Safety practices for in-office laryngology procedures during clinical reintroduction amidst COVID-19.

Objective: Describe safety practices for performing in-office laryngology procedures during clinical re-introduction amidst the coronavirus disease 2019 (COVID-19) pandemic.

Methods: An anonymous survey in Qualtrics was created to evaluate demographics, preprocedure testing, practice settings, anesthesia, and personal protective equipment (PPE) use for five procedure categories (non-mucosal-traversing injections, mucosal-traversing injections, endoscopy without suction, endoscopy with suction/mucosal intervention via working channel, and laser via working channel). The survey was emailed to the Fall Voice Community on Doc Matter and to members of the American Broncho-Esophagological Association (ABEA) from May to June 2020.

Current Indications for Transnasal Esophagoscopy: An American Broncho-Esophagological Association Survey.

Introduction:: The aim of this study was to evaluate the current indications for and clinical factors influencing the use of transnasal esophagoscopy (TNE).

Methods:: An online survey was sent to American Broncho-Esophagological Association members, including questions on demographics, indications, and factors influencing the use of TNE.

Results:: Sixty of 251 members (24%) completed the survey.

Sulforaphane suppresses the growth of glioblastoma cells, glioblastoma stem cell-like spheroids, and tumor xenografts through multiple cell signaling pathways.

OBJECTIVE Defects in the apoptotic machinery and augmented survival signals contribute to drug resistance in glioblastoma (GBM). Moreover, another complexity related to GBM treatment is the concept that GBM development and recurrence may arise from the expression of GBM stem cells (GSCs). Therefore, the use of a multifaceted approach or multitargeted agents that affect specific tumor cell characteristics will likely be necessary to successfully eradicate GBM.

Microarray Analysis Gene Expression Profiles in Laryngeal Muscle After Recurrent Laryngeal Nerve Injury.

Objectives: The pathophysiology of recurrent laryngeal nerve (RLN) transection injury is rare in that it is characteristically followed by a high degree of spontaneous reinnervation, with reinnervation of the laryngeal adductor complex (AC) preceding that of the abducting posterior cricoarytenoid (PCA) muscle. Here, we aim to elucidate the differentially expressed myogenic factors following RLN injury that may be at least partially responsible for the spontaneous reinnervation.

Methods: F344 male rats underwent RLN injury (n = 12) or sham surgery (n = 12).

Stem cell-derived tissue-engineered constructs for hemilaryngeal reconstruction.

Objectives: As an initial step toward our goal of developing a completely tissue-engineered larynx, the aim of this study was to describe and compare three strategies of creating tissue-engineered muscle-polymer constructs for hemilaryngeal reconstruction.

Methods: Cartilage-mimicking polymer was developed from electrospun poly(D,L-lactide-co-ε-caprolactone) (PCL). Primary muscle progenitor cell cultures were derived from syngeneic F344 rat skeletal muscle biopsies.

Differences in laryngeal neurotrophic factor gene expression after recurrent laryngeal nerve and vagus nerve injuries.

Objectives: Recurrent laryngeal nerve (RLN) and vagus nerve (VN) injuries characteristically are followed by differing degrees of spontaneous reinnervation, yet laryngeal muscle neurotrophic factor (NF) expression profiles after RLN and VN injuries have not been well elucidated. This study's objective was to determine the relative changes in gene expression of 5 well-characterized NFs from laryngeal muscle after RLN or VN injuries in a time-dependent fashion, and demonstrate how these changes correspond with electromyography-assessed innervation status.

Methods: Thirty-six male rats underwent left RLN transection (12 rats), left VN transection (12 rats), or a sham procedure (12 rats).

The interarytenoid spatial relationship: accuracy and interrater reliability for determining sidedness in cases of unilateral adductor paresis.

