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Barnett E, Heaton JT, Petrillo RH, Purnell P, Burns JA. Minimizing Thermal Damage During Thulium Laser-Assisted Partial Arytenoidectomy: Pulsed Versus Continuous Cutting in an Ex-Vivo Calf Model. Ann Otol Rhinol Laryngol 2023; 132:1355-1360. [PMID: 36824026 DOI: 10.1177/00034894231157648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The 2 µm-wavelength thulium laser is an effective cutter during partial arytenoidectomy, but thermal trauma can damage adjacent laryngeal tissue. Pulsing laser energy may reduce trauma when compared to continuous-wave cutting. This study measured temperature changes, thermal trauma, and time to complete partial arytenoidectomy, with and without pulsing, in an ex-vivo calf model. METHODS Tissue temperature and time to complete a trans-cartilaginous cut were measured during partial arytenoidectomy on ex-vivo calf vocal folds (N = 24) using a thulium laser in continuous-wave (CW, N = 12) and pulsed-wave (PW, N = 12) modes. Energy was 5 W for CW and PW cuts; pulse-widths were 250, 500, and 750 ms. Thermal damage was analyzed histologically by measuring the depth of lactate dehydrogenase (LDH) inactivation perpendicular to the laser-cut edge at the vocal process. Paired t-tests compared CW and PW modes. RESULTS Change in temperature was lower using CW (6.5°C) compared to PW modes (250 ms = 18°; 500 ms = 16°; 750 = 19°; P < .05). Trans-cartilaginous cuts were completed faster using CW (37 seconds) compared to PW (250 ms = 136 seconds; 500 ms = 61 seconds; 750 = 44 seconds; P < .05), and both modes delivered the same total Joules. The average depth of LDH depletion (thermal damage) was similar for all cuts. CONCLUSIONS 1. Thulium laser cuts in continuous-mode unexpectedly produced less tissue heating yet created similar thermal damage than pulsed-mode cuts during simulated partial arytenoidectomy. 2. Trans-cartilaginous cuts were completed significantly faster in continuous-mode as compared to pulsed-mode cutting. 3. Pulsing the thulium laser does not minimize thermal damage compared to continuous wave cutting during thulium laser-assisted partial arytenoidectomy.
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Affiliation(s)
| | - James T Heaton
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
| | - Robert H Petrillo
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
| | - Philip Purnell
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
| | - James A Burns
- Harvard Medical School, Boston, MA, USA
- Department of Surgery - Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation - Massachusetts General Hospital, Boston, MA, USA
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2
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Salis AT, Bray SCE, Lee MSY, Heiniger H, Barnett R, Burns JA, Doronichev V, Fedje D, Golovanova L, Harington CR, Hockett B, Kosintsev P, Lai X, Mackie Q, Vasiliev S, Weinstock J, Yamaguchi N, Meachen JA, Cooper A, Mitchell KJ. Lions and brown bears colonized North America in multiple synchronous waves of dispersal across the Bering Land Bridge. Mol Ecol 2022; 31:6407-6421. [PMID: 34748674 DOI: 10.1111/mec.16267] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/09/2020] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 01/13/2023]
Abstract
The Bering Land Bridge connecting North America and Eurasia was periodically exposed and inundated by oscillating sea levels during the Pleistocene glacial cycles. This land connection allowed the intermittent dispersal of animals, including humans, between Western Beringia (far northeast Asia) and Eastern Beringia (northwest North America), changing the faunal community composition of both continents. The Pleistocene glacial cycles also had profound impacts on temperature, precipitation and vegetation, impacting faunal community structure and demography. While these palaeoenvironmental impacts have been studied in many large herbivores from Beringia (e.g., bison, mammoths, horses), the Pleistocene population dynamics of the diverse guild of carnivorans present in the region are less well understood, due to their lower abundances. In this study, we analyse mitochondrial genome data from ancient brown bears (Ursus arctos; n = 103) and lions (Panthera spp.; n = 39), two megafaunal carnivorans that dispersed into North America during the Pleistocene. Our results reveal striking synchronicity in the population dynamics of Beringian lions and brown bears, with multiple waves of dispersal across the Bering Land Bridge coinciding with glacial periods of low sea levels, as well as synchronous local extinctions in Eastern Beringia during Marine Isotope Stage 3. The evolutionary histories of these two taxa underline the crucial biogeographical role of the Bering Land Bridge in the distribution, turnover and maintenance of megafaunal populations in North America.
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Affiliation(s)
- Alexander T Salis
- Australian Centre for Ancient DNA (ACAD), School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Division of Vertebrate Zoology, American Museum of Natural History, New York, New York, USA
| | - Sarah C E Bray
- Australian Centre for Ancient DNA (ACAD), School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Michael S Y Lee
- College of Science and Engineering, Flinders University, Bedford Park, South Australia, Australia.,South Australian Museum, Adelaide, South Australia, Australia
| | - Holly Heiniger
- Australian Centre for Ancient DNA (ACAD), School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ross Barnett
- Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - James A Burns
- Curator Emeritus, Royal Alberta Museum, Edmonton, Alberta, Canada
| | | | - Daryl Fedje
- Department of Anthropology, University of Victoria, Victoria, B.C, Canada
| | | | - C Richard Harington
- Curator Emeritus and Research Associate, Research Division (Paleobiology), Canadian Museum of Nature, Ottawa, Canada
| | - Bryan Hockett
- US Department of Interior, Bureau of Land Management, Nevada State Office, Reno, Nevada, USA
| | - Pavel Kosintsev
- Institute of Plant and Animal Ecology, Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Department of History, Ural Federal University, Yekaterinburg, Russia
| | - Xulong Lai
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences, Wuhan, Hubei, China
| | - Quentin Mackie
- Department of Anthropology, University of Victoria, Victoria, B.C, Canada
| | - Sergei Vasiliev
- Institute of Archaeology and Ethnography, Russian Academy of Sciences, Russia
| | - Jacobo Weinstock
- Faculty of Humanities (Archaeology), University of Southampton, UK
| | - Nobuyuki Yamaguchi
- Institute of Tropical Biodiversity and Sustainable Development, University Malaysia Terengganu, Kuala Nerus, Malaysia
| | - Julie A Meachen
- Anatomy Department, Des Moines University, Des Moines, Iowa, USA
| | - Alan Cooper
- South Australian Museum, Adelaide, South Australia, Australia
| | - Kieren J Mitchell
- Australian Centre for Ancient DNA (ACAD), School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Zoology, Otago Palaeogenetics Laboratory, University of Otago, Dunedin, New Zealand
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Van Stan JH, Ortiz AJ, Marks KL, Toles LE, Mehta DD, Burns JA, Hron T, Stadelman-Cohen T, Krusemark C, Muise J, Fox AB, Nudelman C, Zeitels S, Hillman RE. Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females. J Speech Lang Hear Res 2021; 64:3446-3455. [PMID: 34463536 PMCID: PMC8642084 DOI: 10.1044/2021_jslhr-21-00082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 05/31/2023]
Abstract
Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = -0.25). The posttreatment patient group's DPI was still significantly higher than the control group (d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Carol Krusemark
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jason Muise
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | - Charles Nudelman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Steven Zeitels
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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Baird BJ, Tynan MA, Tracy LF, Heaton JT, Burns JA. Surgeon Positioning During Awake Laryngeal Surgery: An Ergonomic Analysis. Laryngoscope 2021; 131:2752-2758. [PMID: 34296439 DOI: 10.1002/lary.29717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/29/2021] [Revised: 05/06/2021] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings. STUDY DESIGN Prospective cohort study. METHODS Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso. RESULTS The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly. CONCLUSION Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Brandon J Baird
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Monica A Tynan
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - James T Heaton
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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5
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Van Stan JH, Ortiz AJ, Cortes JP, Marks KL, Toles LE, Mehta DD, Burns JA, Hron T, Stadelman-Cohen T, Krusemark C, Muise J, Fox-Galalis AB, Nudelman C, Zeitels S, Hillman RE. Differences in Daily Voice Use Measures Between Female Patients With Nonphonotraumatic Vocal Hyperfunction and Matched Controls. J Speech Lang Hear Res 2021; 64:1457-1470. [PMID: 33900807 PMCID: PMC8608188 DOI: 10.1044/2021_jslhr-20-00538] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency (f o), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1-H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased f o (Cohen's d = 0.6), reduced CPP (d = -0.9), and less positive H1-H2 skewness (d = -1.1). Classifiers used CPP mean and H1-H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as "normal" or "not NPVH," respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched (f o), and has less abrupt vocal fold closure (H1-H2 skew) compared to the matched control group. The combination of CPP mean and H1-H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - Juan P. Cortes
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Carol Krusemark
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jason Muise
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | - Charles Nudelman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Steven Zeitels
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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Burckardt ES, Lopez-Guerra G, Kobler JB, Tynan MA, Petrillo RH, Van Stan JH, Burns JA. Optimal Arytenoid Position in Laryngeal Framework Surgery: An Anatomic Human Larynx Study. Laryngoscope 2021; 131:2540-2544. [PMID: 33864644 DOI: 10.1002/lary.29578] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The purpose of this study was to better understand the effects of stitch placement on arytenoid medialization by measuring normative cricoarytenoid joint anatomy and changes in arytenoid position when varying arytenopexy stitch configuration. METHODS This adult human larynx study was done in two parts. First, measurements of the cricoid and arytenoid cartilage anatomy relevant to cricoarytenoid joint function were made in 45 preserved larynges (26 male (M), 19 female (F)) using digital calipers. Second, the arytenoids of six fresh larynges ( three M, three F) were sutured to the cricoid using various arytenopexy-stitch placements ranging from inferior-lateral to superior-medial, and the resulting arytenoid positions were compared by measuring medial displacement of the arytenoid body and change in glottal configuration from macro still images using Image J. Paired t-tests were used to compare the results. RESULTS Cartilage and joint facet dimensions showed differences between males (M) and females (F). Cricoid facet lengths averaged 9.3 mm (M) and 7.1 mm (F), and widths averaged 4.9 mm (M) and 4.0 mm (F). The arytenoid facet widths averaged 10.5 mm (M) and 9.7 mm (F). Average distances between cricoid facets were 11.8 mm for both males and females. Securing the arytenoid superior-medially on the cricoid facet produced more medialization (2.2 mm vs 1.0 mm, P < .001) and better glottic aperture configuration (9.5° vs 2.7°, P < .001) than securing the arytenoid inferior-laterally on the facet. CONCLUSIONS Anatomic consistency in cricoarytenoid anatomy provides reliable surgical landmarks for ideal placement of an arytenopexy suture to optimally reposition the arytenoid cartilage. Optimal arytenoid medialization can be accurately reproduced with an arytenopexy-suture that is placed superior-medially on the cricoid facet. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Elizabeth S Burckardt
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Gerardo Lopez-Guerra
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - James B Kobler
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Monica A Tynan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Robert H Petrillo
