Diagnostic strategies and treatment algorithms for pediatric dysphonia and dysphagia have undergo... more Diagnostic strategies and treatment algorithms for pediatric dysphonia and dysphagia have undergone significant changes in recent years. With these new techniques, otolaryngologists play an increasing role in the diagnosis and management of children with these conditions, often in a multidisciplinary fashion.The miniseminar’s format will be that of a multidisciplinary interactive panel of experts from the fields of pediatric otolaryngology, pediatric
Archives of Otolaryngology Head Neck Surgery, 2006
Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube... more Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube obstruction immediately postoperatively in patients receiving TT for otitis media and to compare patients receiving postoperative otic drops with controls.
The Annals of otology, rhinology, and laryngology, 2005
There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides... more There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides of cytosine and guanine (CpG) are potent immune stimulants that have shown efficacy against tumors as monotherapy, as vaccine adjuvants, and in combination with chemotherapies. We examined the therapeutic effect of CpG oligodeoxynucleotides in the treatment of papillomavirus in a cottontail rabbit model (CRPV). Twenty rabbits were infected with CRPV; 10 were treated with 11 weekly CpG inoculations while treatment control rabbits received intralesional saline solution. Eight rabbits (4 treatment, 4 control) were rechallenged with CRPV 17 weeks after the initial viral challenge and monitored for new papilloma development. Papillomas developed in all 20 rabbits (100%) within 4 weeks of infection. The diagnosis was confirmed histologically. There was no difference in the average tumor burden between the treatment and control groups after 11 weeks of CpG treatments or after 9 additional week...
International Journal of Pediatric Otorhinolaryngology, 2008
Objective: Recurrent respiratory papillomatosis (RRP) is a benign aerodigestive tract neoplasm. C... more Objective: Recurrent respiratory papillomatosis (RRP) is a benign aerodigestive tract neoplasm. Cidofovir, an antiviral drug, has demonstrated efficacy in slowing and/or reducing RRP recurrence. This investigation examined the differential gene expression of RPP before and after cidofovir use in vivo. Methods: Papillomas were harvested from two patients pre-and post-cidofovir treatment. RNA was extracted from the tissues and separate Serial Analysis of Gene Expression (SAGE) libraries created. Overall gene expression as well as relative gene expression in the four libraries was compared. Results: Over 19,000 tags were found in each of the libraries, with over 6000 unique transcripts identified in the pre-treatment and over 6000 identified in the postcidofovir libraries of both patient 1 and 2. Following cidofovir treatment, the greatest up-regulation was in gene families associated with cell proliferation, metabolism, transport and response to biotic stimuli. Post-treatment up-regulation was seen in numerous specific genes, such as Interferon Regulatory Factor 7 (P = 0.000014), which has been associated with virus-host interactions, passive viral induction of host immune response, and response to DNA damage stimulus. Down-regulation was demonstrated in gene families associated with transcription, regulation of nucleic acid metabolism, and signal transduction. Discussion: Creation of RRP SAGE libraries demonstrates a broad list of genes expressed in RRP, as well as significant differences in gene expression after exposure to cidofovir, potentially allowing for a more thorough understanding of important
The purpose of this study is to evaluate the potential role of food intolerances in the managemen... more The purpose of this study is to evaluate the potential role of food intolerances in the management of recurrent respiratory papillomatosis (RRP). This is a retrospective case review of 4 pediatric patients with RRP. All of the patients, cared for by the primary author between 2005 and 2010, were managed using microdebrider resection, intralesional injection of cidofovir, and required multiple surgeries. Skin prick test (SPT) and/or radioallergosorbent test (RAST) were obtained for 2 patients. Oral food challenge was utilized in all 4 patients. Standard SPT and RAST did not identify any immunoglobulin E (IgE)-based allergens. A detailed medical history followed by an oral food challenge was successful at identifying food intolerances in all 4 patients. When specific food elimination was implemented in these patients' treatments in addition to microdebrider resection and cidofovir injection, statistically significant long-term remissions were achieved. Food intolerance and its impact on RRP and immune dysfunction deserve further investigation and may benefit some patients with RRP.
