The use of vitamin D in preventing post-thyroidectomy hypocalcemia: An endocrinologist survey study.

OBJECTIVE: To evaluate the use of preoperative vitamin D levels and postoperative vitamin D supplementation among endocrinologists for the prevention of post-thyroidectomy hypocalcaemia. METHODS: Endocrinologist members of the American Thyroid Association (ATA) were contacted via email to complete a 21-question survey, which included both questions about demographic information, and preventing and managing postoperative hypocalcaemia after thyroidectomy. Univariate and multivariate analysis was performed to determine the respondents' use of preoperative vitamin D levels, dose and duration of preoperative vitamin D repletion, decision to delay surgery for low vitamin D levels in the case of a benign or malignant disease, and routine prescription of postoperative calcium or vitamin D supplementation. RESULTS: 225 endocrinologists who were ATA members responded to the questionnaire. When compared to endocrinologists practicing in other countries, those that practice in the United States were 2.5 times more likely to check preoperative vitamin D levels (95% CI[1.404, 4.535], P = .002), significantly more likely to replete vitamin D deficient patients with high-dose vitamin D (ie ≥50K IU/week), 4.458 times more likely to prescribe prophylactic supplemental calcium (95% CI[2.446, 8.126]; P < .0001) and 3.48 more likely to prescribe supplemental vitamin D (95% CI [1.906, 6.355]; P < .0001). Endocrinologists who have been in practice for >10 years were also 1.915 times more likely to prescribe supplemental vitamin D (95% CI (1.080, 3.395); P = .0263). Physicians that treat >50 thyroidectomy cases/year were 2.083 more likely to recommend a vitamin D repletion duration of >1 month than those that treat ≤50 cases/year ([1.036, 4.190], P = .0395). Lastly, if the patient has low preoperative vitamin D levels, 47.05% of respondents chose to delay surgery in a benign disease, while only 11.61% of respondents would do so in a case of malignant disease. CONCLUSIONS: Approximately one-half of surveyed endocrinologists reported using preoperative vitamin D levels to assess a patient's risk for post-thyroidectomy hypocalcaemia. Endocrinologists practicing in the United States, compared to those practicing in other countries, were more likely to both test for preoperative vitamin D levels and to recommend prophylactic post-thyroidectomy calcium and vitamin D supplementation.

Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study.

OBJECTIVE: To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy. METHODS: All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia. RESULTS: A total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist. CONCLUSIONS: Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.

Laryngeal Manipulation for Dysphagia with Muscle Tension Dysphonia.

The purpose of the article is to describe the use of laryngeal manipulation as a treatment for dysphagia resulting from excessive paralaryngeal muscle tension and to identify the patients likely to have symptomatic improvement. This is a retrospective single-center case series. A retrospective review identified patients from 2007 to 2013 with laryngeal manipulation for muscle tension dysphagia in an academic Otolaryngology practice. Subjects with dysphagia not attributable to an anatomic cause who attended therapy at least one time were included in the study. The primary outcome of the study was subjective improvement in dysphagia symptoms (yes/no) during follow-up. Symptoms, demographic information, treatment, and response to therapy were recorded. The Kruskal-Wallis test was used for analysis of continuous variables, while a Chi-squared test or fisher's exact test was used for analysis of all categorical variables. Forty-four subjects were included, consisting of 37 women and 7 men. Subjective improvement in dysphagia was seen in 34 subjects (77.3%). No significant differences were seen in improvement based on gender (p = 0.3223), race (p = 0.4317), number of sessions with a speech pathologist (p = 0.3198), or presenting symptoms including hoarseness (p = 0.0853), pain (p = 1.000), globus (p = 0.2834), and cough (p = 1.000). We found subjective improvement with laryngeal manipulation as reported during follow-up visits to clinic among individuals with muscle tension dysphagia. Patient age, presenting symptoms, and number of therapy sessions were not found to be significantly associated with resolution of symptoms.

Management of chronic laryngopharyngeal neuropathy in the United States and Europe.

OBJECTIVE: This study aimed to analyze differences in the evaluation of laryngopharyngeal neuropathy by laryngologists in the United States and Europe. METHODS: Members of the American Laryngological Association (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were emailed to all 179 members of the ALA and all 324 members of the ELS. RESULTS: Of the ALA members surveyed, 40 (23.3%) responded, compared to 72 members (22.2%) of the ELS group. Of the ALA respondents, 79.5% identified laryngology as their primary area of practice, whereas 56.9% of ELS respondents identified devoting more than 50% of their practice to laryngology. Of ELS laryngologists, 81.1% received training in laryngology or associated subspecialties. For diagnosing laryngopharyngeal neuropathy, the average comfort level on the Likert scale was significantly greater for ALA members than ELS members (P<.01). Furthermore, ALA laryngologists were less likely to consider laryngopharyngeal reflux as an overdiagnosed condition compared to ELS laryngologists (P<.05). CONCLUSION: Laryngologists in the United States and Europe vary significantly in their familiarity with laryngopharyngeal neuropathy. This could reflect either differences in awareness concerning this condition or a more critical perspective of European providers regarding the chronic laryngopharyngeal neuropathy (CLPN) diagnosis. As CLPN is still lacking definitive proof, the addition of European researchers could aid in validating CLPN and determining its overall effect on the chronic cough population.

U.S. practice variations in the treatment of chronic laryngopharyngeal neuropathy.

OBJECTIVES/HYPOTHESIS: To evaluate differences in evaluation and workup of laryngopharyngeal neuropathy in a population of general otolaryngologists and fellowship-trained laryngologists. STUDY DESIGN: Survey. METHODS: Members of the American Laryngological Association (ALA) and a general otolaryngologist database from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were surveyed. A questionnaire was e-mailed or mailed to 179 members of the ALA and 900 members from the AAO-HNS database. RESULTS: Responses were received from 43 subjects in the ALA group (24.5%) and 96 in the AAO-HNS database group (10.6%). Compared to the general otolaryngologists surveyed, ALA members were found to be more likely to practice in academics (79.6% vs. 6.6%) and to have been fellowship trained (79.5% vs. 16.5%). Among the general otolaryngologists, 44.6% reported being unfamiliar with laryngopharyngeal neuropathy compared to 0% from the ALA group (P < .0001). After accounting for the respondents unfamiliar with the condition, the general otolaryngologists reported being less comfortable in diagnosing laryngopharyngeal neuropathy (P < .0001) and were more concerned about the over-diagnosis of laryngopharyngeal reflux when compared to the ALA (P = .0030). CONCLUSION: General otolaryngologists and fellowship-trained laryngologist have several differences in the knowledge, workup, and treatment of chronic laryngopharyngeal neuropathy. This may translate to unnecessary treatments and tests for effected patients and should be addressed with further education targeting general otolaryngologists. LEVEL OF EVIDENCE: 4.

Low birth weight neonatal choanal atresia repair using image guidance.

This case report demonstrates a novel technique for image-guided choanal atresia repair in the undersized neonate. A surgical navigation system (Stryker, Inc., Kalamazoo, MI) face mask was applied in an "inch-worm" technique facilitating a registration "work-around," also detailed here, to permit intraoperative image guidance despite the patient's small head size. At age 10 days, the premature neonate underwent successful image-guided endoscopic repair of bilateral choanal atresia, permitted by a unique adaptation of face mask application and registration technique. This report presents the smallest weight patient in the literature to date to undergo image guidance during transnasal bilateral choanal atresia repair.