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Jarrad H Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Toles LE, Ortiz AJ, Marks KL, Burns JA, Hron T, Van Stan JH, Mehta DD, Hillman RE. Differences Between Female Singers With Phonotrauma and Vocally Healthy Matched Controls in Singing and Speaking Voice Use During 1 Week of Ambulatory Monitoring. Am J Speech Lang Pathol 2021; 30:199-209. [PMID: 33472007 PMCID: PMC8740583 DOI: 10.1044/2020_ajslp-20-00227] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose Previous ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population. Method Forty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor. Weeklong statistics (average, standard deviation, skewness, kurtosis) for sound pressure level (SPL), fundamental frequency, cepstral peak prominence, the magnitude ratio of the first two harmonics (H1-H2 ), and three vocal dose measures were computed from the neck surface acceleration signal and separated into singing and speech using a singing classifier. Results Mixed analysis of variance models found expected differences between singing and speech in each voice parameter, except SPL kurtosis. SPL skewness, SPL kurtosis, and all H1-H2 distributional parameters differentiated patients and controls when singing and speech were combined. Interaction effects were found in H1-H2 kurtosis and all vocal dose measures. Patients had significantly higher vocal doses in speech compared to controls. Conclusions Consistent with prior work, the pathophysiology of phonotrauma in singers is characterized by more abrupt/complete glottal closure (decreased mean and variation for H1-H2 ) and increased laryngeal forces (negatively skewed SPL distribution) during phonation. Application of a singing classifier to weeklong data revealed that singers with phonotrauma spent more time speaking on a weekly basis, but not more time singing, compared to controls. Results are used as a basis for hypothesizing about the role of speaking voice in the etiology of phonotraumatic vocal hyperfunction in singers.
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Affiliation(s)
- Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
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8
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Van Stan JH, Mehta DD, Ortiz AJ, Burns JA, Marks KL, Toles LE, Stadelman-Cohen T, Krusemark C, Muise J, Hron T, Zeitels SM, Fox AB, Hillman RE. Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction. J Speech Lang Hear Res 2020; 63:3934-3944. [PMID: 33197360 PMCID: PMC8608140 DOI: 10.1044/2020_jslhr-20-00168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1-H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = -0.86) and voice therapy (d = -1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1-H2). Further validation of the DPI is needed to better understand its potential clinical use.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Carol Krusemark
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jason Muise
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Steven M. Zeitels
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | | | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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9
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Kridgen S, Hillman RE, Stadelman-Cohen T, Zeitels S, Burns JA, Hron T, Krusemark C, Muise J, Van Stan JH. Patient-Reported Factors Associated with the Onset of Hyperfunctional Voice Disorders. Ann Otol Rhinol Laryngol 2020; 130:389-394. [PMID: 32909443 DOI: 10.1177/0003489420956379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Prevention, diagnosis, and treatment of hyperfunctional voice disorders would be improved by better understanding their etiological contributing factors. Therefore, this study estimated the prevalence of etiological factors using self-reported data about disorder onset from a large cohort of patients with Phonotraumatic Vocal Hyperfunction (PVH) and Non-Phonotraumatic Vocal Hyperfunction (NPVH). METHODS Retrospective chart review extracted the self-reported rate (gradual, sudden) and events associated (voice use, anxiety/stress, upper respiratory infection [URI]) with disorder onset from 1,577 patients with PVH and 979 patients with NPVH. RESULTS Both patient groups reported a gradual onset more than a sudden onset. Voice use was the most frequently reported event for PVH and the NPVH group self-reported all three events at equal frequency. The largest PVH subgroups were associated with voice use while the NPVH subgroups were associated with only voice use, only URI, or only anxiety/stress. CONCLUSION The results support the general clinical view that PVH is most strongly related to the gradual accumulated effects of phonotrauma, while NPVH has a more heterogeneous etiology. The identified PVH and NPVH subgroups may have clinical relevance and future work could investigate differences in treatment and outcomes among these subgroups.
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Affiliation(s)
- Samantha Kridgen
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Tara Stadelman-Cohen
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Steven Zeitels
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - James A Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Tiffiny Hron
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Carol Krusemark
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Jason Muise
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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10
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Marks KL, Lin JZ, Burns JA, Hron TA, Hillman RE, Mehta DD. Estimation of Subglottal Pressure From Neck Surface Vibration in Patients With Voice Disorders. J Speech Lang Hear Res 2020; 63:2202-2218. [PMID: 32610028 PMCID: PMC7838842 DOI: 10.1044/2020_jslhr-19-00409] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 05/15/2023]
Abstract
Purpose Given the established linear relationship between neck surface vibration magnitude and mean subglottal pressure (Ps) in vocally healthy speakers, the purpose of this study was to better understand the impact of the presence of a voice disorder on this baseline relationship. Method Data were obtained from participants with voice disorders representing a variety of glottal conditions, including phonotraumatic vocal hyperfunction, nonphonotraumatic vocal hyperfunction, and unilateral vocal fold paralysis. Participants were asked to repeat /p/-vowel syllable strings from loud-to-soft loudness levels in multiple vowel contexts (/pa/, /pi/, /pu/) and pitch levels (comfortable, higher than comfortable, lower than comfortable). Three statistical metrics were computed to analyze the regression line between neck surface accelerometer (ACC) signal magnitude and Ps within and across pitch, vowel, and voice disorder category: coefficient of determination (r 2), slope, and intercept. Three linear mixed-effects models were used to evaluate the impact of voice disorder category, pitch level, and vowel context on the relationship between ACC signal magnitude and Ps. Results The relationship between ACC signal magnitude and Ps was statistically different in patients with voice disorders than in vocally healthy controls; patients exhibited higher levels of Ps given similar values of ACC signal magnitude. Negligible effects were found for pitch condition within each voice disorder category, and negligible-to-small effects were found for vowel context. The mean of patient-specific r 2 values was .63, ranging from .13 to .92. Conclusions The baseline, linear relationship between ACC signal magnitude and Ps is affected by the presence of a voice disorder, with the relationship being participant-specific. Further work is needed to improve ACC-based prediction of Ps, across treatment, and during naturalistic speech production.
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Affiliation(s)
- Katherine L. Marks
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Rehabilitation Science, MGH Institute of Health Professions, Boston, MA
| | - Jonathan Z. Lin
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - James A. Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Tiffiny A. Hron
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Rehabilitation Science, MGH Institute of Health Professions, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Rehabilitation Science, MGH Institute of Health Professions, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard Medical School, Boston, MA
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11
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Van Stan JH, Mehta DD, Ortiz AJ, Burns JA, Toles LE, Marks KL, Vangel M, Hron T, Zeitels S, Hillman RE. Differences in Weeklong Ambulatory Vocal Behavior Between Female Patients With Phonotraumatic Lesions and Matched Controls. J Speech Lang Hear Res 2020; 63:372-384. [PMID: 31995428 PMCID: PMC7210443 DOI: 10.1044/2019_jslhr-19-00065] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Purpose Previous work using ambulatory voice recordings has shown no differences in average vocal behavior between patients with phonotraumatic vocal hyperfunction and matched controls. This study used larger groups to replicate these results and expanded the analysis to include distributional characteristics of ambulatory voice use and measures indicative of glottal closure. Method Subjects included 180 adult women: 90 diagnosed with vocal fold nodules or polyps and 90 age-, sex-, and occupation-matched controls with no history of voice disorders. Weeklong summary statistics (average, variability, skewness, kurtosis) of voice use were computed from neck-surface acceleration recorded using an ambulatory voice monitor. Voice measures included estimates of sound pressure level (SPL), fundamental frequency (f o), cepstral peak prominence, and the difference between the first and second harmonic magnitudes (H1-H2). Results Statistical comparisons resulted in medium-large differences (Cohen's d ≥ 0.5) between groups for SPL skewness, f o variability, and H1-H2 variability. Two logistic regressions (theory-based and stepwise) found SPL skewness and H1-H2 variability to classify patients and controls based on their weekly voice data, with an area under the receiver operating characteristic curve of 0.85 and 0.82 on training and test sets, respectively. Conclusion Compared to controls, the weekly voice use of patients with phonotraumatic vocal hyperfunction reflected higher SPL tendencies (negatively skewed SPL) with more abrupt glottal closure (reduced H1-H2 variability, especially toward higher values). Further work could examine posttreatment data (e.g., after surgery and/or therapy) to determine the extent to which these differences are associated with the etiology and pathophysiology of phonotraumatic vocal fold lesions.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Mark Vangel
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Steven Zeitels
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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12
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Lechien JR, Burns JA, Akst LM. The Use of 532-Nanometer-Pulsed Potassium-Titanyl-Phosphate (KTP) Laser in Laryngology: A Systematic Review of Current Indications, Safety, and Voice Outcomes. Ear Nose Throat J 2020; 100:4S-13S. [PMID: 31928082 DOI: 10.1177/0145561319899183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the indications, efficacy, safety, and outcomes of potassium-titanyl-phosphate (KTP) laser procedures for treatment of laryngeal disease. METHODS PubMed, Cochrane Library, and Scopus were searched for studies providing information about the indications, efficacy, and safety of both in-office and operative suspension microlaryngoscopy KTP laser procedure in treatment of laryngeal disease. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS Of the initial screened 140 papers, 17 met our inclusion criteria. Six papers involved KTP laser procedures for benign and malignant vocal fold lesions in suspension microlaryngoscopy only, 10 papers focused on only in-office KTP laser procedures for benign vocal fold lesions, and 1 paper included both in-office and suspension microlaryngoscopy procedures. The following lesions may be considered as indications for KTP laser procedures: Reinke's edema, sulcus vocalis, vocal fold hemorrhage, polyp, granuloma, cyst, scar, papillomatosis, dysplasia, leukoplakia, and early vocal fold malignancies. Irrespective of the types of procedure (in-office vs suspension microlaryngoscopy), the KTP laser is associated with a low complication rate and overall good vocal fold vibration recovery. There is an important heterogeneity among studies concerning laser settings, indications, and outcomes used for the assessment of treatment effectiveness. There are no controlled studies directly comparing KTP laser with other lasers (ie, carbon dioxide laser). CONCLUSION The use of KTP laser procedures for treatment of laryngeal disease has increased over the past decade, especially for office-based management of vocal fold lesions. Future controlled studies are needed to compare the safety and outcomes of the KTP laser to other techniques.