International Journal of Pediatric Otorhinolaryngology, 2003
Vocal fold paralysis (VFP) is the second most common congenital abnormality that affects the lary... more Vocal fold paralysis (VFP) is the second most common congenital abnormality that affects the larynx. Unilateral cases may be asymptomatic or feature symptoms related to laryngeal incompetence, such as aspiration and dysphonia. Management has traditionally been conservative as a high percentage of these paralyses recover spontaneously. The literature is scant on the acute or chronic management of unilateral vocal fold paralysis related symptoms in children. We present a series of four children (age 21 days, 5 years, 5 years, and 18 years) with unilateral VFP paralysis treated with collagen (Cymmtera) augmentation for control of symptoms related to laryngeal incompetence. Two children (age 21 days and 5 years) were managed in the acute setting. Follow-up has ranged from 4 to 12 months, and all have maintained excellent outcomes. Vocal fold augmentation with collagen is an effective therapeutic option in the management of symptoms related to unilateral VFP and laryngeal incompetence. It decreases the risk of aspiration and improves vocal quality. Collagen augmentation can be used in the acute setting to decrease aspiration, possibly avoiding a tracheotomy or gastrostomy tube placement, or to augment patients with a tracheotomy who are still severely aspirating.
The Annals of otology, rhinology, and laryngology, 2005
Diagnostic and management strategies for adult unilateral vocal fold immobility (UVFI) vary among... more Diagnostic and management strategies for adult unilateral vocal fold immobility (UVFI) vary among otolaryngologists. The aim of this study was to determine the current attitudes and practices regarding laryngeal electromyography (LEMG) for the management of adult UVFI within a cohort of subspecialty laryngologists. A 19-item instrument focused on diagnosis and management of adult UVFI was mailed to active members (n = 249) of the American Broncho-Esophagological Association (ABEA). The subset of questions related to LEMG is reviewed in this report. Statistical analysis using a chi2 test was performed. The survey response rate was 34% (n = 84), with 8 surveys returned incomplete because of pediatric-limited practices. Of the respondents, 75% (n = 57) rely on LEMG for evaluation of UVFI, whereas 25% (n = 19) do not use LEMG. Of those who use LEMG, 54% place their own electrodes and 44% interpret the LEMG results themselves. Monopolar electrodes are used by 57% (n = 25), bipolar electr...
The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation ... more The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation of the laryngeal cartilage window during medialization thyroplasty. Basic science. Forty thyroplasty windows were constructed in fresh, unpreserved cadaver larynges. A 6 x 13-mm rectangular window and a 4 x 4-mm round window were created on each side of the larynges in a symmetrical fashion. A standard surgical drill with a 3-mm cutting burr was used on one side; the ultrasonic surgical aspirator was used on the contralateral side. The time required for window construction was recorded, as was the status of the inner perichondrium at window completion. For creation of the 6 x 13-mm window, a mean time of 128 seconds was required using a standard surgical drill. The mean time using the ultrasonic aspirator device was 91 seconds for the window of the same size (P < .008). For the 4-mm round window, drilling completed the task in a mean time of 63 seconds, compared with 40 seconds (P < .016) for the ultrasonic aspirator. On creation of the 6 x 13-mm window, there were 4 of 10 perichondrial violations in the drilled specimens, and there were no violations in creation of the window of the same size with the ultrasonic aspirator (P = .12). The 4-mm round window had no perichondrium violations in the standard drill group and only 1 of 10 violations in the ultrasonic aspirator group (P = .99). The study suggested that the ultrasonic surgical aspirator device may be an effective, efficient alternative to the standard drill for medialization thyroplasty window creation. Prospective clinical trials are warranted to better characterize its applicability.
Oral lesions in very young children usually have a benign presentation, and only rarely contribut... more Oral lesions in very young children usually have a benign presentation, and only rarely contribute to significant aerodigestive symptomatology. Management begins with early recognition of the pathology and appropriate diagnosis. Hemangiomas, lymphangiomas, and teratomas may present with airway compromise or feeding difficulties, necessitating early intervention.
