Endoscopic Distance and its Impact on Quantified Age-related Vocal Fold Atrophy Measures.

INTRODUCTION: The bowing index (BI) and normalized glottal gap area (NGGA) are used to quantify vocal fold morphology in ARVA; however, the influence of the distance between the flexible laryngoscope lens and the target area is not known. The goal is to test whether the endoscopic distance impacts vocal fold morphology measurements in patients with ARVA during flexible video laryngostroboscopy (VLS). METHOD: Patients with ARVA who underwent VLS were included. Images were classified into near (close to the petiole of the epiglottis) and far (below nasopharynx, with tongue base and entire epiglottis visible) conditions. BI was calculated using a mobile application, and NGGA was measured using ImageJ. RESULTS: This study included 23 patients; the mean age was 77 ± 7 years. Mean BI measured at the near distance was higher than far distances with a mean difference of 1.94 (95% CI: 0.92-2.96, p = 0.001). NGGA showed difference with changed distance -0.24 (95% CI: -0.48 to 0.01, p < 0.05).When stratifying patients into two groups based on median BI measurement, there was a statistically significant difference between near and far conditions, with increased BI in the near condition for patients above the median (p < 0.05), but no difference between the near and far condition for patients with BI below the median. CONCLUSION: The BI and NGGA were impacted by the endoscopic distance during flexible VLS. BI was significantly higher in the near condition compared with the far condition. The difference in BI between the near and far conditions was more pronounced when the vocal fold bowing was greater. These findings call for heightened awareness of measurement discrepancies secondary to the endoscopic distance during flexible laryngostroboscopy. LEVEL OF EVIDENCE: Level 2 Laryngoscope, 2024.

Neurophysiology of the Superior Laryngeal Nerve in an In Vivo Rat Model.

OBJECTIVE: The superior laryngeal nerve (SLN) is fundamental in laryngeal sensation, cough reflex, and pitch control. SLN injury has substantial consequences including altered sensation, aspiration, and dysphonia. To date, in vivo measurement of the SLN remains elusive. The purpose of this study was to assess the feasibility of recording motor and sensory evoked potentials in a rat SLN model. METHODS: Twenty-two rat hemi-laryngeal preparations (n = 11) were obtained from 4-month-old Sprague-Dawley rats and included in this study. Compound motor action potentials (CMAPs) and motor unit number estimation (MUNE) were calculated by stimulating the SLN at the point of medial extension near the carotid artery and by placing a recording electrode on the cricothyroid muscle. Sensory response was determined through stimulation of the SLN and laryngoscopic visualization of a laryngeal adductor reflex (LAR). SLN and cricothyroid muscle cross-sections were stained and histologic morphometrics were quantified. RESULTS: Laryngeal evoked potentials were successfully obtained in all trials. Mean CMAP latency and negative durations were 0.99 ± 0.57 ms and 1.49 ± 0.57 ms, respectively. The median MUNE was 2.06 (IQR 1.88, 3.51). LAR was induced with a mean intensity of 0.69 ± 0.20 mV. Mean axon count, myelin thickness, and g-ratio were 681 ± 192.2, 1.72 ± 0.26, and 0.45 ± 0.04, respectively. CONCLUSIONS: This study demonstrates the feasibility of recording evoked response potentials following SLN stimulation. We hypothesize that this work will provide a tractable animal model to study changes in laryngeal sensation and cricothyroid motor function with aging, neurodegenerative disease, aspiration, or nerve injury. LEVEL OF EVIDENCE: NA Laryngoscope, 134:1778-1784, 2024.

Otolaryngologic conditions in children with neonatal abstinence syndrome: A descriptive study.

PURPOSE: Literature on otolaryngologic sequelae of children with neonatal abstinence syndrome (NAS) has been scarce to date. Prior reports suggest some otologic conditions associated with long-term NAS outcomes, but no comprehensive exploration of these relationships currently exists. This study aims to characterize the breadth of otolaryngologic conditions diagnosed in children with NAS. METHODS: This is a retrospective descriptive study conducted at a tertiary care hospital. We identified 524 children with NAS born between 1/1/2014 and 12/31/2019 who were evaluated by the otolaryngology department. Diagnoses were categorized as otologic, oropharyngeal, sinonasal, and laryngeal. Additional diagnoses of obstructive sleep apnea (OSA) and congenital abnormalities of head and neck were noted separately. Descriptive statistics were calculated, and ANCOVA testing analyzed for differences in mean number of diagnoses. RESULTS: 680 total otolaryngologic diagnoses were analyzed across 524 patients. Otologic conditions comprised 39.7 % of total diagnoses, oropharyngeal conditions 26.8 %, sinonasal conditions 18.4 %, laryngeal conditions 5.3 %, OSA 1.5 %, and congenital abnormalities 8.3 %. After adjusting for covariates, there were a significantly higher number of otologic diagnoses compared to the other subcategories with mean (standard deviation) of 0.46 (0.83), followed by oropharyngeal 0.35 (0.55), sinonasal 0.24 (0.49), and laryngeal 0.07 (0.29). Thirty total otolaryngology-related procedures were performed in our sample, with myringotomy with tube insertion as the most common. CONCLUSION: Understanding the otolaryngologic sequelae of children with NAS is important as these conditions impact children's early development. Our study also highlights various socioeconomic factors that may impact pediatric ENT care and the follow-up of patients born with NAS.