Background/objective: When adductor vocal fold paresis manifests without obvious motion impairment, identifying the paretic side can be challenging. Although increased vocal fold waveform amplitude ("floppiness") on videostroboscopy may be helpful, it has been shown to have low interrater reliability. We have found that the interarytenoid spatial relationship (IASR) can often accurately be used to predict the sidedness of electromyography (EMG)-determined unilateral adductor (thyroarytenoid/lateral cricoarytenoid [TA/LCA]) paresis.

Rosai-Dorfman disease with isolated laryngeal involvement.

Rosai-Dorfman disease is a rare histiocyte disorder that is typically characterized by massive cervical lymphadenopathy. Isolated extranodal involvement is uncommon, and isolated laryngeal involvement is extremely rare. We report an unusual case of Rosai-Dorfman disease with isolated laryngeal involvement that led to recurrent dysphonia and airway obstruction.

Neurotrophic factor-secreting autologous muscle stem cell therapy for the treatment of laryngeal denervation injury.

Objectives/hypothesis: To determine if the spontaneous reinnervation that characteristically ensues after recurrent laryngeal nerve (RLN) injury could be selectively promoted and directed to certain laryngeal muscles with the use of neurotrophic factor (NF)-secreting muscle stem cell (MSC) vectors while antagonistic reinnervation is inhibited with vincristine (VNC).

Study Design: Basic science investigation involving primary cell cultures, gene cloning/transfer, and animal experiments.

Methods: MSC survival assays were used to test multiple individual NFs in vitro.

A rapid, novel model of culturing cranial nerve X-derived motoneurons for screening trophic factor outgrowth response.

Objectives: After cranial nerve X (CN X) injury, vocal fold paralysis treatments currently face a myriad of obstacles in achieving non-synkinetic, functional reinnervation. Of particular therapeutic interest is the targeted administration of locally expressed biological neurotrophic factors (NFs). To date, a method to culture mature CN X motoneurons for NF responsiveness screening has not been described.

Managing voice impairment after injection laryngoplasty.

To date, there is a paucity of literature on the management of suboptimal voice outcomes after injection laryngoplasty. We present three cases of worsened voice quality and impaired mucosal waveform propagation on videostroboscopy after calcium hydroxylapatite (CaHA) injection. The first was found to have superficial deposits of CaHA in Reinke's space.

The effect of cartilaginous reinforcing sutures on initial tracheal anastomotic strength: a cadaver study.

Objective: During tracheal resection with primary anastomosis, cartilaginous reinforcing sutures may be placed outside of the primary anastomosis with the goal of preventing early dehiscence. The direct effect of such reinforcing sutures on anastomotic strength has not been previously investigated. The goal of this study was to determine if the addition of cartilaginous reinforcing sutures adds to tracheal anastomosis stability.

Office-based laser surgery of the larynx: cost-effective treatment at the office's expense.

Objective: While office-based laser surgery (OBLS) for benign laryngeal disease is cost-effective for the patient, the financial impact on the office offering the service has not been characterized. We hypothesize that OBLS offers savings to the patient that are not widely realized because of the financial liability the technology poses.

Study Design: A 2-part financial analysis.

A multi-institutional analysis of tracheotomy complications.

Objectives/hypothesis: To define the prevalence of tracheotomy tube complications and evaluate risk factors (RFs) associated with their occurrence.

Study Design: Multi-institution historical cohort.

Methods: Data regarding tracheotomy tube complications from consecutive surgeries performed across eight participating institutions between January 1, 2008 and December 31, 2009 were retrospectively collected.

An experimental model to investigate initial tracheal anastomosis strength.

Objectives/hypothesis: Early anastomotic dehiscence is a devastating complication of segmental tracheal resection. Although wound healing, patient comorbidities, and anastomotic tension are all influential factors, there is a paucity of information available on initial tracheal stability after various tracheal anastomosis techniques in human tissue.

Study Design: Prospective cadaver study.

Local neurotoxins for prevention of laryngeal synkinesis after recurrent laryngeal nerve injury.