Our goal was to investigate the presence of laryngeal abnormalities is patients with paradoxical ... more Our goal was to investigate the presence of laryngeal abnormalities is patients with paradoxical vocal fold dysfunction (PVFD). A retrospective chart review was performed of patients referred for evaluation of paradoxical vocal fold dysfunction between July 2002 and December 2002. The patients completed questionnaires at the time of the office visit. Data collected from the medical record included age, gender, duration of symptoms before evaluation, asthma, gastroesophageal reflux symptoms, and laryngoscopic findings. Exercise stress test was performed when suitable. The diagnosis of PVFD was made based on patient history and laryngoscopy. Thirty patients were identified. There was a 27:3 (90%) female predominance, and mean age of presentation at was 28 years (range, 12 to 67 years). The median time from the onset of respiratory symptoms to diagnosis was 4.5 years (range, 0.5 to 30 years). Of the 30 patients, 17 (56%) had asthma, 16 had laryngeal findings suggestive of gastroesophageal reflex disease, 4 (12%) had laryngoscopic findings of chronic laryngitis, and 10 (33%) had additional findings, including laryngomalacia, vocal fold motion impairment, sulcus vocalis, nodules, and subglottic stenosis, mostly in the exercise-induced group. Concomitant laryngeal abnormalities are present in a many patients with PVFD, particularly in those with exercise-induced symptoms. Laryngoscopy is important in the management of these patients.
known medical diagnoses. The most frequent complaint (50%) was shortness of breath, followed by c... more known medical diagnoses. The most frequent complaint (50%) was shortness of breath, followed by change in voice, throat tightening, or choking sensation, coughing, throat clearing, excess saliva, globus, and swallowing complaints. The most common related medical diagnosis was GERD (42%), followed by asthma and allergies. Several patients had undergone prior surgeries, laryngeal trauma, illness, or severe emotional stress around time of onset. A laryngoscopic examination revealed hyperkinetic laryngeal behaviors in 38% of patients. Although 26% of patients had complained of dysphagia or globus, only 1 patient had documented pharyngeal dysphagia. Similarly, less than half of those patients who complained of globus actually had GERD. Finally, behavorial therapy was recommended for 80% of patients.
signs, seizures, and fever in the sinusitis group. Meningeal signs and seizures were more commonl... more signs, seizures, and fever in the sinusitis group. Meningeal signs and seizures were more commonly associated with intracranial disease. Otalgia, fever, mastoid tenderness and erythema were seen in the mastoiditis group. Several children had unremarkable clinical profiles despite multiple evolving intracranial complications. Patients were managed with appropriate parenteral antibiotics and surgical intervention.
false-negative results. Those with moderate to severe obstruction required surgery in more than 8... more false-negative results. Those with moderate to severe obstruction required surgery in more than 85%. There was a significant interobserver agreement only in the extremes.
false-negative results. Those with moderate to severe obstruction required surgery in more than 8... more false-negative results. Those with moderate to severe obstruction required surgery in more than 85%. There was a significant interobserver agreement only in the extremes.
The rehabilitation of glottic incompetence by injection laryngoplasty is important in the managem... more The rehabilitation of glottic incompetence by injection laryngoplasty is important in the management of thoracic surgery patients with vocal cord paralysis. This group of patients presents special considerations that favor injection under local anesthesia. The objective of this study is to characterize our experience with this minimally invasive approach in both the acute and subacute settings. The study was conducted using a retrospective chart review. From a database of 108 patients who received awake percutaneous injection laryngoplasty over a 3-year period, 15 cases were identified that underwent augmentation shortly following thoracic surgery. These records were reviewed for patient demographics, clinical characteristics, complications, and short-term outcomes. Fifteen patients were identified (12 male, 3 female); the age range for the group was 18-91 years (median 5 55 years). All the patients reported vocal improvement following injection; all 15 also were improved by perceptual assessment. Five of six dysphagic patients improved following injection. One patient's injection was aborted due to vocal fold edema; no significant bleeding or airway embarrassment was observed. No procedures were terminated because of patient discomfort. Awake percutaneous injection laryngoplasty for vocal paralysis can be performed safely in the postoperative thoracic surgery patient. Swallowing and voice complaints were almost universally improved following treatment. For patients who cannot tolerate or choose not to have open thyroplasty or vocal fold injection under general anesthesia, this procedure may offer a safe and effective alternative.
Archives of Otolaryngology–Head & Neck Surgery, 2006
Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube... more Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube obstruction immediately postoperatively in patients receiving TT for otitis media and to compare patients receiving postoperative otic drops with controls.
Archives of Otolaryngology–Head & Neck Surgery, 2004
The activation of signal transducer and activator of transduction (STAT) protein is thought to le... more The activation of signal transducer and activator of transduction (STAT) protein is thought to lead to the genesis of neoplasia by promoting cellular growth and preventing apoptosis, and by immune system modulation; STAT3 protein has also been implicated in tumor survival and propagation in recurrent respiratory papillomatosis (RRP).