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Affiliation(s)
- Jerome R Lechien
- Laryngology Study Group of Young-Otolaryngologists, International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human Anatomy and Experimental Oncology, School of Medicine, UMONS Research Institute for Health Sciences and Technology, 54521University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin en Yvelines (University Paris Saclay), Paris, France
| | - James A Burns
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, 1501Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Powell ME, Deliyski DD, Zeitels SM, Burns JA, Hillman RE, Gerlach TT, Mehta DD. Efficacy of Videostroboscopy and High-Speed Videoendoscopy to Obtain Functional Outcomes From Perioperative Ratings in Patients With Vocal Fold Mass Lesions. J Voice 2019; 34:769-782. [PMID: 31005449 DOI: 10.1016/j.jvoice.2019.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 10/22/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A major limitation of comparing the efficacy of videostroboscopy (VS) and high-speed videoendoscopy (HSV) is the lack of an objective reference by which to compare the functional assessment ratings of the two techniques. For patients with vocal fold mass lesions, intraoperative measures of lesion size and depth may serve as this objective reference. This study compared the relationships between the pre- to postoperative change in VS and HSV visual-perceptual ratings to intraoperative measures of lesion size and depth. DESIGN Prospective visual-perceptual study with intraoperative measures of lesion size and depth. METHODS VS and HSV samples were obtained preoperatively and postoperatively from 28 patients with vocal fold lesions and from 17 vocally healthy controls. Two experienced clinicians rated amplitude, mucosal wave, vertical phase difference, left-right phase asymmetry, and vocal fold edge on a visual-analog scale using both imaging techniques. The change in perioperative ratings from VS and HSV was compared between groups and correlated to intraoperative measures of lesion size and depth. RESULTS HSV was as reliable as VS for ratings of amplitude and edge, and substantially more reliable for ratings of mucosal wave and left-right phase asymmetry. Both VS and HSV had mild-moderate correlations between change in perioperative ratings and intraoperative measures of lesion area. Change in function could be obtained in more patients and for more parameters using HSV than VS. Group differences were noted for postoperative ratings of amplitude and edge; however, these differences were within one level of the visual-perceptual rating scale. The presence of asynchronicity in VS recordings renders vibratory features either uninterpretable or potentially distorted and thus should not be rated. CONCLUSIONS Amplitude and edge are robust vibratory measures for perioperative functional assessment, regardless of imaging modality. HSV is indicated for evaluation of subepithelial lesions or if asynchronicity is present in the VS image sequence.
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Affiliation(s)
- Maria E Powell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee; Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio.
| | - Dimitar D Deliyski
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio; Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Steven M Zeitels
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - James A Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
| | - Terri Treman Gerlach
- Voice and Swallowing Center, Charlotte Eye Ear Nose and Throat Associates, Charlotte, North Carolina
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
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14
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Tracy LF, Kobler JB, Van Stan JH, Burns JA. Carbon debris and fiber cleaving: Effects on potassium-titanyl-phosphate laser energy and chorioallantoic membrane model vessel coagulation. Laryngoscope 2019; 129:2244-2248. [PMID: 30908661 DOI: 10.1002/lary.27948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/14/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Photoangiolytic precision afforded by the 532-nm potassium-titanyl-phosphate (KTP) laser relies on predictable energy delivery. Inadequate energy output can cause vessel rupture, and excessive energy can cause thermal damage. The quality of the cleaved surface and carbon deposits from ablated tissue are two factors that could negatively impact fiber performance. The effects of these on energy output and blood vessel coagulation were assessed using a chorioallantoic membrane (CAM) model. STUDY DESIGN Comparative analysis. METHODS Laser fibers with carbon debris, optimal fiber cleaving, and suboptimal cleaving were inspected at three times magnification, and the light dispersion pattern of each fiber was rated. The average energy output from consecutive pulses through each fiber configuration was recorded. The effect of these fiber conditions on clinical efficacy was estimated by measuring vessel coagulation versus rupture in the CAM model. Repeated measures analysis of variance compared results. RESULTS Carbon debris and suboptimal cleaving resulted in decreased energy output in comparison to optimal cleaving ([-Δ244 mJ, d = 4.31, P < .001] and [-Δ195 mJ, d = 6.04, P < .001]). Optimal cleaving resulted in immediate coagulation of vessels. Fibers with suboptimal cleaving and carbon debris had unpredictable outcomes, requiring multiple pulses for coagulation or causing vessel rupture. CONCLUSIONS KTP laser fiber function is significantly affected by fiber tip condition. Carbon debris and suboptimal cleaving create significant attenuation of energy, which results in an unpredictable angiolytic effect, as demonstrated by increased vessel rupture in the CAM model. Optimal recleaving of KTP laser fibers restores prior energy output and predictable coagulation. Care should be taken to avoid carbon debris on laser-fiber tips and to cleave fibers properly. LEVEL OF EVIDENCE NA Laryngoscope, 129:2244-2248, 2019.
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Affiliation(s)
- Lauren F Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - James B Kobler
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Jarrad H Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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15
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Zeitels SM, Lombardo P, Chaves JL, Burns JA, Hillman RE, Heaton JT, Kobler JB. Glottic Stenosis: An Anatomic Analysis and New Treatment With a Self-Retaining Interarytenoid Spring. Ann Otol Rhinol Laryngol 2019; 128:94S-105S. [DOI: 10.1177/0003489418802284] [Citation(s) in RCA: 3] [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: 11/16/2022]
Abstract
Introduction: Endotracheal (ET) intubation is a common cause of acquired glottic stenosis. Severe cases often require an irreversible arytenoidectomy/cordectomy, which typically results in poor voice quality. Adult human cadaver larynges were studied to gain insights about ET tube–induced posterior glottic injuries, hoping to create a less invasive remedy. Study Design: Human cadaver investigation and case reports. Methods: Microlaryngeal assessments were done on 10 human cadaver larynges (5 men, 5 women) with and without ET tubes. After supracricoid soft tissue resection, measurements were obtained, including the distance between the outer diameter of the ET tube and the medial aspect of the cricoarytenoid joint facet. Additionally, measurements of the circumferential arc of differently sized ET tubes were made alongside both cricoarytenoid joint capsules. This information was used to design a silastic stent that would function as a self-retaining interarytenoid spring to treat posterior glottic stenosis in 5 patients. Four of 5 patients included in the clinical study were tracheotomy dependent, primarily because of glottic stenosis. The human surgical technique is described in detail. Results: The shortest distance between the outer diameter of the ET tube to the medial cricoid facet averaged 5.02 mm in men and 3.62 mm in women. On the basis of the diameter of the intralaryngeal component of the initially round stent, and the position of the cricoarytenoid joint facets, the interarytenoid spring would have a subtended arc between 110° and 175°. These data helped fashion parameters for modifying a conventional T-tube to form a new self-retaining silastic interarytenoid spring. The first 5 human cases have been successful, allowing effective tracheotomy tube decannulation and excellent voice quality. Conclusions: The anatomic investigation herein provided key insights into ET tube–induced glottic stenosis and facilitated a new straightforward procedure to surgically improve the airway yet preserve excellent vocal function in patients with acquired glottic stenosis. Level of Evidence: NA
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Affiliation(s)
- Steven M. Zeitels
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Lombardo
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jaime L. Chaves
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Robert E. Hillman
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James T. Heaton
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James B. Kobler
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, MA, USA
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16
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Cook AB, Peltier R, Zhang J, Gurnani P, Tanaka J, Burns JA, Dallmann R, Hartlieb M, Perrier S. Hyperbranched poly(ethylenimine-co-oxazoline) by thiol–yne chemistry for non-viral gene delivery: investigating the role of polymer architecture. Polym Chem 2019. [DOI: 10.1039/c8py01648h] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Synthesis of long-chain hyperbranched poly(ethylenimine-co-oxazoline)s by AB2 thiol–yne chemistry is reported, and their application as pDNA transfection agents studied.
