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Hernandez-Morato I, Koss S, Honzel E, Pitman MJ. Netrin-1 as A neural guidance protein in development and reinnervation of the larynx. Ann Anat 2024; 254:152247. [PMID: 38458575 DOI: 10.1016/j.aanat.2024.152247] [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] [Received: 08/21/2023] [Revised: 02/01/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Neural guidance proteins participate in motor neuron migration, axonal projection, and muscle fiber innervation during development. One of the guidance proteins that participates in axonal pathfinding is Netrin-1. Despite the well-known role of Netrin-1 in embryogenesis of central nervous tissue, it is still unclear how the expression of this guidance protein contributes to primary innervation of the periphery, as well as reinnervation. This is especially true in the larynx where Netrin-1 is upregulated within the intrinsic laryngeal muscles after nerve injury and where blocking of Netrin-1 alters the pattern of reinnervation of the intrinsic laryngeal muscles. Despite this consistent finding, it is unknown how Netrin-1 expression contributes to guidance of the axons towards the larynx. Improved knowledge of Netrin-1's role in nerve regeneration and reinnervation post-injury in comparison to its role in primary innervation during embryological development, may provide insights in the search for therapeutics to treat nerve injury. This paper reviews the known functions of Netrin-1 during the formation of the central nervous system and during cranial nerve primary innervation. It also describes the role of Netrin-1 in the formation of the larynx and during recurrent laryngeal reinnervation following nerve injury in the adult.
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Affiliation(s)
- Ignacio Hernandez-Morato
- Department of Otolaryngology-Head & Neck Surgery, The Center for Voice and Swallowing, Columbia University College of Physicians and Surgeons, New York, NY, United States; Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Madrid, Spain.
| | - Shira Koss
- ENT Associates of Nassau County, Levittown, NY, United States
| | - Emily Honzel
- Department of Otolaryngology-Head & Neck Surgery, The Center for Voice and Swallowing, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Michael J Pitman
- Department of Otolaryngology-Head & Neck Surgery, The Center for Voice and Swallowing, Columbia University College of Physicians and Surgeons, New York, NY, United States
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Kemfack AM, Hernandez-Morato I, Moayedi Y, Pitman MJ. Transcriptome Analysis of Left Versus Right Intrinsic Laryngeal Muscles Associated with Innervation. Laryngoscope 2024. [PMID: 38721727 DOI: 10.1002/lary.31487] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent laryngeal nerve injury diagnosed as idiopathic or due to short-term surgery-related intubation exhibits a higher incidence of left-sided paralysis. While this is often attributed to nerve length, it is hypothesized there are asymmetric differences in the expression of genes related to neuromuscular function that may impact reinnervation and contribute to this laterality phenomenon. To test this hypothesis, this study analyzes the transcriptome profiles of the intrinsic laryngeal muscles (ILMs), comparing gene expression in the left versus right, with particular attention to genetic pathways associated with neuromuscular function. STUDY DESIGN Laboratory experiment. METHODS RNA was extracted from the left and right sides of the rat posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA), respectively. After high-throughput RNA-Sequencing, 88 samples were organized into 12 datasets according to their age (P15/adult), sex (male/female), and muscle type (PCA/LTA/MTA). A comprehensive bioinformatics analysis was conducted to compare the left-right ILMs across different conditions. RESULTS A total of 774 differentially expressed genes were identified across the 12 experimental groups, revealing age, sex, and muscle-specific differences between the left versus right ILMs. Enrichment analysis of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways implicated several genes with a left-right laryngeal muscle asymmetry. These genes are associated with neuronal and muscular physiology, immune/inflammatory response, and hormone control. CONCLUSION Bioinformatics analysis confirmed divergent transcriptome profiles between the left-right ILMs. This preliminary study identifies putative gene targets that will characterize ILM laterality. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Angela M Kemfack
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Ignacio Hernandez-Morato
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Yalda Moayedi
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, U.S.A
- Pain Research Center, New York University College of Dentistry, New York University, New York, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
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Enver N, Axiotakis LG, Sulica L, Pitman MJ. Quality of Office-based Procedure Training During Laryngology Fellowship. Laryngoscope 2024; 134:1802-1806. [PMID: 37747121 DOI: 10.1002/lary.31068] [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] [Received: 04/15/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The primary objective was to assess the perspectives of recent laryngology fellowship graduates on office-based procedure training, with a secondary objective to compare this with previous research on perspectives of fellowship directors. METHODS Recent laryngology fellowship graduates were surveyed via an online survey platform regarding post-fellowship practice and various aspects of office-based procedure training, including perceived competence, mentorship, and barriers. RESULTS There were 51 respondents. Seventy-six percent of respondents felt they "definitely" received adequate office procedure training. Number of procedures as primary surgeon was significantly associated with perception of adequate training (OR 1.54, 95% CI: 1.08-2.19, p = 0.018) and high post-fellowship office procedure volume (OR 1.56, 95% CI: 1.02-2.39, p = 0.040). Fellows reported a lower percentage of procedures as primary surgeons compared with program directors (46.8% vs. 61.9%, p = 0.028). Fellows and directors agreed that informal debriefs were more commonly employed than more structured training elements such as checklists and simulators. Of nine office procedures, laryngeal electromyography, KTP laser, and transnasal esophagoscopy had the greatest decreases in practice after training. CONCLUSION Although most recent laryngology fellowship graduates endorse adequate office-based procedure training, a range of individual experiences exists, and office procedure volume, both overall and across individual procedures, may decrease after fellowship. Fellows performing office procedures as primary surgeons may be linked to perceived quality of training and post-fellowship volume. LEVEL OF EVIDENCE NA Laryngoscope, 134:1802-1806, 2024.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Lucas G Axiotakis
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irvine Medical Center, New York City, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York-Presbyterian Hospital, New York City, New York, U.S.A
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York-Presbyterian Hospital, New York City, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irvine Medical Center, New York City, New York, U.S.A
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Honzel E, Joshi A, Hernandez-Morato I, Pennington-FitzGerald W, Pitman MJ. A comparison of confocal and epifluorescence microscopy for quantification of RNAScope and immunohistochemistry fluorescent images. J Neurosci Methods 2024; 403:110050. [PMID: 38145719 PMCID: PMC10874114 DOI: 10.1016/j.jneumeth.2023.110050] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Quantification of RNA expression and protein production in fluorescent stainings provides critical information concerning neurodevelopment. A trustable independent quantification technique requires acquisition of reliable images prior to image processing. There is uncertainty in existing literature regarding the use of confocal microscopy compared to standard epifluorescence microscopy, especially in the context of RNA in situ hybridization protocols. NEW METHOD The hindbrains of developing rat embryos from embryologic day 14 (E14) to E20 were sectioned and stained for expression of Hoxb1, Hoxb2, and Phox2b using both RNAScope and immunohistochemistry. Islet1 was used for identification of hindbrain motoneuron cell bodies. Slides were imaged using both confocal and epifluorescence microscopy. RESULTS Expression patterns of both mRNA and protein were similar in both imaging modalities. Analyses of Hoxb1 and Hoxb2 mRNA expression were particularly concordant between-scopes, with similar p-values and posthoc differences between timepoints. Confocal imaging of Hoxb2 protein yielded a significant peak at E18, but this level of significance was not reached using epifluorescence microscopy. Although similar trends were observed, only Phox2b RNAScope results were statistically significant when analyzed with confocal microscopy. In contrast, Phox2b immunostaining analyses showed significant differences using both microscopes. COMPARISON WITH EXISTING METHODS Researchers may save time and financial resources if epifluorescence microscopy provides comparable or equal results as confocal. CONCLUSIONS Epifluorescence microscopy appears sufficient for quantification of RNAScope experiments with relatively low puncta per cell, while confocal microscopy gives clearer definition to immunohistochemical protein relationships and may be preferable especially in targets with low protein production.
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Affiliation(s)
- Emily Honzel
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States.
| | - Abhinav Joshi
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States.
| | - Ignacio Hernandez-Morato
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States.
| | - William Pennington-FitzGerald
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States.
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States.
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Pennington-FitzGerald W, Joshi A, Honzel E, Hernandez-Morato I, Pitman MJ, Moayedi Y. Development and Application of Automated Vocal Fold Tracking Software in a Rat Surgical Model. Laryngoscope 2024; 134:340-346. [PMID: 37543969 DOI: 10.1002/lary.30930] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/21/2023] [Accepted: 07/15/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The rat is a widely used model for studying vocal fold (VF) function after recurrent laryngeal nerve injury, but common techniques for evaluating rat VF motion remain subjective and imprecise. To address this, we developed a software package, called RatVocalTracker1.0 (RVT1.0), to quantify VF motion and tested it on rats with iatrogenic unilateral vocal fold paralysis (VFP). METHODS A deep neural network was trained to identify the positions of the VFs and arytenoid cartilages (ACs) in transoral laryngoscope videos of the rat glottis. Software was developed to estimate glottic midline, VF displacement, VF velocity, and AC angle. The software was applied to laryngoscope videos of adult rats before and after right recurrent and superior laryngeal nerve transection (N = 15; 6M, 9F). All software calculated metrics were compared before and after injury and validated against manually calculated metrics. RESULTS RVT1.0 accurately tracked and quantified VF displacement, VF velocity, and AC angle. Significant differences were found before and after surgery for all RVT1.0 calculated metrics. There was strong agreement between programmatically and manually calculated measures. Automated analysis was also more efficient than nearly all manual methods. CONCLUSION This approach provides fast, accurate assessment of VF motion in rats with minimal labor and allows for quantitative comparison of lateral differences in movement. Through this novel analysis method, we can differentiate healthy movement from unilateral VFP. RVT1.0 is open-source and will be a valuable tool for researchers using the rat model for laryngology research. LEVEL OF EVIDENCE NA Laryngoscope, 134:340-346, 2024.