Diagnostic strategies and treatment algorithms for pediatric dysphonia and dysphagia have undergo... more Diagnostic strategies and treatment algorithms for pediatric dysphonia and dysphagia have undergone significant changes in recent years. With these new techniques, otolaryngologists play an increasing role in the diagnosis and management of children with these conditions, often in a multidisciplinary fashion.The miniseminar’s format will be that of a multidisciplinary interactive panel of experts from the fields of pediatric otolaryngology, pediatric
Archives of Otolaryngology Head Neck Surgery, 2006
Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube... more Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube obstruction immediately postoperatively in patients receiving TT for otitis media and to compare patients receiving postoperative otic drops with controls.
The Annals of otology, rhinology, and laryngology, 2005
There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides... more There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides of cytosine and guanine (CpG) are potent immune stimulants that have shown efficacy against tumors as monotherapy, as vaccine adjuvants, and in combination with chemotherapies. We examined the therapeutic effect of CpG oligodeoxynucleotides in the treatment of papillomavirus in a cottontail rabbit model (CRPV). Twenty rabbits were infected with CRPV; 10 were treated with 11 weekly CpG inoculations while treatment control rabbits received intralesional saline solution. Eight rabbits (4 treatment, 4 control) were rechallenged with CRPV 17 weeks after the initial viral challenge and monitored for new papilloma development. Papillomas developed in all 20 rabbits (100%) within 4 weeks of infection. The diagnosis was confirmed histologically. There was no difference in the average tumor burden between the treatment and control groups after 11 weeks of CpG treatments or after 9 additional week...
International Journal of Pediatric Otorhinolaryngology, 2008
Objective: Recurrent respiratory papillomatosis (RRP) is a benign aerodigestive tract neoplasm. C... more Objective: Recurrent respiratory papillomatosis (RRP) is a benign aerodigestive tract neoplasm. Cidofovir, an antiviral drug, has demonstrated efficacy in slowing and/or reducing RRP recurrence. This investigation examined the differential gene expression of RPP before and after cidofovir use in vivo. Methods: Papillomas were harvested from two patients pre-and post-cidofovir treatment. RNA was extracted from the tissues and separate Serial Analysis of Gene Expression (SAGE) libraries created. Overall gene expression as well as relative gene expression in the four libraries was compared. Results: Over 19,000 tags were found in each of the libraries, with over 6000 unique transcripts identified in the pre-treatment and over 6000 identified in the postcidofovir libraries of both patient 1 and 2. Following cidofovir treatment, the greatest up-regulation was in gene families associated with cell proliferation, metabolism, transport and response to biotic stimuli. Post-treatment up-regulation was seen in numerous specific genes, such as Interferon Regulatory Factor 7 (P = 0.000014), which has been associated with virus-host interactions, passive viral induction of host immune response, and response to DNA damage stimulus. Down-regulation was demonstrated in gene families associated with transcription, regulation of nucleic acid metabolism, and signal transduction. Discussion: Creation of RRP SAGE libraries demonstrates a broad list of genes expressed in RRP, as well as significant differences in gene expression after exposure to cidofovir, potentially allowing for a more thorough understanding of important
The purpose of this study is to evaluate the potential role of food intolerances in the managemen... more The purpose of this study is to evaluate the potential role of food intolerances in the management of recurrent respiratory papillomatosis (RRP). This is a retrospective case review of 4 pediatric patients with RRP. All of the patients, cared for by the primary author between 2005 and 2010, were managed using microdebrider resection, intralesional injection of cidofovir, and required multiple surgeries. Skin prick test (SPT) and/or radioallergosorbent test (RAST) were obtained for 2 patients. Oral food challenge was utilized in all 4 patients. Standard SPT and RAST did not identify any immunoglobulin E (IgE)-based allergens. A detailed medical history followed by an oral food challenge was successful at identifying food intolerances in all 4 patients. When specific food elimination was implemented in these patients' treatments in addition to microdebrider resection and cidofovir injection, statistically significant long-term remissions were achieved. Food intolerance and its impact on RRP and immune dysfunction deserve further investigation and may benefit some patients with RRP.
