Tanya Meyer

Experts used to believe that spasmodic dysphonia (SD) was a psychogenic disorder. Although SD is now established as a neurological disorder, the rates of co-morbid anxiety and depression range from 7.1% to 62%. Our objective was to study the prevalence and risk factors associated with these mood disorders in SD patients. Retrospective. SD patients who presented for botulinum toxin injections were recruited. Demographic data, Hospital Anxiety and Depression Scale (HADS), Voice Handicap Index-10 (VHI-10), General Self-Efficacy scale (GSES), Disease Specific Self-Efficacy in Spasmodic Dysphonia scale (DSSE), and Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) were collected. One hundred and forty two patients (age (59.2 ± 13.6) years, 25.4% male) had VHI-10 of 26.3 ± 6.9 (mean ± standard deviation), GSES 33.2 ± 5.8, CAPE-V 43.9 ± 20.9, HADS anxiety 6.7 ± 3.7, and HADS depression 3.6 ± 2.8. About 19 (13.4%) and 4 (2.8%) had symptoms of anxiety and depression respectively. Fin...

Across all boluses, PAS scores had negligible correlations with the QoL outcome. Similarly, oral residue and pharyngeal residue had negligible correlations with the QoL measure (HNCI eating). Conversely, PAS scores had mild to moderate correlations with the diet measure (PSS diet). Similarly, oral residue and pharyngeal residue had mild to moderate correlations with the same diet outcome measure. To further investigate the relationship between residue and aspiration, we looked at aspiration timing. Aspiration occurred at a greater frequency after the swallow on all boluses, as compared to before or during the swallow.

... Despite dramatic advances in the instrumentation and diagnostic imaging available for the treatment of paranasal sinusitis, the surgical management of chronic frontal sinusitis continues to ... They correlated a more acute nasofrontal angle in specimens with a thicker spina nasalis ...

The objective of this study was to obtain initial reactions and suggested modifications to two existing presenteeism scales: the Stanford Presenteeism Scale 6 (SPS-6) and the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem (WPAI-SHP) among a cohort of employed individuals with a focal laryngeal dystonia, spasmodic dysphonia (SD). The study design is a qualitative study. Nine speakers with SD underwent cognitive interviews, during which they were asked to evaluate the relevance of statements and clarity of wording on the SPS-6, the WPAI-SHP, and an additional set of voice-related statements designed by the researchers. Participants were asked to complete the scales, rank order statements in terms of perceived importance, and suggest additional statements of relevance. Although all participants noted that their SD did have an effect on their jobs, there were suggestions for modifying both the WPAI-SHP and the SPS-6. Participants regarded specific voice-...

Aural myiasis is a rare otolaryngological disease typically seen in poor hygienic conditions and medically disabled patients. We present a case of aural myiasis in a healthy woman who had no apparent risk factors for infestation and required extensive surgical intervention. We also discuss the literature of documented otolaryngological cases of myiasis and effective therapies. In our patient, symptoms of otalgia, otorrhea, and tinnitus resolved after multiple attempts at extraction resulted in successful eradication of larvae. The patient required tympanoplasty to reconstruct the damaged external and middle ear. Physicians should have a clinical suspicion of aural myiasis in patients with a travel history and an atypical presentation of acute otalgia and otorrhea.

We discuss the phonatory characteristics of a previously undescribed focal laryngeal dystonia present in the singing voice. We performed a retrospective chart review of 5 patients with singer's dystonia at a neurolaryngology referral center. Four patients reviewed demonstrated phonatory characteristics consistent with adductor spasmodic dysphonia present in their singing voice. One patient demonstrated abductor spasmodic dysphonia in the singing voice. Each patient initially exhibited normal connected speech in conversational voicing. The treatment protocol and outcome are discussed, including the use of botulinum toxin. Singer's dystonia is a previously undescribed neurologic disorder that should be understood by those who treat voice performers and voice disorders.

