Laryngology

Editors Picks

Giant Zenker diverticulum

August 26, 2015     Vini Balakrishnan, MS; Jason Handwerker, MD; Sunil P. Verma, MD
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Open procedures are typically preserved for larger sacs and cases in which transoral access is limited.

Analysis of predisposing factors for complications of percutaneous tracheostomy

August 26, 2015     Ivan Domènech, MD, PhD; Paula Cruz Toro, MD; Jordi Tornero, MD; Ana Giordano, MD; Àngela Callejo, MD
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Abstract

Since the turn of the century, percutaneous tracheostomy (PT) has become an alternative to the classic open technique and is an elective procedure in intensive care units at most centers. We conducted a prospective study to identify and quantify the complication rate with PT and to analyze this procedure's association with potential risk factors. Our study population was made up of 114 patients-83 men (72.8%) and 31 women (27.2%), aged 18 to 81 years (mean: 57 ± 15)-who underwent PT at our center over an 18-month period. We sought to determine if there were any associations between PT complications and sex, previous fibroscopy, cervical length, cervical risk factors, and general risk factors. Generally minor complications were noted in 15 patients (13.2%); 13 patients experienced hemorrhage, 1 exhibited subcutaneous emphysema, and 1 had a vagal reaction that resolved with medical treatment. Only 3 of these cases (2.6%) were considered to be clinically relevant: 1 hemorrhage (which was treated with ligation), the emphysema (which resolved spontaneously), and the vagal reaction (which resolved with medical treatment). Statistically, we found that PT complications were significantly correlated with two factors: coagulopathy (p = 0.015) and hemodynamic instability (p = 0.017). Even so, these complications were not clinically significant, and they resolved with conservative treatment measures. Given the low incidence and mild degree of these complications, we consider PT to be a safe procedure, even in patients with a high risk of hemorrhage or cervical anatomic difficulties.

Supraglottoplasty in a 39-year-old woman

August 26, 2015     Hilary M. Caruso Sales, DO; Amanda Hu, MD, FRCSC; Robert T. Sataloff, MD, DMA, FACS
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In this case, the patient's larynx was diffusely erythematous and edematous, with thick secretions and severe posterior “cobblestoning.”

Anthracosis: An unusual cause of vocal fold paralysis

July 20, 2015     Sedat Aydin, MD; Ozlem Celebi, MD; Merve Kiroglu, MD; Mehmet Gökhan Demir, MD
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Abstract

Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.

Upper aerodigestive amyloidosis

July 20, 2015     Jaime Eaglin Moore, MD; Amanda Hu, MD; Al Hillel, MD
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As the patient was asymptomatic, close observation and only laser excision were recommended if the patient's condition progressed.

Salivary gland adenoid cystic carcinoma

July 20, 2015     Lester D.R. Thompson, MD
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Tumors are poorly circumscribed with an infiltrative border, including extracapsular extension beyond the salivary gland.

A rare case of malignant fibrous histiocytoma (pleomorphic undifferentiated sarcoma NOS) of the vocal fold

July 20, 2015     Jin Pyeong Kim, MD; Jin Yong Kim, MD; Gyung Hyuck Ko, MD; Seung Hoon Woo, MD
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Abstract

Malignant fibrous histiocytoma, also known as pleomorphic undifferentiated sarcoma not otherwise specified, arises in numerous organs. The first-line treatment is complete excision of the mass, but in some cases postoperative chemo- and/or radiotherapy is recommended. Only a few cases of malignant fibrous histiocytoma of the vocal fold have been previously reported in the literature. We report a new case, which originated in the true vocal fold of a 65-year-old man. The mass was removed via CO2 laser excision with preservation of the vocal fold and without the need for further treatment. At 3 years of follow-up, the patient remained recurrence-free.

Cricotracheal resection

June 4, 2015     Amanda Hu, MD, FRCSC; James McCaffrey, MD; Al Hillel, MD
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As much as half of the trachea can be resected with a low incidence of anastomotic complications.

