1
|
Sinclair CF, Buczek E, Cottril E, Angelos P, Barczynski M, Ho AS, Makarin V, Musholt T, Scharpf J, Schneider R, Stack BC, Tellez MJ, Tolley N, Woodson G, Wu CW, Randolph G. Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring. Head Neck 2021; 44:460-471. [PMID: 34850992 DOI: 10.1002/hed.26946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Intraoperative neuromonitoring (IONM) techniques have evolved over the past decade into intermittent IONM (I-IONM) and continuous IONM (C-IONM) modes of application. Despite many prior publications on both types of IONM, there remains uncertainty about what outcomes should be measured for each form of IONM. The primary objective of this paper is to define categories of benefit for I-IONM/C-IONM and to clarify and standardize their reporting outcomes. METHODS Expert review consensus statement utilizing modified Delphi methodology. RESULTS I-IONM provides diagnosis, classification, and prevention of nerve injury through accurate and early nerve identification. C-IONM provides real-time information on nerve functional integrity and thus may prevent some types of nerve injury but cannot assist in nerve localization. Sudden mechanisms of nerve injury cannot be predicted or prevented by either technique. CONCLUSIONS I-IONM and C-IONM are complementary techniques. Future studies evaluating the utility of IONM should focus on outcomes that are appropriate to the type of IONM being utilized.
Collapse
Affiliation(s)
- Catherine F Sinclair
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Cottril
- Department of Otolaryngology Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Allen S Ho
- Department of Otolaryngology Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Viktor Makarin
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Thomas Musholt
- Department of Endocrine Surgery, Gutenberg University Mainz, Mainz, Germany
| | - Joseph Scharpf
- Department of Otolaryngology Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Brendan C Stack
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Maria J Tellez
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Neil Tolley
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Gayle Woodson
- Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Che Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Greg Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Dhillon VK, Randolph GW, Stack BC, Lindeman B, Bloom G, Sinclair CF, Woodson G, Brooks JA, Childs LF, Esfandiari NH, Evangelista L, Guardiani E, Quintanilla-Dieck L, Naunheim MR, Shindo M, Singer M, Tolley N, Angelos P, Kupfer R, Banuchi V, Liddy W, Tufano RP. Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment. Head Neck 2020; 42:3779-3794. [PMID: 32954575 DOI: 10.1002/hed.26472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms "immediate vocal fold paralysis" and "partial neural dysfunction" and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group. METHODS A multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta-analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach. RESULTS Twenty-two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with "immediate vocal fold paralysis" and "partial neural dysfunction" after thyroid and parathyroid surgery. CONCLUSION After endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.
Collapse
Affiliation(s)
- Vaninder K Dhillon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University National Capital Region, Bethesda, Maryland, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Brenessa Lindeman
- Department of General Surgery, Surgical Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors' Association, Inc., Olney, Maryland, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Gayle Woodson
- Department of Otolaryngology-Head and Neck Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jennifer A Brooks
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lesley F Childs
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nazanene H Esfandiari
- Department of Internal Medicine, Metabolism, Endocrinology & Diabetes (MEND), University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, California, USA
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Michael Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Neil Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College NHS Trust, London, UK
| | - Peter Angelos
- Department of Surgery, University of Chicago School of Medicine, Chicago, Illinois, USA
| | - Robbi Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York, USA
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, Al-Quaryshi Z, Angelos P, Brauckhoff K, Brooks JA, Cernea CR, Chaplin J, Chen AY, Davies L, Diercks GR, Duh QY, Fundakowski C, Goretzki PE, Hales NW, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Miyauchi A, Orloff L, Rastatter JC, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Stack BC, Tolley NS, Slycke SV, Snyder SK, Urken ML, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Randolph GW. International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope 2018; 128 Suppl 3:S18-S27. [PMID: 30291765 DOI: 10.1002/lary.27360] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/22/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022]
Abstract
The purpose of this publication was to inform surgeons as to the modern state-of-the-art evidence-based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real-time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision-making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18-S27, 2018.
Collapse
Affiliation(s)
- Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University, Third Chair of General Surgery, Krakow, Poland
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Henning Dralle
- Department of General Surgery, University Hospital Halle, Halle/Saale, Germany
| | - Rick Schneider
- Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Zaid Al-Quaryshi
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Peter Angelos
- Division of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jennifer A Brooks
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudio R Cernea
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - John Chaplin
- Department of Otolaryngology-Head and Neck Surgery, Gillies Hospital and Clinics, Epsom, New Zealand
| | - Amy Y Chen
- VA Endocrine Surgery, Department of Otolaryngology Emory University School of Medicine, Atlanta, GA, USA
| | - Louise Davies
- Outcomes Group, Veterans Affairs Medical Center, Norwich, Vermont, U.S.A
| | - Gill R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Quan Yang Duh
- Department of Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Peter E Goretzki
- P.G. Stadtische Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Nordrhein-Westfalen, DE
| | - Nathan W Hales
- Department of Otolaryngology, Uniformed Services of the Health Sciences, San Antonio, Texas, U.S.A.,San Antonio Head and Neck, San Antonio, Texas, U.S.A
| | - Dana Hartl
- Department of Otolaryngology Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Dipti Kamani
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Natalia Kyriazidis
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | | | - Lisa Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Jonathan Serpell
