 points dans les dix domaines suivants: recrutement, professeurs, résidents, recherche et formation, programme de chirurgie, travail clinique, avantages sociaux et planification de carrière, bien-être, environnement et genre de la direction des professeurs. Résultats: Les chercheurs ont utilisé le service canadien de jumelage des résidents pour repérer tous les programmes canadiens agréés en chirurgie plastique (n = 13) et ont retenu ceux qui étaient dotés d'un site Web consacré au programme pour en analyser le contenu. En moyenne, ils leur ont attribué un score de 33,5 (ÉT = 13,7). La majorité des programmes n'obtenaient pas de scores différents au critère de la répartition géographique (P > 0,05) ou du classement (P > 0,05). Conclusions: La plupart des sites Web des programmes canadiens de résidence en chirurgie plastique ne contiennent pas d'information pertinente pour les candidats potentiels. Si les programmes connaissent les lacunes de leur contenu en ligne, ils pourront apporter les correctifs nécessaires pour informer de solides candidats et les recruter dans leur programme de résidence.

Indexing Cognitive Resource Usage for Acquisition of Initial Voice Therapy Targets.

PURPOSE: The purpose of this study was to index cognitive resource usage for acquisition of initial targets of two common voice therapy techniques (resonant voice therapy [RVT] and conversation training therapy [CTT]) based on the theorized depletion effect (i.e., when an initial task requiring high cognitive load leads to poorer performance on a subsequent task). METHOD: Eleven vocally healthy participants, ages 23-41 years, read aloud the Rainbow Passage and produced consonant-vowel resonant targets (/mi, ma, mu/) followed by a baseline computerized Stroop task and a 15-min washout. Following this baseline period, participants watched and interacted with two videos instructing them in RVT or CTT initial targets. After viewing each video and practicing the associated vocal skills, participants rated the degree of mental effort required to engage in the target vocal technique on a modified Borg scale. Participants recorded their attempts at RVT on /mi, ma, mu/ and CTT on the Rainbow Passage, which were later rated by three voice-specialized speech-language pathologists as to how representative they were of each respective target technique. Changes in fundamental frequency and average auditory-perceptual ratings from baseline were examined to determine if participants adjusted their technique from RVT and CTT baseline to acquisition. RESULTS: Performance on the Stroop task was, on average, worse post CTT than post RVT, but both post-CTT and post-RVT Stroop scores were poorer than baseline. These results suggest that both treatment techniques taxed cognitive resources but that CTT was more cognitively taxing than RVT. However, despite differences in raw averages, no statistically significant differences were found between the baseline, post-CTT, and post-RVT Stroop scores, likely due to the small sample size. Participant ratings of mental effort for CTT and RVT were statistically similar. Likewise, poorer post-RVT Stroop scores were associated with participants' greater perceived mental effort with RVT acquisition, but there was no significant association between mental effort ratings for CTT acquisition and post-CTT Stroop scores. Significantly higher fundamental frequency and perceived ratings of the accuracy of technique from baseline to acquisition for both CTT and RVT were found, providing evidence of vocal behavior changes as a result of each technique. CONCLUSIONS: Brief exposure to initial treatment tasks in CTT is more cognitively depleting than initial RVT tasks. Results also indicate that vocally healthy participants are able to make a voice change in response to a brief therapy prompt. Finally, participant-rated measures of mental effort and secondary measures of cognitive depletion do not always correlate.

Vocal Acoustics and Aerodynamics During Scripted Reading Compared to Spontaneous Speech.