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Affiliation(s)
| | - Raoul Peltier
- Department of Chemistry
- University of Warwick
- Coventry
- UK
| | | | | | - Joji Tanaka
- Department of Chemistry
- University of Warwick
- Coventry
- UK
| | - James A. Burns
- Syngenta
- Jealott's Hill International Research Centre
- Bracknell
- Berkshire
- UK
| | | | | | - Sébastien Perrier
- Department of Chemistry
- University of Warwick
- Coventry
- UK
- Warwick Medical School
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17
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Cook AB, Peltier R, Barlow TR, Tanaka J, Burns JA, Perrier S. Branched poly (trimethylphosphonium ethylacrylate- co-PEGA) by RAFT: alternative to cationic polyammoniums for nucleic acid complexation. J Interdiscip Nanomed 2018; 3:164-174. [PMID: 30774985 PMCID: PMC6360508 DOI: 10.1002/jin2.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
Cationic and highly branched poly (trimethylphosphonium ethylacrylate-co-poly (ethylene glycol) acrylate) (p (TMPEA-co-PEGA)), and its ammonium equivalent, have been synthesised from post-polymerisation modification of a poly (bromo ethylacrylate-co-poly (ethylene glycol) acrylate) (p (BEA-co-PEGA)) precursor polymer produced using reversible addition fragmentation chain transfer (RAFT) polymerisation. The cationic polymers were evaluated for their ability to complex nucleic acids, their in vitro cytotoxicity and their GFP pDNA transfection efficiency. The results show RAFT copolymerisation of BEA and PEGA is a simple route to polyphosphoniums showing reduced cytotoxicities and higher transfection efficiencies than their polyammonium alternatives.
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Affiliation(s)
| | - Raoul Peltier
- Department of ChemistryUniversity of WarwickCoventryCV4 7ALUK
| | | | - Joji Tanaka
- Department of ChemistryUniversity of WarwickCoventryCV4 7ALUK
| | - James A. Burns
- Syngenta, Jealott's Hill International Research Centre, BracknellBerkshireRG42 6EYUK
| | - Sébastien Perrier
- Department of ChemistryUniversity of WarwickCoventryCV4 7ALUK
- Faculty of Pharmacy and Pharmaceutical SciencesMonash University381 Royal ParadeParkvilleVictoria3052Australia
- Warwick Medical SchoolUniversity of WarwickCoventryCV4 7ALUK
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18
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Tracy LF, Kwak PE, Bayan SL, Van Stan JH, Burns JA. Vocal Fold Motion Recovery in Patients With Iatrogenic Unilateral Immobility: Cervical Versus Thoracic Injury. Ann Otol Rhinol Laryngol 2018; 128:44-49. [DOI: 10.1177/0003489418808306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Prognostic information about the return of vocal fold mobility in patients with iatrogenic unilateral vocal fold immobility (UVFI) can help with informed decisions about temporary and permanent treatment options. Although many variables can influence the likelihood of recovery, clinical experience suggests that cervical versus thoracic injury is a determining factor. The purpose of this study was to compare recovery rates from UVFI between cervical and thoracic injuries. Methods: A retrospective review of the medical record was performed on all adult patients diagnosed with complete iatrogenic UVFI from 2005 to 2015 (n = 923). Patients with incomplete data and etiologies of idiopathic, malignancy, or stenosis were excluded, leaving a study cohort of 502 patients who were categorized as having UVFI after cervical (n = 329) or thoracic (n = 173) injury. Data regarding site of iatrogenic injury (cervical vs thoracic), mobility status, and time interval to recovery or surgical intervention were recorded and compared using χ2 analyses. Results: Overall, 15% of patients recovered vocal fold mobility at a median of 4.1 months. Patients with cervical injury (65 of 329 [20%]) were significantly more likely to recover mobility than patients with thoracic injury (11 of 173 [6.4%]) (odds ratio, 3.63). The cervical cohort contained more women (68% vs 31%) and was younger (mean age, 60.4 ± 13.8 vs 64.1 ± 16.1 years; Cohen’s D = 0.25). Conclusions: Patients with cervical injuries resulting in UVFI are 4 times more likely to recover mobility than patients with thoracic injuries. This information can be valuable in counseling patients with UVFI and may affect clinical decision making.
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Affiliation(s)
- Lauren F. Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Paul E. Kwak
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Semirra L. Bayan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
| | - Jarrad H. Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Communication Sciences and Disorders, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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19
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Tracy LF, Hron TA, Van Stan JH, Burns JA. Wound healing after transoral angiolytic laser surgery for early glottic carcinoma. Laryngoscope 2018; 129:435-440. [PMID: 30194756 DOI: 10.1002/lary.27283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Wound healing after transoral angiolytic laser surgery for early glottic carcinoma was analyzed to identify factors influencing healing and clinical significance of persistent granulation tissue. STUDY DESIGN Retrospective review. METHODS A retrospective review of 100 consecutive patients undergoing endoscopic angiolytic laser surgery for T1 and T2 glottic carcinoma was performed. Patients with prior radiation or incomplete data were excluded. Postoperative endoscopic images were analyzed for time to healing, size and location of wound, and presence of granulation tissue. Three blinded, independent raters graded wound appearance and presence of granulation tissue. RESULTS Seventy-nine patients healed without need for intervention at a median of 3.5 months. Two patients had office-based ablation of granulation without biopsy and healed. The remaining 19 patients had biopsy for granulation tissue. Wounds that underwent biopsy at >3 months were more likely to contain carcinoma (5/6 patients, 83%) than wounds that were biopsied <3 months (2/13 patients, 15%) (P = .004). Presence of granulation significantly correlated with resection involving anterior commissure (P = .01), > 75%vocal fold length (P = .006), and depth into muscle (P = .001). Delayed healing (>3 months) correlated with T2b tumors (P = .02), depth into ligament (P = .002) and anterior commissure involvement (P = .04). T1a carcinomas more commonly healed in <3 months (P = .005). CONCLUSIONS Many vocal fold wounds heal completely within 3.5 months after angiolytic laser surgery for early glottic carcinoma. Larger and deeper wounds are more likely to heal with granulation tissue. Granulation can resolve without surgical intervention; however, granulation present > 3 months warrants biopsy due to increased risk of malignancy. LEVEL OF EVIDENCE 4 Laryngoscope, 129:435-440, 2019.
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Affiliation(s)
- Lauren F Tracy
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Tiffiny A Hron
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Jarrad H Van Stan
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.,Department of Communication Sciences and Disorders, Massachusetts General Hospital Institute of Health Professions, Charlestown, Massachusetts, U.S.A
| | - James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Whitfield R, Anastasaki A, Truong NP, Cook AB, Omedes-Pujol M, Loczenski Rose V, Nguyen TAH, Burns JA, Perrier S, Davis TP, Haddleton DM. Efficient Binding, Protection, and Self-Release of dsRNA in Soil by Linear and Star Cationic Polymers. ACS Macro Lett 2018; 7:909-915. [PMID: 35650964 DOI: 10.1021/acsmacrolett.8b00420] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Double stranded RNA (dsRNA) exhibits severe degradation within 3 days in live soil, limiting its potential application in crop protection. Herein we report the efficient binding, protection, and self-release of dsRNA in live soil through the usage of a cationic polymer. Soil stability assays show that linear poly(2-(dimethylamino)ethyl acrylate) can delay the degradation of dsRNA by up to 1 week while the star shaped analogue showed an increased stabilization of dsRNA by up to 3 weeks. Thus, the architecture of the polymer can significantly affect the lifetime of dsRNA in soil. In addition, the hydrolysis and dsRNA binding and release profiles of these polymers were carefully evaluated and discussed. Importantly, hydrolysis could occur independently of environmental conditions (e.g., different pH, different temperature) showing the potential for many opportunities in agrochemicals where protection and subsequent self-release of dsRNA in live soil is required.
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Affiliation(s)
- Richard Whitfield
- Chemistry Department, University of Warwick, Library Road, CV4 7AL, Coventry, U.K
| | - Athina Anastasaki
- Chemistry Department, University of Warwick, Library Road, CV4 7AL, Coventry, U.K
| | - Nghia P. Truong
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - Alexander B. Cook
- Chemistry Department, University of Warwick, Library Road, CV4 7AL, Coventry, U.K
| | - Marta Omedes-Pujol
- Formulation Technology Group, Syngenta, Jealotts Hill international Research Centre, Bracknell, Berkshire RG42 6EY, U.K
| | - Vanessa Loczenski Rose
- Formulation Technology Group, Syngenta, Jealotts Hill international Research Centre, Bracknell, Berkshire RG42 6EY, U.K
| | - Tuan A. H. Nguyen
- School of Chemical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia
| | - James A. Burns
- Formulation Technology Group, Syngenta, Jealotts Hill international Research Centre, Bracknell, Berkshire RG42 6EY, U.K
| | - Sébastien Perrier
- Chemistry Department, University of Warwick, Library Road, CV4 7AL, Coventry, U.K
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), 399 Royal Parade, Parkville, Victoria 3152, Australia
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, U.K
| | - Thomas P. Davis
- Chemistry Department, University of Warwick, Library Road, CV4 7AL, Coventry, U.K
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - David M. Haddleton
- Chemistry Department, University of Warwick, Library Road, CV4 7AL, Coventry, U.K
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), 399 Royal Parade, Parkville, Victoria 3152, Australia
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Burns JA, Adlard SD, Kobler JB, Tynan MA, Petrillo RH, Tracy LF. A Comparison of Laser-Protected Endotracheal Tubes. Otolaryngol Head Neck Surg 2018; 159:871-878. [PMID: 30130457 DOI: 10.1177/0194599818796106] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the physical characteristics of 3 laser-protected endotracheal tubes (LPETs) commonly used in endoscopic laser surgery. To report potential intraoperative problems related to LPET use and suggest practical solutions. STUDY DESIGN Comparative analysis. SETTING Academic laboratory. SUBJECTS AND METHODS Physical characteristics of the Mallinckrodt Laser-Flex (MTL), Medtronic Laser-Shield II (ML-II), and Rusch LaserTubus (RL) were compared. The effect of bending LPETs on airflow resistance was estimated with a pressure transducer. The force required to pull each tube through the glottis and the pressure exerted during this maneuver were measured in a fresh cadaveric human larynx. RESULTS The design features and physical characteristics of LPETs differ, including varying balloon-tip lengths. Bending LPETs to acute angles caused significant pressure increase within the RL tube (Δ 3.42 cm H2O) and minimal change within the ML-II (Δ 0.12 cm H2O) and MTL (Δ 0.21 cm H2O) tubes. The average force required to pull the RL (48.12 g, P = .003) and MTL (282.4 g, P = .001) tubes through the glottis was 7.6× and 44.5× greater than that for the ML-II (6.39 g). When pulled through the vocal folds, the ML-II cuff exerted no detectable pressure, whereas higher pressures were measured for the RL (2.2 cm H2O) and MTL (6.5 cm H2O) tubes. CONCLUSION The ML-II tube had the most favorable characteristics, with minimal pressure during extubation and resistance to kinking. The RL tube kinks readily with a resultant increase in resistance to airflow. The MTL tube extends farther into the trachea due to a relatively elongated balloon-tip configuration. Future LPET designs should incorporate features that avoid intraoperative difficulties related to airway protection and ventilation.