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Affiliation(s)
| | - Abhinav Joshi
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Emily Honzel
- College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Ignacio Hernandez-Morato
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Yalda Moayedi
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
- Department of Neurology, Columbia University, New York, New York, U.S.A
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Doruk C, Pitman MJ. Lateral Transcervical In-office Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction. Laryngoscope 2024; 134:283-286. [PMID: 37421251 DOI: 10.1002/lary.30871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 03/02/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Operating room (OR) injection of botulinum toxin (BTX) injection is effective in the management of retrograde cricopharyngeal dysfunction (RCPD). This study aims to analyze the efficacy and safety of in-office (IO) 30 Unit BTX injection into the cricopharyngeus via lateral transcervical approach. METHODS A retrospective chart review of patients who underwent BTX injection either in the OR or IO for RCPD was performed. Postoperative success, defined by patient-reported complete or near complete resolution of symptoms, side effects, and complication rates of each group was determined and compared. To determine the learning curve of IO injections, success rates of the injections performed in the early and late 6 months were compared. Chi-square test was used for determining the statistical significance. RESULTS Overall, 78 injections (37 IO and 41 OR) for RCPD were performed by the senior author. The success rate of OR injections (90.2%) is significantly higher than IO injections (64.9%) at the first-month follow-up (p = 0.022). No significant difference was found in the side effect rates. Success and side effect rates were also similar in early and late injections (p > 0.05). CONCLUSIONS IO lateral transcervical BTX injection for RCPD is a safe method that does not require general or topical anesthesia. While the side effects are similar and IO injections have many advantages, the success rates are lower than OR injections. LEVEL OF EVIDENCE 3 Laryngoscope, 134:283-286, 2024.
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Affiliation(s)
- Can Doruk
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Michael J Pitman
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
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Honzel E, Hernandez-Morato I, Joshi A, Pennington-Fitzgerald W, Moayedi Y, Pitman MJ. Temporal Expression of Hox Genes and Phox2b in the Rat Nucleus Ambiguus During Development: Implications on Laryngeal Innervation. Laryngoscope 2023; 133:3462-3471. [PMID: 37350386 PMCID: PMC10907063 DOI: 10.1002/lary.30826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES Recurrent laryngeal nerve (RLN) injury results in synkinetic reinnervation and vocal fold paralysis. Investigation of cues expressed in the developing brainstem that influence correct selective targeting of intrinsic laryngeal muscles may elucidate post-injury abnormalities contributing to non-functional reinnervation. Primary targets of interest were Hoxb1 and Hoxb2, members of the Hox family that create overlapping gradients in the developing brain, and their target Phox2b, a transcription factor necessary for cranial nerve branchio- and visceromotoneuron survival. METHODS Rat embryos at developmental days E14, E16, E18, and E20 (4 animals/age) were sectioned for RNA in situ hybridization to detect Hoxb1, Hoxb2, and Phox2b mRNA within the brainstem. Slides were costained with Islet1 antibody for identification of the nucleus ambiguus. Results were confirmed using immunohistochemistry. Sections were imaged on a confocal microscope. RNA and protein expressions were quantified using QuPath. Statistical analyses were performed using R. RESULTS Hoxb1, Hoxb2, and Phox2b expressions varied according to embryologic age. Hoxb1 and Hoxb2 expression peaked at E16, with significant decreases at E18 and E20 (one-way ANOVA p = 0.001 for both). Phox2b expression was highest at E14 and trended downward with increased embryologic age (one-way ANOVA p = 0.005). CONCLUSION Peak expression of Hoxb1 and Hoxb2 is observed at time points when the RLN arrives at the larynx and begins to branch toward individual muscles, positioning these gene products to be involved in cueing laryngeal motoneuron identity and target identification. Higher expression of Phox2b earlier in development suggests a role in laryngeal motoneuron formation. LEVEL OF EVIDENCE NA Laryngoscope, 133:3462-3471, 2023.
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Affiliation(s)
- Emily Honzel
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| | - Ignacio Hernandez-Morato
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| | - Abhinav Joshi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| | - William Pennington-Fitzgerald
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| | - Yalda Moayedi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
- Department of Neurology, Columbia University, New York, New York, U.S.A
| | - Michael J Pitman
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
- Department of Neurology, Columbia University, New York, New York, U.S.A
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Kemfack AM, Hernández-Morato I, Moayedi Y, Pitman MJ. Transcriptome analysis of left versus right intrinsic laryngeal muscles associated with innervation. bioRxiv 2023:2023.08.25.554869. [PMID: 37873132 PMCID: PMC10592802 DOI: 10.1101/2023.08.25.554869] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives/Hypothesis Recurrent laryngeal nerve injury diagnosed as idiopathic or due to short-term surgery-related intubation exhibits a higher incidence of left-sided paralysis. While this is often attributed to nerve length, it is hypothesized there are asymmetric differences in the expression of genes related to neuromuscular function that may impact reinnervation and contribute to this laterality phenomenon. To test this hypothesis, this study analyzes the transcriptome profiles of the intrinsic laryngeal muscles (ILMs), comparing gene expression in the left versus right, with particular attention to genetic pathways associated with neuromuscular function. Study Design Laboratory experiment. Methods RNA was extracted from the left and right sides of the rat posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA), respectively. After high-throughput RNA-Sequencing (RNA-Seq), 88 samples were organized into 12 datasets according to their age (P15/adult), sex (male/female), and muscle type (PCA/LTA/MTA). A comprehensive bioinformatics analysis was conducted to compare the left-right ILMs across different conditions. Results 774 differentially expressed genes (DEGs) were identified across the 12 experimental groups, revealing age, sex, and muscle-specific differences between the left versus right ILMs. Enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways implicated several genes with a left-right laryngeal muscle asymmetry. These genes are associated with neuronal and muscular physiology, immune/inflammatory response, and hormone control. Conclusion Bioinformatics analysis confirmed divergent transcriptome profiles between the left-right ILMs. This preliminary study identifies putative gene targets that will characterize ILM laterality. Level of Evidence N/A. LAY SUMMARY Vocal fold paralysis is more common on the left. This study shows left versus right differences in gene expression related to innervation, suggesting the increased rate of left recurrent laryngeal nerve paralysis may be associated with genetic differences, not just nerve length.
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Blount Q, Hernandez-Morato I, Moayedi Y, Pitman MJ. Expression of Glial Cell-Derived Neurotrophic Factor Receptors Within Nucleus Ambiguus During Rat Development. Laryngoscope 2023; 133:2240-2247. [PMID: 36271908 PMCID: PMC10121972 DOI: 10.1002/lary.30440] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/08/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The nucleus ambiguus (NAmb) is a column of neurons in the medulla oblongata, involved in bulbar functions. Expression of Glial Cell-Derived Neurotrophic Factor (GDNF) and its receptors (GDNFR) is observed within the cell bodies during reinnervation following recurrent laryngeal nerve (RLN) injury. Little is known regarding GDNFR expression in the formation of the NAmb and the laryngeal innervation during embryogenesis. Understanding the timing and pattern of GDNFR expression in embryogenesis versus after RLN injury may provide insights into therapeutic targets for regeneration after RLN injury. STUDY DESIGN Laboratory experiment. METHODS Rat brainstems at E14.5/E16.5/E18.5/E20.5/adult were stained for GDNFR: GFRα-1/GFRα-2/GFRα-3/Ret. Islet1 and choline acetyltransferase were used as cell body markers. Sections were observed using fluorescent microscopy and quantified through manual cell counting. RESULTS Expression of GFRα-1, GFRα-3, and Ret was identified within the NAmb, hypoglossal, and facial nuclei of the adult medulla. During development, GFRα-1 immunoreactivity was seen at E20.5. GFRα-2 expression was not observed at any timepoint. GFRα-3 expression began at E16.5. Ret expression within nerve fibers in the NAmb were observed beginning at E14.5, but never in the cell bodies. CONCLUSION Embryonic GDNFR expression in the NAmb differs from that of the adult after RLN injury. The developing brainstem experienced upregulation at discrete timepoints with signaling sustained through adulthood. In contrast, adult RLN-transected rats experienced patterns of up and down regulation. GFRα-1 may contribute to muscle targeting and neuromuscular junction maturation, GFRα-3 may contribute to both, as well as axon guidance. It is likely that GDNF is functioning via a Ret-independent pathway. LEVEL OF EVIDENCE NA Laryngoscope, 133:2240-2247, 2023.
