The Critical Response Team in Airway Emergencies.

Successful outcomes of airway emergencies (AEs) in the hospital depend on rapid recognition and intervention before patients become unstable. We describe our medical center's experience with a coordinated rapid response to AEs, including an illustrative case. This approach emphasizes early recognition of impending AEs and instantaneous activation of a team of specialists and operating room personnel to rapidly respond to AEs anywhere in our medical center.The literature on critical response teams for AEs is reviewed.

Delayed tracheal rupture following thyroidectomy.

Thyroidectomy is a commonly performed, low-risk procedure. Tracheal perforation during thyroidectomy is rare, and delayed rupture of the trachea rarer still. We present the case of a patient who underwent total thyroidectomy secondary to Grave's disease who, on postoperative day 7, developed massive subcutaneous emphysema and respiratory distress. Surgical exploration revealed a rupture of the anterolateral tracheal wall at the level of the first tracheal ring. The defect was repaired primarily and the patient recovered uneventfully. The risk factors for and the management of this rare complication are discussed.

Laser-assisted voice adjustment (LAVA) in transsexuals.

OBJECTIVE: The objective of this study was to evaluate results of laser-assisted voice adjustment (LAVA) surgery in male-to-female (MTF) transsexual patients with androphonia. METHODS: The authors conducted a prospective case-control study of MTFs who underwent CO2 laser vocal fold vaporization between 1997 and 2003. Thirty-one patients were self-referred for voice feminization. Pre- and postoperative evaluations were completed. Patients' voices were recorded to obtain Fo before and after surgery. Voice Handicap Index (VHI) questionnaires were completed by post-LAVA patients. A panel of blinded listeners identified patients as male or female based on samples of connected speech recorded over the telephone. RESULTS: Mean follow-up (23 weeks) revealed pitch increases averaging 26 Hz. Self-evaluations revealed increases in voice femininity, congruity with self-image, and satisfaction. However, the evaluations also showed decreased vocal quality, loudness, and vocal range. Mean VHI was consistent with VHI scores associated with Reinke's edema. Six of 10 patients were consistently perceived as female. CONCLUSION: LAVA provides a conservative treatment for androphonia. Postoperative voice therapy may optimize outcomes.

Pediatric epistaxis.

OBJECTIVES/HYPOTHESIS: Otolaryngologists are frequently consulted for the evaluation and treatment of pediatric epistaxis. There is a lack of consensus as to the optimal approach to this problem. This study evaluated an approach used to evaluate and treat patients referred on an outpatient basis. STUDY DESIGN: Retrospective study. METHODS: Charts from 90 patients referred for the treatment of epistaxis were reviewed. RESULTS: Anemia was identified in 22% of patients. An abnormal coagulation study was identified in 7.8% of patients. Computed tomography (CT) imaging of the sinuses was obtained in nearly 90% of patients and revealed no suspicious masses. Opacification of the sinuses consistent with sinusitis was commonly seen. The majority of cases were resolved by the first follow-up visit with a topical nasal emollient. CONCLUSIONS: The outpatient evaluation of epistaxis should include a screen for anemia and coagulopathy. Routine CT imaging of the sinuses is unhelpful and is not recommended. The majority of cases are easily treated with rehydration of the nasal mucosa. Consideration should be given to rhinosinusitis as a co-existing factor in patients with epistaxis.

The impact of long-term botulinum toxin injections on symptom severity in patients with spasmodic dysphonia.

Injection of botulinum toxin (BT) into the muscles of the larynx is an effective treatment for the symptoms of spasmodic dysphonia (SD). To date, however, there have been no studies that have used blinded raters to assess the efficacy of BT injections on overall symptom severity in a cohort of SD patients followed over a prolonged period. In this study, 102 subjects with SD were treated with serial BT injections for up to 2 years. Voice recordings were obtained at several time points during treatment and were played to a panel of expert and novice listeners who rated them based on overall symptom severity in a single-blind fashion. Subjects demonstrated significant improvement over baseline at all time points. In addition, patients showed a sustained responsiveness to therapy over time. These results provide support for the efficacy of serial BT injections for SD and suggest that successful treatment may depend, in part, on patients' early recognition of returning symptoms.

Histological evaluations following 1,064-nm Nd:YAG laser resurfacing.

BACKGROUND AND OBJECTIVES: The long pulse 1,064-nm Nd:YAG laser is used clinically to decrease rhytid formation. The dermal level at which this change occurs has not been established. This study attempts to answer these questions using a porcine skin model. STUDY DESIGN/MATERIALS AND METHODS: Non-randomized prospective experimental trial involving the domestic piglet treated serially with the long pulse 1,064-nm Nd:YAG laser. RESULTS: Collagen formation occurred at the level of the reticular dermis. After one laser treatment, a significant level of collagen formation was induced in the reticular dermis compared to controls. The greatest gain was observed after four laser treatments. Energy levels of 20, 30, 40, and 50 J/cm2 were evaluated. Although not statistically significant, 30 J/cm2 had the greatest effect on collagen formation. However, at 50 J/cm2, marked ablative changes to the epidermis were observed. CONCLUSIONS: The long pulse 1,064-nm Nd:YAG laser induces collagen formation in the reticular dermis in porcine skin.