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Affiliation(s)
- James A Burns
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen D Adlard
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James B Kobler
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Monica A Tynan
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert H Petrillo
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren F Tracy
- 1 Center for Laryngeal Surgery and Voice Rehabilitation, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Wellenstein DJ, Schutte HW, Takes RP, Honings J, Marres HA, Burns JA, van den Broek GB. Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology. J Voice 2018; 32:502-513. [DOI: 10.1016/j.jvoice.2017.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
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Cook AB, Peltier R, Hartlieb M, Whitfield R, Moriceau G, Burns JA, Haddleton DM, Perrier S. Cationic and hydrolysable branched polymers by RAFT for complexation and controlled release of dsRNA. Polym Chem 2018. [DOI: 10.1039/c8py00804c] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The complexation and sustained release of dsRNA from highly branched polymers prepared via RAFT polymerisation and copolymerisation of the monomers DMAEA, DMAPA, and DMAEMA, is reported.
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Affiliation(s)
| | - Raoul Peltier
- Department of Chemistry
- University of Warwick
- Coventry
- UK
| | | | | | | | - James A. Burns
- Syngenta
- Jealott's Hill International Research Centre
- Berkshire
- UK
| | - David M. Haddleton
- Department of Chemistry
- University of Warwick
- Coventry
- UK
- Faculty of Pharmacy and Pharmaceutical Sciences
| | - Sébastien Perrier
- Department of Chemistry
- University of Warwick
- Coventry
- UK
- Faculty of Pharmacy and Pharmaceutical Sciences
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24
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Van Stan JH, Maffei M, Masson MLV, Mehta DD, Burns JA, Hillman RE. Self-Ratings of Vocal Status in Daily Life: Reliability and Validity for Patients With Vocal Hyperfunction and a Normative Group. Am J Speech Lang Pathol 2017; 26:1167-1177. [PMID: 29086800 PMCID: PMC5945061 DOI: 10.1044/2017_ajslp-17-0031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/03/2017] [Accepted: 06/12/2017] [Indexed: 05/24/2023]
Abstract
PURPOSE The aim of this study was to establish reliability and validity for self-ratings of vocal status obtained during the daily activities of patients with vocal hyperfunction (VH) and matched controls. METHOD Eight-four patients with VH and 74 participants with normal voices answered 3 vocal status questions-difficulty producing soft, high-pitched phonation (D-SHP); discomfort; and fatigue-on an ambulatory voice monitor at the beginning, 5-hr intervals, and the end of each day (7 total days). Two subsets of the patient group answered the questions during a 2nd week after voice therapy (29 patients) or laryngeal surgery (16 patients). RESULTS High reliability resulted for patients (Cronbach's α = .88) and controls (α = .95). Patients reported higher D-SHP, discomfort, and fatigue (Cohen's d = 1.62-1.92) compared with controls. Patients posttherapy and postsurgery reported significantly improved self-ratings of vocal status relative to their pretreatment ratings (d = 0.70-1.13). Within-subject changes in self-ratings greater than 20 points were considered clinically meaningful. CONCLUSIONS Ratings of D-SHP, discomfort, and fatigue have adequate reliability and validity for tracking vocal status throughout daily life in patients with VH and vocally healthy individuals. These questions could help investigate the relationship between vocal symptom variability and putative contributing factors (e.g., voice use/rest, emotions).
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marc Maffei
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Maria Lúcia Vaz Masson
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- Federal University of Bahia, Brazil
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
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25
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Lechien JR, Saussez S, Harmegnies B, Finck C, Burns JA. Laryngopharyngeal Reflux and Voice Disorders: A Multifactorial Model of Etiology and Pathophysiology. J Voice 2017; 31:733-752. [DOI: 10.1016/j.jvoice.2017.03.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
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26
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27
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Rabanus-Wallace MT, Wooller MJ, Zazula GD, Shute E, Jahren AH, Kosintsev P, Burns JA, Breen J, Llamas B, Cooper A. Correction: Corrigendum: Megafaunal isotopes reveal role of increased moisture on rangeland during late Pleistocene extinctions. Nat Ecol Evol 2017. [DOI: 10.1038/s41559-017-0199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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28
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Rabanus-Wallace MT, Wooller MJ, Zazula GD, Shute E, Jahren AH, Kosintsev P, Burns JA, Breen J, Llamas B, Cooper A. Megafaunal isotopes reveal role of increased moisture on rangeland during late Pleistocene extinctions. Nat Ecol Evol 2017; 1:125. [DOI: 10.1038/s41559-017-0125] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/28/2017] [Indexed: 11/09/2022]
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29
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Van Stan JH, Mehta DD, Petit RJ, Sternad D, Muise J, Burns JA, Hillman RE. Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules. Am J Speech Lang Pathol 2017; 26:1-10. [PMID: 28124070 PMCID: PMC5533549 DOI: 10.1044/2016_ajslp-15-0187] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/18/2016] [Accepted: 06/01/2016] [Indexed: 05/28/2023]
Abstract
PURPOSE Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented. METHOD The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities. RESULTS With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed. CONCLUSIONS Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.
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Affiliation(s)
- Jarrad H Van Stan
- Massachusetts General Hospital, BostonMGH Institute of Health Professions, Boston, MA
| | - Daryush D Mehta
- Massachusetts General Hospital, BostonMGH Institute of Health Professions, Boston, MAHarvard Medical School, Boston, MA
| | | | | | | | - James A Burns
- Massachusetts General Hospital, BostonHarvard Medical School, Boston, MA
| | - Robert E Hillman
- Massachusetts General Hospital, BostonMGH Institute of Health Professions, Boston, MAHarvard Medical School, Boston, MA
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30
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Hartlieb M, Floyd T, Cook AB, Sanchez-Cano C, Catrouillet S, Burns JA, Perrier S. Well-defined hyperstar copolymers based on a thiol–yne hyperbranched core and a poly(2-oxazoline) shell for biomedical applications. Polym Chem 2017. [DOI: 10.1039/c7py00303j] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Well defined ‘hyperstar’ copolymers were synthesized by combining hyperbranched polymers produced by thiol–yne chemistry with poly(oxazoline)s.