- Breast, Endocrine and General Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University School of Languages, Literatures, Cultures, and Linguistics, Clayton, Victoria, Australia
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Brendan C Stack
- Department of Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Neil S Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College Hospitals NHS Trust, St. Mary's Hospital, London, United Kingdom
| | | | - Samuel K Snyder
- Department of General Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, U.S.A
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Erivelto Volpi
- Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ian Witterick
- Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Richard J Wong
- Department of Surgery-Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A
| | | | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Gregory W Randolph
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
4
|
Schneider R, Randolph GW, Dionigi G, Wu CW, Barczynski M, Chiang FY, Al-Quaryshi Z, Angelos P, Brauckhoff K, Cernea CR, Chaplin J, Cheetham J, Davies L, Goretzki PE, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Orloff L, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Singer MC, Snyder SK, Tolley NS, Van Slycke S, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Dralle H. International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 2018; 128 Suppl 3:S1-S17. [DOI: 10.1002/lary.27359] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Rick Schneider
- Martin Luther University Halle-Wittenberg; Department of General, Visceral, and Vascular Surgery; Halle Germany
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
- Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, at the Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University Hospital G. Martino; University of Messina; Italy
| | - Che-Wei Wu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Marcin Barczynski
- Jagiellonian University, Department of Endocrine Surgery, Third Chair of General Surgery; Krakow Poland
| | - Feng-Yu Chiang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Zaid Al-Quaryshi
- University of Iowa Hospitals and Clinics, Otolaryngology; Iowa City Iowa
| | - Peter Angelos
- University of Chicago; Division of Endocrine Surgery, Department of Surgery; Chicago Illinois
| | - Katrin Brauckhoff
- Haukeland Universitetssjukehus; Department of Breast and Endocrine Surgery; Bergen Norway
| | - Claudio R. Cernea
- University of Sao Paulo Medical School; Department of Head and Neck Surgery; Sao Paulo SP Brazil
| | | | - Jonathan Cheetham
- Cornell University, Clinical Sciences, College of Veterinary Medicine; Ithaca New York
| | - Louise Davies
- VA Outcomes Group at the Veterans Affairs Medical Center; Norwich Vermont
| | - Peter E. Goretzki
- Stadtische Kliniken Neuss Lukaskrankenhaus GmbH; Neuss Nordrhein-Westfalen Germany
| | - Dana Hartl
- Institut Gustave Roussy, Otolaryngology Head & Neck Surgery; Villejuif France
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
| | - Emad Kandil
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
| | - Natalia Kyriazidis
- State University of New York Upstate Medical University; Otolaryngology; Syracuse New York
| | - Whitney Liddy
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Otolaryngology; Chicago Illinois
| | - Lisa Orloff
- Stanford University School of Medicine, Otolaryngology, Division of Head and Neck Surgery; Stanford California
| | | | - Jonathan Serpell
- Alfred Hospital; Melbourne Victoria Australia
- Monash University School of Languages Literatures Cultures and Linguistics; Clayton Victoria Australia
| | | | | | - Michael C. Singer
- Henry Ford Hospital, Otolaryngology-Head & Neck Surgery; Detroit Michigan
| | - Samuel K. Snyder
- University of Texas Rio Grande Valley School of Medicine; Department of General Surgery; Edinburg Texas
| | - Neil S. Tolley
- St. Mary's Hospital, Imperial College Hospitals NHS Trust, St. Mary's Hospital; London United Kingdom
| | | | - Erivelto Volpi
- Hospital das Clinicas-University of Sao Paulo Medical School; Sao Paulo Brazil
| | - Ian Witterick
- Mount Sinai Hospital; Department of Otolaryngology; Toronto Ontario Canada
| | - Richard J. Wong
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Head and Neck Service; New York New York
| | | | - Mark Zafereo
- MD Anderson Cancer Center, Head and Neck Surgery; Houston Texas U.S.A
| | - Henning Dralle
- Allgemeinchirurgie, Uniklinik Halle; Halle/Saale Germany
| |
Collapse
|
5
|
Affiliation(s)
- Craig E. Berzofsky
- ENT Faculty Practice, LLP/New York Medical College, Arsdley, New York, USA
| | - Tali Lando
- ENT Faculty Practice, LLP/New York Medical College, Arsdley, New York, USA
| | - Sandra Ettema
- Southern Illinois University, Springfield, Iliinois, USA
| | | | - Gayle Woodson
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Behkam R, Roberts KE, Bierhals AJ, Jacobs ME, Edgar JD, Paniello RC, Woodson G, Vande Geest JP, Barkmeier-Kraemer JM. Aortic arch compliance and idiopathic unilateral vocal fold paralysis. J Appl Physiol (1985) 2017; 123:303-309. [PMID: 28522763 DOI: 10.1152/japplphysiol.00239.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/15/2017] [Indexed: 01/06/2023] Open
Abstract
Unilateral vocal fold paralysis (UVP) occurs related to recurrent laryngeal nerve (RLN) impairment associated with impaired swallowing, voice production, and breathing functions. The majority of UVP cases occur subsequent to surgical intervention with approximately 12-42% having no known cause for the disease (i.e., idiopathic). Approximately two-thirds of those with UVP exhibit left-sided injury with the average onset at ≥50 yr of age in those diagnosed as idiopathic. Given the association between the RLN and the subclavian and aortic arch vessels, we hypothesized that changes in vascular tissues would result in increased aortic compliance in patients with idiopathic left-sided UVP compared with those without UVP. Gated MRI data enabled aortic arch diameter measures normalized to blood pressure across the cardiac cycles to derive aortic arch compliance. Compliance was compared between individuals with left-sided idiopathic UVP and age- and sex-matched normal controls. Three-way factorial ANOVA test showed that aortic arch compliance (P = 0.02) and aortic arch diameter change in one cardiac cycle (P = 0.04) are significantly higher in patients with idiopathic left-sided UVP compared with the controls. As previously demonstrated by other literature, our finding confirmed that compliance decreases with age (P < 0.0001) in both healthy individuals and patients with idiopathic UVP. Future studies will investigate parameters of aortic compliance change as a potential contributor to the onset of left-sided UVP.NEW & NOTEWORTHY Unilateral vocal fold paralysis results from impaired function of the recurrent laryngeal nerve (RLN) impacting breathing, swallowing, and voice production. A large proportion of adults suffering from this disorder have an idiopathic etiology (i.e., unknown cause). The current study determined that individuals diagnosed with left-sided idiopathic vocal fold paralysis exhibited significantly greater compliance than age- and sex-matched controls. These seminal findings suggest a link between aortic arch compliance levels and RLN function.