Laryngeal findings and acoustic changes in light cigar smokers

June 4, 2015     Abdul-latif Hamdan, MD, FACS; Randa Al-Barazi, MD; Jihad Ashkar, MD; Sami Husseini, MD; Alexander Dowli, MD; Nabil Fuleihan, MD
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Abstract

The aim of this prospective study was to look at the laryngeal findings and acoustic changes in light cigar smokers in comparison to nonsmokers, in the setting of a voice clinic. A total of 22 cigar smokers and 19 nonsmokers used as controls were enrolled in the study. Demographic data included age, number of years smoking, number of cigars per week, history of allergy, and history of reflux. The confounding effects of allergy and reflux were accounted for in the control group. Subjects underwent laryngeal endoscopy and acoustic analysis. On laryngeal endoscopy, the most common laryngeal finding was thick mucus. There was no significant difference in the prevalence of any of the laryngeal findings in cigar smokers vs. controls. In comparison with the control group, both the fundamental frequency and habitual pitch were significantly lower in cigar smokers (p value = 0.034 and 0.004, respectively). We conclude that cigar smokers have lower fundamental frequency and habitual pitch compared to nonsmokers.

Advanced airway management teaching in otolaryngology residency programs in Canada: A survey of residents

April 27, 2015     Valérie Côté, MD; Lukas H. Kus, MD, MSc; Xun Zhang, PhD; Keith Richardson, MD; Lily H.P. Nguyen, MD, MSc, FRCS(C)
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Abstract

We conducted a study to assess residents' levels of comfort with advanced airway management in Canadian otolaryngology residency programs. In October 2008, an electronic questionnaire was sent to all otolaryngology residents in Canada. Responses were voluntary and anonymous. The response rate was 64.8% (94 of 145 residents). Residents were asked about the amount of teaching they received and the amount they would like to receive each year in four areas: emergency surgical airway, pediatric airway, airway trauma, and management of complications during laryngoscopy/bronchoscopy. They were also asked how comfortable they were with their current level of knowledge in these areas. Overall, residents were not comfortable with difficult airway situations, scoring a mean of 3.08 on a 5-point Likert scale. Residents were most comfortable with the emergency airway and least comfortable with the pediatric airway. Overall, residents indicated that they had not received adequate teaching on advanced airway management, and they consistently desired more. With respect to the type of instruction, most residents requested more teaching via simulations, mannequins, and cadaver or animal models. Linear regression models revealed a positive relationship between their overall comfort with airway management and the number of airway teaching hours they received. Their consensus was that formal airway training should occur during postgraduate year (PGY) 2, with refresher courses offered every 2 years. This is the first wide-scale assessment of the status of airway teaching in otolaryngology residency programs in Canada. Overall, our findings suggest that otolaryngology residents in these programs are not comfortable with advanced airway management early in their training and feel they would benefit from a significant increase in airway teaching time. Comfort levels improved with increasing levels of training such that PGY5 residents indicated they were indeed comfortable with advanced airway management.

Biphasic synovial sarcoma of the hypopharynx

April 27, 2015     Ustun Osma, MD; Hülya Eyigor, MD; Dinc Suren, MD; Cem Sezer, MD; Mustafa Deniz Yilmaz, MD
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Abstract

Synovial sarcoma is a malignant mesenchymal neoplasm usually involving the extremities of young adults. Localization in the head and neck region is rare. Histologically, these lesions have biphasic and monophasic variants, the latter being more rare and difficult to identify. Immunohistochemistry plays a crucial role in the diagnosis. We report a case of a biphasic synovial sarcoma arising in the hypopharynx with a review of the literature concerning this rare neoplasm.

Bilateral true vocal fold atrophy

April 27, 2015     Jason Bell, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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The most common cause of vocal fold atrophy is aging, but other causes include paresis, menopause, and thyroiditis, as well as neuromuscular junction disorders such as myasthenia gravis.