International Journal of Pediatric Otorhinolaryngology, 2003
Vocal fold paralysis (VFP) is the second most common congenital abnormality that affects the lary... more Vocal fold paralysis (VFP) is the second most common congenital abnormality that affects the larynx. Unilateral cases may be asymptomatic or feature symptoms related to laryngeal incompetence, such as aspiration and dysphonia. Management has traditionally been conservative as a high percentage of these paralyses recover spontaneously. The literature is scant on the acute or chronic management of unilateral vocal fold paralysis related symptoms in children. We present a series of four children (age 21 days, 5 years, 5 years, and 18 years) with unilateral VFP paralysis treated with collagen (Cymmtera) augmentation for control of symptoms related to laryngeal incompetence. Two children (age 21 days and 5 years) were managed in the acute setting. Follow-up has ranged from 4 to 12 months, and all have maintained excellent outcomes. Vocal fold augmentation with collagen is an effective therapeutic option in the management of symptoms related to unilateral VFP and laryngeal incompetence. It decreases the risk of aspiration and improves vocal quality. Collagen augmentation can be used in the acute setting to decrease aspiration, possibly avoiding a tracheotomy or gastrostomy tube placement, or to augment patients with a tracheotomy who are still severely aspirating.
The Annals of otology, rhinology, and laryngology, 2005
Diagnostic and management strategies for adult unilateral vocal fold immobility (UVFI) vary among... more Diagnostic and management strategies for adult unilateral vocal fold immobility (UVFI) vary among otolaryngologists. The aim of this study was to determine the current attitudes and practices regarding laryngeal electromyography (LEMG) for the management of adult UVFI within a cohort of subspecialty laryngologists. A 19-item instrument focused on diagnosis and management of adult UVFI was mailed to active members (n = 249) of the American Broncho-Esophagological Association (ABEA). The subset of questions related to LEMG is reviewed in this report. Statistical analysis using a chi2 test was performed. The survey response rate was 34% (n = 84), with 8 surveys returned incomplete because of pediatric-limited practices. Of the respondents, 75% (n = 57) rely on LEMG for evaluation of UVFI, whereas 25% (n = 19) do not use LEMG. Of those who use LEMG, 54% place their own electrodes and 44% interpret the LEMG results themselves. Monopolar electrodes are used by 57% (n = 25), bipolar electr...
The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation ... more The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation of the laryngeal cartilage window during medialization thyroplasty. Basic science. Forty thyroplasty windows were constructed in fresh, unpreserved cadaver larynges. A 6 x 13-mm rectangular window and a 4 x 4-mm round window were created on each side of the larynges in a symmetrical fashion. A standard surgical drill with a 3-mm cutting burr was used on one side; the ultrasonic surgical aspirator was used on the contralateral side. The time required for window construction was recorded, as was the status of the inner perichondrium at window completion. For creation of the 6 x 13-mm window, a mean time of 128 seconds was required using a standard surgical drill. The mean time using the ultrasonic aspirator device was 91 seconds for the window of the same size (P < .008). For the 4-mm round window, drilling completed the task in a mean time of 63 seconds, compared with 40 seconds (P < .016) for the ultrasonic aspirator. On creation of the 6 x 13-mm window, there were 4 of 10 perichondrial violations in the drilled specimens, and there were no violations in creation of the window of the same size with the ultrasonic aspirator (P = .12). The 4-mm round window had no perichondrium violations in the standard drill group and only 1 of 10 violations in the ultrasonic aspirator group (P = .99). The study suggested that the ultrasonic surgical aspirator device may be an effective, efficient alternative to the standard drill for medialization thyroplasty window creation. Prospective clinical trials are warranted to better characterize its applicability.
Oral lesions in very young children usually have a benign presentation, and only rarely contribut... more Oral lesions in very young children usually have a benign presentation, and only rarely contribute to significant aerodigestive symptomatology. Management begins with early recognition of the pathology and appropriate diagnosis. Hemangiomas, lymphangiomas, and teratomas may present with airway compromise or feeding difficulties, necessitating early intervention.