Collapse
Affiliation(s)
- Reza Behkam
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kara E Roberts
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona
| | - Andrew J Bierhals
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - M Eileen Jacobs
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gayle Woodson
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jonathan P Vande Geest
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania; .,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Louis J. Fox Center for Vision Restoration, University of Pittsburgh, Pittsburgh, Pennsylvania; and.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie M Barkmeier-Kraemer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Voice Laboratory, University of Utah, Salt Lake City, Utah
| |
Collapse
|
7
|
Sinclair CF, Bumpous JM, Haugen BR, Chala A, Meltzer D, Miller BS, Tolley NS, Shin JJ, Woodson G, Randolph GW. Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement. Head Neck 2016; 38:811-9. [PMID: 26970554 DOI: 10.1002/hed.24409] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/09/2022] Open
Abstract
This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck 38: 811-819, 2016.
Collapse
Affiliation(s)
- Catherine F Sinclair
- Department of Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey M Bumpous
- Department of Otolaryngology, University of Louisville, Louisville, Kentucky
| | | | - Andres Chala
- University of Caldas, Manizales, Caldas, Colombia, South America
| | | | - Barbra S Miller
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Neil S Tolley
- Department of Surgery, Imperial College of London, London, United Kingdom
| | | | - Gayle Woodson
- Department of Otolaryngology, Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Gregory W Randolph
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| |
Collapse
|
8
|
Abstract
BACKGROUND Voice changes commonly occur from thyroidectomy and may be due to neural or nonneural causes. Such changes can be a source of significant morbidity for any patient, but thyroidectomy in the professional singer carries special significance. We test the hypothesis that the career of singers and professional voice users is not impaired after neural monitored thyroid surgery. METHODS A quantitative analysis of pre- and postoperative neural monitored thyroid surgery voice outcomes utilizing three validated vocal instruments-Voice Handicap Index (VHI), Singing Voice Handicap Index (SVHI), and Evaluation of Ability to Sing Easily (EASE)-in a unique series of professional singers/voice users was performed. Additional quantitative analysis related to final intraoperative electromyography (EMG) amplitude, the time to return to performance, and vocal parameters affected during this interval was performed. RESULTS Twenty-seven vocal professionals undergoing thyroidectomy were identified, of whom 60% had surgery for thyroid cancer. Pre- and postsurgery flexible fiberoptic laryngeal exams were normal in all patients. Return to performance rate was 100%, and mean time to performance was 2.26 months (±1.61). All three vocal instrument mean scores, pre-op vs. post-op, were unchanged: VHI, 4.15 (±5.22) vs. 4.04 (±3.85), p=0.9301; SVHI, 11.26 (±14.41) vs.12.07 (±13.09), p=0.8297; and EASE, 6.19 (±9.19) vs. 6.00 (±7.72), p=0.9348. The vocal parameters most affected from surgery until first performances were vocal fatigue (89%), high range (89%), pitch control and modulation (74%), and strength (81%). Final mean intraoperative EMG amplitude was within normal limits for intraoperative stimulation and had no relationship with time to first professional performance (p=0.7199). CONCLUSIONS Neural monitored thyroidectomy, including for thyroid malignancy, in professional voice users is safe without any changes in three different voice/singing instruments, with 100% return to performance. Intraoperative EMG data at the conclusion of surgery and postoperative laryngeal exam were normal in all patients. Specific vocal parameters are transiently affected during the postoperative recovery phase, which is important to outline in the consent process of this unique patient population and may provide insight into the physiologic state of the larynx subsequent to thyroid surgery.
Collapse
Affiliation(s)
- Gregory W Randolph
- 1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- 2Division of Surgical Oncology, Endocrine Surgical Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Niranjan Sritharan
- 1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Phil Song
- 3Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Ramon Franco
- 3Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Dipti Kamani
- 1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Gayle Woodson
- 4Division of Otolaryngology - Head and Neck Surgery, Southern Illinois School of Medicine, Springfield, Illinois
| |
Collapse
|
9
|
Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 2013; 123 Suppl 4:S1-14. [DOI: 10.1002/lary.24301] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery; Jagiellonian University Medical College; Kraków; Poland
| | | | - Claudio R. Cernea
- Department of Head and Neck Surgery; University of São Paulo Medical School; São Paulo; Brazil
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery; Martin Luther University Halle-Wittenberg; Halle; Germany
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences; Endocrine Surgery Research Center, University of Insubria; Varese-Como; Italy
| | - Piero F. Alesina
- Department of Surgery and Center for Minimally Invasive Surgery; Kliniken Essen-Mitte, Academic Teaching Hospital, University of Duisburg-Essen; Essen; Germany
| | - Radu Mihai
- Department of Endocrine Surgery; John Radcliffe Hospital; Oxford; United Kingdom
| | - Camille Finck
- Department of Otorhinolaryngology; University of Liège; Liège; Belgium
| | - Davide Lombardi
- Department of Otorhinolaryngology; University of Brescia; Brescia; Italy
| | - Dana M. Hartl
- Department of Head and Neck Oncology; Institute Gustave Roussy; Villejuif; France
| | | | - Jonathan Serpell
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne; Victoria; Australia
| | - Samuel Snyder
- Department of Surgery; Texas A&M Health Science Center College of Medicine, Scott and White Clinic; Temple; Texas; U.S.A
| | - Erivelto Volpi
- Department of Surgery; Faculty of Medical Sciences-Santa Casa; São Paulo; Brazil
| | - Gayle Woodson
- Department of Surgery, Division of Otolaryngology; Southern Illinois University School of Medicine; Springfield; Illinois; U.S.A
| | - Jean Louis Kraimps
- Department of Endocrine Surgery; Poitiers University, Jean Bernard Hospital; Poitiers; France
| | - Abdullah N. Hisham
- Department of Breast and Endocrine Surgery; Putrajaya Hospital; Putrajaya; Malaysia
| | | |
Collapse
|
10
|
Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121 Suppl 1:S1-16. [PMID: 21181860 DOI: 10.1002/lary.21119] [Citation(s) in RCA: 605] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.