BACKGROUND: Examination of vocal acoustics and phonatory aerodynamics during connected speech provide a more ecologically valid approach to voice assessment than single phoneme measures. The purpose of the current investigation was to determine if differences exist in vocal acoustics and aerodynamics between reading and spontaneous speech tasks in patients with common voice disorders. METHODS: The Emory University Institutional Review Board approved this retrospective study. The voice records of 100 patients (74 females and 26 males) diagnosed with benign voice disorders and referred for voice evaluation at the Emory Voice Center between November 2018 and March 2019 were analyzed. These consisted of reading a scripted passage (the Rainbow Passage) and spontaneous speech (describing how to make a peanut butter and jelly sandwich). Data collected included gender, voice diagnosis, mean fundamental frequency (F0), mean airflow during voicing, and mean inspiratory airflow (MIA). RESULTS: Univariate analysis assessed normality of the data. Variables with normal distribution utilized paired t test. Non-normal data were log transformed. Mean F0 was not significant for complete case analysis (P = 0.053) but gender based stratified analysis, for females (mean difference = 4.68 Hz; 95% CI = 0.359, 9.0012; P = 0.03). Gender-related statistical differences were also found in MIA in women (P = 0.0001), and P = 0.0003 for MIA in men. The direction and range of change between scripted reading and the spontaneous speech tasks in all metrics varied widely. No consistent patterns were noted in gender, age and diagnosis across the parameters studied. However, clinically salient findings in the range of MIA were noted in a small subgroup of participants. CONCLUSIONS: This study suggests that multiple testing stimuli for phonatory aerodynamic and acoustic outcomes measurement may be appropriate for use depending on the need and vocal challenges of the individual patient. Clinically, both structured reading and spontaneous speech provide valuable insight into the vocal capabilities of the patient.

Phonation Resistance Training Exercises (PhoRTE) With and Without Expiratory Muscle Strength Training (EMST) For Patients With Presbyphonia: A Noninferiority Randomized Clinical Trial.

OBJECTIVES: Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone. STUDY DESIGN: Prospective, randomized, controlled, single-blinded, non-inferiority. MATERIALS AND METHODS: Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10. RESULTS: Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P < 0.001; PhoRTE + EMST M = -9.58, P < 0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm H2O, PhoRTE + EMST M = 32.63 cm H2O; P= 0.015). Some secondary acoustic and aerodynamic outcomes displayed trends toward improvement. CONCLUSION: This study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.

Effect of Behavioral Cough Suppression Therapy Delivered via Telehealth.

OBJECTIVES/HYPOTHESIS: Behavioral cough suppression therapy (BCST) has demonstrated up to 88% effectiveness at treating refractory chronic cough (RCC). With onset of the COVID-19 pandemic, along with many other medical services, BCST shifted to telehealth delivery. Our group hypothesized that BCST delivered via telemedicine by a specialized Speech-Language Pathologist would be comparable to previously reported response to treatment for in-person settings. STUDY DESIGN: Retrospective review. METHODS: An Emory IRB approved, retrospective review of electronic medical records was completed for RCC patients who received BCST via telehealth from March 2020 through January 2022 at Emory Voice Center. Patients were included in the study if they had a diagnosis of RCC, were referred for BCST, were seen for at least one therapy session in the telehealth setting, and provided Cough Severity Index (CSI) data pre and post-treatment. Patients were excluded if they had incomplete datasets, a known pulmonary condition, structural laryngeal disorders, smoking history, dysphagia, and ACE-inhibitor use. Change in CSI score pre- and post-treatment was calculated to determine treatment effect. Paired-samples t-tests were conducted to compare pre-and post-treatment CSI score change. RESULTS: Fifty-one RCC patients were included in this study; 88% were female with an average age of 60 years (SD = 12.68). Post-treatment CSI scores were significantly lower than pretreatment CSI scores (P < 0.0001). These findings are comparable to historical documented CSI change achieved with in-person BCST. CONCLUSIONS: This study provides preliminary evidence of the efficacy of BCST via telehealth for treating RCC. The findings of this study support the continued flexibility in speech-language pathology service delivery to include in-person and telehealth platforms for RCC beyond the COVID-19 pandemic.

Immediate Effects of Mindfulness Meditation on the Voice.

