The clinical impact of bedside fiberoptic laryngoscopic recording on a tertiary consult service.

OBJECTIVES/HYPOTHESIS: Fiberoptic laryngoscopy is dependent on accurate descriptions of examination findings. Traditional recording methods can be impractical for inpatient consults. Therefore, we aim to determine the utility of a smartphone-coupled portable recording system with flexible laryngoscopy for transmitting information between resident and attending physicians in a real-time setting. STUDY DESIGN: Pilot prospective study in a tertiary academic hospital. METHODS: This is a prospective study of inpatient consultations in a tertiary referral hospital over a 3-month period from April 2015 to June 2015. Flexible laryngoscopy was performed by a resident physician, and mobile recordings were relayed to an attending physician. Concordance of laryngoscopy interpretations between resident and attending physicians as well as changes in management were documented. RESULTS: Seventy-nine fiberoptic examinations were recorded and compared. Each consult was categorized as follows: airway evaluation (AE) (43%, 34/79), voice evaluation (VE) (3.7%, 3/79), dysphagia (D) (24%, 19/79), and aerodigestive tract mass/pathology (ADM) (29.1%, 23/79). Nine examinations showed discordance between resident and attending interpretations. Inter-rater agreement was good, with a kappa value of 0.747 (95% confidence interval: 0.643-0.851). The frequency of discordant exams within each group was as follows: AE (15%, 5/34), VE (33%, 1/3), D (11%, 2/19), and ADM (4.3%, 1/23). In five patients, changes in laryngoscopy interpretation changed clinical management. Seven nondiscordant exams had a change in management after attending review. Of the 79 exams, only one required repeat flexible laryngoscopy by the attending physician. CONCLUSIONS: Portable recording of flexible laryngoscopy is an effective tool for timely management of inpatient consultations. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:818-822, 2018.

Pediatric Myofibroma of the Palate with Ulceration and Bone Destruction.

Myofibroma is a rare benign neoplasm occurring in the head and neck, arising primarily in infants and children. Frequently, myofibromas grow rapidly leading to suspicion of malignancy and the potential for overaggressive surgical excision. We aim to report a rare case of myofibroma with ulceration and bone destruction. A nine-year-old female presented with an ulcerated left hard palate mass. Open biopsy was performed with pathology suggestive of myofibroma. A left partial maxillectomy and reconstruction with a buccal advancement flap were performed. Final pathology confirmed the diagnosis of a benign myofibroma. Myofibroma is a rare benign tumor of the head and neck which must be considered in the differential diagnosis by the clinician and the pathologist in order to prevent inappropriate and/or overaggressive treatment.

Hearing loss in singers: a preliminary study.

OBJECTIVE: Singers need good hearing; however, they may be exposed to loud noises during their musical activities. The objectives of this study were to describe the incidence and type of hearing loss (HL) in singers. STUDY DESIGN: Retrospective case cohort. METHODS: Billing records identified patients who had undergone videostroboscopy and audiogram during the same visit over a 3 year period. A singer was defined as anyone who self-identified as a singer (professional or avocational). Age and gender matched nonsingers were used as controls. Patients with otologic diagnoses, surgery, or complaints were excluded. Retrospective chart review was conducted for the presence of HL, type of HL, and pure tones audiogram results. Statistical analysis included descriptive statistics, Students t test, chi-square test, and Fisher exact test. RESULTS: Of 172 singers (44.7 years, 37.8% male), 31 (17.5%) had HL. Pure tone thresholds for the singers with HL subgroup at 3, 4, and 6 kHz were 21.0, 26.5, and 34.4 dB in the right, and 22.8, 30.3, and 38.8 dB in the left ear, respectively. Older age (P = 0.000000000000001), male gender (P < 0.001), longer number of years of singing (P = 0.0000000003), and baritone voice (P < 0.001) were associated with HL. There was no association with genre of music. When compared with controls, the incidence of HL (19.8%) was not significantly different (χ2 = 0.300, P = 0.58). Pure tones at 3, 4, and 6 kHz were not significantly different than controls with HL. Most common type of HL in singers was bilateral sensorineural (83.9%), which was significantly higher than controls (39.0%, χ2 = 14.6, P < 0.001). CONCLUSIONS: The incidence of HL in singers was 17.5%, which was not significantly different from controls. Bilateral sensorineural HL was most common.

Management of supraglottic stenosis using a novel stent design.

OBJECTIVES: To present a novel design for a stent for management of a traumatic supraglottic web. METHODS: Case report and literature review (PubMed 1964-2013). RESULTS: A 48-year-old man was presented after penetrating laryngeal trauma. He had severe dysphonia and was tracheotomy dependent. He had been treated previously with open reduction and fixation of laryngeal fracture. On examination, we identified an avulsed left vocal fold and a supraglottic web. He initially underwent reapproximation of the avulsed left vocal fold, and subsequently, the supraglottic web was treated using a stent designed by the senior author (R.T.S.). In addition, he underwent later resection of scar tissue to improve dysphonia and then he was decanulated. CONCLUSIONS: There are a few techniques presented in the literature and mostly are adaptations of subglottic stenosis management techniques. Individualized treatment is needed for these difficult cases. We present our experience with supraglottic web treatment to expand the literature on this uncommon disorder.

Manipulating Reduction Potentials in an Artificial Safranin Cofactor.

Safranines hold great promise as artificial flavin-like electron transfer cofactors with tunable properties. We report the design and chemical synthesis of the p-methoxy derivative of safranine O using a new synthetic route based on the Ulmann condensation. Spectroelectrochemical comparison of the purified parent safranine and this derivative demonstrates that the modification increases its two-electron reduction potential by 125 mV, or 5.75 kcal/mol. This modification also causes redshifts in the absorbance and fluorescence spectra of the cofactor, suggesting that it may find future utility in arrayed sensor applications.

Afghanistan, poppies, and the global pain crisis.

The World Health Organization has reported that somewhere between 30-86 million people suffer from moderate to severe pain due to cancer, HIV/AIDS, burns, wounds and other illnesses annually and do not have access to proper opiate anesthetics to control the pain [1]. The vast majority of these people live in poor nations where medicinal opiates are either too expensive or not readily available. In this paper, it is argued that access to adequate healthcare is a human right and that adequate healthcare includes management of pain. The solution to this problem may be in Afghanistan, a country now overwhelmed with poverty and war. Afghanistan is the world's leading producer of heroin. The increase in heroin production in Afghanistan has caused the United States and the international community to begin to eradicate Afghanistan's poppy fields leading to increased poverty among poppy farmers. This paper proposed a paradigm that can be implemented in Afghanistan which would allow for Afghan farmers to continue growing their poppy crop for medicinal opiates like morphine for poor nations. The paradigm covers all parameters of medicinal opiates production including licensing, security, cultivation, harvest, and factory production of medicinal opiates. The paradigm proposed is less expensive than eradication, brings honest income to Afghan farmers and the new Afghan nation, and can eventually lead to Afghanistan acquiring a respectable role in the world community. In closing, a full ethical analysis of the paradigm is included to justify the arguments made in the paper.