Collapse
Affiliation(s)
- Gregory W Randolph
- Department of Otology and Laryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Objectives I report further experience with arytenoid abduction (AAb), a procedure that enlarges the glottis by external rotation of the arytenoid cartilage and thus moves the vocal process laterally and rostrally, but does not preclude adduction for phonation. Therefore, AAb has the potential to preserve voice in patients with bilateral abductor laryngeal paralysis. Methods I performed a retrospective review of AAb in 11 patients with bilateral laryngeal paralysis and 3 patients with other neurologic causes of glottal airway compromise, ie, adductor breathing dystonia, frequent laryngospasm, and progressive laryngeal breathing dysfunction. Results Seven of the 11 patients with bilateral paralysis had dramatic airway improvement. One patient required a tracheotomy after AAb, and 3 patients with an existing tracheotomy could not be decannulated. Arytenoid abduction relieved airway obstruction in the patient with recurrent laryngospasm and in the child with progressive laryngeal breathing dysfunction, but the patient with adductor breathing dystonia has persistent stridor. The factors associated with a poor airway outcome included prolonged tracheotomy, electromyographic evidence of inspiratory activity of adductor muscles, chronic obstructive pulmonary disease, sleep apnea, and prior cordotomy or arytenoidectomy. Conclusions Arytenoid abduction is most effective in patients with bilateral laryngeal paralysis of less than 1 year's duration who do not have unfavorable laryngeal adductor activity.
Collapse
Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois
| |
Collapse
|
12
|
Woodson G. Arytenoid Abduction: Indications and Limitations. Ann Otol Rhinol Laryngol 2010. [DOI: 10.1177/000348941011901117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives I report further experience with arytenoid abduction (AAb), a procedure that enlarges the glottis by external rotation of the arytenoid cartilage and thus moves the vocal process laterally and rostrally, but does not preclude adduction for phonation. Therefore, AAb has the potential to preserve voice in patients with bilateral abductor laryngeal paralysis. Methods I performed a retrospective review of AAb in 11 patients with bilateral laryngeal paralysis and 3 patients with other neurologic causes of glottal airway compromise, ie, adductor breathing dystonia, frequent laryngospasm, and progressive laryngeal breathing dysfunction. Results Seven of the 11 patients with bilateral paralysis had dramatic airway improvement. One patient required a tracheotomy after AAb, and 3 patients with an existing tracheotomy could not be decannulated. Arytenoid abduction relieved airway obstruction in the patient with recurrent laryngospasm and in the child with progressive laryngeal breathing dysfunction, but the patient with adductor breathing dystonia has persistent stridor. The factors associated with a poor airway outcome included prolonged tracheotomy, electromyographic evidence of inspiratory activity of adductor muscles, chronic obstructive pulmonary disease, sleep apnea, and prior cordotomy or arytenoidectomy. Conclusions Arytenoid abduction is most effective in patients with bilateral laryngeal paralysis of less than 1 year's duration who do not have unfavorable laryngeal adductor activity.
Collapse
Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University
School of Medicine, Springfield, Illinois
| |
Collapse
|
13
|
Woodson G. Arytenoid abduction: indications and limitations. Ann Otol Rhinol Laryngol 2010; 119:742-748. [PMID: 21140633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES I report further experience with arytenoid abduction (AAb), a procedure that enlarges the glottis by external rotation of the arytenoid cartilage and thus moves the vocal process laterally and rostrally, but does not preclude adduction for phonation. Therefore, AAb has the potential to preserve voice in patients with bilateral abductor laryngeal paralysis. METHODS I performed a retrospective review of AAb in 11 patients with bilateral laryngeal paralysis and 3 patients with other neurologic causes of glottal airway compromise, ie, adductor breathing dystonia, frequent laryngospasm, and progressive laryngeal breathing dysfunction. RESULTS Seven of the 11 patients with bilateral paralysis had dramatic airway improvement. One patient required a tracheotomy after AAb, and 3 patients with an existing tracheotomy could not be decannulated. Arytenoid abduction relieved airway obstruction in the patient with recurrent laryngospasm and in the child with progressive laryngeal breathing dysfunction, but the patient with adductor breathing dystonia has persistent stridor. The factors associated with a poor airway outcome included prolonged tracheotomy, electromyographic evidence of inspiratory activity of adductor muscles, chronic obstructive pulmonary disease, sleep apnea, and prior cordotomy or arytenoidectomy. CONCLUSIONS Arytenoid abduction is most effective in patients with bilateral laryngeal paralysis of less than 1 year's duration who do not have unfavorable laryngeal adductor activity.
Collapse
Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9662, USA
| |
Collapse
|
14
|
Zaya NE, Woodson G. Proton Pump Inhibitor Suppression of Calcium Absorption Presenting as Respiratory Distress in a Patient with Bilateral Laryngeal Paralysis and Hypocalcemia. Ear Nose Throat J 2010. [DOI: 10.1177/014556131008900209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report an unusual case of hypocalcemia and respiratory distress related to acid-suppressive therapy. The patient was a 50-year-old woman with bilateral laryngeal paralysis and hypoparythyroidism resulting from a thyroidectomy performed more than 30 years previously. She required large doses of calcium supplementation to maintain a normal calcium level. Her airway had been marginally adequate. A few weeks prior to presentation, she began to experience increasing dyspnea. Examination was suggestive of laryngopharyngeal reflux, and she was started on a therapeutic trial of esomeprazole 40 mg twice daily. Three days later, she presented to the emergency room with airway distress. Laboratory studies indicated that the patient had hypocalcemia. The esomeprazole was discontinued, and she was treated with intravenous calcium; her symptoms resolved. We attribute the airway distress to tetany in synkinetically reinnervated laryngeal adductor muscles. We recommend that acid-suppressive therapy should be used with caution in patients with hypoparathyroidism or hypocalcemia.