OBJECTIVES: The benefits of mindfulness meditation are well documented. This study evaluated the immediate effects of mindfulness meditation (MM) on the voice and voice user. STUDY DESIGN: Prospective experimental study. METHODS: Participants: 19 vocally healthy (VH) individuals, and 26 individuals with common voice disorders (CVD; benign lesions and hyperfunctional muscle tension) deemed stimulable for voice therapy. Exclusionary criteria: prior training or regular meditation practice. Participants recorded speech samples before and after a 11.5-minute prerecorded session of MM. PRIMARY OUTCOMES: phonatory aerodynamics and participants' self-reported experience of voice. SECONDARY OUTCOMES: self-reported anxiety, vocal acoustics, speech breathing patterns, and auditory-perceptual outcomes. Baseline self-reported measures of voice (Voice Handicap Index-10 - VHI-10), breathing (Dyspnea Index - DI), stress (Perceived Stress Scale - PSS), and trait mindfulness (Cognitive and Mindfulness Scale - Revised, CAMS-R, Five Facet Mindfulness Questionnaire - FFMQ) were compared between groups. RESULTS: At baseline, CVD had significantly higher VHI-10 (P< 0.001) and DI (P= 0.0014), and lower trait mindfulness (CAMS-R, P= 0.02). No difference between groups for PSS or FFMQ. Changes postMM: decreased CPP for all-voiced sentences for VH (P= 0.003), decreased mean SPL (P= 0.012) on sustained vowel for VH, increased mean phonatory airflow during sustained vowel for CVD (P = 0.012). VH demonstrated a decrease in CPP on the all-voice sentence, and CVD demonstrated an increase, resulting in a significant between group difference (P= 0.013). Participants reported improvements in voice, emotional and physical states. State anxiety decreased for both groups (= < 0.001). No other objective outcomes reached significance. CONCLUSIONS: After a brief MM, participants experienced improvement in physical, emotional, and cognitive states, and in their perceptions of their voice. Results indicate that a brief, single session of MM may be beneficial for some, but not sufficient to override habitual voice and speech patterns. Given the benefits of MM, future work should evaluate MM in a standard voice therapy protocol.

Racial and Gender Profile of Public Health Faculty in the United States of America.

Introduction In the context of shifting population demographics in the United States (US), a diverse workforce in the discipline of public health can improve outcomes for various populations through the provision of culturally competent public health policies and corresponding research. This study explored the academic, racial, and gender profile of public health faculty in the USA. Methods In this retrospective cross-sectional analysis, we analyzed the Association of American Medical Colleges (AAMC) annual report of faculty appointments at US medical schools. Descriptive data analysis was performed for chairperson, full professor, associate professor, assistant professor, instructor, and other positions from 2007 to 2018. Results There was a decrease in appointments at all academic ranks from 2007 to 2018 with an absolute change of -239. Overall, most academic positions were occupied by Whites compared to other races, especially in leadership ranks. However, year-by-year analysis showed a gradual decrease in the number of positions held by Whites. Over the last decade, there was a positive trend with a marginally greater number of minorities appointed at academic ranks, specifically Asians. Similarly, no significant change was seen in appointments for Hispanics. Additionally, females occupied a greater number of new positions as compared to their male counterparts except for the higher academic ranks. The data obtained from the AAMC were voluntarily reported and thus may not provide a complete picture of medical faculty in academic medicine. Conclusion Women have shown progress in public health faculty positions during our 12-year study period. However, racial and gender incongruity still exists at higher academic ranks and leadership positions. Further research is warranted to explore factors influencing faculty appointment and promotion, and strategies to reduce inequities.

Beauty and Attractiveness in the Human Voice.