Objectives: Persistent vocal fold motion impairment after recurrent laryngeal nerve (RLN) injury is not characteristically due to absent reinnervation, but often results from spontaneous aberrant reinnervation (synkinesis). We administered local neurotoxins to selected laryngeal muscles after RLN injury to determine whether aberrant reinnervation could be selectively inhibited.

Methods: Unilateral RLN transection was performed in 24 male rats.

Patient tolerance of the flexible CO2 laser for office-based laryngeal surgery.

Objective: The OmniGuide flexible carbon dioxide (CO(2)) laser can be readily used in the office but patient tolerance has not been established. The aim of this pilot study was to determine patient tolerance of the flexible CO(2) laser. As a reference point, the 585-nm pulsed-dye laser (PDL) was selected for comparison because it is the only office-based laser in which patient tolerance has specifically been studied.

Influence of anxiety and depression on the predictive value of the Reflux Symptom Index.

Objectives: Although the Reflux Symptom Index (RSI) is a validated laryngopharyngeal reflux (LPR) outcomes tool, its predictive value for LPR is controversial. Because psychiatric problems may lead to exaggerated patient-perceived symptoms and RSI values,the aim of this study was to determine whether the positive predictive value of the RSI for pH probe-documented LPR is influenced by anxiety and depression.

Methods: We reviewed the charts of all patients who underwent pH probe testing for LPR between January 2006 and July 2008 at our institution.

Laryngeal granulomas associated with superior laryngeal nerve paresis.

The association between superior laryngeal nerve (SLN) paresis and laryngeal granuloma formation has not been described earlier. The aim of this study was to present a series of patients with isolated unilateral SLN paresis who developed contralateral vocal process granulomas. The study design was a retrospective chart review including all patients presenting to Indiana University from February 2006 to August 2007 with laryngeal electromyography (LEMG)-documented unilateral SLN paresis and evidence of laryngeal granuloma on videostroboscopy.

A new treatment option for laryngeal sensory neuropathy.

Objectives/hypothesis: Laryngeal sensory neuropathy (LSN) may produce a variety of symptoms, including chronic cough, globus sensation, odynophonia, and/or odynophagia. Etiologies are often iatrogenic, viral, or idiopathic, although the diagnosis is generally one of exclusion. The aim of this study is to introduce pregabalin (Lyrica, Pfizer Inc.

Localization of the muscular process for arytenoid adduction surgery.

Objectives/hypothesis: Arytenoid adduction (AA) surgery can be technically challenging, potentially limiting its utilization in general practice. Because AA often serves as an adjunct to thyroplasty type I (TTI) in the management of unilateral vocal fold paralysis, this study sought to define the anatomic position of the muscular process (MP) of the arytenoid cartilage in relation to the TTI window and other key thyroid cartilage landmarks, thereby facilitating a more efficient surgical approach.

Study Design: Cadaveric anatomic dissections.

Characterization of laryngeal muscle stem cell survival and proliferation.

Objectives/hypothesis: Laryngeal muscle and skeletal muscle stem cells (MSC) have been shown to differ in physiological basal activity and responsiveness to stimuli. Given these differences, it is the purpose of this investigation to characterize the in vitro proliferation and survival of laryngeal and skeletal MSC to determine whether intrinsic differences exist that may account for differences noted in vivo.

Study Design: Basic science experiment utilizing rat MSC.

Optimization of autologous muscle stem cell survival in the denervated hemilarynx.

Objective: Current treatments for vocal fold paralysis are suboptimal in that they fail to restore dynamic function. Autologous muscle stem cell (MSC) therapy is a promising potential therapy for vocal fold paralysis in that it can attenuate denervation-induced muscle atrophy and provide a vehicle for delivery of neurotrophic factors, thereby potentially selectively guiding reinnervation. The goal of this project was to characterize optimal conditions for injected autologous MSC survival in the thyroarytenoid (TA) muscle following recurrent laryngeal nerve (RLN) injury by local administration of adjuvant factors.