Collapse
Affiliation(s)
- Ninef E. Zaya
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Gayle Woodson
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| |
Collapse
|
15
|
Zaya NE, Woodson G. Proton pump inhibitor suppression of calcium absorption presenting as respiratory distress in a patient with bilateral laryngeal paralysis and hypocalcemia. Ear Nose Throat J 2010; 89:78-80. [PMID: 20155676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report an unusual case of hypocalcemia and respiratory distress related to acid-suppressive therapy. The patient was a 50-year-old woman with bilateral laryngeal paralysis and hypoparythyroidism resulting from a thyroidectomy performed more than 30 years previously. She required large doses of calcium supplementation to maintain a normal calcium level. Her airway had been marginally adequate. A few weeks prior to presentation, she began to experience increasing dyspnea. Examination was suggestive of laryngopharyngeal reflux, and she was started on a therapeutic trial of esomeprazole 40 mg twice daily. Three days later, she presented to the emergency room with airway distress. Laboratory studies indicated that the patient had hypocalcemia. The esomeprazole was discontinued, and she was treated with intravenous calcium; her symptoms resolved. We attribute the airway distress to tetany in synkinetically reinnervated laryngeal adductor muscles. We recommend that acid-suppressive therapy should be used with caution in patients with hypoparathyroidism or hypocalcemia.
Collapse
Affiliation(s)
- Ninef E Zaya
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9662, USA
| | | |
Collapse
|
16
|
Zanchetta J, Høiseth A, Kendler D, Yuen C, Brown J, Stonkus S, Goemaere S, Recknor C, Woodson G, Bolognese M, Franek E, Brandi M, Wang A, Libanati C, McClung M. Denosumab Increased BMD of the Lumbar Spine, Total Hip, Femoral Neck, and Trochanter as Measured by QCT in Postmenopausal Women with Osteoporosis. J Clin Densitom 2010. [DOI: 10.1016/j.jocd.2010.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Lay PC, Woodson G. SP352 – Balloon-assisted removal of obstructing bronchial granuloma. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Abstract
Objectives: I review the literature on management of neurologic disorders of the larynx. Methods: I reviewed the literature on laryngeal physiology, clinical evaluation of laryngeal function, and the clinical presentation and treatment of neurologic disorders that frequently affect the larynx. Results: Laryngeal function is complex, as this organ is important in breathing, speech, and swallowing. Coordination of these roles is very susceptible to disruption by neurologic disorders. Diagnosis of neurologic disease is primarily based on history and physical examination; however, the diagnosis of laryngeal dysfunction is frequently overlooked, because the larynx is not easily accessible to examination by non-otolaryngologists. Evaluation of laryngeal function includes listening to the voice, systematic observation of the larynx during speech and nonspeech tasks, and, sometimes, ancillary tests. Neurologic disorders that affect laryngeal function include Parkinson's disease, essential tremor, stroke, amyotrophic lateral sclerosis, multiple sclerosis, and dystonia. The otolaryngologist can sometimes provide treatment to specifically improve symptoms of laryngeal involvement. Conclusions: Otolaryngology consultation is important in the diagnosis and treatment of neurologic disorders that affect laryngeal function. The otolaryngologist should be able to perform a systematic evaluation of laryngeal and pharyngeal function, and should be aware of the clinical presentation of neurologic disorders that affect the larynx.
Collapse
|
19
|
Abstract
AbstractAccepted concepts of the pathophysiology and treatment of laryngeal paralysis have changed over the years. It has long been observed that symptoms of laryngeal paralysis vary greatly, both between patients and over time. There have been various theories to explain these differences. This article reviews how these ideas have changed over time as research has produced new information. Currently, the most popular view is that the laryngeal nerve regenerates after injury, albeit incompletely and inconsistently, and that variations in symptoms and laryngeal posture can be accounted for by muscle activity.
Collapse
Affiliation(s)
- G Woodson
- Division of Otolaryngology, Southern Illinois University, Springfield, Illinois 62794-9662, USA.
| |
Collapse
|
20
|
Abstract
OBJECTIVES Bilateral laryngeal paralysis results in airway obstruction, but the voice is often nearly normal. Tracheotomy provides an airway and preserves voice. Surgical procedures to statically enlarge the glottis can permit decannulation, but do so at the expense of the voice. Motion analysis in cadaver larynges has demonstrated that adductor and abductor muscles rotate the arytenoid cartilage around different axes. We sought to determine whether external rotation of the arytenoid cartilage could enlarge the airway without abolishing residual phonatory adduction. METHODS We performed arytenoid abduction in 6 patients with obstructing laryngeal paralysis. A suture was placed in the muscular process and posterior-inferior traction was applied, anchoring the suture to the inferior cornu of the thyroid cartilage. Outcomes were evaluated by assessing airway symptoms, by assessing the voice, and by documentation of laryngeal motion via videolaryngoscopy. RESULTS Three patients with severe stridor had marked relief of symptoms, and 2 of the 3 tracheotomy-dependent patients were decannulated. Three patients had good voices, 2 had mild breathiness, and 1 was very breathy. CONCLUSIONS Arytenoid abduction is a promising treatment for relieving airway obstruction in patients with laryngeal paralysis. It has the potential to preserve voice in patients with residual phonatory adduction.