OBJECTIVE: The objective of this study was to investigate the difference between vocal beauty and vocal attractiveness by determining whether perceptual ratings of vocal beauty and vocal attractiveness could be dissociated in a cohort of normal raters without a diagnosed sexual desire disorder. METHODS: Twenty five gay male participants were presented with randomly-chosen samples from the Geneva Voices and Faces Database, and were asked to rate each sample in terms of beauty, attractiveness for a relationship of short duration, and attractiveness for a relationship of long duration. Responses were recorded on a visual analog scale (0-100) using a touch-screen interface. The number of stimulus repetitions and the participant response times were also recorded. Statistical analyses were done using two-way Analysis of Variance tests and independent student's t tests. P values were considered statistically significant at the P < 0.05 level. RESULTS: Participants rated male voices significantly higher in terms of beauty, attractiveness for a relationship of long duration, and attractiveness for a relationship of short duration (P < 0.001). Participants rated female voices significantly higher for beauty than for attractiveness for relationship of long or short duration (P < 0.001). There was no significant difference in response time between male and female voices when rating vocal beauty (P = 0.5608). Response time was significantly longer for male voices than for female voices when assessing attractiveness for a relationship of short duration (P < 0.002) but not for long duration (P < 0.3496). Attractive voices (male and female) were repeated more often, and male voices were repeated more often than female voices for both long-term and short-term attractiveness. There was no difference in stimulus replay behavior as a function of the beauty ratings. CONCLUSION: In a cohort of gay male raters without a diagnosed sexual desire disorder, vocal beauty and vocal attractiveness ratings of male and female voices are two related but distinct perceptual constructs that can, under certain circumstances, be dissociated. In general, gay men rated male voices equivalently for beauty, short-term, and long-term attractiveness, while the same ratings for female voices showed a significant difference between ratings of beauty and ratings of short-term and long-term attractiveness.

Need for Speed: Investigating Publication Times and Impact Factors of Plastic Surgery Journals.

BACKGROUND: Prolonged publishing time in scientific journals can be discouraging for researchers because earlier publication can mean a higher h-index and more academic opportunities. In this study, we evaluated the publication time for articles in plastic surgery journals compared with journals in surgery and medicine. We also assessed correlations between publication speed and journal impact factors (IFs). METHODS: The overall indexes of all plastic surgery journals were compared with journals in the discipline of surgery and medicine. In addition, we evaluated original articles published in all plastic surgical journals and the highest-ranking journals from various surgical subspecialties listed in the 2018 Journal Citation Report, assessing the time intervals from submission to publication, submission to acceptance, and acceptance to publication. Correlation between time interval and journal IF were analyzed. RESULTS: A total of 18 plastic surgery journals were compared with 210 surgical journals. Our study found that the IFs of journals significantly affect submission-to-acceptance times of the articles (P < 0.05, Wilcoxon test). The median submission-to-publication time for all plastic surgery and all surgical journals was 29.7 weeks (IQR, 12.1 and 35.8) and 22.1 days (IQR,18.8 and 36.8), respectively. CONCLUSIONS: There is a significant submission to publication time lag in plastic surgery journals when compared with other nonplastic-surgery journals. There was a positive correlation between submission-to publication time and IF for plastic surgery journals but a negative correlation for surgery journals (Spearman Correlation). In the last 14 years, plastic surgery journals have remained slow in publishing articles.

How Comprehensive Are Canadian Plastic Surgery Fellowship Websites?

Background Online fellowship program websites are more commonly becoming the primary information resource used by prospective applicants. This study aimed to analyze the online content of Canadian plastic surgery fellowship program websites.  Methods The content of all accredited Canadian Plastic Surgery fellowship program websites was evaluated using a 75-point criterion in the following ten domains: recruitment, faculty, residents/fellows, research and education, surgical program, clinical work, benefits, and career planning, wellness, environment and gender of faculty leadership.  Results On average, fellowship program websites obtained a score of 29.9 (SD=12.6). No correlation was detected between program websites and location (P > 0.05) nor by ranking (P > 0.05).  Conclusions Most Canadian plastic surgery fellowship program websites lacked content relevant to prospective applicants. More comprehensive fellowship program websites may be of benefit to prospective applicants and the programs.