Aim. To describe the subsequent treatment of airway trauma sustained during laryngoscopy and endotracheal intubation.Methods. A rare injury occurring during laryngoscopy and endotracheal intubation that resulted in perforation of the tongue by an endotracheal tube and the subsequent management of this unusual complication are discussed. A 65-year-old female with intraparenchymal brain hemorrhage with rapidly progressive neurologic deterioration had the airway secured prior to arrival at the referral institution. The endotracheal tube (ETT) was noted to have pierced through the base of the tongue and entered the trachea, and the patient underwent operative laryngoscopy to inspect the injury and the ETT was replaced by tracheostomy.Results. Laryngoscopy demonstrated the ETT to perforate the base of the tongue. The airway was secured with tracheostomy and the ETT was removed.Conclusions. A wide variety of complications resulting from direct and video-assisted laryngoscopy and tracheal ...

The use of illicit drugs remains a substantial public health concern in many societies. National Center on Addiction and Substance Abuse at Columbia University reported in 2009 that local, state, and federal governments spend nearly half a trillion dollars per year on substance abuse and addiction [1].

Awoman in her 60s presented to the otolaryngology clinic with a 1-month history of hoarseness. Her medical history was significant for metastatic colon cancer for which she had received primary surgical therapy in 1999. She subsequently developed lungmetastases and was treated by her oncologist with different combinations of capecitabine, irinotecan, fluorouracil, leucovorin, and oxaliplatin. Following progression despite use of these agents, she received fluorouracil plus bevacizumab, an anti–vascular endothelial growth factor (VEGF) monoclonal antibody. One week after her third cycle of anti-VEGF treatment, she reported new-onset, rapidly progressive hoarseness. On examination, she exhibited severe dysphonia and flexible transnasal laryngoscopy revealed bilateral, symmetric, white membranous true vocal fold lesions sparing the anterior commissure (Figure). Vocal fold mobility was unaffected, but videostroboscopy demonstrated near-complete loss of bilateral mucosal waves. The patient was never a smoker, did not drink alcohol, and had no other symptoms indicative of laryngopharyngeal reflux. Empirical treatment with systemic antifungal therapy had no effect. What is your diagnosis? A B

The impact of the disordered voice on standard work productivity measures and employment trends is difficult to quantify; this is in large part due to the heterogeneity of the disease processes. Spasmodic dysphonia (SD), a chronic voice disorder, may be a useful model to study this impact. Self-reported work measures (worked missed, work impairment, overall work productivity, and activity impairment) were studied among patients receiving botulinum toxin (BTX) treatments for SD. It was hypothesized that there would be a substantial difference in work-related measures between the best and worst voicing periods. In addition, job types, employment shifts, and vocal requirements during the course of vocal disability from SD were investigated for each individual, and the impact of SD on these patterns was studied. A total of 145 patients with SD, either adductor or abductor, who were established in routine therapeutic BTX injections agreed to participate in a self-administered questionnaire study. Seventy-two participants were currently working and provided highly detailed information on work-related measures. Their answers characterized the effect of SD on their employment status, productivity at work, activity impairment outside of work, employment retention or change, and whether the individual perceived that BTX therapy affected these measures. Patients were asked to complete the Work Productivity and Activity Impairment (WPAI) instrument to determine these measures for their best and worst voicing weeks over the duration since their previous BTX injection. Voice-specific quality of life instruments (Voice Handicap Index-10) and perceptual assessments (Consensus Auditory Perceptual Evaluation of Voice) were elicited to provide correlations of work measures with patient-perceived voice handicap and clinician-perceived voice quality. Cross-sectional analysis using self-administered questionnaire. A total of 108 patients reported ever working during their diagnosis and treatment of SD, and 72 patients were currently working and had undergone BTX therapy for at least 1 year at the time of the analysis. Currently employed patients reported a mean 4.4% decrease in work missed (absenteeism), a 28.1% decrease in work impairment (presenteeism), a 29.4% decrease in work productivity, and a 21.4% decrease in activity impairment (P <.001) in their best, as compared to their worst voicing period over their last BTX injection cycle. Presenteeism accounted for the major component of the percent work productivity impairment calculation. There was neither apparent shift in job categories nor any change in the vocal demands of their employment over the course of their disease. Among patients that have worked during their diagnosis of SD, greater than 98% report that BTX injections helped them at work. Patients with SD reported that their vocal dysfunction caused a significant negative effect on work productivity and increase in activity impairment. There was a significant improvement in their voice-related work parameters from their worst to best voicing periods over their last BTX injection cycle. Patients undergoing long-term BTX treatment report a positive effect of this treatment in their workplace. Spasmodic dysphonia is a meaningful model in which to study the effects of voice disorders on work productivity and employment patterns.