Collapse
Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9662, USA
| | | |
Collapse
|
21
|
Abstract
Botulinum toxin has been widely accepted as an effective therapy for controlling the symptoms of adductor spasmodic dysphonia (ADSD). Reported experience with botulinum treatment for abductor spasmodic dysphonia (ABSD) has been less impressive. Factors that may impair outcomes for ABSD include differences in the pathophysiology of ADSD and ABSD and limitation of maximal dose from airway restriction with posterior cricoarytenoid muscle (PCA) weakness. We report our experience with botulinum injection of the PCA with an asymmetric dose escalation protocol, based on clinical observations that in ABSD, abductor spasms are often stronger on one side, usually the left. The nondominant side was injected with 1.25 units. Dominant side dose began at 5 units, with step-wise increments of 5 units per week until one of three endpoints was reached: Elimination of breathy voice breaks, complete abductor paralysis of the dominant side, or airway compromise. Fourteen of 17 patients achieved good or fair voice, with dominant-side doses ranging from 10 to 25 units. Exercise intolerance limited PCA dose in two patients. One patient had persisting breathiness that improved with medialization thyroplasty. Asymmetric botulinum toxin injection into PCA muscles can suppress abductor spasm in patients with ABSD, but breathiness may persist, because of inadequate glottal closure.
Collapse
Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University School of Medicine, St. Johns/SIU Voice Center, Springfield, Illinois 62794-9662, USA.
| | | | | |
Collapse
|
22
|
Affiliation(s)
- Gayle Woodson
- Southern Illinois University School of Medicine Springfield, Illinois
| |
Collapse
|
23
|
Woodson G. Women in otolaryngology. Ear Nose Throat J 2004; 83:443-4. [PMID: 15372906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
|
24
|
Baker SE, Sapienza CM, Martin D, Davenport S, Hoffman-Ruddy B, Woodson G. Inspiratory pressure threshold training for upper airway limitation: a case of bilateral abductor vocal fold paralysis. J Voice 2003; 17:384-94. [PMID: 14513961 DOI: 10.1067/s0892-1997(03)00066-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A single subject design was used to determine if pressure threshold training strengthens the inspiratory muscles in a subject with a limited glottal airway as well as diminish dyspnea and improve parameters of speech. The subject was a 19-year-old woman whose glottal airway was limited due to bilateral abductor vocal fold paralysis following a thyroidectomy. A 5-week inspiratory muscle strength-training program was implemented using a pressure-threshold trainer to strengthen the inspiratory muscles with the intent of enabling the generation of higher inspiratory pressures. The pressure threshold on the trainer was set at 75% of the subject's maximum inspiratory pressure (MIP). The subject was required to generate sufficient inspiratory pressure to bring air through the trainer during an inspiratory maneuver. MIP was the dependent variable used as an indication of inspiratory muscle strength. MIP increased by 47% following the training program. Maximal minute ventilation and oxygen uptake increased posttraining. Dyspnea during exercise and speech decreased as reported by the subject. Total reading duration and pause duration demonstrated a declining trend during connected speech. The results indicated that inspiratory muscle training using a pressure threshold device improves functional tasks such as exercise and speech in a subject with upper airway limitation.
Collapse
Affiliation(s)
- Susan E Baker
- Department of Communication Sciences and Disorders, 63 Dauer Hall, PO Box 117420, University of Florida, Gainesville, FL 32611, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Woodson G. Rose. Arch Otolaryngol Head Neck Surg 2003; 129:814. [PMID: 12925336 DOI: 10.1001/archotol.129.8.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gayle Woodson
- Department of Otolaryngology, University of Florida, PO Box 100264, Gainesville, FL 32610-0624, USA.
| |
Collapse
|
26
|
Sapienza CM, Cannito MP, Murry T, Branski R, Woodson G. Acoustic variations in reading produced by speakers with spasmodic dysphonia pre-botox injection and within early stages of post-botox injection. J Speech Lang Hear Res 2002; 45:830-843. [PMID: 12381042 DOI: 10.1044/1092-4388(2002/067)] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Acoustic analysis of a reading passage was used to identify the abnormal phonatory events associated with adductor spasmodic dysphonia (ADSD) pre- and postinjection of Botulinum Toxin A (Botox). Thirty-one patients (age 22 to 74 years) diagnosed with ADSD were included for study. All patients were new recipients of Botox, and the examination of their voice occurred before and after their initial injection of Botox. Acoustic events were identified from reading samples of the Rainbow Passage produced by each of the patients. These events were examined from sentences containing primarily voiced sound segments. Dependent variables included the number of phonatory breaks, frequency shifts, and aperiodic segments--all variables previously defined by the investigators. Additionally, calculated variables were made of the percentage of time these events occurred relative to the duration of the cumulative voiced segments. A sex- and age-matched control group (+/-2 years) was included for statistical comparison. Results indicated that those with ADSD produced more aberrant acoustic events than the controls. Aperiodicity was the predominant acoustic event produced during the reading, followed by frequency shifts and phonatory breaks. Within the ADSD group, the number of atypical acoustic events decreased following Botox injection. It is important that the occurrence of specific abnormal acoustic events was sufficient to differentiate the disordered speakers from the controls following as well as preceding initial Botox injection, as indicated by discriminant function analysis. This paper complements our previous work using this acoustic analysis method for defining the abnormal events present in the voice of those with ADSD and further suggests that these measures can be used in conjunction with perceptual impressions to differentiate speakers on the basis of initial severity.