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Affiliation(s)
| | - Thomas Floyd
- Department of Chemistry
- The University of Warwick
- Coventry CV4 7AL
- UK
| | | | | | | | - James A. Burns
- Syngenta
- Jealott's Hill International Research Centre
- Berkshire
- UK
| | - Sébastien Perrier
- Department of Chemistry
- The University of Warwick
- Coventry CV4 7AL
- UK
- Faculty of Pharmacy and Pharmaceutical Sciences
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31
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Whitfield R, Anastasaki A, Truong NP, Wilson P, Kempe K, Burns JA, Davis TP, Haddleton DM. Well-Defined PDMAEA Stars via Cu(0)-Mediated Reversible Deactivation Radical Polymerization. Macromolecules 2016. [DOI: 10.1021/acs.macromol.6b01511] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Richard Whitfield
- Chemistry Department, University of Warwick, Library Road, CV4 7AL Coventry, United Kingdom
| | - Athina Anastasaki
- Chemistry Department, University of Warwick, Library Road, CV4 7AL Coventry, United Kingdom
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology,
Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Campus, 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - Nghia P. Truong
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology,
Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Campus, 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - Paul Wilson
- Chemistry Department, University of Warwick, Library Road, CV4 7AL Coventry, United Kingdom
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology,
Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Campus, 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - Kristian Kempe
- Chemistry Department, University of Warwick, Library Road, CV4 7AL Coventry, United Kingdom
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology,
Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Campus, 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - James A. Burns
- Formulation Technology Group, Jealotts Hill international Research
Centre, Syngenta, Bracknell, Berkshire RG42 6EY, United Kingdom
| | - Thomas P. Davis
- Chemistry Department, University of Warwick, Library Road, CV4 7AL Coventry, United Kingdom
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology,
Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Campus, 399 Royal Parade, Parkville, Victoria 3152, Australia
| | - David M. Haddleton
- Chemistry Department, University of Warwick, Library Road, CV4 7AL Coventry, United Kingdom
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology,
Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Campus, 399 Royal Parade, Parkville, Victoria 3152, Australia
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Powell ME, Deliyski DD, Hillman RE, Zeitels SM, Burns JA, Mehta DD. Comparison of Videostroboscopy to Stroboscopy Derived From High-Speed Videoendoscopy for Evaluating Patients With Vocal Fold Mass Lesions. Am J Speech Lang Pathol 2016; 25:576-589. [PMID: 27716854 PMCID: PMC5373695 DOI: 10.1044/2016_ajslp-15-0050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/31/2015] [Accepted: 03/31/2016] [Indexed: 05/25/2023]
Abstract
PURPOSE Videostroboscopy (VS) uses an indirect physiological signal to predict the phase of the vocal fold vibratory cycle for sampling. Simulated stroboscopy (SS) extracts the phase of the glottal cycle directly from the changing glottal area in the high-speed videoendoscopy (HSV) image sequence. The purpose of this study is to determine the reliability of SS relative to VS for clinical assessment of vocal fold vibratory function in patients with mass lesions. METHODS VS and SS recordings were obtained from 28 patients with vocal fold mass lesions before and after phonomicrosurgery and 17 controls who were vocally healthy. Two clinicians rated clinically relevant vocal fold vibratory features using both imaging techniques, indicated their internal level of confidence in the accuracy of their ratings, and provided reasons for low or no confidence. RESULTS SS had fewer asynchronous image sequences than VS. Vibratory outcomes were able to be computed for more patients using SS. In addition, raters demonstrated better interrater reliability and reported equal or higher levels of confidence using SS than VS. CONCLUSION Stroboscopic techniques on the basis of extracting the phase directly from the HSV image sequence are more reliable than acoustic-based VS. Findings suggest that SS derived from high-speed videoendoscopy is a promising improvement over current VS systems.
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Affiliation(s)
- Maria E. Powell
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
- Laryngeal Biology Laboratory, Vanderbilt University, Nashville, TN
| | - Dimitar D. Deliyski
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Steven M. Zeitels
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
| | - James A. Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Burns JA, Botelho JL, Bell JI, Faquin W, Lopez-Guerra G, Ackerman JL, Kobler JB. Injectable Aorta Tissue Paste for Vocal Fold Medialization: Residence Time, Biocompatibility, and Comparison to Predicates in a Guinea Pig Subdermal Model. Ann Otol Rhinol Laryngol 2016; 125:900-911. [PMID: 27440067 DOI: 10.1177/0003489416660114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Aortic homografts integrate well with laryngeal tissue when used in reconstructive surgery. It was hypothesized that a paste of aortic homograft, rich in slow-to-degrade elastin, would compare favorably in residence time and biocompatibility to predicate materials used for vocal fold injection-medialization. METHODS An injectable aorta paste (AP) was made by pulverizing aortic homografts at -196°C (cryomilling). To assess residence time and biocompatibility, 0.3 cc was injected subdermally in guinea pigs (n = 3 per 2-, 4-, 8-, 16-, 24-week time points) followed by histological analysis. To test particle size versus residence time, APs made using 80 or 200 seconds of cryomilling were compared. Implant characteristics of AP were then compared to Restylane, Radiesse Voice (Hydroxylapatite), Radiesse Voice Gel, and Cymetra in additional animals (n = 6 per 4-, 8-, 12-week time points). RESULTS Injected AP formed ovoid masses with minimal inflammation. Cellular infiltration was mild and increased with survival time. There was a gradual reduction of implant volume to ~40% at 24 weeks. Increased residence time for paste with larger particles (80 cryomilling seconds) was noted. Von Kossa staining showed progressive calcification of the AP. Cymetra was difficult to reconstitute reliably but formed subdermal masses similar to AP in shape, size, and reactivity and without calcification. The other predicates showed good biocompatibility but spread more widely and erratically in the tissue. CONCLUSION Aortic paste is easy to create, biocompatible, degrades slowly, and forms well-defined implants in guinea pig subdermal tissue. The AP implants calcified over time, and experiments are ongoing to determine the source of calcification and how it might be controlled or exploited clinically.
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Affiliation(s)
- James A Burns
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jaime L Botelho
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan I Bell
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gerardo Lopez-Guerra
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jerome L Ackerman
- Department of Imaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James B Kobler
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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34
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Broadhurst MS, Kobler JB, Burns JA, Anderson RR, Zeitels SM. Chick Chorioallantoic Membrane as a Model for Simulating Human True Vocal Folds. Ann Otol Rhinol Laryngol 2016; 116:917-21. [DOI: 10.1177/000348940711601208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Evolving photoangiolytic laser techniques for treating vocal fold lesions motivated the development of a model for research and surgical training. The chick chorioallantoic membrane (CAM), which is composed of a microvasculature suspended within the egg albumen, simulates the vocal fold microcirculation within the superficial lamina propria (SLP). To characterize this model, we compared measurements of vessel diameters to superficial vessels in human vocal folds. Methods: The diameters of first-, second-, and third-order CAM vessels were measured in fertilized chicken eggs. The superficial blood vessels of the human vocal fold were measured from intraoperative images. Results: According to the branching pattern, vessel segments were identified as first-, second-, or third-order, with average diameters of 0.035 mm (0.02 to 0.1 mm), 0.18 mm (0.12 to 0.41 mm), and 0.8 mm (0.6 to 0.98 mm), respectively. The total vessels measured included 362 first-order, 119 second-order, and 82 third-order vessels. In 10 adult human vocal folds, an average vessel diameter of 0.04 mm (0.015 to 0.1 mm) was observed in 50 vessels. Conclusions: The CAM microvasculature suspended in albumen provides a useful surgical model simulating the microcirculation within the SLP of the human vocal fold. Although first-order CAM vessels best approximate the size of normal vocal fold subepithelial vessels seen at surgery, second- and third-order vessels resemble the vascular abnormalities frequently encountered during microsurgery for phonotraumatic lesions.
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Zeitels SM, Akst LM, Burns JA, Hillman RE, Broadhurst MS, Anderson RR. Office-Based 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis and Dysplasia. Ann Otol Rhinol Laryngol 2016; 115:679-85. [PMID: 17044539 DOI: 10.1177/000348940611500905] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [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: 11/16/2022]
Abstract
Objectives: Treatment of glottal papillomatosis and dysplasia was mirror-guided and done in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. The primary treatment goals, which are disease regression and voice restoration and/or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. To obviate general anesthesia, office-based laser laryngeal surgery was first done in 2001 with the 585-nm pulsed dye laser (PDL), because it employs a fiber delivery system and its energy is selectively absorbed by oxyhemoglobin. Since then, this new angiolytic laser treatment paradigm has become a mainstay of management for many surgeons; however, there are a number of shortcomings of the PDL. To further develop this concept and address the limitations of the PDL, we used a 532-nm pulsed potassium titanyl phosphate (KTP) laser. Methods: A prospective assessment was performed on 48 patients in 72 cases of recurrent glottal dysplasia (36) or papillomatosis (36). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Results: Two dysplasia patients did not tolerate the procedure. Of the treatable dysplasia cases, there was follow-up in 29 of 34. Disease regression was at least 75% in 18 of 29 cases (62%), 50% to 75% in 7 of 29 (24%), and 25% to 50% in the remaining 4 of 29 (14%). Papilloma patients returned for treatment when symptoms recurred, so disease regression could not be assessed accurately. Similar to data obtained with the PDL, these data confirmed that dysplastic mucosa could normalize without resection. Conclusions: Our observations revealed that the 532-nm pulsed KTP laser provided enhanced performance over the PDL laser in a number of ways. The ability to use smaller glass fibers precluded mechanical trauma to the channels of the flexible laryngoscopes and allowed for improved suctioning of secretions. Oxyhemoglobin absorbs energy better at 532 nm than at 585 nm, and the KTP laser can be delivered through a longer pulse width. These factors provide enhanced hemostasis and improved intralesional energy absorbance. Finally, unlike the PDL, the KTP laser is a solid-state laser and is not prone to mechanical failure.
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Affiliation(s)
- Steven M Zeitels
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital Boston, MA 02114, USA
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Zeitels SM, Franco RA, Dailey SH, Burns JA, Hillman RE, Anderson RR. Office-Based Treatment of Glottal Dysplasia and Papillomatosis with the 585-NM Pulsed Dye Laser and Local Anesthesia. Ann Otol Rhinol Laryngol 2016; 113:265-76. [PMID: 15112968 DOI: 10.1177/000348940411300403] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [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: 11/16/2022]
Abstract
Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation, denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.
