Use of a transnasal flexible laryngoscope tip for laryngeal culturing: A novel in-office technique.

BACKGROUND: In-office culture of the larynx using a flexible laryngoscope tip can help identify laryngeal pathogens in cases of laryngitis. OBJECTIVE: This retrospective case series aimed to investigate the feasibility of in-office laryngoscope tip culture to identify laryngeal pathogens and help guide medical treatment. METHODS: This case series consists of 8 patients who underwent 11 in-office laryngeal cultures using the tip of the flexible laryngoscope. Concurrent nasal cultures were performed on two patients to assess for possible nasal contamination of these laryngoscope tip cultures. RESULTS: Nine patients underwent laryngeal culture with laryngoscope tip in-office, with two patients undergoing repeat swabs for a total of eleven swabs. Then, 8 of 11 swabs (73%) grew methicillin-sensitive Staphylococcus aureus, while 1 of 11 (9.1%) swabs grew methicillin-resistant S. aureus. Three of eleven swabs (27%) grew Candida species. Concurrent culture was performed of the contralateral nasal cavity in two patients to assess for the possibility of nasal contamination of laryngoscope tip cultures. Concurrent contralateral nasal cultures grew distinct pathogens compared to the laryngeal cultures, suggesting that nasal contamination did not occur. CONCLUSION: In-office laryngoscope tip culture allows safe identification of laryngeal pathogens in an ambulatory setting. In-office laryngoscope tip culture can help guide medical treatment of laryngeal infections. LEVEL OF EVIDENCE: 4.

Laser plume containment during flexible transnasal laryngoscopy.

Objective: To evaluate a negative pressure microenvironment designed to contain laser plume during flexible transnasal laryngoscopy. Methods: The Negative Pressure Face Shield (NPFS) was previously reported as well tolerated with initial use on 30 patients. Diagnostic transnasal laryngoscopy was performed on an additional 108 consecutive patients who were evaluated by questionnaires and sequential pulse oximetry. Further study addressed operative transnasal potassium-titanyl-phosphate (KTP) laser laryngoscopy with biopsy done on four patients employing the NPFS. Results: The previously described NPFS version 3 (v.3), a transparent acrylic barrier with two anterior instrumentation ports, was modified by repositioning the side suction port closer to the level of the nose and deepening the lateral sides, squaring off the lower projection. A post-procedure questionnaire employing a 5-point Likert scale ranging from no symptoms (rating of 1) to intolerable (rating of 5) identified excellent patient tolerance of the new design (v.4), among 22 patients evaluated and similar in the comparison to the 116 patients using version 3. Among the 138 patients analyzed, only one patient rated the experience as greater than "mild claustrophobia." 100% of patients answered either "none" or "mild" to the pain and shortness of breath questions. The NPFS (v.4) was then successfully used in four patients for laser laryngoscopy with biopsy of laryngeal papilloma (3/4) and hemorrhagic polyp (1/4). Post-procedure questionnaire identified no shortness of breath (4/4), no claustrophobia (4/4), no pain (4/4) and no significant changes in pulse oximetry during use. Conclusion: Extensive experience in performing diagnostic laryngoscopy with the NPFS directed design changes leading to successful use for transnasal flexible laser laryngoscopy with biopsy in a negative pressure microenvironment. Level of Evidence: Level 2b (Cohort Study).

Negative pressure face shield for flexible laryngoscopy in the COVID-19 era.

OBJECTIVE: Introduce novel methods and materials to limit microdroplet spread when performing transnasal aerosol generating procedures in the COVID-19 era. METHODS: Prototypes of a negative pressure face shield (NPFS) were tested then used clinically to create a suction-clearing negative pressure microenvironment with controlled access to the nose and mouth. Air pressure measurements within prototypes were followed by prospective evaluation of 30 consecutive patients treated with the device assessed through questionnaires and monitoring oximetry. RESULTS: The NPFS is a transparent acrylic barrier with two anterior instrumentation ports and a side port to which continuous suction is applied. It is positioned on a stand and employs a disposable antimicrobial wrap to secure an enclosure around the head. This assembly was successfully used to complete transnasal laryngoscopy in all 30 patients studied. Tolerance of the design was excellent, with postprocedure questionnaire identifying no shortness of breath (27/30), no claustrophobia (27/30), no pain (29/30), and no significant changes in pulse oximetry. CONCLUSION: Diagnostic laryngoscopy was successfully performed in a negative pressure microenvironment created to limit dispersion of aerosols. Further application of the NPFS device is targeted for use with transnasal laryngeal laser and biopsy procedures to be followed by additional modification to enable intranasal and intraoral procedures in a similar protected environment. LEVEL OF EVIDENCE: Level 2b (Cohort Study).

Steering Sheath for 2-Nostril Transnasal Office Laryngoscopy.

OBJECTIVE: The aim was to study the feasibility of performing office-based laryngeal procedures employing a flexible hollow steerable sheath placed contralateral to the nostril through which a standard flexible video endoscope is placed. METHODS: The study design included simulation of transnasal endoscopic laryngeal procedures evaluating the use of a flexible steering sheath in laboratory and clinic settings. Transnasal laryngeal procedures were performed in an otolaryngology office setting employing an airway-management-trainer mannequin and then repeated in a human cadaver lab with standard transnasal flexible video laryngoscopy. Video documentation assessed use of a lever-manipulated deflecting ureteral access sheath with an inner diameter of 2.97 mm, an outer diameter of 4.95 mm, and a length of 45 cm. Simulated transnasal laryngoscopy procedures deployed devices through the deflecting sheath to mimic vocal fold needle injection, biopsy with forceps, balloon dilation, and laser treatment to identify strengths and shortcomings to the technology and technique. RESULTS: Simulation was successful in appropriately directing instrumentation for all procedures tested. Shortcomings included limitations in steering capacity, greater length to the sheath than desirable for laryngeal procedures, and the need for additional assistants to perform procedures. CONCLUSION: Steering sheath technology is applicable to enhance in-office transnasal laryngoscopy procedures.