Our goal was to investigate the presence of laryngeal abnormalities is patients with paradoxical ... more Our goal was to investigate the presence of laryngeal abnormalities is patients with paradoxical vocal fold dysfunction (PVFD). A retrospective chart review was performed of patients referred for evaluation of paradoxical vocal fold dysfunction between July 2002 and December 2002. The patients completed questionnaires at the time of the office visit. Data collected from the medical record included age, gender, duration of symptoms before evaluation, asthma, gastroesophageal reflux symptoms, and laryngoscopic findings. Exercise stress test was performed when suitable. The diagnosis of PVFD was made based on patient history and laryngoscopy. Thirty patients were identified. There was a 27:3 (90%) female predominance, and mean age of presentation at was 28 years (range, 12 to 67 years). The median time from the onset of respiratory symptoms to diagnosis was 4.5 years (range, 0.5 to 30 years). Of the 30 patients, 17 (56%) had asthma, 16 had laryngeal findings suggestive of gastroesophageal reflex disease, 4 (12%) had laryngoscopic findings of chronic laryngitis, and 10 (33%) had additional findings, including laryngomalacia, vocal fold motion impairment, sulcus vocalis, nodules, and subglottic stenosis, mostly in the exercise-induced group. Concomitant laryngeal abnormalities are present in a many patients with PVFD, particularly in those with exercise-induced symptoms. Laryngoscopy is important in the management of these patients.
known medical diagnoses. The most frequent complaint (50%) was shortness of breath, followed by c... more known medical diagnoses. The most frequent complaint (50%) was shortness of breath, followed by change in voice, throat tightening, or choking sensation, coughing, throat clearing, excess saliva, globus, and swallowing complaints. The most common related medical diagnosis was GERD (42%), followed by asthma and allergies. Several patients had undergone prior surgeries, laryngeal trauma, illness, or severe emotional stress around time of onset. A laryngoscopic examination revealed hyperkinetic laryngeal behaviors in 38% of patients. Although 26% of patients had complained of dysphagia or globus, only 1 patient had documented pharyngeal dysphagia. Similarly, less than half of those patients who complained of globus actually had GERD. Finally, behavorial therapy was recommended for 80% of patients.
signs, seizures, and fever in the sinusitis group. Meningeal signs and seizures were more commonl... more signs, seizures, and fever in the sinusitis group. Meningeal signs and seizures were more commonly associated with intracranial disease. Otalgia, fever, mastoid tenderness and erythema were seen in the mastoiditis group. Several children had unremarkable clinical profiles despite multiple evolving intracranial complications. Patients were managed with appropriate parenteral antibiotics and surgical intervention.
false-negative results. Those with moderate to severe obstruction required surgery in more than 8... more false-negative results. Those with moderate to severe obstruction required surgery in more than 85%. There was a significant interobserver agreement only in the extremes.
false-negative results. Those with moderate to severe obstruction required surgery in more than 8... more false-negative results. Those with moderate to severe obstruction required surgery in more than 85%. There was a significant interobserver agreement only in the extremes.
The rehabilitation of glottic incompetence by injection laryngoplasty is important in the managem... more The rehabilitation of glottic incompetence by injection laryngoplasty is important in the management of thoracic surgery patients with vocal cord paralysis. This group of patients presents special considerations that favor injection under local anesthesia. The objective of this study is to characterize our experience with this minimally invasive approach in both the acute and subacute settings. The study was conducted using a retrospective chart review. From a database of 108 patients who received awake percutaneous injection laryngoplasty over a 3-year period, 15 cases were identified that underwent augmentation shortly following thoracic surgery. These records were reviewed for patient demographics, clinical characteristics, complications, and short-term outcomes. Fifteen patients were identified (12 male, 3 female); the age range for the group was 18-91 years (median 5 55 years). All the patients reported vocal improvement following injection; all 15 also were improved by perceptual assessment. Five of six dysphagic patients improved following injection. One patient's injection was aborted due to vocal fold edema; no significant bleeding or airway embarrassment was observed. No procedures were terminated because of patient discomfort. Awake percutaneous injection laryngoplasty for vocal paralysis can be performed safely in the postoperative thoracic surgery patient. Swallowing and voice complaints were almost universally improved following treatment. For patients who cannot tolerate or choose not to have open thyroplasty or vocal fold injection under general anesthesia, this procedure may offer a safe and effective alternative.
Archives of Otolaryngology–Head & Neck Surgery, 2006
Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube... more Objectives: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube obstruction immediately postoperatively in patients receiving TT for otitis media and to compare patients receiving postoperative otic drops with controls.
Archives of Otolaryngology–Head & Neck Surgery, 2004
The activation of signal transducer and activator of transduction (STAT) protein is thought to le... more The activation of signal transducer and activator of transduction (STAT) protein is thought to lead to the genesis of neoplasia by promoting cellular growth and preventing apoptosis, and by immune system modulation; STAT3 protein has also been implicated in tumor survival and propagation in recurrent respiratory papillomatosis (RRP).
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Papers by Nalin Patel