Reliability of the perceptual evaluation of adductor spasmodic dysphonia.

OBJECTIVES: Although perceptual assessment by experienced voice clinicians remains the gold standard for the diagnosis and assessment of severity of adductor spasmodic dysphonia (ADSD), the interrater reliability of voice experts for this task has not been assessed. In addition, it is unknown whether telephone-recorded or -transmitted voice samples could be used for this task. The aims of this study were (1) to assess the reliability of perceptual analysis of ADSD severity by voice experts and (2) to compare the results between digitally recorded voice samples and those recorded over the telephone. METHODS: Five laryngologists randomly selected voice samples from 46 ADSD patients and rated the severity of ADSD on a 5-point rating scale. A set of digital voice recordings and a set of telephone voice recordings made from filtering the digital set via the telephone were rated, and each voice set was rated twice. Measures of intrarater and interrater reliability, as well as a measure of the probability of agreement among the raters, were calculated. RESULTS: There was a high level of agreement on ADSD severity, with excellent interrater and intrarater reliability (Cronbach's alpha, .93 to .96). The probabilities of rater agreement on the digitally recorded and telephone-filtered voice samples were similar (chi2, p = .07). The ratings of digital versus telephone voice samples were highly correlated (Pearson r, 0.99; p < .001). CONCLUSIONS: These results demonstrate that voice experts are reliably able to judge and agree on the severity of ADSD. Telephone-filtered voices appear to convey adequate ADSD perceptual cues for expert listeners to judge the severity of spasmodic dysphonia.

Videostroboscopic findings in unilateral superior laryngeal nerve paralysis and paresis.

OBJECTIVES: Our aim was to present laryngovideostroboscopic findings in unilateral superior laryngeal nerve paresis and paralysis. STUDY DESIGN AND SETTING: Retrospective case review, academic voice clinic. METHODS: Blinded retrospective review of videostroboscopic recordings from cases confirmed by laryngeal electromyography. RESULTS: Three cases of unilateral superior laryngeal nerve paresis and paralysis were identified. At rest, there were no common abnormal laryngeal findings. Upon phonation, common findings were ipsilateral vocal fold bowing and shortening, vocal process height asymmetry with the ipsilateral vocal process overriding the normal, and ipsilateral hyperadduction of the false vocal fold. CONCLUSIONS: The common features noted in these cases of laryngeal electromyography-proved uSLNp could be used to make a presumptive diagnosis of this disorder.

Safety of percutaneous injection of bovine dermal crosslinked collagen for glottic insufficiency.

OBJECTIVE: Our aim was to review the safety of percutaneous injection laryngoplasty using bovine crosslinked collagen, focusing specifically on two often-stated concerns: injecting patients who are taking the anticoagulant medication warfarin, and injecting patients without prior skin hypersensitivity testing. STUDY DESIGN AND SETTING: Retrospective chart review of injection laryngoplasty performed between 1997 and 2006 at the University of California, Los Angeles. RESULTS: The study group consisted of 895 patients who underwent 1290 injection laryngoplasty procedures. No bleeding complications were noted in 59 patients taking warfarin. No allergic complications were reported in 845 patients who did not undergo skin hypersensitivity testing before injection laryngoplasty. CONCLUSION: Percutaneous bovine crosslinked collagen injection laryngoplasty is safe in patients taking warfarin. Skin testing for hypersensitivity does not appear to be necessary before injection. SIGNIFICANCE: Patients on warfarin are candidates for injection laryngoplasty without the need to discontinue the medication. Eliminating skin hypersensitivity testing before percutaneous bovine crosslinked collagen injection laryngoplasty allows for a prompt treatment of glottic insufficiency.

Thyroidectomy for substernal goiter via a mediastinoscopic approach.

We report an unusual case in which a patient presented with a large posterior mediastinal goiter that extended to the level of the aorta. The goiter was resected through a standard Kocher neck incision with mediastinoscopic assistance. The large goiter was completely excised without the need for a sternotomy.

Primary B-cell lymphoma of the clivus: case report.

BACKGROUND: Lymphomas usually present in extranodal sites late in the course of the disease. Moreover, it is uncommon for a primary non-Hodgkin's lymphoma to present with cranial nerve palsies; reports in the literature are rare. CASE DESCRIPTION: We report the case of a 60-year-old woman with complaints of headache and double vision. MRI revealed an expansive clival lesion without pituitary invasion. An endoscopic transsphenoidal procedure was performed for diagnosis and partial resection of the mass. CONCLUSION: Primary diffuse large B-cell lymphoma of the clivus is rare. An endoscopic transsphenoidal approach to the skull base is described, along with characteristic clinical, radiologic, and pathologic findings of the lesions.