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Affiliation(s)
- Quinton Blount
- Mercer University School of Medicine, Columbus, USA
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, U.S.A
| | - Ignacio Hernandez-Morato
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, U.S.A
| | - Yalda Moayedi
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, U.S.A
- Department of Neurology, Columbia University, New York, U.S.A
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, U.S.A
- Principal Investigator
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Axiotakis LG, Enver N, Kennedy EL, Duncan KA, Pitman MJ. Duration of Clinical Response After In-Office Steroid Injection for Vocal Fold Scar. Laryngoscope 2023; 133:2333-2339. [PMID: 36594519 DOI: 10.1002/lary.30539] [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] [Received: 10/04/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the duration of clinical response after in-office vocal fold steroid injection (VFSI) for vocal fold (VF) scar. METHODS Demographic and clinical data for in-office VFSI occurring from 2017 to 2020 were collected. Two Speech-Language Pathologists (SLPs) used perceptual evaluation of voice and functional scales to evaluate blinded voice and laryngovideostroboscopy (LVS) samples collected pre- and post-injection across multiple timepoints. RESULTS Blinded SLP ratings were used for 30 individual VFs undergoing initial injection in 18 patients. Persistent improvement in voice past 6 months was seen in 57% of patients after VFSI. Multiple measures of voice and amplitude, percent vibrating tissue, and closed phase predominance significantly improved at various follow-up timepoints on average. CONCLUSION Accounting for patient heterogeneity and disease progression, in-office VFSI for VF scar is associated with sustained improvement in a subset of patients. Approximately half of patients can expect to experience a lasting improvement in voice. Future studies of larger scale are required to identify patient factors associated with long-term benefit. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2333-2339, 2023.
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Affiliation(s)
- Lucas G Axiotakis
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Necati Enver
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan L Kennedy
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Kimberly A Duncan
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael J Pitman
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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Hernández-Morato I, Yu VX, Pitman MJ. Corrigendum: A review of the peripheral proprioceptive apparatus in the larynx. Front Neuroanat 2023; 17:1206526. [PMID: 37250206 PMCID: PMC10214863 DOI: 10.3389/fnana.2023.1206526] [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: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fnana.2023.1114817.].
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Affiliation(s)
- Ignacio Hernández-Morato
- Department of Otolaryngology – Head and Neck Surgery, Columbia University Irving Medical Center / New York Presbyterian, New York, NY, United States
| | - Victoria X. Yu
- Department of Otolaryngology – Head and Neck Surgery, Columbia University Irving Medical Center / New York Presbyterian, New York, NY, United States
| | - Michael J. Pitman
- Department of Otolaryngology – Head and Neck Surgery, Columbia University Irving Medical Center / New York Presbyterian, New York, NY, United States
- The Center for Voice and Swallowing, Department of Otolaryngology - Head & Neck Surgery, Columbia University Irving Medical Center / New York Presbyterian, New York, NY, United States
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12
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Cole CL, Yu VX, Perry S, Seenauth A, Lumpkin EA, Troche MS, Pitman MJ, Moayedi Y. Healthy Human Laryngopharyngeal Sensory Innervation Density Correlates with Age. Laryngoscope 2023; 133:773-784. [PMID: 35841384 DOI: 10.1002/lary.30287] [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: 03/01/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Somatosensory feedback from upper airway structures is essential for swallowing and airway defense but little is known about the identities and distributions of human upper airway neurons. Furthermore, whether sensory innervation modifies with aging is unknown. In this study, we quantify neuronal and chemosensory cell density in upper airway structures and correlate with age. METHODS Participants underwent biopsies from base of tongue, lateral and midline pharyngeal wall, epiglottis, and arytenoids (N = 25 13 female/12 male; 20-80 years, mean 51.4 years without clinical diagnosis of dysphagia or clinical indication for biopsy). Tissue sections were labeled with antibodies for all neurons, myelinated neurons, and chemosensory cells. Densities of lamina propria innervation, epithelial innervation, solitary chemosensory cells, and taste buds were calculated and correlated with age. RESULTS Arytenoid had the highest density of innervation and chemosensory cells across all measures compared to other sites. Taste buds were frequently observed in arytenoid and epiglottis. Base of tongue, lateral pharynx, and midline posterior pharynx had minimal innervation and few chemosensory cells. Epithelial innervation was present primarily in close proximity to chemosensory cells and taste buds. Overall innervation and myelinated fibers in the arytenoid lamina propria decline with aging. CONCLUSION Findings establish the architecture of healthy adult sensory innervation and demonstrate the varied distribution of laryngopharyngeal innervation, necessary steps toward understanding the sensory basis for swallowing and airway defense. We also document age-related decline in arytenoid innervation density. These findings suggest that sensory afferent denervation of the upper airway may be a contributing factor to presbyphagia. LEVEL OF EVIDENCE NA Laryngoscope, 133:773-784, 2023.
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Affiliation(s)
- Caroline L Cole
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Victoria X Yu
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA
| | - Sarah Perry
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.,Department of Medicine, University of Otago, Christchurch, New Zealand.,The University of Canterbury Rose Center for Stroke Recovery & Research at St. George's Medical Center, Christchurch, New Zealand
| | - Anisa Seenauth
- Department of Neurology, Columbia University, New York, New York, USA
| | - Ellen A Lumpkin
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Michael J Pitman
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA
| | - Yalda Moayedi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA.,Department of Neurology, Columbia University, New York, New York, USA.,Department of Physiology and Cellular Biophysics, Columbia University, New York, New York, USA
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13
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Montalbaron MB, Tian L, Yu VX, Awad MI, Bensoussan Y, Leber WS, Lamm S, Edelmayer L, Postma GN, Bock JM, Anderson J, Pitman MJ. Multi-institutional search for patient factors associated with adverse events following tracheotomy. Am J Otolaryngol 2023; 44:103773. [PMID: 36657236 DOI: 10.1016/j.amjoto.2022.103773] [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: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tracheotomy is a common procedure for otolaryngologists. The risk of complications is difficult to predict. This study aims to identify measurable preoperative indicators associated with adverse events following tracheotomy. METHODS The charts of adults undergoing tracheotomy for respiratory failure at one of four university-affiliated hospitals between 1/2012 and 8/2018 were reviewed. Complications were analyzed in the context of demographics, physiologic parameters, and comorbidities. RESULTS Among 507 tracheotomies performed, the most common complications included infection, bleeding, and cardiac arrest. Mortality was 39 % in patients with pulmonary hypertension, 42 % in those with ejection fraction ≤ 40 and 32 % in those with abnormal right ventricular function, double the rates in patients without each of these findings. CONCLUSION Many critically ill tracheotomy patients experience significant rates of adverse events. Risk factors for mortality include ejection fraction ≤ 40, pulmonary hypertension, and abnormal ventricular function. These should be considered for use in preoperative counseling. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Michael B Montalbaron
- Columbia University Irving Medical Center/Harkness Pavillion, 180 Fort Washington Ave, New York, NY 10032, United States of America.
| | - Likun Tian
- Columbia University Irving Medical Center/Harkness Pavillion, 180 Fort Washington Ave, New York, NY 10032, United States of America
| | - Victoria X Yu
- Columbia University Irving Medical Center/Harkness Pavillion, 180 Fort Washington Ave, New York, NY 10032, United States of America
| | - Mahmoud I Awad
- Columbia University Irving Medical Center/Harkness Pavillion, 180 Fort Washington Ave, New York, NY 10032, United States of America
| | - Yael Bensoussan
- St Michael's Hospital, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada
| | - W Schaefer Leber
- Medical College of Wisconsin, 900 N 92nd St, Milwaukee, WI 53226, United States of America
| | - Scott Lamm
- Medical College of Wisconsin, 900 N 92nd St, Milwaukee, WI 53226, United States of America
| | - Luke Edelmayer
- Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912, United States of America
| | - Gregory N Postma
- Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912, United States of America
| | - Jonathan M Bock
- Medical College of Wisconsin, 900 N 92nd St, Milwaukee, WI 53226, United States of America
| | - Jennifer Anderson
- St Michael's Hospital, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada
| | - Michael J Pitman
- Columbia University Irving Medical Center/Harkness Pavillion, 180 Fort Washington Ave, New York, NY 10032, United States of America
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14
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Kelebeyev S, Davison W, Ford BL, Pitman MJ, Bulman WA. The Effects of Endotracheal Tube Size During Bronchoscopy in Simulated Models of Intubated Patients. Laryngoscope 2023; 133:147-153. [PMID: 35218022 DOI: 10.1002/lary.30074] [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: 09/23/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim is to use a simulation lung model to assess the possibility of performing bronchoscopy through endotracheal tubes (ETT) less than 8.0-mm while appropriately ventilating patients with normal and ARDS lungs in the setting of SARS-CoV-2. METHODS Five SHERIDAN® ETTs were used to ventilate SimMan® 3G under respiratory compliance levels representing normal and severe ARDS lungs. Baseline measurements of peak pressure, plateau pressure, and auto-positive end expiratory pressure (auto-PEEP) were recorded at four different inspiratory times (Ti). Three different-sized disposable bronchoscopes were inserted, and all measurements were repeated. RESULTS Normal lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures <30 cm H2 O, and increasing Ti to minimize peak pressure resulted in low auto-PEEP. Regular bronchoscopes in 7.0-mm ETTs had similar results. Large bronchoscopes in 7.5-mm ETTs generated plateau pressures ranging from 28 to 35 cm H2 O with modest auto-PEEP. Severe ARDS lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures of 46 and an auto-PEEP of 5 cm H2 O. Regular bronchoscopes in 7.0-mm ETTs generated similar results. Large bronchoscopes in 8.0-mm ETTs displayed plateau pressures of 44 and an auto-PEEP of 2 cm H2 O. CONCLUSION To mitigate risk of laryngeal injury, larger ETTs during bronchoscopy should be avoided. Our data show bronchoscopy with any ETT causes auto-PEEP and high plateau pressures, especially in lungs with poor compliance; however, ETT less than 7.5 mm can be used when considering several factors. Our data also suggest similar studies in patients with varying degrees of ARDS would be informative. LEVEL OF EVIDENCE NA Laryngoscope, 133:147-153, 2023.