To compare post-operative complication rates between inpatient and outpatient endoscopic airway surgery in patients with laryngotracheal stenosis. Secondary objectives included characterization of a cohort of patients with this disease. Retrospective review of patients with laryngotracheal stenosis in a tertiary care laryngology practice over a 5-year period. Ninety-one patients underwent 223 endoscopic airway surgeries. Of 114 outpatient interventions, 1 patient (0.8%) sought emergent medical care following discharge for respiratory distress. Of 109 procedures resulting in admission, no patients required transfer to a higher level of care, endotracheal intubation or placement of a surgical airway. There was no statistically significant difference in complication rates between patients treated as outpatients or inpatients (p=0.33, chi square). There were no cardiopulmonary events. There were no pneumothoraces despite frequent use of jet ventilation. The most common etiologic category was idiopathic (58%), followed by granulomatosis with polyangiitis (16%) and history of tracheotomy (12%). Most patients with idiopathic disease were female (p<0.001, Fisher's exact test). Patients undergoing endoscopic surgery for airway stenosis rarely have post-operative complications, and outpatient surgery appears to be a safe alternative to post-operative admission and observation.

Poor speech intelligibility adversely affects quality of life self-assessment in long term survivors of head and neck cancer treatment. Observational case series including both objective clinical speech testing and subjective quality of life questionnaire administration. Five-year head and neck cancer survivors were recruited to study the association between speech intelligibility and quality of life. Survivors were analyzed as an entire group, and also subdivided into laryngectomees and non-laryngectomees. Objective testing included sentence and word intelligibility. Subjective testing included quality of life questionnaires (UWQOL, FACT, FACT-head and neck, and PSS-HN) and a locally prepared "cancer concern" question. Associations were sought between intelligibility, quality of life and demographics. Sixty-two survivors underwent testing. Lower sentence intelligibility and word intelligibility scores were associated with diminished self-perceived UWQOL Speech (P = .0001 and P = .0001, respectively) and PSS-HN Understandability of Speech (P = .009 and P = .005). Decreased word intelligibility was additionally associated with decreased UWQOL Chewing (P = .003), UWQOL Swallowing (P = .02), UWQOL Recreation (P = .05), PSS-HN Willingness to Eat in Public (P = .03), and PSS-HN Normalcy of Diet (P = .0001). The associations continued even after patients who had undergone laryngectomy were excluded. Long-term survivors of head and neck cancer continue to have both objective and subjective deficits in speech parameters five years after treatment. Objective deficits are associated with subjective concerns about speech, eating, and recreation. Understanding how communication deficits affect quality of life in long-term head and neck cancer survivors may allow more effective therapies to modulate these concerns in the recovery period.

Objective: According to the National Center for Health Statistics, 3 of the top 10 most common reasons for physician visits pertain to otolaryngology, including cough, sore throat, and ear ache. We explored the gaps in otolaryngologic knowledge among a group of primary care providers attending an educational event. Method: A brief web-based anonymous survey regarding knowledge of basic otolaryngologic conditions was administered to primary care providers, both physicians and allied health practitioners. Results: Thirty-seven surveys were collected from 50 participants, of which 59% were allied health and 41% were physicians. Participants practiced in adult, pediatric, and family medicine. Gaps in knowledge were identified across several otolaryngologic subjects, including laryngology, rhinology, head and neck oncology, otology, sleep surgery, and pediatric otolaryngology. Conclusion: There appear to be deficiencies in otolaryngologic knowledge among the primary care specialties. Inc...

