Laryngotracheal Reconstruction for Subglottic and Tracheal Stenosis.

Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although endoscopic procedures are effective in opening the airway lumen, open resection and reconstruction can be necessary to reconstitute a functional airway. When resection and anastomosis are insufficient due to extensive length or location of the stenosis, autologous grafts can be used to expand the airway. Future directions in airway reconstruction include tissue engineering and allotransplantation.

Otolaryngology Residency Application during the SARS-CoV-2 (COVID-19) Pandemic.

The escalation of the COVID-19 pandemic has affected health care at every level, including medical education. As some fourth-year medical students graduate early to join the front lines, we must now turn our attention to those trainees in their penultimate year. In this commentary, we address the unique dilemmas facing otolaryngology residency candidates for the 2020-2021 cycle, with a focus on those applicants with no institutional otolaryngology department.

What makes us tick: Implications of personality differences among otolaryngology residents and faculty.

OBJECTIVE: The rapid personal and professional growth experienced during medical training and practice is impacted by personality. The surgeon's personality is renowned in both medical lore and literature. However, it is now known that the personality characteristics of today's millennial trainees differ from older faculty. This study investigates the variability of different personality attributes among otolaryngology residents and faculty, as well as the practical implications of these findings. METHODS: The opportunity to complete a series of web-based, commercially available, self-administered five factor-based personality assessments was given to otolaryngology residents and faculty at nine academic training programs. The psychometrically validated assessments evaluate innate personality 1) strengths, 2) challenges, and 3) motivators/values. Differences between groups in the assessed metrics were evaluated using two-tailed t tests. RESULTS: Seventy-eight otolaryngology faculty and 104 residents completed all three assessments. Of the assessed metrics, there were several significant differences between residents and faculty (all P < 0.05). Residents scored higher than faculty in the domains of interpersonal sensitivity, sociability, and inquisitiveness. With respect to potential challenges, faculty displayed higher levels of skepticism and reservation. In contrast, residents scored higher in the categories of mischievous and dutiful. As for motivators/values, although both groups were highly motivated by altruism, faculty valued tradition more than residents, whereas residents valued hedonism and affiliation more than faculty. CONCLUSION: There are notable differences between residents and faculty in multiple domains, with implications for communication, education, and professional development. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:2286-2290, 2019.

Commentary on Bowe et al, "The State of the Otolaryngology Match: A Review of Applicant Trends, 'Impossible' Qualifications, and Implications".

An objective evidence-based review of the metrics used to evaluate applicants entering our field ultimately found these figures to have upward trends without any major correlation to performance in residency. The rise of these metrics coincides with a yearly drop in senior applicants, and in 2017, nearly 10% of programs did not match their contingent. The causes of unmatched spots must be examined to ensure that the field of otolaryngology can continue to grow and attract medical students who will excel in our field. Considerations into revising the applicant selection process, early introduction and mentorship within the otolaryngology field, and changes to the current otolaryngology interview process are discussed.

Work-related musculoskeletal symptoms among otolaryngologists by subspecialty: A national survey.

OBJECTIVE: Given the high prevalence of work-related musculoskeletal symptoms, increased appreciation for workplace ergonomics is critical. The purpose of this study is to assess work-related musculoskeletal symptoms and injury among otolaryngologists across subspecialties, as well as to quantify the understanding and application of ergonomic principles in the operating room. STUDY DESIGN: Cross-sectional study. METHODS: An online REDCap survey was distributed electronically to University of Kansas faculty, alumni, and residents; members of the American Academy of Facial Plastic and Reconstructive Surgery; and residency program coordinators for distribution to residents and faculty between August 2016 and March 2017. The survey assessed caseload, ergonomic practices, and associated musculoskeletal symptoms by type of procedure and impact of symptoms on surgeon practice. RESULTS: The survey was distributed to 3,006 individuals. We received 377 responses (12.5%), with 63.9% reporting symptoms. The majority of respondents began to experience symptoms in residency or fellowship. Neck and shoulder were the most affected body areas across all types of surgeries. One-third of surgeons were formally taught or actively sought information on ergonomics principles. Among those who applied ergonomics in practice, 69.6% observed improvement in their symptoms. CONCLUSION: Although musculoskeletal issues are prevalent among otolaryngologists, awareness of surgical ergonomics principles among otolaryngologists remains limited. Early instruction in ergonomic principles is important because work-related musculoskeletal symptoms commonly present in residency. Most respondents reporting the application of ergonomic principles also acknowledge symptom improvement. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:632-640, 2018.

