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1.
Laryngoscope Investig Otolaryngol ; 8(1): 150-155, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36846431

ABSTRACT

Objective: A key outcome measure in the clinical evaluation of dysphonia is the Voice Handicap Index (VHI-10). The clinical validity of the VHI-10 was established from surveys administered in the physician's office. We aim to understand whether VHI-10 responses remain reliable when the questionnaire is completed in settings other than the physician's office. Methods: This is a prospective observational study conducted over a 3-month period in the outpatient laryngology setting. Thirty-five adult patients presenting with a complaint of dysphonia, which was symptomatically stable for the preceding 3 months, were identified. Each patient completed a VHI-10 survey during the initial office visit, followed by three weekly out-of-office (termed "ambulatory") VHI-10 surveys, over the course of 12 weeks. The specific setting in which the patient completed the survey was recorded (social, home, or work). The Minimal Clinically Important Difference (MCID) is defined as 6 points based on existing literature. T-tests and a test of one proportion were used for analysis. Results: A total of 553 responses were collected. Of these, 347 ambulatory scores (63%) differed from the Office score by at least the MCID. Specifically, 94 (27%) were higher than the in-office score by 6 or more points while 253 (73%) were lower. Conclusion: The setting in which the VHI-10 is completed affects how the patient answers the questions. The score is dynamic, reflecting effects of the patients' environment during completion. Utilization of VHI-10 scores to measure clinical treatment response is only valid if each response is obtained in the same setting. Level of Evidence: 4.

2.
Ann Otol Rhinol Laryngol ; 132(2): 133-137, 2023 Feb.
Article in English | MEDLINE | ID: mdl-35189725

ABSTRACT

INTRODUCTION: We compare long-term voice outcomes in patients treated with European Laryngeal Society (ELS) classification Type I, Type II, or Type V cordectomy. The aim is to understand the impact of Type V cordectomy on voice outcomes in relation to Type I and Type II cordectomy. METHODS: A retrospective review of patients treated with Type I, Type II, or Type V cordectomy by a single surgeon over a 20-year period was performed. Voice Handicap Index-10 (VHI-10) scores, Cepstral Spectral Index of Dysphonia (CSID) measures from CAPE-V sentences, and two-rater GRBAS scores were analyzed. RESULTS: Sixty-two patients were identified with a mean follow-up of 52 months. Of these, there were 43 Type I and 19 Type II cordectomies, including 8 in each group with Type V resections. Significant differences in all parameters were noted between the Type I (VHI 5.7, CSID 20.6, Grade 1.3) and the Type II cohorts (VHI 12.6, CSID 36.3, Grade 1.8) who did not undergo Type V cordectomy. Patients undergoing Type V cordectomy demonstrated voice outcomes (VHI 9.4, CSID 35.6, Grade 1.7) which fell between those of Type I and Type II cordectomies. CONCLUSIONS: Better long-term subjective, objective, and computer-analyzed voice outcomes are noted for patients undergoing Type I rather than Type II cordectomy. When Type V cordectomy is performed, voice outcomes are comparable to those of both Type I and Type II cordectomy, a surprising finding given the expectation of worsened dysphonia in longer resections. Further work is needed to explain this finding and define voice outcomes after Type V cordectomy.


Subject(s)
Dysphonia , Laryngeal Neoplasms , Laser Therapy , Humans , Vocal Cords/surgery , Glottis/surgery , Dysphonia/etiology , Dysphonia/surgery , Voice Quality , Treatment Outcome , Laryngeal Neoplasms/surgery , Laser Therapy/adverse effects
3.
Laryngoscope ; 133(3): 615-620, 2023 03.
Article in English | MEDLINE | ID: mdl-35634734