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Affiliation(s)
- Saveliy Kelebeyev
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Wesley Davison
- Department of Otolaryngology - Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York, New York, USA
| | - Branden L Ford
- Mary & Michael Jaharis Simulation Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael J Pitman
- Department of Otolaryngology - Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York, New York, USA
| | - William A Bulman
- Department of Medicine - Division of Pulmonary, Allergy and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
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15
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Hernández-Morato I, Yu VX, Pitman MJ. A review of the peripheral proprioceptive apparatus in the larynx. Front Neuroanat 2023; 17:1114817. [PMID: 36910514 PMCID: PMC9998684 DOI: 10.3389/fnana.2023.1114817] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 03/14/2023] Open
Abstract
The larynx is an organ of the upper airway that participates in breathing, glutition, voice production, and airway protection. These complex functions depend on vocal fold (VF) movement, facilitated in turn by the action of the intrinsic laryngeal muscles (ILM). The necessary precise and near-instantaneous modulation of each ILM contraction relies on proprioceptive innervation of the larynx. Dysfunctional laryngeal proprioception likely contributes to disorders such as laryngeal dystonia, dysphagia, vocal fold paresis, and paralysis. While the proprioceptive system in skeletal muscle derived from somites is well described, the proprioceptive circuitry that governs head and neck structures such as VF has not been so well characterized. For over two centuries, researchers have investigated the question of whether canonical proprioceptive organs, muscle spindles, and Golgi tendon organs, exist in the ILM, with variable findings. The present work is a state-of-the-art review of the peripheral component of laryngeal proprioception, including current knowledge of canonical and possible alternative proprioceptive circuitry elements in the larynx.
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Affiliation(s)
- Ignacio Hernández-Morato
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Victoria X Yu
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY, United States
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16
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Kemfack AM, Hernandez-Morato I, Moayedi Y, Pitman MJ. An optimized method for high-quality RNA extraction from distinctive intrinsic laryngeal muscles in the rat model. Sci Rep 2022; 12:21665. [PMID: 36522411 PMCID: PMC9755529 DOI: 10.1038/s41598-022-25643-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Challenges related to high-quality RNA extraction from post-mortem tissue have limited RNA-sequencing (RNA-seq) application in certain skeletal muscle groups, including the intrinsic laryngeal muscles (ILMs). The present study identified critical factors contributing to substandard RNA extraction from the ILMs and established a suitable method that permitted high-throughput analysis. Here, standard techniques for tissue processing were adapted, and an effective means to control confounding effects during specimen preparation was determined. The experimental procedure consistently provided sufficient intact total RNA (N = 68) and RIN ranging between 7.0 and 8.6, which was unprecedented using standard RNA purification protocols. This study confirmed the reproducibility of the workflow through repeated trials at different postnatal time points and across the distinctive ILMs. High-throughput diagnostics from 90 RNA samples indicated no sequencing alignment scores below 70%, validating the extraction strategy. Significant differences between the standard and experimental conditions suggest circumvented challenges and broad applicability to other skeletal muscles. This investigation remains ongoing given the prospect of therapeutic insights to voice, swallowing, and airway disorders. The present methodology supports pioneering global transcriptome investigations in the larynx previously unfounded in literature.
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Affiliation(s)
- Angela M Kemfack
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Ignacio Hernandez-Morato
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
| | - Yalda Moayedi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
- Department of Neurology, Irving Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Michael J Pitman
- Department of Otolaryngology-Head & Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
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17
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Caplan IF, Hernandez-Morato I, Pitman MJ. Temporal expression of Laminin-111 in the developing rat larynx. Neurosci Lett 2022; 781:136658. [PMID: 35483501 PMCID: PMC9194551 DOI: 10.1016/j.neulet.2022.136658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/01/2021] [Revised: 04/08/2022] [Accepted: 04/22/2022] [Indexed: 12/31/2022]
Abstract
Laminin-111 is a basement membrane protein that participates in motor innervation and reinnervation. During axonal pathfinding, laminin-111 interacts with netrin-1 (NTN1) and changes its attractant growth cone properties into repulsion. While previous models of recurrent laryngeal nerve (RLN) transection show increased Laminin-111 and NTN1 production after injury, developmental expression in the larynx has not been defined. This study investigates the expression of laminin-111 in laryngeal muscles during primary laryngeal innervation of Sprague Dawley rats. Adult larynges and embryos were sectioned for immunohistochemistry with βIII-Tubulin, laminin subunit α-1 (LAMA1), NTN1, and α-bungarotoxin. Sections were processed for single-molecule inexpensive RNA fluorescence in situ hybridization analysis of LAMA1 mRNA. LAMA1 expression increased in all intrinsic laryngeal muscles, except the medial thyroarytenoid (MTA), at E20.5. At E20.5 there was increased expression in the lateral thyroarytenoid (LTA) and posterior cricoarytenoid (PCA) compared to the MTA. NTN1 upregulation was limited to the LTA and lateral cricoarytenoid (LCA) at E16.5 without any increase in the MTA or PCA. LAMA1 and NTN1 expression did not strictly follow expected patterns relative to the known timing of innervation and does not appear to be acting similarly to its role following RLN injury. These differences between developmental and post-injury innervation provide targets for investigations of therapeutics after nerve injury.
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Affiliation(s)
- Ian F. Caplan
- Columbia University Irving Medical Center/New York Presbyterian, Department of Otolaryngology Head & Neck Surgery, New York, NY, USA
| | - Ignacio Hernandez-Morato
- Columbia University Irving Medical Center/New York Presbyterian, Department of Otolaryngology Head & Neck Surgery, New York, NY, USA,Corresponding author at: Columbia University Irving Medical Center, Otolaryngology-Head and Neck Surgery, 180 Fort Washington Avenue, Rm 860 8th Floor. Harkness Pavilion, New York, NY 10032, USA. (I. Hernandez-Morato)
| | - Michael J. Pitman
- Columbia University Irving Medical Center/New York Presbyterian, Department of Otolaryngology Head & Neck Surgery, New York, NY, USA,Columbia University Irving Medical Center/New York Presbyterian, The Center for Voice and Swallowing, Department of Otolaryngology Head & Neck Surgery, New York, NY, USA
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18
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Axiotakis LG, Enver N, Keating CL, Pitman MJ. Response. Chest 2021; 160:e317-e318. [PMID: 34488978 DOI: 10.1016/j.chest.2021.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Lucas G Axiotakis
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Claire L Keating
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
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19
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Naunheim MR, Bock J, Doucette PA, Hoch M, Howell I, Johns MM, Johnson AM, Krishna P, Meyer D, Milstein CF, Nix J, Pitman MJ, Robinson-Martin T, Rubin AD, Sataloff RT, Sims HS, Titze IR, Carroll TL. Safer Singing During the SARS-CoV-2 Pandemic: What We Know and What We Don't. J Voice 2021; 35:765-771. [PMID: 32753296 PMCID: PMC7330568 DOI: 10.1016/j.jvoice.2020.06.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Nix
- University of Texas at San Antonio, San Antonio, TX
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20
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Simonyan K, Barkmeier-Kraemer J, Blitzer A, Hallett M, Houde JF, Jacobson Kimberley T, Ozelius LJ, Pitman MJ, Richardson RM, Sharma N, Tanner K. Laryngeal Dystonia: Multidisciplinary Update on Terminology, Pathophysiology, and Research Priorities. Neurology 2021; 96:989-1001. [PMID: 33858994 DOI: 10.1212/wnl.0000000000011922] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To delineate research priorities for improving clinical management of laryngeal dystonia, the NIH convened a multidisciplinary panel of experts for a 1-day workshop to examine the current progress in understanding its etiopathophysiology and clinical care. METHODS The participants reviewed the current terminology of disorder and discussed advances in understanding its pathophysiology since a similar workshop was held in 2005. Clinical and research gaps were identified, and recommendations for future directions were delineated. RESULTS The panel unanimously agreed to adopt the term "laryngeal dystonia" instead of "spasmodic dysphonia" to reflect the current progress in characterizations of this disorder. Laryngeal dystonia was recognized as a multifactorial, phenotypically heterogeneous form of isolated dystonia. Its etiology remains unknown, whereas the pathophysiology likely involves large-scale functional and structural brain network disorganization. Current challenges include the lack of clinically validated diagnostic markers and outcome measures and the paucity of therapies that address the disorder pathophysiology. CONCLUSION Research priorities should be guided by challenges in clinical management of laryngeal dystonia. Identification of disorder-specific biomarkers would allow the development of novel diagnostic tools and unified measures of treatment outcome. Elucidation of the critical nodes within neural networks that cause or modulate symptoms would allow the development of targeted therapies that address the underlying pathophysiology. Given the rarity of laryngeal dystonia, future rapid research progress may be facilitated by multicenter, national and international collaborations.