Tendencias en el tratamiento de la papilomatosis respiratoria recurrente / Trends in recurrent respiratory papillomatosis treatment

La papilomatosis respiratoria recurrente (PRR) consiste en tumores benignos en las vías respiratorias causados por la infección del virus del papiloma humano. Las lesiones pueden provocar cambios en la fonación y obstruir las vías respiratorias. El objetivo de este estudio es evaluar las diferentes terapias quirúrgicas y adyuvantes disponibles para el tratamiento de esta afección que se han reportado en los años recientes. Se realizó una búsqueda en PubMed de artículos sobre el tratamiento de la PPR publicados entre 2014 y 2018. De los encontrados, 40 artículos con 1.425 pacientes con PRR cumplieron con los criterios. De estos, 24 artículos evaluaban el uso de terapias adyuvantes como el bevacizumab, el cidofovir y la vacuna contra el virus del papiloma humano. Ha habido un aumento en las opciones terapéuticas adyuvantes para la PRR en los últimos años. El conocimiento de estas opciones resalta las lagunas y oportunidades en la atención de estos pacientes, abre la puerta a nuevos protocolos para controlar la enfermedad, aumenta los intervalos quirúrgicos y nos guía hacia nuevos caminos en el futuro

Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future

Validation of the Communicative Participation Item Bank as an Outcome Measure for Spasmodic Dysphonia.

OBJECTIVES: Current patient-reported outcome measures do not adequately capture the impact of spasmodic dysphonia (SD) on communication in daily life situations. The aim of this study was to validate the Communicative Participation Item Bank (CPIB), which specifically measures a disease's impact on daily conversational situations, as an outcome measure for SD. STUDY DESIGN: Multi-institutional prospective cohort study. METHODS: A prospective study was conducted with administration of the 46-question CPIB and the Voice Handicap Index-10 (VHI-10) to 190 participants with SD before (time 1) and 6 weeks after (time 2) botulinum toxin injection. Differential item function (DIF) analyses were performed to examine potential item bias. Paired t-tests were used to assess change in each of the CPIB and VHI-10 scores after treatment. Pearson correlations were calculated between the CPIB and VHI-10. RESULTS: DIF analyses revealed no clinically meaningful difference between the item parameters generated for this SD sample and the original CPIB calibration sample. There were statistically significant changes between the pre-treatment and post-treatment time points for both the CPIB and VHI-10. Correlations between the CPIB and VHI were moderate-high. CONCLUSIONS: The CPIB item bank, General Short Form, and scoring parameters can be used with people with SD for valid and reliable measurement of the impact of communication disorders on communication in everyday life. The CPIB is sensitive to changes with intervention, proving useful for clinical and research purposes to assess the efficacy and effectiveness of interventions. LEVEL OF EVIDENCE: Level 2, prospective observational research with an experimental design (ie, cohort study). Laryngoscope, 131:859-864, 2021.

Trends in recurrent respiratory papillomatosis treatment. / Tendencias en el tratamiento de la papilomatosis respiratoria recurrente.

Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future.

Characterization of inpatient rehabilitation outcomes among HIV/AIDS patients: a retrospective cohort study.

ABSTRACT Survival time in HIV/AIDS patients has increased as a result of improved treatments, but many acquire functional impairments that may necessitate multidisciplinary medical rehabilitation. In the United States, inpatient rehabilitation facilities (IRF) provide this care, but outcomes are not well described in this population. We used the Uniform Data System for Medical Rehabilitation (UDSMR) database to describe 11,051 HIV/AIDS IRF patients; HIV/AIDS patients were grouped according to the following admission criteria: (1) HIV/AIDS as primary reason for admission (n = 225); (2) HIV/AIDS symptomatic comorbidity (n = 6569); and (3) HIV/AIDS asymptomatic comorbidity (n = 4257). We used standard descriptive statistics to summarize demographic, medical, rehabilitation, and discharge setting characteristics by group. When compared to patients with HIV/AIDS as a comorbidity, primary HIV/AIDS patients had worse outcomes. They made less functional change (25.1 versus 29.8 and 28.9, p < .001), went home less (73.8% versus 74.5% and 77.8%, p < .001) and to an acute care hospital more frequently (18.2% versus 13.9% and 10.1%, p < .001). These findings help to characterize the HIV/AIDS patient population who receive inpatient medical rehabilitation, which helps inform clinical care, and highlight the positive impact IRF care can make to minimize functional disability among chronic HIV/AIDS patients and possibly decrease costs of home health care.