ABSTRACT

BACKGROUND: To date, 1-year evaluation of pitch elevation in patients undergoing modified Wendler glottoplasty (WG) in combination with VT has not been assessed. OBJECTIVES: To determine whether 1-year pitch elevation is sustained in patients who undergo modified WG in combination with VT for voice feminization. METHODS: A retrospective review of patients who underwent WG in combination with voice therapy (VT) was performed from 2016 to 2020. Charts were reviewed for sustained vowel fundamental frequency (F0/a/), speaking fundamental frequency (SF0), and Trans Woman Voice Questionnaire (TWVQ) at preoperative, initial postoperative (3-6 months after surgery), and 12-month postoperative visits. RESULTS: Change in average F0/a/, SF0 and TWVQ was 50.25 Hz, 32.96 Hz, and 32.6 at 12-months postoperatively compared to preoperative values. Initial and 12-month postoperative SF0 were significantly higher than preoperative SF0 (Mann-Whitney U test p = 0.0042, p = 0.0010). There was no difference in initial postoperative and 12-month postoperative SF0 (p = 0.50). TWVQ at 12 months was significantly lower than preoperative TWVQ (ANOVA p < 0.001, Tukey honestly significant difference HSD p < 0.05). CONCLUSIONS: Pitch elevation remains sustained at one year in patients undergoing modified WG in combination with VT. Modified Wendler glottoplasty combined with VT results in relatively long-term improvements in voice-related quality of life and is possibly a beneficial addition in the long-term management of patients who desire voice feminization. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:615-620, 2023.


Subject(s)
Transgender Persons , Voice , Male , Humans , Female , Voice Quality , Feminization/surgery , Quality of Life , Speech Acoustics
5.
Head Neck ; 44(3): 745-748, 2022 03.
Article in English | MEDLINE | ID: mdl-34957635

ABSTRACT

BACKGROUND: Postparotidectomy sialocele is a frustrating challenge. Published rates of postparotidectomy fluid collections range from 6% to 39%. We report our experience of 398 parotidectomies performed over a 6-year period. METHODS: A retrospective chart review of parotidectomies performed over a 6-year period was completed. Drain placement, smoking status, tumor size, and postoperative utilization of scopolamine were analyzed. Binary logistical regression and odds ratio calculations were performed. RESULTS: Postparotidectomy sialocele occurred in 25% of patients. Neither suction drain placement nor usage of immediate postoperative scopolamine (in a 22-patient subset) prevented sialocele formation. Smoking status also did not correlate. Increasing resection size was linearly correlated with the risk of sialocele. CONCLUSION: Drain placement and smoking status do not correlate with sialocele prevention after parotidectomy. Sialocele formation directly correlates with the resection size. These data may guide preoperative counseling; however, additional work is necessary to identify effective prevention mechanisms for postparotidectomy sialocele.


Subject(s)
Parotid Diseases , Parotid Neoplasms , Humans , Parotid Diseases/surgery , Parotid Gland/surgery , Parotid Neoplasms/surgery , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Retrospective Studies
6.
Facial Plast Surg ; 38(1): 7-12, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34225377

ABSTRACT

Genetic, developmental, traumatic factors can produce a wide variety of nasal septal deformities in caudal-cephalic/dorsal-maxillary planes alone or in combination. These can be corrected by an endonasal approach through a transfixion incision by resecting, transposing, or utilizing principles of cartilage biomechanics. The authors are proposing a "Rosetta Stone" based on a trizonal analysis of the deviated nose that considers the contribution of each region to the deformity. Clinical assessment of the deviated nose should be segmental as well as global. Surgical correlation of the nasal bones, perpendicular, and quadrilateral plates, lateral cartilages, and turbinates may be necessary to achieve a satisfactory cosmetic and functional results.