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Affiliation(s)
- Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT.
| | - Julie Barkmeier-Kraemer
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Andrew Blitzer
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Mark Hallett
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - John F Houde
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Teresa Jacobson Kimberley
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Laurie J Ozelius
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Michael J Pitman
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Robert Mark Richardson
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Nutan Sharma
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Kristine Tanner
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
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21
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Axiotakis LG, Enver N, Keating CL, Pitman MJ. Laryngeal Injury Due to Amikacin Inhalation for Refractory Mycobacterium avium Complex Infection. Chest 2021; 159:e185-e187. [PMID: 34022015 DOI: 10.1016/j.chest.2020.11.045] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/19/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Inhaled antibiotics have long been used for chronic lung infections, especially in patients with cystic fibrosis and increasingly for non-cystic fibrosis bronchiectasis. Amikacin liposome inhalation suspension (ALIS) has emerged as a promising treatment for Mycobacterium avium complex infection refractory to oral antibiotics. However, despite its efficacy, nearly one-half of patients in phase II and III trials experienced dysphonia as a treatment-associated adverse effect. Here, we describe a patient who experienced severe, acute-onset laryngitis while receiving ALIS for refractory M avium complex infection, prompting discontinuation of ALIS therapy. This is the first report directly describing vocal fold injury due to such therapy. Given the high frequency of dysphonia reported with ALIS, this case highlights the potential severity of laryngeal toxicity, the importance of coordination of care for patients receiving inhaled antibiotics for chronic pulmonary disease, and the need for better insight into mechanisms of toxicity.
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Affiliation(s)
- Lucas G Axiotakis
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY; Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY
| | - Claire L Keating
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY.
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22
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Abstract
Recent events bring the importance of respiratory health to the forefront of our collective attention. In this issue of Cell, a new study by Prescott and Umans et al. reveals how a dedicated laryngeal sensory motor reflex circuit protects our airways from aspirated foods or liquids.
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Affiliation(s)
- Yalda Moayedi
- Department of Physiology and Cellular Biophysics, Columbia University Medical Center, 1150 Saint Nicholas Ave, New York, NY 10032; Thompson Family Foundation Initiative at CUMC, New York, NY, USA
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, 180 Fort Washington Ave, New York, NY 10032
| | - Joriene C de Nooij
- Department of Neurology, Columbia University Medical Center, 630 West 168(th) Street, New York, NY 10032; Columbia University Motor Neuron Center, Columbia University Medical Center, 650 West 168(th) Street, New York, NY 10032; Thompson Family Foundation Initiative at CUMC, New York, NY, USA.
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23
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Enver N, Ramaswamy A, Sulica L, Pitman MJ. Office-Based Procedure Training in Laryngology Fellowship Programs. Laryngoscope 2020; 131:2054-2058. [PMID: 33043999 DOI: 10.1002/lary.29170] [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: 04/23/2020] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the current practices and challenges of training office-based procedures to laryngology fellows in the United States. METHODS An anonymous web-based survey study was distributed to laryngology fellowship program directors, as listed by the American Laryngological Association. The survey was a 19-item questionnaire with free-text, Likert scale, and multiple-choice answers. RESULTS Twenty-two of 27 program directors (81.4%) replied to the survey. Many programs (8/16) have three or more laryngologists and do more than 10 procedures each week (10/16). Sixty-nine percent (11/16) of directors had not been trained for office procedures in their fellowship. The fellows are allowed to be primary surgeon on 68.75% and 75% of vocal fold augmentation and laser procedures, respectively. The expected competencies for these procedures on graduation are average-moderate and moderate. When program directors asked about the methods used for training, a minority of them use simulators (2/16), procedural checklists (2/16), or structured debriefing (2/16). The most commonly used methods were case-based troubleshooting (13/16) and unstructured debriefing (13/16). Patients being awake and patients' expectations are seen as the most important obstacles. Most of the directors thought office-based procedure training could be improved (14/16). The most common suggestions were using step-wise checklists, simulator-labs, and formal debriefings. CONCLUSION This is the first study evaluating the training of office-based laryngeal procedures during laryngology fellowship. Given the increasing importance of these procedures in practice and the herein identified barriers and need for improvement, fellowships should investigate the use of systematic training tools to improve fellow competency with office-based procedures. Laryngoscope, 131:2054-2058, 2021.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A.,Department of Otolaryngology - Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Apoorva Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Lucian Sulica
- Department of Otolaryngology - Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
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24
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Gupta DK, Viñuela A, Green PHR, Pitman MJ, Vonsattel JP, Fahn S. High-Frequency Palatal Tremor and Stimulus-Sensitive Leg Myoclonus with Degeneration of Inferior Olivary Nuclei in Celiac Disease. Mov Disord Clin Pract 2020; 7:S93-S95. [PMID: 33015235 DOI: 10.1002/mdc3.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Deepak K Gupta
- Department of Neurological Sciences Larner College of Medicine at University of Vermont Burlington Vermont USA
| | - Angel Viñuela
- Neurosciences Institute, Manati Medical Center Ponce Health Sciences University Ponce Puerto Rico
| | - Peter H R Green
- Celiac Disease Center Columbia University New York City New York USA
| | - Michael J Pitman
- Division of Laryngology, Department of Head & Neck Surgery Columbia University New York City New York USA
| | - Jean P Vonsattel
- NewYork Brain Bank, Department of Pathology Columbia University New York City New York USA
| | - Stanley Fahn
- Division of Movement Disorders, Department of Neurology Columbia University New York City New York USA
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25
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Enver N, Ramaswamy A, Pitman MJ. How I Do It: A Novel Technique for Endoscopic Placement of Stent in Management of Anterior Glottic Webs. Laryngoscope 2020; 131:1320-1323. [PMID: 32902885 DOI: 10.1002/lary.28965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Necati Enver
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Apoorva Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
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26
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Yiu Y, Baylor CR, Bamer AM, Shelly S, Klein AM, Garrett CG, Pitman MJ. Validation of the Communicative Participation Item Bank as an Outcome Measure for Spasmodic Dysphonia. Laryngoscope 2020; 131:859-864. [PMID: 32710809 DOI: 10.1002/lary.28897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/12/2020] [Accepted: 06/11/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Current patient-reported outcome measures do not adequately capture the impact of spasmodic dysphonia (SD) on communication in daily life situations. The aim of this study was to validate the Communicative Participation Item Bank (CPIB), which specifically measures a disease's impact on daily conversational situations, as an outcome measure for SD. STUDY DESIGN Multi-institutional prospective cohort study. METHODS A prospective study was conducted with administration of the 46-question CPIB and the Voice Handicap Index-10 (VHI-10) to 190 participants with SD before (time 1) and 6 weeks after (time 2) botulinum toxin injection. Differential item function (DIF) analyses were performed to examine potential item bias. Paired t-tests were used to assess change in each of the CPIB and VHI-10 scores after treatment. Pearson correlations were calculated between the CPIB and VHI-10. RESULTS DIF analyses revealed no clinically meaningful difference between the item parameters generated for this SD sample and the original CPIB calibration sample. There were statistically significant changes between the pre-treatment and post-treatment time points for both the CPIB and VHI-10. Correlations between the CPIB and VHI were moderate-high. CONCLUSIONS The CPIB item bank, General Short Form, and scoring parameters can be used with people with SD for valid and reliable measurement of the impact of communication disorders on communication in everyday life. The CPIB is sensitive to changes with intervention, proving useful for clinical and research purposes to assess the efficacy and effectiveness of interventions. LEVEL OF EVIDENCE Level 2, prospective observational research with an experimental design (ie, cohort study). Laryngoscope, 131:859-864, 2021.
