Laryngeal Manifestations of Ehlers-Danlos Syndrome.

Objectives: The identification of voice and airway manifestations of Ehlers-Danlos Syndrome (EDS), diagnoses, and potential treatment modalities.

Study Design: Single institution retrospective case series.

Methods: We examined all patients presenting to our institution over a span of 10 years with a history of EDS or who were subsequently diagnosed with EDS after their evaluation.

Correlating Perceptual Voice Quality in Adductor Spasmodic Dysphonia With Computer Vision Assessment of Glottal Geometry Dynamics.

Purpose: This study examined the relationship between voice quality and glottal geometry dynamics in patients with adductor spasmodic dysphonia (ADSD).

Method: An objective computer vision and machine learning system was developed to extract glottal geometry dynamics from nasolaryngoscopic video recordings for 78 patients with ADSD. General regression models were used to examine the relationship between overall voice quality and 15 variables that capture glottal geometry dynamics derived from the computer vision system.

An updated review of the epidemiological factors associated with recurrent respiratory papillomatosis.

Objectives: To identify studies evaluating the epidemiology of recurrent respiratory papillomatosis (RRP), including patient demographics, human papillomavirus (HPV) immunology, clinical course, surgical and medical treatments, and psychosocial factors.

Methods: A systematic literature search through PubMed was performed to identify studies evaluating the epidemiological factors associated with RRP. All studies were screened through a priori selection criteria using the titles and abstracts.

Lessons learned from open laryngotracheal airway resection and primary anastomosis in high risk patients.

Objective: Laryngotracheal stenosis is one of the most difficult conditions treated by the Otolaryngologist. Open resection of stenosis with primary airway anastomosis is the definitive treatment for this condition. However, some patients are considered high risk candidates for open airway surgery and management and outcomes in this group have not been reported.

Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System.

Objectives: In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase.

Transplanted human multipotent stromal cells reduce acute tongue fibrosis in rats.

Background: Tongue fibrosis resulting from head and neck cancer, surgery, radiation, chemotherapy, or a combination thereof devastates one's quality of life. Therapeutic options are limited. Here we investigate human bone marrow-derived multipotent stromal cells (MSC) as a novel injectable treatment for post-injury tongue fibrosis.

Consensus-Based Attributes for Identifying Patients With Spasmodic Dysphonia and Other Voice Disorders.

Importance: A roadblock for research on adductor spasmodic dysphonia (ADSD), abductor SD (ABSD), voice tremor (VT), and muscular tension dysphonia (MTD) is the lack of criteria for selecting patients with these disorders.

Objective: To determine the agreement among experts not using standard guidelines to classify patients with ABSD, ADSD, VT, and MTD, and develop expert consensus attributes for classifying patients for research.

Design, Setting And Participants: From 2011 to 2016, a multicenter observational study examined agreement among blinded experts when classifying patients with ADSD, ABSD, VT or MTD (first study).

Bilateral Vocal Fold Medialization: A Treatment for Abductor Spasmodic Dysphonia.

Introduction: Abductor spasmodic dysphonia, a difficult-to-treat laryngologic condition, is characterized by spasms causing the vocal folds to remain abducted despite efforts to adduct them during phonation. Traditional treatment for abductor spasmodic dysphonia-botulinum toxin injection into the posterior cricoarytenoid muscle-can be both technically challenging and uncomfortable. Due to the difficulty of needle placement, it is often unsuccessful.

Endoscopic Management of Subglottic Stenosis.

Importance: Optimal management of subglottic stenosis has not been established. Endoscopic techniques include balloon dilation, radial incisions with carbon dioxide laser or cold knife, and combinations of techniques. Adjunctive measures include mitomycin application and glucocorticoid injection.

Idiopathic Subglottic Stenosis: A Comparison of Tracheal Size.

Objective: To assess the size of the cervical and thoracic trachea among female patients with idiopathic subglottic stenosis (SGS).

Methods: Computed tomography (CT) scans of neck/chest from female patients with idiopathic SGS (n = 7) and normal controls (n = 30) were analyzed. Only female patients were included.

Preliminary Study of the Open Quotient in an Ex Vivo Perfused Human Larynx.

Importance: Scientific understanding of human voice production to date is a product of indirect investigations including animal models, cadaveric tissue study, or computational modeling. To our knowledge, direct experimentation of human voice production has previously not been possible owing to its invasive nature. The feasibility of an ex vivo perfused human phonatory model has recently allowed systematic investigation in virtually living human larynges with parametric laryngeal muscle stimulation.

Development of the ex vivo laryngeal model of phonation.

Objectives/hypothesis: The direct study of human phonation is limited by the invasive and painful nature of human laryngeal neuromuscular manipulation. As a platform for the study of human phonation, indirect models have been utilized for decades such as animal, cadaveric, and computational. We sought to develop a research method allowing direct scientific control of virtually living larynges to expand our ability to understand human phonation.