Subject(s)
Nose Diseases , Rhinoplasty , Cartilage , Humans , Maxilla , Nasal Septum/surgery , Nose/surgery
7.
J Cancer Educ ; 37(1): 128-132, 2022 02.
Article in English | MEDLINE | ID: mdl-32562200

ABSTRACT

Massage therapists are uniquely positioned to identify skin cancer. Seminal work in 2013 revealed that 40% of massage therapists do not receive any training in skin cancer identification (Campbell et al. J Cancer Educ 28:158-164, 2013). Limited work has been published assessing optimal training methodologies to close this educational gap. We present the results of a study in which students were given access to a 30-min self-driven web-based learning module designed to teach the high yield points of melanoma demographics and clinical features. The students completed pre- and post-testing, the results of which indicated improved knowledge levels and improved confidence in detecting suspected melanoma. We conclude that a 30-min learning module may be sufficient to improve massage therapists' ability and comfort level in identifying melanoma. The ease of delivery of web-based modules may make this an important approach in ensuring that massage therapists receive basic training in skin cancer identification.


Subject(s)
Melanoma , Skin Neoplasms , Humans , Learning , Massage/education , Melanoma/diagnosis , Skin Neoplasms/diagnosis , Students
8.
Laryngoscope ; 131(6): E1792-E1796, 2021 06.
Article in English | MEDLINE | ID: mdl-33320360

ABSTRACT

OBJECTIVES/HYPOTHESIS: To determine the impact of electronic consultation on the otolaryngology clinic workflow at our high-volume public hospital. STUDY DESIGN: Retrospective Observational Study. METHODS: This is a retrospective observational analysis study. Operational data regarding clinic volume, referral patterns, and scheduling efficiency were assessed over a 9-month period in 2018 prior to implementation of electronic consultation. The same data were collected for the 9-month period immediately following implementation of electronic consultation in 2019. RESULTS: During the pre-implementation (pre-EC) period, 3,243 otolaryngology referrals were made as compared to 4,249 post-implementation (post-EC). 86% of referrals were scheduled for a clinic appointment pre-EC, compared to 61% post-EC (P < .00001) 24.5% of patients were evaluated within 30 days pre-EC compared to 53.6% post-EC (P < .00001). The average time to be seen by an otolaryngology provider declined from 60.8 days pre-EC to 42.8 days post-EC (P = .0029). There was a 50% decline in the percentage of appointments canceled by patients in the post-EC period as compared to pre-EC. CONCLUSIONS: In our experience, implementation of electronic consultation significantly reduced both wait times for a clinic appointment and the percentage of no-show or canceled appointments. Electronic consultation may be a valuable tool in improving the efficiency and yield of the modern otolaryngology clinic. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1792-E1796, 2021.


Subject(s)
Efficiency, Organizational/statistics & numerical data , Otolaryngology/trends , Remote Consultation/statistics & numerical data , Workflow , Appointments and Schedules , Electronic Health Records , Hospitals, Public , Humans , New York City , Retrospective Studies , Time Factors
9.
J Patient Saf ; 17(2): 95-100, 2021 03 01.
Article in English | MEDLINE | ID: mdl-30907784

ABSTRACT

OBJECTIVE: The objective of this quality improvement project was to decrease the rate of nonemergent use of emergency department (ED) resources in children undergoing adenotonsillectomy by 50% and/or reach a future state of 5% or less overall ED visits among all postoperative patients within 1 year. A secondary objective was to standardize the preoperative, intraoperative, and postoperative management of these patients. METHODS: The study was a quality improvement project using Lean. The target population was children younger than 18 years undergoing tonsillectomy with or without adenoidectomy. A retrospective review of adenotonsillectomy was performed for a 12-month period. Lean tools including A3 Thinking, Ishikawa "fishbone" diagram, and value stream mapping were used to analyze the problem and identify interventions. Postintervention data were collected for a 10-month period. RESULTS: Compared with the baseline period, the ED visit rate after adenotonsillectomy decreased from 36.2% to 15.5% (P = 0.0095). The rate of ED visits for nonbleeding complaints decreased from 30.4% to 12.1% (P = 0.01748). There was no significant change in rate of ED visits for bleeding (decreased from 5.8% to 3.5% [P = 0.6873]). There was no significant change in the use of intraoperative dexamethasone and acetaminophen. CONCLUSIONS: Postadenotonsillectomy patients often use emergency resources better reserved for other patients. Addressing this problem with Lean principles significantly decreased postoperative ED visit rates by more than 50%. IMPLICATIONS FOR PRACTICE: To our knowledge, this is the first reported use of Lean principles to decrease utilization of emergency resources in the postoperative period. Lean can be applied to other processes in our field to eliminate waste and add value to improve patient outcomes. LEVEL OF EVIDENCE: NA.