Localized amyloidosis of the larynx is a rare entity of unclear etiology. Surgical debulking is the primary treatment modality but often is not curative. A 41-year-old woman presenting with increasing hoarseness, dysphagia, dyspnea, and weight loss was found to have a submucosal mass in the left false vocal fold. Biopsy of the specimen revealed amyloid. After negative work-up for systemic disease, the patient underwent surgical debulking. Specimens revealed a population of clonal plasma cells demonstrating lambda restriction. The patient was treated with adjuvant external beam radiation to a dose of 45 Gy. At 11 months, the patient's voice, breathing, and swallowing have all improved substantially. Recent pathologic studies suggest that localized amyloidosis of the larynx is caused by a localized, nonmalignant plasma cell disorder. Because full resection is difficult, we recommend a combination of surgery and radiation therapy to cure this disease.

The larynx is an amazingly versatile musculocartilaginous organ with complex sensory and motor responsibilities which allow functional coordination of the upper aerodigestive tract. Phylogeny, anatomy, and function of the larynx are reviewed. The major laryngeal responsibilities are phonation, deglutition, control of respiration, and airway protection. Although phonation is the least important laryngeal function for survival, it is possibly the most "human" function, and special attention is paid to the mechanism of the human voice. Parkinson's hypophonia, vocal fold paralysis, and spasmodic dysphonia cases are presented to illustrate specific examples of neurologic dysfunction. Understanding laryngeal function will promote earlier diagnosis of neurologic deficits and facilitate accurate evaluation and treatment of laryngeal dysfunction.

... Despite dramatic advances in the instrumentation and diagnostic imaging available for the treatment of paranasal sinusitis, the surgical management of chronic frontal sinusitis continues to ... They correlated a more acute nasofrontal angle in specimens with a thicker spina nasalis ...

Introduction The utility of laparoscopic Nissen fundoplication in the treatment of laryngopharyngeal reflux symptoms remains controversial. We hypothesized that a carefully selected population with these symptoms would benefit from antireflux surgery. Materials and Methods ...

Epithelial cultures exposed to increasing doses of IL-6 demonstrated greater amounts of mucin secretion (p=0.018). Additionally, cultures exposed to IL-6 at 50 ng/ml showed significant increased secretion of mucin over control in time-dependent experiments at 6-, 15-and 24-h time ...

The goals in the treatment of frontal sinus injuries are to provide an esthetic outcome, restore function, and prevent complications. However, there is no consensus as to how to best achieve these goals. Unfortunately, the questions that Stanley proposed in 1989 still lack definitive answers more than 19 years later: (1) Which fractures, if left untreated, will lead to an immediate or delayed complication? and (2) What is the appropriate surgical procedure if treatment of the fracture is deemed necessary? This article discusses the controversies in the surgical treatment of such fractures and provides a scientific rationale for proper management.

Described by Schaefer in 1916, frontal cells have been implicated as a cause of frontal recess obstruction. In this cross-sectional study, we determine the prevalence of frontal cells and other anatomic variants and examine their relationships. Coronal computed tomography scans of the sinuses performed from January 2000 to June 2001 were evaluated for frontal cells, other anatomic variants, and sinus disease. Of 1009 scans evaluated, 768 scans were included for data collection. Frontal cells were classified. In this population, 20.4% of individuals had frontal cells (14.9% had type I, 3.1% had type II, 1.7% had type III, and 2.1% had type IV). The presence of frontal cells was positively associated with hyperpneumatization of the frontal sinus (p = 0.01) and negatively associated with hypopneumatization of the frontal sinus (p < 0.01). Individuals with frontal cells had an increased prevalence of concha bullosa compared with individuals without frontal cells (41.4% versus 24.1%, p < 0.01). The prevalence of frontal mucosal thickening was increased in individuals with type III and type IV cells compared with individuals without frontal cells (38.5 and 69.0% versus 17.1%, p = 0.04 and p < 0.01). The prevalence of frontal cells among a population undergoing sinus computed tomography is 20.4%. Frontal cells are associated with other variants of sinonasal pneumatization and should be suspected when these variants are noted. The presence of…