Scedosporium Infection After Intralesional Steroid Injections for Idiopathic Subglottic Stenosis.

Intralesional steroid injections are commonly used to treat idiopathic subglottic stenosis and are believed to have minimal systemic effects. This case report presents an immunocompetent 67-year-old woman with idiopathic subglottic stenosis who developed Scedosporium apiospermum infection of the subglottis following in-office steroid injections, suggesting a potential risk for infection associated with this treatment. This highlights the need for further research to understand the impact of intralesional steroid injections on local and systemic immunocompetency to inform treatment protocols for idiopathic subglottic stenosis. Laryngoscope, 2024.

Adductor Spasmodic Dysphonia Improves with Bilateral Thalamic Deep Brain Stimulation: Report of 3 Cases Done Asleep and Review of Literature.

Background: To date, there are only six published reports of adductor spasmodic dysphonia (SD) responding to awake thalamic deep brain stimulation (DBS). Methods: We retrospectively reviewed cases of Essential Tremor (ET) with SD that were seen in our center from 2012 to 2020. We further identified those that have undergone thalamic DBS, and had a blinded laryngologist rate first the audio voice recordings before and after DBS using the Unified Spasmodic Dysphonia Rating Scale (USDRS), and the video recordings last to rate the related movements and facial grimacing. Results: We identified three cases of adductor SD with ET that had undergone bilateral ventralis intermedius (VIM) DBS under general anesthesia. All patients noted improvement of their limb and voice tremor, as well as their SD post-DBS. Although improvement of tremor was observed even with initial programming in all three, improvement of SD was noted only upon reaching higher amplitudes or wider pulse widths. Blinded voice assessments showed improvement of USDRS scores post-DBS compared to pre-DBS, and with stimulator on compared to stimulator off. Discussion: We report the first three cases of SD responding favorably to bilateral VIM asleep DBS and summarize the nine cases so far of SD who have undergone thalamic DBS.

The utility of office-based biopsy for laryngopharyngeal lesions: comparison with surgical evaluation.

OBJECTIVES/HYPOTHESIS: Advances in flexible endoscopy with working-channel biopsy forceps have led to excellent visualization of laryngopharyngeal lesions with capability for in-office awake biopsy. Potential benefits include prompt diagnosis without risk of general anesthesia, preoperative counseling, and avoiding an anesthetic should the lesion return benign. We evaluate the accuracy of these biopsies in order to determine their role and diagnostic value. STUDY DESIGN: Retrospective chart review. METHODS: Medical records were reviewed from January 1, 2010, through July 31, 2013, of patients who underwent office-based current procedural terminology code 31576 and were taken to the operating room for direct microlaryngoscopy with biopsy/excision. Clinical diagnoses and pathology reports were reviewed. For statistical analysis, we considered three groups: 1) malignant and premalignant, 2) lesions of uncertain significance, and 3) benign lesions. RESULTS: In the study period, 76 patients with an office biopsy had a clinical picture to warrant direct microlaryngoscopy and biopsy/excision. Kendall's coefficient for each group indicated moderate correlation only. When groups 1 and 2 were considered together, there was a substantial and statistically significant correlation. For malignant and premalignant lesions, the office biopsy analysis was as follows: sensitivity = 60%, specificity = 87%, positive predictive value = 78%, and negative predictive value = 74%. CONCLUSION: Office biopsy may offer early direction and avoid operative intervention in some cases; however, for suspected dysplastic or malignant lesions, direct microlaryngoscopy should be the standard of care to ensure adequate full-thickness sampling and staging. For benign pathology, office biopsy is a safe and viable alternative to direct microlaryngoscopy and biopsy/excision.

Prevalence of over-the-counter and complementary medication use in the otolaryngology preoperative patient: a patient safety initiative.

OBJECTIVES/HYPOTHESIS: To determine the prevalence of over-the-counter and complementary and alternative medication use in the preoperative otolaryngology patient population. STUDY DESIGN: Cross-sectional survey. METHODS: Data were collected from preoperative surveys given to all patients undergoing surgery by a single physician with an academic practice over a 6-month period from March to September 2010. Responses were compiled and combined with demographic information obtained from the computer-based chart system. RESULTS: A total of 92 patients, with ages ranging from 5 to 84 years old (average, 41), completed the survey. Fifty-three (58%) patients were female, and 39 (42%) were male. Forty-two (46%) patients reported the use of nonprescription medications, and 48% reported the use of multiple medications. Of those who reported using medication, 11 (26%) were male and 31 (74%) were female. The average age of nonprescription medication users was 49 years. The most commonly reported over-the-counter medications were aspirin and ibuprofen. The most commonly reported complementary and alternative medications were green tea, fish oil, and vitamin E. CONCLUSIONS: The use of nonprescription medications in the otolaryngology preoperative population is very common, especially in the female patient. The most commonly reported medications are associated with serious potential complications, and awareness of their use is critical before the patient undergoes surgery.