Subject(s)
Adenoidectomy/methods , Patient Safety/standards , Tonsillectomy/methods , Adenoidectomy/adverse effects , Adolescent , Child , Child, Preschool , Female , Humans , Male , Postoperative Period , Quality Improvement , Retrospective Studies , Tonsillectomy/adverse effects
10.
Am J Otolaryngol ; 41(6): 102692, 2020.
Article in English | MEDLINE | ID: mdl-32877798

ABSTRACT

OBJECTIVE: We aimed to assess operative workflow and efficiency in microvascular free flaps via a direct observational study based on Lean principles of quality improvement (QI). METHODS: Observers monitored the workflow of twenty-three free flaps. Pre-operative preparation and surgical duration was recorded with supplemental data provided from our institution's surgical tracking database. Traffic patterns of operating room (OR) staff were documented as "entries" and "exits" from the OR and classified by role and the reason that the entry or exit was required. Patient data was obtained via chart review. RESULTS: The mean surgical time was 9.0 h. Approximately 20% of OR time was dedicated to the pre-incision process, averaging 1.6 h per case. One third of entries and exits occurred during this period. In total, 180.2 surgical hours were observed during which 6215 "entries" and "exits" occurred. The mean number of entries and exits per case was 270; the most common reasons were supplies and communication. No association was observed between elapsed surgical time or total number of entries and exits with post-operative infection rates. CONCLUSION: Comprehensive observational workflow studies of free flaps are challenging to execute due to lengthy procedure times. At our high-volume institution, a significant portion of OR time is devoted to the pre-incision period, largely due to inadequate supply availability and pre-operative communication. These findings will serve as a foundation for QI interventions at our institution, while our observational model provides a broadly applicable framework for assessing surgical efficiency.


Subject(s)
Efficiency , Free Tissue Flaps , Medical Staff/statistics & numerical data , Operating Rooms/statistics & numerical data , Otorhinolaryngologic Surgical Procedures , Plastic Surgery Procedures , Quality Improvement , Quality of Health Care , Workflow , Communication , Equipment and Supplies, Hospital , Humans , Operative Time , Preoperative Care , Time Factors
12.
Am J Otolaryngol ; 39(2): 253-256, 2018.
Article in English | MEDLINE | ID: mdl-29279249

ABSTRACT

This report describes a bilateral sphenoid sinus mucosal flap for the repair of a sellar floor defect and CSF leak following endoscopic endonasal skull base surgery. The key advantage of this technique is enabling the sphenoid mucosal flaps to remain vascularized, which reduces postoperative complications including CSF leakage, recurrent sinusitis, meningitis, encephalitis and pneumocephalus. The use of this technique is a viable and possibly favorable alternative to free grafts in the reconstruction of small to medium sized sellar defects with low flow or absent CSF leaks base surgery.


Subject(s)
Nasal Mucosa/transplantation , Natural Orifice Endoscopic Surgery/adverse effects , Pituitary Neoplasms/surgery , Plastic Surgery Procedures/methods , Postoperative Complications/surgery , Skull Base/surgery , Surgical Flaps , Adult , Humans , Magnetic Resonance Imaging , Male , Nose , Pituitary Neoplasms/diagnosis , Reoperation , Skull Base/diagnostic imaging , Sphenoid Sinus/surgery , Tomography, X-Ray Computed
13.
Cureus ; 8(3): e528, 2016 Mar 10.
Article in English | MEDLINE | ID: mdl-27081589

ABSTRACT

Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation. We conclude that the use of balanced fluids, such as Ringer's Lactate, seems very promising but further research is needed to confirm their role.

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