The Use of Race and Socioeconomic Status Variables in Published Otolaryngologic Research.

OBJECTIVE: To characterize the use of race and socioeconomic status (SES) variables in clinical otolarynogologic research. METHODS: Databases were queried for all articles published in 2016 issues of 5 major otolaryngologic journals. One thousand, one hundred and forty of 1593 articles abstracted met inclusion criteria for analysis. RESULTS: In total, 244 (21.4%) studies specified race as a variable. The subspecialty of Head and Neck cancer specified race at statistically higher rates compared to other subspecialties (P = .002). Two hundred nine (34.0%) domestic studies specified race compared to 35 (6.7%) international studies. Of the 244 studies that specified race, 79 (32.4%) defined race using racial and ethnic categories interchangeably. Two hundred twenty-four (91.8%) studies reported data by race, 145 (59.4%) analyzed the data, and 112 (45.9%) discussed race-based results.In total, 94 (8.2%) studies specified SES. All subspecialties specified SES at statistically similar rates. Seventy (11.4%) domestic studies specified SES compared to 24 (4.6%) international studies. Of the 94 studies that specified SES, 42 (44.7%) defined SES using insurance status, 35 (37.2%) used education, and 32 (34.0%) used income. Seventy-eight (83.0%) studies reported data by SES, 71 (75.5%) analyzed the data, and 68 (72.3%) discussed SES-based results. CONCLUSION: In clinical otolaryngologic research, the study of race and SES is limited. To improve quality of research and patient care for all patients, investigators should clearly justify their use of race and SES variables, carefully select their measures of race and SES (if the use of these variables is justified), and study race/SES-based data beyond just a superficial level.

Pharyngesophageal Diverticula Following Anterior Cervical Discectomy and Fusion.

OBJECTIVES: Development of traction pharyngesophageal diverticula following anterior cervical discectomy and fusion (ACDF) is a rare but morbid cause of dysphagia and the optimal surgical management is unclear. METHODS: PubMed, GoogleScholar, Embase database reviews of "traction diverticula/um + anterior cervical/ACDF." Patient demographics, presenting symptoms, surgical technique, and outcomes were compared. RESULTS: Seventeen manuscripts reported 21 cases of pharyngesophageal diverticulum (PED) following ACDF (10 F:11 M, mean age 45 years). Presenting symptoms included dysphagia (n = 18), regurgitation (n = 10), and weight loss (n = 6). The average interval to presentation was 4.5 years after ACDF (range: 6 months-18 years) and ACDF levels most commonly involved were C5-C6 and/or C6-C7 (n = 12). Open diverticulectomy with (n = 12) and without (n = 6) cricopharyngeal myotomy was the most common approach and reinforcement with vascularized tissue was used in 6 patients (29%). Attempted endoscopic diverticula repair was successful in 1 patient, was converted to open repair in 5 patients, and 1 patient did not have surgical repair. ACDF hardware was removed in 11 cases (52%) and was routinely removed when concomitant infection was present. Complications following repair were reported in 6 patients (30%). CONCLUSION: Traction pharyngesophageal diverticula are a rare cause of dysphagia which occur after a variable interval following ACDF. Open surgical diverticulectomy yields superior outcomes compared to the endoscopic approach. In the setting of infection hardware removal is recommended. Vascularized tissue reinforcement can limit potential esophageal leak; however, the risk of post-operative complications remains high.

Adenoid Cystic Carcinoma of the Larynx: A SEER Database Review.

BACKGROUND: Adenoid cystic carcinoma (AdCC) of the larynx is an uncommon malignancy of the head and neck with very little literature discussing treatment paradigms and prognostic factors influencing survival. METHODS: This retrospective cohort study uses data obtained from the Surveillance, Epidemiology and End Result database comprising of patients diagnosed with laryngeal AdCC from 1978 to 2016. RESULTS: A total of 89 records were analyzed. High histologic grade was a significant negative prognostic factor compared to low histologic grade disease for overall survival (OS; 5-year OS: 35.7% vs 90.5%, P < .005) and disease-specific survival (DSS; 5-year DSS: 38.7% vs 95.2%, P < .005). No differences in OS (5-year OS: 88.9% vs 76.4%, P = .287) or DSS (5-year DSS: 100% vs 79.1%, P = .159) were noted between patients with early versus late American Joint Committee on Cancer (AJCC) stage disease. No differences in DSS was noted in cohorts treated with just definitive surgery versus surgery and adjuvant radiation (5-year DSS: 92.9% vs 74.3%, P = .140) even when stratified for late stage disease (5-year DSS: 100% vs 78.6%, P = .290) or high-grade histology (5-year DSS: 100% vs 83.3%, P = .773). CONCLUSIONS: Histologic grade may be a more significant prognostic factor than AJCC stage for survival in laryngeal AdCC. Treatment with surgery and radiation may provide no additional survival advantage compared to just definitive surgery in these patients, although further study is warranted.

Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic.

OBJECTIVE: To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status. STUDY DESIGN: Retrospective cohort study. METHODS: This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018. RESULTS: Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71-0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976-0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64-0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979-0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98-1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25-3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75-3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99-1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not associated with attendance or no-shows. CONCLUSION: Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes. QUALITY OF EVIDENCE: Level 3 Laryngoscope, 132:895-900, 2022.

Association of vaping with decreased vascular endothelial growth factor expression and decreased microvessel density in cutaneous wound healing tissue in rats.

Vaping is suggested to be a risk factor for poor wound healing akin to smoking. However, the molecular and histologic mechanisms underlying this postulation remain unknown. Our study sought to compare molecular and histologic changes in cutaneous flap and non-flap tissue between vaping, smoking and control cohorts. Animal study of 15 male Sprague-Dawley rats was randomized to three cohorts: negative control (n = 5), e-cigarette (n = 5) and cigarette (n = 5) and exposed to their respective treatments with serum cotinine monitoring. After 30 days, random pattern flaps were raised and healed for 2 weeks after which skin punch biopsies of flap and non-flap tissues were collected for quantitative-reverse transcription-polymerase chain reaction of three selected wound healing genes (transforming growth factor ß [TGF-ß], vascular endothelial growth factor [VEGF], matrix metalloproteinase-1 [MMP-1]); then, immunohistochemistry for CD68 expression, α-smooth muscle actin looking at microvessel density (MVD) and in situ hybridization to localize VEGF production were undertaken. In flap tissue, vaping (mean[SEM]) (0.61[0.07]) and smoking (0.70[0.04]) were associated with decreased fold change of VEGF expression compared with controls (0.91[0.03]) (p < 0.05, p < 0.05, respectively). In non-flap tissue, only vaping was associated with decreased VEGF expression (mean[SEM]) (0.81[0.07]), compared with controls (1.17[0.10]) (p < 0.05) with expression primarily localized to basal keratinocytes and dermal capillaries. Immunohistochemistry showed decreased MVD in smoking (0.27[0.06]) and vaping (0.26[0.04]) flap tissue compared to matched controls (0.65[0.14]) (p < 0.05, p < 0.05, respectively) and decreased areas of fibrosis compared with controls on gross histology. Vaping and smoking were similarly associated with decreased VEGF expression, MVD and fibrotic changes in flap tissue. The results suggest attenuated angiogenesis via decreased VEGF expression as a mechanism for poor wound healing in vaping-exposed rats.

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea.

OBJECTIVE/HYPOTHESIS: Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing. STUDY DESIGN: Retrospective cohort study from 2015 to 2019 at a single tertiary referral center. METHODS: Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported. RESULTS: A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40-6.32)), increased apneic-hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO2 (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term. CONCLUSIONS: Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1909-1914, 2021.

Paediatric laryngeal squamous cell carcinoma: Systematic review and pooled analysis.

BACKGROUND: Paediatric squamous cell carcinoma (SCC) of the larynx is rare; however, recent data seem to support the notion that this pathology is increasing in incidence. Although this has been the case for several decades, treatment algorithms for this patient population remain identical to those of adults. METHODS: The study consists of a systematic review and pooled analysis of oncologic outcomes in paediatric laryngeal SCC from a comprehensive literature search on OVID MEDLINE and EMBASE. RESULTS: The average cohort age was 12.1 years. Nine (36%) had supraglottic primaries, and 16 (64%) had glottic primaries. Treatment included unimodal and combination therapy. No significant difference in survival was noted between surgically treated and non-surgically treated patients (5-year overall survival (OS): 68.2% vs 76.2%, P = .905), even when stratified for advanced-stage and supraglottic disease. CONCLUSIONS: Paediatric patients with laryngeal HNSCC may have different presentations and responses to therapy than their adult counterparts.

Pediatric laryngeal sarcoma: Systematic review and pooled analysis.