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Affiliation(s)
- Yin Yiu
- Texas Voice Center, Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Carolyn R Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Sandeep Shelly
- Emory Voice Center, Department of Otolaryngology - Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Emory Voice Center, Department of Otolaryngology - Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology - Head & Neck Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, U.S.A
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27
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Montalbano MB, Hernández-Morato I, Tian L, Yu VX, Dodhia S, Martinez J, Pitman MJ. Recurrent Laryngeal Nerve Reinnervation in Rats Posttransection: Neurotrophic Factor Expression over Time. Otolaryngol Head Neck Surg 2019; 161:111-117. [PMID: 30776993 DOI: 10.1177/0194599819831289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Recurrent laryngeal nerve (RLN) injury causes vocal fold paralysis from which functional recovery is typically absent due to nonselective reinnervation. This study investigates expression of axon guidance cues and their modulators relative to the chronology of reinnervation by examining the expression of glial-derived neurotrophic factor (GDNF), netrin 1, and laminin 111 (LAMA1) in nonpooled laryngeal muscles. This study is the first to describe the post-RLN injury expression pattern of LAMA1, a target of particular interest as it has been shown to switch netrin 1-mediated growth cone attraction to repulsion. STUDY DESIGN Animal experiment (rat model). SETTING Basic science laboratory. METHODS The right RLNs of 64 female Sprague-Dawley rats were transected, with sacrifice at 1, 3, 7, 21, 28, and 56 days postinjury (DPI). Single-animal messenger RNA was isolated from the ipsilateral posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA) for quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis. Immunostaining for LAMA1 expression was performed in the same muscles. RESULTS LAMA1 was elevated in the PCA at 3 to 56 DPI, LTA at 7 DPI, and MTA at 14 and 28 DPI. This correlates with the chronology of laryngeal reinnervation. Using a new protocol, single-animal muscle qRT-PCR possible and expression results for GDNF and netrin 1 were similar to previous pooled investigations. CONCLUSION Reliable qRT-PCR is possible with single rat laryngeal muscles. The expression of netrin 1 and LAMA1 is chronologically coordinated with muscle innervation in the LTA and MTA. This suggests that LAMA1 may influence netrin 1 to repel axons and delay LTA and MTA reinnervation.
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Affiliation(s)
- Michael B Montalbano
- 1 Columbia University College of Physicians and Surgeons, New York, New York, USA
| | | | - Likun Tian
- 1 Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Victoria X Yu
- 1 Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sonam Dodhia
- 2 Columbia University Medical Center/New York Presbyterian, New York, New York, USA
| | - Jose Martinez
- 3 Columbia University Medical Scientist Training Program, New York, New York, USA
| | - Michael J Pitman
- 2 Columbia University Medical Center/New York Presbyterian, New York, New York, USA
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28
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Best SR, Esquivel D, Mellinger-Pilgrim R, Roden RBS, Pitman MJ. Infectivity of murine papillomavirus in the surgical byproducts of treated tail warts. Laryngoscope 2019; 130:712-717. [PMID: 31041820 DOI: 10.1002/lary.28026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/08/2019] [Accepted: 04/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV) is a highly stable DNA virus that causes disease in human organ systems, including the larynx and oropharynx. The treatment of HPV-associated diseases with scalpels, lasers, and other surgical instruments has the potential to release infectious particles, placing healthcare workers at risk. The objectives of this study were to create a reproducible in vivo animal model of papillomavirus infectivity and to compare the infectivity of byproducts of surgically treated mouse papillomavirus (MmuPV1) warts. STUDY DESIGN Animal study. METHODS Nude laboratory mice (Mus musculus) with established MmuPV1 tail warts were treated with scalpel excision, potassium titanyl phosphate (KTP) laser ablation, and coblator treatment. Uninfected nude mice were challenged with surgical byproducts, including ablated and heated tissue, and surgical smoke products. The incidence and time course of the appearance of warts was recorded. RESULTS There was rapid transmission of virus in mice challenged with scalpel-treated warts, with 50% penetrance of infection at day 13 and 100% at day 32. For KTP-treated warts, there was the slower development of infection (50% by day 35) but 100% penetrance by day 52. Coblator-treated tissue reached 50% penetrance at day 59 and a maximum of 73% penetrance. Smoke plume captured during treatment with the KTP laser and coblator was highly infectious, as was the material captured in a laser filter. CONCLUSIONS MmuPV1 remains infectious in all modes of surgically treated tissue, and the smoke plume is capable of transmitting infection. Healthcare workers should use appropriate precautions to lower their risk of infection when treating papillomavirus-associated diseases. LEVEL OF EVIDENCE NA Laryngoscope, 130:712-717, 2020.
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Affiliation(s)
- Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Esquivel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Richard B S Roden
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Voice and Swallowing Institute, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, U.S.A
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29
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Hernandez-Morato I, Tian L, Montalbano M, Pitman MJ. Expression of trophic factors receptors during reinnervation after recurrent laryngeal nerve injury. Laryngoscope 2019; 129:2537-2542. [PMID: 30811036 DOI: 10.1002/lary.27649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE An injury of the recurrent laryngeal nerve (RLN) triggers axonal regeneration but results in a poor functional recovery. Netrin-1 and glial cell-derived neurotrophic factor (GDNF) expression are up-regulated in laryngeal muscles during RLN regeneration, but the role of their receptors produced in the nucleus ambiguus is unknown. The aim of this work was to determine the timing of the production of Netrin-1 and GDNF receptors during RLN regeneration and correlate this with the previously identified timing of up-regulation of their trophic factors in the laryngeal muscles. STUDY DESIGN Laboratory experiment with rat model. METHODS The right RLN was transected and dextran amine tracer applied. At 7, 14, and 21 days postinjury (DPI), brainstems were removed and harvested. Immunostaining was performed for Netrin-1 (deleted in colorectal carcinoma [DCC], UNC5A) and GDNF receptors (rearranged during transfection [Ret], glycosylphosphatidylinositol-linked cell surface receptors [GFRα1, GFRα2, GFRα3]). The timing and type of receptor production relative to injury as well as their position in the nucleus ambiguus was analyzed. RESULTS Netrin-1 UNC5A receptors were minimal in the nucleus ambiguus during RLN regeneration. DCC, the receptor that plays an attract role, was immunopositive from 7 to 21 DPI. All GDNF receptors, except GFRα2, were clearly positive from 7 to 14 DPI. No differences of production were observed according to the position of the motor neurons in the nucleus ambiguus. CONCLUSION An injury of the RLN leads to a higher production of Netrin-1 DCC and GDNF receptors in the nucleus ambiguus. The timing of receptor production is similar to up-regulation of their trophic factors in the laryngeal muscles. LEVEL OF EVIDENCE NA. Laryngoscope, 129:2537-2542, 2019.
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Affiliation(s)
- Ignacio Hernandez-Morato
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Likun Tian
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Michael Montalbano
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
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Hall D, Stong N, Lippa N, Pitman MJ, Pullman SL, Levy OA. Spasmodic Dysphonia in Hereditary Spastic Paraplegia Type 7. Mov Disord Clin Pract 2019; 5:221-222. [PMID: 30746405 DOI: 10.1002/mdc3.12580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Devin Hall
- Department of Neurology Columbia University Medical Center New York NY
| | - Nicholas Stong
- Institute of Genomic Medicine Columbia University Medical Center New York NY
| | - Natalie Lippa
- Institute of Genomic Medicine Columbia University Medical Center New York NY
| | - Michael J Pitman
- Department of Otolaryngology Columbia University Medical Center New York NY
| | - Seth L Pullman
- Department of Neurology Columbia University Medical Center New York NY
| | - Oren A Levy
- Department of Neurology Columbia University Medical Center New York NY
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31
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Ramaswamy AT, Tian L, Bock JM, Klein AM, Pitman MJ. Carcinoma presenting as idiopathic anterior glottic webs: A case series. Laryngoscope 2018; 129:2118-2120. [PMID: 30593686 DOI: 10.1002/lary.27711] [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] [Accepted: 10/29/2018] [Indexed: 11/08/2022]
Abstract
An anterior glottic web is an abnormal fusion of the anterior aspect of the membranous vocal folds. Noncongenital glottic webs are usually iatrogenic from intubation or laryngeal surgery. We present six adult patients whose initial in-office diagnoses were consistent with "idiopathic" benign anterior glottic webs as determined by three laryngologists (a.m.k., j.m.b., m.j.p.). Further evaluation revealed the diagnoses of laryngeal squamous cell carcinoma in all cases. The high risk of malignancy in cases of idiopathic anterior glottic web necessitates biopsy for tissue diagnosis of all such lesions. Laryngoscope, 129:2118-2120, 2019.