Staged laryngotracheoplasty in adult laryngotracheal stenosis: predictors of long-term decannulation.

Importance: This study reviews a single center's experience of performing staged laryngotracheoplasty (LTP) for the treatment of laryngotracheal stenosis with the ultimate goal of attaining long-term airway patency without restenosis.

Objective: To identify staged LTP as an efficacious surgical treatment option for laryngotracheal stenosis.

Design, Setting, And Participants: From January 2000 to January 2012, patients at a tertiary care academic institution presenting with diagnoses of laryngeal or laryngotracheal stenosis were retrospectively identified.

A comparative study of cricotracheal resection and staged laryngotracheoplasty for adult subglottic stenosis.

Objective: Cricotracheal resection (CTR) and laryngotracheoplasty (LTP) are open surgical treatments for severe subglottic stenosis. This study aims to compare the applications and outcomes of these techniques.

Method: Patients with subglottic stenosis at a tertiary academic institution from 2000 to 2012 were identified by diagnosis codes.

A unique case of sclerosing polycystic adenosis of the sinonasal tract.

Sclerosing polycystic adenosis is an extremely uncommon, recently described, sclerosing lesion of the salivary glands that appears histologically similar to fibrocystic changes of the breast. The key histopathologic features of sclerosing polycystic adenosis include lobular proliferation of ductal and acinar elements, cystically dilated ducts exhibiting frequent apocrine and sebaceous metaplasia, eosinophilic intracytoplasmic granules within some acinar-type cells, intraductal epithelial hyperplasia, and dense fibrosis. Most described cases have occurred in the major salivary glands, particularly the parotid gland.

Neuromuscular induced phonation in a human ex vivo perfused larynx preparation.

Considering differences in laryngeal anatomy, degree of control, and range of voice qualities between animals and humans, investigations of the neuromuscular process of voice control are better conducted using a living human larynx in which parametric stimulation of individual laryngeal muscles is possible. Due to difficulties in access and monitoring of laryngeal muscle activities, such investigations are impossible in living human subject experiments. This study reports the recent success in developing an ex vivo perfused human larynx model, which allows parametric muscle stimulation and observation of its influence on phonation of a virtually living human larynx in a well-controlled laboratory environment.

Surgery or botulinum toxin for adductor spasmodic dysphonia: a comparative study.

Objectives: Currently, botulinum toxin (Botox) injection is the standard of treatment for adductor spasmodic dysphonia (ADSD). We sought to compare the outcome of selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery for ADSD to that of Botox injections.

Methods: Patient-oriented measures (VHI-10) and objective single-blinded gradings of digital voice recordings were utilized as outcome measures.

Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia.

Selective laryngeal adductor denervation-reinnervation surgery (SLAD-R) offers a viable surgical alternative for patients with adductor spasmodic dysphonia refractory to botulinum toxin injections. SLAD-R selectively denervates the symptomatic thyroarytenoid muscle by dividing the distal adductor branch of the recurrent laryngeal nerve (RLN), and preventing reinnervation, by the proximal RLN and maintaining vocal fold bulk and tone by reinnervating the distal RLN with the ansa cervicalis. We present a patient who had previously undergone successful SLAD-R but presented 10 years postoperatively with a new regional dystonia involving his strap muscles translocated to his reinnervated larynx by his previous ansa-RLN neurorraphy.

Scientific attributes of a researcher and member of The Triological Society.

This presidential address discusses the comments from the first Mayo Clinic's Chair, Harold Lille, MD, regarding different contributions by members of The Triological Society in his 1939 presidential address. It then goes on to discuss scientific research attributes expected of members of the Society that were gleaned from a fusion of Dr. Berke's notions with what other famous researchers, inventors, and philosophers have said about aspects of research.

Cervical variations of the phrenic nerve.

Objectives/hypothesis: Selective reinnervation of the posterior cricoarytenoid muscle with a single phrenic nerve rootlet has been shown to restore physiologic motion in animal models. However, clinical translation of this work is challenged by the limited knowledge of the cervical anatomy of the phrenic nerve.

Study Design: Prospective collaborative study.

Optimal timing of surgical intervention following adult laryngeal trauma.

Objective: Laryngeal trauma is an infrequent diagnosis with a scarcity of published data. We aim to further define the factors associated with positive surgical outcomes of adult laryngeal trauma.

Study Design: Multi-institution database analysis.

The Triological Society 2011 presidential address.

The Triological Society 2011 Presidential Address was presented at The Triological Society's 2011 Combined Sections Meeting in Scottsdale, Arizona, Thursday January 27-29, 2011, by Gerald Berke, MD. The address captures the president's inspiration for the annual address as the past, present, and future of otolaryngology. A review of the financing and economics of health care in the United States over time is presented, and the future of health care with reference to otolaryngology is discussed.