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Affiliation(s)
- Steven M Zeitels
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Zeitels SM, Burns JA, Akst LM, Hillman RE, Broadhurst MS, Anderson RR. Office-Based and Microlaryngeal Applications of a Fiber-Based Thulium Laser. Ann Otol Rhinol Laryngol 2016; 115:891-6. [PMID: 17214262 DOI: 10.1177/000348940611501206] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 11/16/2022]
Abstract
Objectives: The carbon dioxide (CO2) laser is the premier dissecting instrument for hemostatic cutting and ablation during endolaryngeal surgery. However, microlaryngeal tangential dissection and office-based photoablation have been limited by the lack of a fiber-based delivery system. To address this limitation, a new laser was designed, which is a diode-pumped solid-state laser with a thulium-doped yttrium-aluminum-garnet laser rod. It produces a continuous-wave beam with a wavelength of 2,013 nm and a target chromophore of water. This new laser functions similarly to a CO2 laser with the benefit of being delivered through a small glass fiber (0.365 to 0.550 mm). Methods: A prospective pilot trial was done in 74 cases to explore applications of the new thulium laser. Thirty-two procedures were done with the laser used as an ablating instrument and topical anesthesia through a flexible laryngoscope (papillomatosis, 20; microinvasive carcinoma, 6; benign supraglottic lesions, 3; edema, 2; granuloma, 1). Forty-two procedures were done with the laser used as a cutting or ablating instrument for microlaryngeal dissection and general anesthesia. These included 27 partial laryngeal resections (supraglottis, 15; glottis, 10; subglottis, 2) and 8 posterior glottic laryngoplasties. The laser was also used as an ablative instrument during microlaryngoscopy in 7 cases. Results: The thulium laser was used effectively in all cases, under both local and general anesthesia. In microlaryngeal dissection, electrocautery was not needed to control bleeding, even during cutting in the highly vascular paraglottic space. No complications related to the use of the thulium laser were experienced in any case. Conclusions: Because of the fiber-based delivery system, the 2,013-nm continuous-wave thulium laser shows substantial promise for tangential dissection during microlaryngoscopy and soft tissue photoablation during office-based flexible laryngoscopy. Hemostasis was judged to be superior to experiences with the CO2 laser. In this pilot study, performing en bloc laryngeal cancer resection procedures was facilitated by use of the thulium laser.
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Abstract
Every critical advancement in direct laryngoscopic surgical technique has enhanced its precision. Among the most notable was Killian's seminal description of suspension laryngoscopy 90 years ago, which allowed for bimanual direct laryngoscopic surgery. Because of the technical difficulties encountered while performing suspension laryngoscopy, Brünings and Seiffert designed fulcrum laryngoscope holder-stabilizers for spatula laryngoscopes from Killian's original instrument design. Their devices, which were easier to use and better tolerated by patients, were supported from the laryngeal cartilage framework or chest wall. Laryngoscope holder-stabilizers were retrofitted to tubular laryngoscope specula in the 1940s and 1950s, whereupon they became very popular. Suspension laryngoscopy should have become more common subsequent to the introduction of general endotracheal anesthesia with paralysis in the 1960s. However, laryngoscope holder-stabilizers were entrenched as the device preferred by most, and they remain so today. This entrenchment occurred despite the fact that suspension laryngoscopy allows for positioning a larger examining speculum, which in turn allows for enhanced exposure and endolaryngeal procedural precision. The applied vector forces on the mandible, maxilla, oral cavity, pharynx, and larynx associated with suspension laryngoscopy are preferable to those associated with holder-stabilizers. A prospective assessment of 120 cases revealed effective use of suspension laryngoscopy in all. We believe that only a minority of surgeons has actually seen true suspension laryngoscopy and that its merits are worthy of reexamination.
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Affiliation(s)
- Steven M Zeitels
- Department of Otology and Laryngology, Harvard Medical School, and Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA
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Cook AB, Barbey R, Burns JA, Perrier S. Hyperbranched Polymers with High Degrees of Branching and Low Dispersity Values: Pushing the Limits of Thiol–Yne Chemistry. Macromolecules 2016. [DOI: 10.1021/acs.macromol.6b00132] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Alexander B. Cook
- Department
of Chemistry, The University of Warwick, Coventry CV4 7AL, U.K
| | - Raphael Barbey
- Key Centre for Polymers & Colloids, School of Chemistry, Building F11, The University of Sydney, Sydney, NSW 2006, Australia
| | - James A. Burns
- Syngenta, Jealott’s
Hill International Research Centre, Bracknell, Berkshire RG42 6EY, U.K
| | - Sébastien Perrier
- Department
of Chemistry, The University of Warwick, Coventry CV4 7AL, U.K
- Faculty
of Pharmacy and Pharmaceutical Sciences, Monash University, 381
Royal Parade, Parkville, Victoria 3052, Australia
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Barbu AM, Gniady JP, Vivero RJ, Friedman AD, Burns JA. Bedside Injection Medialization Laryngoplasty in Immediate Postoperative Patients. Otolaryngol Head Neck Surg 2015; 153:1007-12. [DOI: 10.1177/0194599815601393] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022]
Abstract
Objectives The morbidity of glottic insufficiency resulting from unilateral vocal fold immobility may significantly compromise postoperative recovery in patients with decreased pulmonary reserve or inability to protect their airway. Injection medialization laryngoplasty is an effective means of treating glottic insufficiency due to unilateral vocal fold immobility. The purpose of this study is to present our experience with bedside transoral injection medialization laryngoplasty in the immediate postoperative period. Study Design Case series with chart review. Setting Academic tertiary care hospital. Subjects and Methods Patient demographics, clinical characteristics, procedural details, and short-term outcome measures of oral intake were recorded in a cohort of 68 patients over 5 years with unilateral vocal cord paralysis who underwent injection medialization as a bedside procedure in the immediate postoperative period. Results Mean time to injection was 8.2 days postoperatively. At the time of injection, 40 of 68 patients were nil per os. Seventy percent (28 of 40) had their diet advanced to adequate oral intake within 5 days of injection. Greater than half of the injections (36 of 68) were performed in the intensive care unit. No complications were noted, and all patients in this cohort were able to tolerate the bedside injection. Conclusion Bedside injection medialization laryngoplasty in the immediate postoperative period via the transoral approach can be performed in patients, even in the intensive care unit, while on anticoagulation, and may be of benefit for hospitalized patients with unilateral vocal fold immobility. Further studies quantifying improvement in voice and swallowing data are merited.
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Affiliation(s)
- Anca M. Barbu
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John P. Gniady
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard J. Vivero
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron D. Friedman
- NorthShore University HealthSystem Department of Surgery, Evanston, Illinois, USA
| | - James A. Burns
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation–Massachusetts General Hospital, Boston, Massachusetts, USA
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Van Stan JH, Mehta DD, Zeitels SM, Burns JA, Barbu AM, Hillman RE. Average Ambulatory Measures of Sound Pressure Level, Fundamental Frequency, and Vocal Dose Do Not Differ Between Adult Females With Phonotraumatic Lesions and Matched Control Subjects. Ann Otol Rhinol Laryngol 2015; 124:864-74. [PMID: 26024911 DOI: 10.1177/0003489415589363] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Clinical management of phonotraumatic vocal fold lesions (nodules, polyps) is based largely on assumptions that abnormalities in habitual levels of sound pressure level (SPL), fundamental frequency (f0), and/or amount of voice use play a major role in lesion development and chronic persistence. This study used ambulatory voice monitoring to evaluate if significant differences in voice use exist between patients with phonotraumatic lesions and normal matched controls. METHODS Subjects were 70 adult females: 35 with vocal fold nodules or polyps and 35 age-, sex-, and occupation-matched normal individuals. Weeklong summary statistics of voice use were computed from anterior neck surface acceleration recorded using a smartphone-based ambulatory voice monitor. RESULTS Paired t tests and Kolmogorov-Smirnov tests resulted in no statistically significant differences between patients and matched controls regarding average measures of SPL, f0, vocal dose measures, and voicing/voice rest periods. Paired t tests comparing f0 variability between the groups resulted in statistically significant differences with moderate effect sizes. CONCLUSIONS Individuals with phonotraumatic lesions did not exhibit differences in average ambulatory measures of vocal behavior when compared with matched controls. More refined characterizations of underlying phonatory mechanisms and other potentially contributing causes are warranted to better understand risk factors associated with phonotraumatic lesions.
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Affiliation(s)
- Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Zeitels
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - James A Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anca M Barbu
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Parker NP, Barbu AM, Hillman RE, Zeitels SM, Burns JA. Revision Transcervical Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2015; 153:593-8. [DOI: 10.1177/0194599815585091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/13/2015] [Indexed: 11/17/2022]
Abstract
Objective To identify patterns of failure following transcervical medialization laryngoplasty for unilateral vocal fold paralysis and describe indications and revision techniques for optimal vocal outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Thirty-nine consecutive patients between January 2005 and April 2014 undergoing transcervical revision of failed primary medialization laryngoplasty were identified. Demographics, etiology, stroboscopic assessment, and surgical techniques were recorded. Patient self-assessment using the Voice-Related Quality-of-Life (VRQOL) questionnaire and objective acoustic and aerodynamic assessments performed pre- and postoperatively were analyzed using t tests for paired comparisons. Results Thirty-nine patients underwent 48 transcervical revision surgeries. Median follow-up was 14.6 months from time of final revision surgery. Indications included anterior glottic incompetence (38/48, 79%), posterior glottic incompetence (20/48, 42%), glottic overclosure (8/48, 17%), and/or decreased phonatory pliability (12/48, 25%). A combination of findings was present in 21 (44%) surgeries. Revision techniques included either anterior augmentation, arytenopexy, and cricothyroid subluxation (alone or in combination) in 46 of 48 (96%) patients or partial implant removal alone in 2 patients. Seven patients (18%) required multiple revisions. A complete set of voice parameters was available for 22 patients, and statistically significant improvements included VRQOL scores, fundamental frequency in females, jitter, noise-to-harmonic ratio, and mean airflow rate. Conclusion Patterns of failure in patients with suboptimal phonatory function after transcervical medialization laryngoplasty included persistent glottic incompetence, glottic overclosure, and decreased vocal fold pliability. Revision transcervical medialization surgery, guided by individualized consideration of vocal fold position and surface pliability, can improve phonatory outcomes.
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Affiliation(s)
- Noah P. Parker
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anca M. Barbu
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert E. Hillman
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven M. Zeitels
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Affiliation(s)
- Eran Brauner
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Kai-Pun Wong
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - James A. Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Bertrand O, Wilson P, Burns JA, Bell GA, Haddleton DM. Cu(0)-mediated living radical polymerisation in dimethyl lactamide (DML); an unusual green solvent with limited environmental impact. Polym Chem 2015. [DOI: 10.1039/c5py01420d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The synthesis of poly-acrylates, methacrylates and styrene derivatives by SET-LRP is reported in a user and environmentally friendly “green” solvent, dimethyl lactamide (DML).