BACKGROUND: Sarcomas are a rare, diverse tumor class of mesenchymal origin affecting all age groups. Survival after diagnosis is influenced by disease site. To date, there are no analyses evaluating treatment of pediatric sarcoma within the larynx specifically. METHODS: A structured literature review following PRISMA guidelines was preformed to identify case reports of pediatric (age 17 and younger) laryngeal sarcoma. RESULTS: Twenty-nine case reports documenting 37 pediatric patients diagnosed with sarcoma in the larynx were identified since 1980. The majority of patients were male (79.4%). The most common histological subtypes were rhabdomyosarcoma (69.4%) and synovial sarcoma (19.4%). The supraglottis was the most common site of disease (62.1%) among laryngeal subsites. Only two patients were known to have succumbed to their disease. Overall survival was not statistically impacted by primary site of tumor, treatment strategy, histology or gender. CONCLUSIONS: Soft tissue sarcoma is rarely found in the pediatric larynx. Patient and tumor characteristics studied were not shown to affect outcomes. Increased documenting of high-quality case reports is needed to advance understanding of this disease.

Expanding Canonical Spider Silk Properties through a DNA Combinatorial Approach.

The properties of native spider silk vary within and across species due to the presence of different genes containing conserved repetitive core domains encoding a variety of silk proteins. Previous studies seeking to understand the function and material properties of these domains focused primarily on the analysis of dragline silk proteins, MaSp1 and MaSp2. Our work seeks to broaden the mechanical properties of silk-based biomaterials by establishing two libraries containing genes from the repetitive core region of the native Latrodectus hesperus silk genome (Library A: genes masp1, masp2, tusp1, acsp1; Library B: genes acsp1, pysp1, misp1, flag). The expressed and purified proteins were analyzed through Fourier Transform Infrared Spectrometry (FTIR). Some of these new proteins revealed a higher portion of ß-sheet content in recombinant proteins produced from gene constructs containing a combination of masp1/masp2 and acsp1/tusp1 genes than recombinant proteins which consisted solely of dragline silk genes (Library A). A higher portion of ß-turn and random coil content was identified in recombinant proteins from pysp1 and flag genes (Library B). Mechanical characterization of selected proteins purified from Library A and Library B formed into films was assessed by Atomic Force Microscopy (AFM) and suggested Library A recombinant proteins had higher elastic moduli when compared to Library B recombinant proteins. Both libraries had higher elastic moduli when compared to native spider silk proteins. The preliminary approach demonstrated here suggests that repetitive core regions of the aforementioned genes can be used as building blocks for new silk-based biomaterials with varying mechanical properties.

Association of Electronic Cigarette Vaping and Cigarette Smoking With Decreased Random Flap Viability in Rats.

IMPORTANCE: Smoking is a known risk to wound healing, but whether electronic cigarettes present the same risk remains unknown. OBJECTIVE: To evaluate the rate of flap necrosis in the e-cigarette vapor-exposed group and the unexposed control and to detect a difference in the rate of flap necrosis between the traditional cigarette smoke-exposed group and the unexposed control. DESIGN, SETTING, AND PARTICIPANTS: From March 10, 2018, to May 4, 2018, a cohort study was conducted on 45 male Sprague-Dawley rats at Boston University School of Medicine. Each rat weighed approximately 100 g at the beginning of the study and was randomized to 1 of 3 groups: negative control (n = 15), experimental (exposed to e-cigarette vapor; n = 15), and positive control (exposed to traditional cigarette smoke; n = 15). Rats in the experimental and positive control groups were exposed to electronic cigarette vapor and traditional cigarette smoke in a smoking chamber for 30 minutes twice a day for 30 consecutive days. Levels of serum cotinine were monitored and maintained between 150 ng/mL and 200 ng/mL. After 30 days, random pattern dorsal skin flaps were raised. MAIN OUTCOMES AND MEASURES: Percentage of flap necrosis for each group. RESULTS: All 45 rats survived the surgical procedure and postoperative recovery, and all rats thrived and gained weight over the course of the study. The highest rate of flap necrosis was found in the positive control cohort, with a mean (SD) of 68.7% (8.6%), followed by the experimental cohort, with a mean (SD) of 65.9% (11.8%); the negative control cohort had the least amount of flap necrosis, with a mean (SD) of 50.8% (9.4%). The percentage of flap necrosis in the negative control rats (95% CI, 46.0-55.6; P < .001) was substantially lower than that for both the positive control rats (95% CI, 64.3-73.0; P < .001) and the experimental rats (95% CI, 59.9-71.8; P < .001). No statistically significant difference in flap necrosis was noted between the rats in the experimental cohort and the rats in the positive control cohort (95% CI, 59.9-71.8 vs 95% CI, 64.3-73.0; P = .46). CONCLUSIONS AND RELEVANCE: Smoking and vaping appear to be equally detrimental to wound healing and to be associated with a statistically significant increase in flap necrosis compared with the unexposed group. The results suggest that vaping should not be seen as a better alternative to cigarette smoking in the context of wound healing. LEVEL OF EVIDENCE: NA.