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Affiliation(s)
- Apoorva T Ramaswamy
- Columbia University Medical Center Department of Otolaryngology, New York, New York
| | - Lisa Tian
- Columbia University Medical Center Department of Otolaryngology, New York, New York
| | - Jonathan M Bock
- Division of Laryngology and the Professional Voice Department of Otolaryngology and Communication Science Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adam M Klein
- Emory Voice Center, Atlanta, Georgia, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Michael J Pitman
- Columbia University Medical Center Department of Otolaryngology, New York, New York.,Columbia Voice and Swallowing Institute, New York, New York
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Schiff CS, Zur KB, Biggs LM, Guo J, Pitman MJ. Pediatricians’ proficiency in the care of the dysphonic child. Laryngoscope 2018; 129:1756-1762. [DOI: 10.1002/lary.27577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Carly S. Schiff
- Department of Otolaryngology; Columbia University Voice and Swallowing Institute; New York New York
| | - Karen B. Zur
- Department of Otolaryngology and Pediatrics; Children's Hospital of Philadelphia; Philadelphia Pennsylvania U.S.A
| | - Lisa M. Biggs
- Department of Otolaryngology and Pediatrics; Children's Hospital of Philadelphia; Philadelphia Pennsylvania U.S.A
| | - Jia Guo
- Department of Otolaryngology; Columbia University Voice and Swallowing Institute; New York New York
| | - Michael J. Pitman
- Department of Otolaryngology; Columbia University Voice and Swallowing Institute; New York New York
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Karle WE, Helman SN, Cooper A, Zhang Y, Pitman MJ. Temporalis Fascia Transplantation for Sulcus Vocalis and Vocal Fold Scar: Long-Term Outcomes. Ann Otol Rhinol Laryngol 2018; 127:223-228. [DOI: 10.1177/0003489417753224] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William E. Karle
- Department of Otolaryngology–Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Samuel N. Helman
- Department of Otolaryngology–Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Amy Cooper
- The Voice and Swallowing Institute, Department of Otolaryngology–Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Yuan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Michael J. Pitman
- The Voice and Swallowing Institute, Department of Otolaryngology–Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
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Dodhia S, Baxter PC, Ye F, Pitman MJ. Investigation of the presence of HPV on KTP laser fibers following KTP laser treatment of papilloma. Laryngoscope 2017; 128:926-928. [PMID: 29171656 DOI: 10.1002/lary.27018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/02/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Recurrent respiratory papillomatosis is often treated with in-office laser procedures using a potassium titanyl phosphate (KTP) laser transmitted through a laser fiber. Although effective, this procedure has notable downsides, including the possibility of transmitting human papillomavirus (HPV) in the smoke plume and the high cost of these single-use fibers. The objective of this study is to determine if HPV can be detected on a laser fiber after use, with or without sterilization. METHODS Twelve patients with laryngeal papillomas were treated with KTP laser energy transmitted via a KTP fiber. Ten fibers were sterilized in CIDEX (ASP, Irvine, California), a glutaraldehyde disinfectant, for 12 minutes, whereas two fibers were left unsterilized. Human papillomavirus DNA amplification was done on all 12 fiber samples with real-time polymerase chain reaction (PCR) using general primer mediated 5+ and 6+. Human papillomavirus genotyping detection was done using type specific probes and/or Sanger sequencing. RESULTS Over 27 strains of HPV were not detected on KTP fibers after use, with or without sterilization. CONCLUSION Human papillomavirus was undetectable by PCR on KTP laser fibers that were sterilized or unsterilized after use. Further studies are needed utilizing a transmission model to determine if HPV can be incubated from this fiber after sterilization. LEVEL OF EVIDENCE NA. Laryngoscope, 128:926-928, 2018.
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Affiliation(s)
- Sonam Dodhia
- Department of Otolaryngology-Head and Neck Surgery, The Voice and Swallowing Institute, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
| | - Peter C Baxter
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Los Angeles, California, U.S.A
| | - Fei Ye
- Department of Pathology, Mount Sinai Health System, New York, New York
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Voice and Swallowing Institute, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
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Pitman MJ, Kurita T, Powell ME, Kimball EE, Mizuta M, Chang S, Garrett CG, Rousseau B. Vibratory function and healing outcomes after small intestinal submucosa biomaterial implantation for chronic vocal fold scar. Laryngoscope 2017; 128:901-908. [PMID: 29105772 DOI: 10.1002/lary.26883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/04/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scar is a major cause of dysphonia, and optimal treatments do not currently exist. Small intestinal submucosa (SIS) is a biomaterial developed for the treatment of a variety of pathologies. The purpose of this study was to investigate the effects of SIS implantation on tissue remodeling in scarred vocal folds using routine staining, immunohistochemistry, and high-speed videoendoscopy (HSV). STUDY DESIGN Prospective, blinded group analysis. METHODS Thirteen New Zealand White rabbits underwent a vocal fold scarring procedure followed by microflap elevation with or without SIS implantation. Seven months later, they underwent a phonation procedure with HSV and laryngeal harvest. Alcian blue and elastica van Gieson staining and immunohistochemistry for collagen types I and III were used to evaluate histological healing outcomes. Dynamic functional remodeling of the scarred vocal fold in the presence of SIS implants was evaluated using HSV imaging to capture restoration of vibratory amplitude, amplitude ratio, and left-right phase symmetry. RESULTS Density of collagen I was significantly decreased in SIS versus microflap-treated vocal folds. No differences were found between groups for hyaluronic acid, elastin, or collagen type III. Organization of elastin in the subepithelial region appeared to affect amplitude of vibration and the shape of the vocal fold edge. CONCLUSIONS SIS implantation into chronic scar reduced the density of collagen I deposits. There was no evidence of a negative impact or complication from SIS implantation. Regardless of treatment type, organization of elastin in the subepithelial region may be important to vibratory outcomes. LEVEL OF EVIDENCE NA. Laryngoscope, 128:901-908, 2018.
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Affiliation(s)
- Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center/New York Presbyterian, New York, New York, U.S.A
| | - Takashi Kurita
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Maria E Powell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Emily E Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Chang
- Corning Research and Development Corporation, Painted Post, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Hernandez-Morato I, Koss S, Sharma S, Pitman MJ. Influence of Netrin-1 on reinnervation of laryngeal muscles following recurrent laryngeal nerve injury. Neurosci Lett 2017; 653:244-249. [DOI: 10.1016/j.neulet.2017.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/16/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
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Koss SL, Baxter P, Panossian H, Woo P, Pitman MJ. Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes. Laryngoscope 2017; 127:1644-1651. [DOI: 10.1002/lary.26445] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Shira L. Koss
- Department of Otolaryngology-Head and Neck Surgery; New York Eye and Ear Infirmary of Mount Sinai
| | - Peter Baxter
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center
| | - Haig Panossian
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center
| | - Michael J. Pitman
- Department of Otolaryngology-Head and Neck Surgery; Voice and Swallowing Institute, Columbia University Medical Center; New York New York U.S.A
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Abstract
Objective: Posterior glottal insufficiency manifests as a rough, breathy voice with poor vocal projection, air hunger, and decreased phonatory efficiency. There are limited medical and surgical therapies. This study reports the use of insetting a buccal mucosa graft into the posterior interarytenoid space to close the posterior glottic gap for phonatory rehabilitation. Methods: Our study is a retrospective case series of 2 female patients undergoing buccal mucosa graft inset to repair acquired posterior glottic insufficiency as a result of prolonged intubation and laryngeal tuberculosis infection. Patients selected for this procedure had posterior glottal insufficiency due to erosion of posterior glottal tissue. They also had dysphonia refractory to voice therapy and injection augmentation. Conclusions: Interarytenoid buccal graft for posterior glottal insufficiency is effective with excellent vocal rehabilitation and minimal donor site morbidity.
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Affiliation(s)
- Samuel N. Helman
- Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary-Mount Sinai Health System, New York, New York, USA
| | - William Karle
- Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary-Mount Sinai Health System, New York, New York, USA
| | - Michael J. Pitman
- Voice and Swallowing Institute, Department of Otolaryngology/Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, USA
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Hernandez-Morato I, Pitman MJ, Sharma S. Muscle specific nucleus ambiguus neurons isolation and culturing. J Neurosci Methods 2016; 273:33-39. [PMID: 27475929 DOI: 10.1016/j.jneumeth.2016.07.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral nerve injury leads to a regenerative state. However, the reinnervation process is highly non-selective. Growing axons are often misrouted and establish aberrant synapsis to abductor or adductor muscles. Determining the complex properties of abductor and adductor motoneurons in a neuron culture, may lay the groundwork for future studies on axon guidance, leading to a clinical treatment for a selective reinnervation. NEW METHOD In the present study we develop a neuron culture protocol to isolate recurrent laryngeal nerve abductor and adductor motoneurons in order to study their unique properties. Comparison with existing methods the best period to perform the present protocol for postnatal rat cranial motoneurons isolation was determined. In addition, the method allows identification of specific motoneurons from other primary motoneurons and interneurons within brainstem. CONCLUSION The present protocol will allow investigators to perform targeted and novel studies of the mechanisms of peripheral nerve regeneration.
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Affiliation(s)
- Ignacio Hernandez-Morato
- Department of Cell Biology and Anatomy, New York Medical College, Basic Sciences Building, 15 Dana Road, Valhalla, New York 10595, United States; Department of Otolaryngology-Head and Neck Surgery, Columbia University, Medical Center, 630 West, 168th Street, New York, NY 10032, United States.