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Affiliation(s)
| | - Paul Wilson
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
| | - James A. Burns
- Formulation Technology Group
- Syngenta
- Jealotts Hill international Research Centre
- Bracknell
- UK
| | - Gordon A. Bell
- Formulation Technology Group
- Syngenta
- Jealotts Hill international Research Centre
- Bracknell
- UK
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Akst LM, Altman KW, Burns JA, Califano J, Quon H, Remacle MJ. Vocal Fold Leukoplakia: Controversies in Evaluation and Treatment. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Program Description: This miniseminar comprehensively reviews evaluation and management of laryngeal leukoplakia. Although white vocal fold lesions are common, management remains challenging. Doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia. Within a framework balancing oncologic with functional outcomes, and using case-based presentations, this miniseminar highlights challenges, controversies, and emerging paradigms in laryngeal leukoplakia care. Perspectives from laryngology, head and neck oncology, and radiation oncology will discuss innovations such as narrow-band imaging, optical coherence tomography, potassium titanyl phosphate (KTP) and CO2 laser, chemotherapy, radiotherapy, and photodynamic therapy as they apply to current and future state-of-the-art management. Educational Objectives: (1) Understand the risk of progression of laryngeal leukoplakia to carcinoma and need to balance oncologic efficacy with functional outcomes in leukoplakia care. (2) Review current and emerging techniques for accurate diagnosis, staging, and surveillance of laryngeal leukoplakia. (3) Discuss treatment alternatives for laryngeal leukoplakia, emphasizing surgical techniques of KTP, CO2, and cold-instrument phonosurgery and including potential roles of radiotherapy, photodynamic therapy, and chemotherapy.
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Ainsworth TA, Kobler JB, Loan GJ, Burns JA. Simulation Model for Transcervical Laryngeal Injection Providing Real-time Feedback. Ann Otol Rhinol Laryngol 2014; 123:881-6. [DOI: 10.1177/0003489414539922] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study aimed to develop and evaluate a model for teaching transcervical laryngeal injections. Methods: A 3-dimensional printer was used to create a laryngotracheal framework based on de-identified computed tomography images of a human larynx. The arytenoid cartilages and intrinsic laryngeal musculature were created in silicone from clay casts and thermoplastic molds. The thyroarytenoid (TA) muscle was created with electrically conductive silicone using metallic filaments embedded in silicone. Wires connected TA muscles to an electrical circuit incorporating a cell phone and speaker. A needle electrode completed the circuit when inserted in the TA during simulated injection, providing real-time feedback of successful needle placement by producing an audible sound. Face validation by the senior authorconfirmed appropriate tactile feedback and anatomical realism. Otolaryngologists pilot tested the model and completed presimulation and postsimulation questionnaires. Results: The high-fidelity simulation model provided tactile and audio feedback during needle placement, simulating transcervical vocal fold injections. Otolaryngology residents demonstrated higher comfort levels with transcervical thyroarytenoid injection on postsimulation questionnaires. Conclusion: This is the first study to describe a simulator for developing transcervical vocal fold injection skills. The model provides real-time tactile and auditory feedback that aids in skill acquisition. Otolaryngologists reported increased confidence with transcervical injection after using the simulator.
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Affiliation(s)
- Tiffiny A. Ainsworth
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James B. Kobler
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory J. Loan
- Department of Radiology–Harvard Medical School, The Simulation Group, Massachusetts General Hospital, Cambridge, Massachusetts, USA
| | - James A. Burns
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Best SR, Kobler JB, Friedman AD, Barbu AM, Zeitels SM, Burns JA. Effect of Mandibular Tori on Glottic Exposure During Simulated Suspension Microlaryngoscopy. Ann Otol Rhinol Laryngol 2014; 123:188-94. [DOI: 10.1177/0003489414522967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Mandibular tori have been identified as a contributing factor in difficult exposure during intubation. However, no investigation has measured the effect of mandibular tori on glottic exposure during suspension microlaryngoscopy (SML). The objective of this study was to measure how the size and location of mandibular tori affect glottic exposure during simulated SML at different thyromental distances. Methods: Suspension microlaryngoscopy was modeled on an anatomically accurate skull and larynx with thyromental distances between 6 and 12 cm. Mandibular tori were simulated by protruding screws 5 to 15 mm from the lingual aspect of the mandible. The tori were positioned either 15 mm (anterior) or 25 mm (posterior) from the midline of the symphysis. The glottic exposure for the various-size tori in each location was measured by recording the displacement of the glottiscope tip relative to the most anterior exposure achievable without tori. The glottiscope angle relative to the horizontal plane was measured for each condition. Results: Mandibular tori of more than 10 mm had a significant impact on glottic exposure. Displacement of the glottiscope tip ranged from 2 to 9 mm for anteriorly placed tori and from 7 to 29 mm for posteriorly placed tori, with larger tori causing greater displacement. Increasing the thyromental distance increased the posterior glottiscope tip displacement regardless of torus size or location. The glottiscope angle increased with larger tori (12º to 28º), but this angle did not change with increasing thyromental distance. Conclusions: Larger size and more-posterior location of mandibular tori more significantly reduce glottic exposure during SML. The inner table of the mandible is the most relevant anatomic constraint on glottic exposure, which varies with the presence or absence of mandibular tori independent of thyromental distance.
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Affiliation(s)
- Simon R. Best
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James B. Kobler
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron D. Friedman
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anca M. Barbu
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven M. Zeitels
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, and the Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Waldron C, Zhang Q, Li Z, Nikolaou V, Nurumbetov G, Godfrey J, McHale R, Yilmaz G, Randev RK, Girault M, McEwan K, Haddleton DM, Droesbeke M, Haddleton AJ, Wilson P, Simula A, Collins J, Lloyd DJ, Burns JA, Summers C, Houben C, Anastasaki A, Li M, Becer CR, Kiviaho JK, Risangud N. Absolut “copper catalyzation perfected”; robust living polymerization of NIPAM: Guinness is good for SET-LRP. Polym Chem 2014. [DOI: 10.1039/c3py01075a] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The controlled polymerization of N-isopropyl acrylamide (NIPAM) is reported in a range of international beers, wine, ciders and spirits utilizing Cu(0)-mediated living radical polymerization (SET-LRP).
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Affiliation(s)
| | - Qiang Zhang
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
| | - Zaidong Li
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
| | | | | | | | - Ronan McHale
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
| | | | | | - Mony Girault
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
| | | | | | | | | | - Paul Wilson
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
| | | | | | | | | | | | | | | | - Muxiu Li
- Dept. of Chemistry
- University of Warwick
- Coventry
- UK
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Burns JA, Haughey BH, Weinstein GS. Surgical Innovations for Larynx and Pharynx Cancer. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Program Description: Transoral treatment of larynx and pharynx cancer has been done for over a century. Despite substantial technical innovations such as enhanced imaging, innovative laser technologies, and robotic guidance systems, chemoradiation protocols dominate treatment strategies at many institutions. Outcomes data on transoral microsurgical management for advanced oropharynx and larynx cancer will be presented to illustrate the efficacy of surgical management of these diseases. Robotics and laser photoangiolysis of laryngeal cancer are two emerging technologies that can enhance endoscopic surgery. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and innovative technology through presentations from experts in the field. Educational Objectives: 1) Evaluate outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Interpret the emerging role of robotics in the endoscopic surgical management of larynx and pharynx cancer. 3) Apply concepts of photoangiolysis in treatment of aerodigestive tract malignancy.
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Friedman AD, Hillman RE, Landau-Zemer T, Burns JA, Zeitels SM. Voice outcomes for photoangiolytic KTP laser treatment of early glottic cancer. Ann Otol Rhinol Laryngol 2013; 122:151-8. [PMID: 23577566 DOI: 10.1177/000348941312200302] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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]
Abstract
OBJECTIVES Surgery and radiotherapy routinely provide high cure rates in treating early glottic cancer. Therefore, key metrics for success are optimal voice outcome and preservation of future cancer treatment options. Remarkably, there is a paucity of pretreatment versus posttreatment voice outcome data. Angiolytic KTP (potassium titanyl phosphate) laser treatment of early glottic cancer with ultranarrow margins was initiated to better preserve vocal function. Given that effective oncological results have been achieved, it was hypothesized that this approach would also result in improved posttreatment measures of vocal function that more closely approximate historical norms than pretreatment values. METHODS Pretreatment and posttreatment voice outcome data were obtained for 92 patients (64 with T1 cancer and 28 with T2 cancer) who underwent 532-nm KTP laser treatment of early glottic cancer in a study design in which each patient essentially served as his or her own control. The evaluations included objective measures (acoustic and aerodynamic) and patients' self-assessments of vocal function (Voice-Related Quality of Life; V-RQOL). A series of mixed analyses of variance were conducted for all vocal function measures, with tumor stage and depth of invasion as the between-subjects variables and time (presurgery versus postsurgery) as the within-subject variable. RESULTS There were statistically significant (p < or = 0.05) postoperative improvements for acoustic (perturbation and noise-to-harmonics ratio) and aerodynamic (subglottic pressure and vocal efficiency) measures of vocal function, as well as for V-RQOL assessment. CONCLUSIONS Comprehensive pretreatment and posttreatment voice measures in a large patient cohort demonstrated that the KTP laser significantly improved postoperative vocal function in patients with early glottic cancer. Furthermore, radiotherapy was preserved as an oncological treatment option.
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Affiliation(s)
- Aaron D Friedman
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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