Using pulmonary function data to assess outcomes in the endoscopic management of subglottic stenosis.

OBJECTIVE: This study aimed to examine the authors' experience with endoscopic management of idiopathic subglottic stenosis (iSGS), and to identify pulmonary function test (PFT) values that can be used to quantify outcomes. METHODS: Retrospective review. RESULTS: Twenty-five patients with a new diagnosis of iSGS were seen between 2006 and 2012. Median age at surgery was 45.3 years (interquartile range [IQR], 38.5-67.0), and median body mass index was 28.7 kg/m(2) (IQR, 23.5-32.1). Forty-five procedures were performed. Median preoperative stenosis was 56.8% (Cotton-Myer grade 2). The typical stenosis began 15 mm below the true vocal folds and was 12 mm long. Median follow-up was 21.4 months (IQR, 5.1-43.1). For patients receiving multiple dilations, median time between procedures was 23.7 months. Four PFT parameters demonstrated significant improvement after intervention: (1) PEF (absolute change = 2.54 L/s), (2) PIF (absolute change = 1.57 L/s), (3) FEV1/PEF (absolute change = 0.44), and (4) FIF50% (absolute change = 1.71 L/s). PIF was the only parameter affected by using a larger balloon (P = .047). CONCLUSION: PEF, PIF, FEV1/PEF, and FIF50% improved significantly after endoscopic incision and dilation of iSGS, and this could potentially be used as a metric by which to evaluate outcomes in the endoscopic management of subglottic stenosis.

LegC3, an effector protein from Legionella pneumophila, inhibits homotypic yeast vacuole fusion in vivo and in vitro.

During infection, the intracellular pathogenic bacterium Legionella pneumophila causes an extensive remodeling of host membrane trafficking pathways, both in the construction of a replication-competent vacuole comprised of ER-derived vesicles and plasma membrane components, and in the inhibition of normal phagosome:endosome/lysosome fusion pathways. Here, we identify the LegC3 secreted effector protein from L. pneumophila as able to inhibit a SNARE- and Rab GTPase-dependent membrane fusion pathway in vitro, the homotypic fusion of yeast vacuoles (lysosomes). This vacuole fusion inhibition appeared to be specific, as similar secreted coiled-coiled domain containing proteins from L. pneumophila, LegC7/YlfA and LegC2/YlfB, did not inhibit vacuole fusion. The LegC3-mediated fusion inhibition was reversible by a yeast cytosolic extract, as well as by a purified soluble SNARE, Vam7p. LegC3 blocked the formation of trans-SNARE complexes during vacuole fusion, although we did not detect a direct interaction of LegC3 with the vacuolar SNARE protein complexes required for fusion. Additionally, LegC3 was incapable of inhibiting a defined synthetic model of vacuolar SNARE-driven membrane fusion, further suggesting that LegC3 does not directly inhibit the activity of vacuolar SNAREs, HOPS complex, or Sec17p/18p during membrane fusion. LegC3 is likely utilized by Legionella to modulate eukaryotic membrane fusion events during pathogenesis.

Differentiating between congenital rhabdomyosarcoma versus fibromatosis of the pediatric tongue.

Congenital rhabdomyosarcoma of the tongue is exceedingly rare. Fibromatosis of the tongue is also rare, and very difficult to distinguish from the spindle cell variant of rhabdomyosarcoma. Both appear histologically as spindle neoplasms replacing normal striated musculature of the tongue. The treatment protocol for the former has been developed by the Intergroup Rhabdomyosarcoma Studies (IRS) I-IV and requires surgery, radiation, and chemotherapy. For fibromatosis, complete surgical excision is usually adequate without additional therapy, although some cases of aggressive fibromatosis also require chemotherapy. With significant differences in appropriate treatment and prognosis, each entity must not be mistaken for the other. We review the differences in radiologic, histologic, and immunohistochemical (IHC) features of both entities.