Collapse
Affiliation(s)
- Christine M Sapienza
- Department of Communication Sciences and Disorders, University of Florida, Gainesville 32611, USA.
| | | | | | | | | |
Collapse
|
27
|
Miller PD, Woodson G, Licata AA, Ettinger MP, Mako B, Smith ME, Wang L, Yates SJ, Melton ME, Palmisano JJ. Rechallenge of patients who had discontinued alendronate therapy because of upper gastrointestinal symptoms. Clin Ther 2000; 22:1433-42. [PMID: 11192135 DOI: 10.1016/s0149-2918(00)83042-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There have been reports from physicians in clinical practice that up to 30% of patients taking bisphosphonate therapy develop upper gastrointestinal (UGI) symptoms, many or most of which they assume to be related to the drug. However, in several large placebo-controlled clinical trials of bisphosphonates, the incidence of UGI symptoms has been > or =30%, even among patients receiving placebo, perhaps reflecting a high background incidence of UGI events in osteoporotic patients. OBJECTIVE To assess the relationship between alendronate treatment and UGI complaints in patients who had discontinued treatment with alendronate in clinical practice because of UGI symptoms, we compared the incidence of such events on rechallenge with alendronate or placebo. METHODS This was a multicenter, double-blind trial in which postmenopausal women with osteoporosis who had previously discontinued alendronate therapy because of a UGI adverse experience were randomized to daily treatment with either alendronate 10 mg or matching placebo (1:1 ratio) for 8 weeks. The primary end point was the cumulative incidence of discontinuations due to any UGI adverse experience. Secondary end points were the incidence of any clinical adverse experiences and the percentage change from baseline in urinary N-telopeptide adjusted for urinary creatinine at week 8. RESULTS A total of 172 women were included in the study. They were a mean of 20.9 years past menopause, ranging in age from 41 to 90 years (mean, 67.0 years); 90.7% were white. On rechallenge, 14.8% (13/88) of patients in the alendronate group and 16.7% (14/84) in the placebo group discontinued treatment because of UGI adverse experiences. CONCLUSION The results of this study suggest that many UGI adverse experiences reported during therapy with alendronate may reflect a high background incidence of UGI complaints and an increased sensitivity to detection of such complaints, rather than a causal relationship to therapy.
Collapse
Affiliation(s)
- P D Miller
- Colorado Center for Bone Research, Lakewood, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Neurolaryngology is the study and management of disorders that impair neural control of the larynx and pharynx in breathing, swallowing, and speech. Advances in functional endoscopy and fluoroscopy and increased understanding of neurophysiology have greatly facilitated the development of this discipline. The empiric observations of effective therapies have been equally important, however. In comparison to other fields of medicine, neurolaryngology is a relatively young discipline, and much remains to be discovered and developed.
Collapse
Affiliation(s)
- G Woodson
- Department of Otolaryngology, University of Tennessee, Memphis, Tennessee 38163, USA
| |
Collapse
|
29
|
Abstract
T-score discordance is observed when the difference between the hip and spine are sufficient to result in the two measurement sites falling into two different diagnoses as defined by the World Health Organization (WHO) classification system. This article examines the prevalence of patterns of T-score discordance between the total hip and PA L1-L4 total spine sites in 5051 female patients undergoing dual X-ray absorptiometry (DXA) bone density testing at a community-based outpatient osteoporosis testing center between 1989 and 1999. Data for all patients was stored in a relational database that was searched for various combinations of T-scores reflecting the nine possible discordant and concordant permutations of normal, osteopenia, and osteoporosis. The WHO diagnostic classification system for osteoporosis categorizes patients into three diagnoses-normal, osteopenia, or osteoporosis-and is based upon their T-score. This system was used to determine the patient diagnoses for the various T-score results in the PA L1-L4 lumbar spine and total hip. Concordance was defined as present when the spine and hip T-score placed the patient in the same diagnostic class. Minor discordance was defined as present when the difference between two sites is no more than one WHO diagnostic class. Major discordance was defined as present when one site is osteoporotic and the other site is normal. The results showed that in 56% of the cases the T-score concordance was present between the hip and the spine, 39% of the time minor discordance was observed, and 5% of the time major discordance was found. Discordance was also classified into five etiological types: physiologic, pathophysiologic, anatomic, artifactual, and technical. In summary, this data analysis showed that while T-score concordance is most commonly observed, minor discordance is seen in about two out of every five patients tested with DXA between the spine and hip sites. Major discordance was uncommon, being found in only 1 out of every 20 patients tested.
Collapse
Affiliation(s)
- G Woodson
- The Atlanta Research Center, Department of Medicine, Emory School of Medicine, Decatur, GA 30033, USA.
| |
Collapse
|
30
|
Affiliation(s)
- G Woodson
- University of Tennessee, Memphis, Department of Otolaryngology, 38163, USA
| |
Collapse
|
31
|
Woodson G. Medical Education and Research: The Impact of a Changing Healthcare System. Ear Nose Throat J 1998. [DOI: 10.1177/014556139807700809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gayle Woodson
- Department of Otolaryngology, University of Tennessee College of Medicine, Memphis, Tennessee
| |
Collapse
|
32
|
Woodson G. Medical education and research: the impact of a changing healthcare system. Ear Nose Throat J 1998; 77:610-3. [PMID: 9745177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- G Woodson
- Department of Otolaryngology, University of Tennessee College of Medicine, Memphis 38163, USA.
| |
Collapse
|
33
|
Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, Robbins KT. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 1998; 124:589-92. [PMID: 9604988 DOI: 10.1001/archotol.124.5.589] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the functional outcomes of weight loss and eating following a targeted chemoradiation protocol consisting of a selective supradose of intra-arterial cisplatin (150 mg/m2 per week for 4 weeks) with parenteral sodium thiosulfate and external-beam irradiation (1.8-2.0 Gy per fraction per day for 35 days). SUBJECTS AND DESIGN Forty-seven patients with advanced head and neck cancer treated with a targeted chemoradiation protocol were monitored for weight and eating status before treatment and as long as 18 months after treatment. RESULTS A statistically significant weight loss (P<.001) occurred during the targeted chemoradiation protocol, with a mean weight ratio of 90% of the starting weight. The ability to eat also declined, with an increase in reported swallowing difficulties and a need for percutaneous endoscopic gastrostomy tubes from 4 (9%) to 12 (26%). There were no significant changes in weight after the initial weight loss. Tumor stage and nodal involvement had no effect on weight loss. At the start of treatment, 18 patients (38%) reported normal eating and 4 (8%) required a feeding tube. By 18 months after treatment, 41 (87%) were eating normally, 34 (72%) reported normal eating, and 6 (13%) required a percutaneous endoscopic gastrostomy tube. CONCLUSIONS Patients undergoing a targeted chemoradiation protocol for head and neck cancer lost about 10% of their pretreatment weight and had a decline in eating ability. Difficulty swallowing during the treatment may be due to adverse effects such as mucositis and nausea. By 18 months after therapy, most were able to eat normally and maintain their weight.
Collapse
Affiliation(s)
- L A Newman
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, College of Medicine, Memphis 38163, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Aspiration caused by unilateral combined laryngeal and pharyngeal paralysis is a serious clinical problem. This article reviews the abnormal physiology, which includes glottal incompetence, impaired pharyngeal propulsion, and sensory loss, and reports the results of surgical treatment of, 13 patients who had significant dysphagia and aspiration caused by unilateral laryngeal and pharyngeal paralysis. In eight patients the cause was surgical resection or trauma of the tenth cranial nerve, with concomitant twelfth nerve injury in four. Four patients had central lesions. One patient had a surgical tenth cranial nerve injury as well as a stroke. Thyroplasty, alone in two patients, and combined with cricopharyngeal myotomy in a third, improved voice, but not swallowing. In all patients treated by arytenoid adduction plus cricopharyngeal myotomy, aspiration was eliminated, and patients gained weight. Six of these patients had been dependent on enteral tube feedings. The results support the safety and efficacy of simultaneous arytenoid adduction and cricopharyngeal myotomy for dysphagia caused by combined laryngeal and pharyngeal paralysis.
Collapse
Affiliation(s)
- G Woodson
- Department of Otolaryngology, University of Tennessee, Memphis 38163, USA
| |
Collapse
|
35
|
Abstract
Aspiration caused by unilateral combined laryngeal and pharyngeal paralysis is a serious clinical problem. This article reviews the abnormal physiology, which includes glottal incompetence, impaired pharyngeal propulsion, and sensory loss, and reports the results of surgical treatment of, 13 patients who had significant dysphagia and aspiration caused by unilateral laryngeal and pharyngeal paralysis. In eight patients the cause was surgical resection or trauma of the tenth cranial nerve, with concomitant twelfth nerve injury in four. Four patients had central lesions. One patient had a surgical tenth cranial nerve injury as well as a stroke. Thyroplasty, alone in two patients, and combined with cricopharyngeal myotomy in a third, improved voice, but not swallowing. In all patients treated by arytenoid adduction plus cricopharyngeal myotomy, aspirationwas eliminated, and patients gained weight. Six of these patients had been dependent on enteral tube feedings. The results support the safety and efficacy of simultaneous arytenoid adduction and cricopharyngeal myotomy for dysphagia caused by combined laryngeal and pharyngeal paralysis.
Collapse
Affiliation(s)
- G Woodson
- Department of Otolaryngology, University of Tennessee, Memphis 38163, USA
| |
Collapse
|
36
|
Neely JG, Woodson G. Medical scholarship: how can a practicing surgeon do research? Otolaryngol Head Neck Surg 1996; 115:275-7. [PMID: 8861879 DOI: 10.1016/s0194-5998(96)70039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
37
|
Abstract
None of the consultants was comfortable with the idea of proceeding with the biopsy of a neck mass in an outpatient clinic setting. All warned about the possible relationship of the mass with important anatomic structures. With regard to needing further information, physicians requested an imaging study of the neck, thoracic cavity, and mediastinum (Dr. Cummings); pelvic examination, breast examination with mammography, chest x-ray, and CBC (Dr. Weymuller); flexible endoscopy, chest x-ray, CBC, and MRI (Dr. Woodson). All three experts advised her to put IVF on hold. After the work-up, they would proceed with a biopsy of the mass and send the tissue to the pathologist in saline. In addition, tissue should be examined for fungus and AFB (Drs. Weymuller and Woodson). Because the patient proceeded with IVF and became pregnant, two experts advised her to abort and proceed with treatment for her Hodgkin's disease (Drs. Cummings and Woodson). The other option was for her to continue her pregnancy and proceed with radiotherapy to her neck, with shielding of the abdomen (Dr. Weymuller).
Collapse
Affiliation(s)
- C W Cummings
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD
| | | | | |
Collapse
|
38
|
Affiliation(s)
- P H Ward
- University of California School of Medicine, Los Angeles
| | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Vacca LL, Hewett D, Woodson G. A comparison of methods using diaminobenzidine (DAB) to localize peroxidases in erythrocytes, neutrophils, and peroxidase-antiperoxidase complex. Stain Technol 1978; 53:331-6. [PMID: 89720 DOI: 10.3109/10520297809111955] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Reactions using diaminobenzidine (DAB) to localize the enzyme peroxidase in neutrophils and peroxidase-antiperoxidase (PAP) complex during immunological staining are usually performed in Tris-HCl or phosphate buffer at pH 7.2-7.6. However, DAB solutions at pH 7.2-7.6 often demonstrate erythrocyte pseudoperoxidase as well. By lowering the pH of the DAB solutions, it is possible to selectively suppress the reactivity of pseudoperoxidase while maintaining optimal reactions in neutrophils and PAP complex. For this purpose we recommend ammonium acetate-citric acid buffer at pH 5.5 (pH 5.0-6.0) containing 44 mg DAB per 100 ml buffer and 0.003%-0.03% with respect to H2O2.
Collapse
|