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, Medical Center, 630 West, 168th Street, New York, NY 10032, United States; Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, 310E, 14th Street, 6th Floor, New York Eye and Ear Infirmary, New York, NY 10003, United States
| | - Sansar Sharma
- Department of Cell Biology and Anatomy, New York Medical College, Basic Sciences Building, 15 Dana Road, Valhalla, New York 10595, United States
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Howell RJ, Pate MB, Ishman SL, Isseroff TF, Rubin AD, Soliman AM, Postma GN, Pitman MJ. Prospective multi-institutional transnasal esophagoscopy: Predictors of a change in management. Laryngoscope 2016; 126:2667-2671. [DOI: 10.1002/lary.26171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/07/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Rebecca J. Howell
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Mariah B. Pate
- Department of Otolaryngology-Head and Neck Surgery and Center for Voice Airway and Swallowing; Georgia Regents University; Augusta Georgia U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine, and Divisions of Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Tova F. Isseroff
- New York Eye and Ear Infirmary of Mount Sinai; New York New York U.S.A
| | - Adam D. Rubin
- Lakeshore Professional Voice; St. Clair Shores Michigan U.S.A
| | - Ahmed M. Soliman
- Department of Otolaryngology-Head and Neck Surgery; Lewis Katz School of Medicine at Temple University; Philadelphia Pennsylvania U.S.A
| | - Gregory N. Postma
- Department of Otolaryngology-Head and Neck Surgery and Center for Voice Airway and Swallowing; Georgia Regents University; Augusta Georgia U.S.A
| | - Michael J. Pitman
- Voice and Swallowing Institute, Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center; New York New York U.S.A
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Helman SN, Pitman MJ. Office-based 532-Nanometer pulsed potassium-titanyl-phosphate laser for marsupialization of laryngeal and vallecular mucoceles. Laryngoscope 2016; 127:1116-1118. [PMID: 27435457 DOI: 10.1002/lary.26173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/22/2016] [Accepted: 06/09/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Many laryngopharyngeal disorders are effectively managed in the office. Herein, an in-office method utilizing the 532-nm potassium-titanyl-phosphate (KTP) laser for the treatment of benign laryngeal and vallecular mucoceles is described. STUDY DESIGN Retrospective case review. METHODS A review was performed of patients who had their vallecular or laryngeal mucoceles marsupialized in the office using KTP laser. RESULTS Outcomes included long-term follow-up laryngoscopy for evidence of recurrence, significant intraprocedural complications, tolerance of the procedure, final pathology of the specimen, and resolution of symptoms. CONCLUSIONS In-office KTP marsupialization of laryngeal and vallecular mucoceles is effective and well tolerated, with no episodes of recurrence to date. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1116-1118, 2017.
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Affiliation(s)
- Samuel N Helman
- Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary-Mount Sinai Health System, New York, New York, U.S.A
| | - Michael J Pitman
- Voice and Swallowing Institute, Department of Otolaryngology/Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
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Hernandez-Morato I, Tewari I, Sharma S, Pitman MJ. Blockade of glial-derived neurotrophic factor in laryngeal muscles promotes appropriate reinnervation. Laryngoscope 2016; 126:E337-42. [DOI: 10.1002/lary.25953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/14/2016] [Accepted: 02/04/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ishan Tewari
- Department of Anatomy and Cell Biology; New York Medical College; Valhalla New York
| | - Sansar Sharma
- Department of Anatomy and Cell Biology; New York Medical College; Valhalla New York
| | - Michael J. Pitman
- Department of Otolaryngology; New York Eye and Ear Infirmary of Mount Sinai; New York New York U.S.A
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Abstract
Objective Contralateral reactive lesions (RLs) represent a distinct entity among benign bilateral vocal fold (VF) lesions. Lack of uniform nomenclature and a myriad of surgical options have hampered attempts to develop treatment guidelines. The objective of this study is to better define RLs and their prognosis, through the development of a standard nomenclature, with an aim to guide treatment and delineate the role of phonosurgery. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Analysis was performed on patients with Current Procedural Terminology code 31545. Operative reports with a primary lesion and contralateral RL were included. Outcomes included the Voice Handicap Index–10 (VHI-10) and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, lesion persistence/recurrence, mucosal wave, and edge character based on blinded videostroboscopy review. Results A nomenclature was developed based on intraoperative RLs (n = 30), defined by lesion consistency (fibrous or polypoid) and relationship to normal VF edge (gradual or steep). Reactive lesion treatment included no intervention, excision, potassium titanyl phosphate laser, steroid injection, or a combination thereof. Observations included the following: inconsistent treatment modalities were employed, excision of RLs did not yield better outcomes, fibrous RLs were more likely to persist and polypoid lesions more likely to recur, gradual lesions were more likely to remain disease free, and most treatments showed improved mucosal wave, VHI-10, and GRBAS. Conclusions Reactive lesions have not been well classified, and treatments are based on subjective intraoperative decision making with unpredictable outcomes. The nomenclature proposed will allow for a better definition of the RL and provide a framework for future research to identify optimal treatment.
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Affiliation(s)
- Shira L. Koss
- Department of Otolaryngology–Head and Neck Surgery, Voice and Swallowing Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Sarah M. Kidwai
- Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Michael J. Pitman
- Department of Otolaryngology–Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center, New York, New York, USA
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Pitman MJ, Cabin JA, Iacob CE. Small Intestinal Submucosa Implantation for the Possible Treatment of Vocal Fold Scar, Sulcus, and Superficial Lamina Propria Atrophy. Ann Otol Rhinol Laryngol 2015; 125:137-44. [DOI: 10.1177/0003489415601685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Evaluate the histologic effects of grafting porcine-derived small intestinal submucosa (SIS) into the vocal fold superficial lamina propria (SLP) layer for the potential treatment of vocal fold scar, sulcus and superficial lamina propria atrophy. Methods: Small intestinal submucosa was implanted into the right vocal fold SLP of 6 mongrel dogs. The left vocal fold served as a sham surgical control. At 2, 4, and 6 weeks postoperative, bilateral vocal fold specimens were evaluated histologically. Results: At 2 and 4 weeks, respectively, SIS-implanted vocal folds demonstrated moderate and mild inflammation and acute and chronic inflammation. At 6 weeks, inflammation was minimal and chronic. The 6-week specimens showed copious amounts of newly generated hyaluronic acid (HA) within the graft. There was no reactive fibrosis at 6 weeks. Conclusions: In the canine model, SIS appears safe for SLP grafting. Inflammation is similar to that of sham surgery. Small intestinal submucosa results in newly generated HA without concomitant fibrosis. Small intestinal submucosa has potential to be used in treatment of disorders with SLP, including vocal fold scar, sulcus, and atrophy. Studies evaluating the effect of SIS implantation on vocal fold function, as well as the ultimate fate of the graft, are required.
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Affiliation(s)
- Michael J. Pitman
- Otolaryngology- HNS, The Voice and Swallowing Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Jonathan A. Cabin
- Otolaryngology-Head & Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Codrin E. Iacob
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Haser GC, Su HK, Pitman MJ, Khorsandi AS. Extramedullary plasmacytoma of the cricoid cartilage with solitary plasmacytoma of the rib. Am J Otolaryngol 2015; 36:598-600. [PMID: 25748689 DOI: 10.1016/j.amjoto.2015.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extramedullary plasmacytoma is a rare plasma cell neoplasm of the soft tissues characterized by the presence of a single, discrete lesion without evidence of systemic disease. Extramedullary plasmacytoma may disseminate into multiple myeloma, a systemic plasma cell disease. METHODS A rare case of extramedullary plasmacytoma of the cricoid cartilage with solitary plasmacytoma of the rib was reviewed. RESULTS The patient was found to have two discrete lesions; one of the cricoid cartilage and one of the lateral left fifth rib. Despite the presence of multiple tumors, the patient was not diagnosed with multiple myeloma as the bone marrow appeared normal. CONCLUSIONS Due to the rarity of these neoplasms and the unusual localization of the extramedullary plasmacytoma tumor, a definitive diagnosis was difficult to make in this case. This case may be instructive for the differential diagnosis of laryngeal lesions.
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Affiliation(s)
- Grace C Haser
- Thyroid Head and Neck Cancer (THANC) Foundation, Mount Sinai Beth Israel, 10 Union Square East, Suite 5B, New York, NY, USA.
| | - Henry K Su
- Thyroid Head and Neck Cancer (THANC) Foundation, Mount Sinai Beth Israel, 10 Union Square East, Suite 5B, New York, NY, USA.
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY, USA.
| | - Azita S Khorsandi
- Department of Radiology, Mount Sinai Beth Israel, 10 Union Square East, New York, NY, USA.
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Hernandez-Morato I, Isseroff TF, Sharma S, Pitman MJ. Differential expression of glial-derived neurotrophic factor in rat laryngeal muscles during reinnervation. Laryngoscope 2014; 124:2750-6. [DOI: 10.1002/lary.24759] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/26/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tova F. Isseroff
- Department of Otolaryngology; The New York Eye and Ear Infirmary; New York New York U.S.A
| | - Sansar Sharma
- Department of Anatomy and Cell Biology; New York Medical College; Valhalla New York
| | - Michael J. Pitman
- Department of Otolaryngology; The New York Eye and Ear Infirmary; New York New York U.S.A
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Pitman MJ, Bock JM, Cohen SM, Courey MS. It’s Not Always Reflux: What Are We Missing? Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a53] [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: Laryngopharyngeal reflux (LPR) is commonly diagnosed in patients seen by otolaryngologists. Prescribing of proton pump inhibitors (PPIs) increased 5-fold from 1990 to 2001 and accounts for 10% of costs in evaluation and management of patients with voice disorders. In response, 46.5% of general otolaryngologists feel they are overdiagnosing LPR. Considering this, what diagnoses are otolaryngologists missing due to the reflexive diagnosis of LPR? The goal of this program is to present a clear clinical approach to the diagnosis and treatment of patients complaining of LPR-like symptoms and suggest alternative diagnoses and treatments as well as an approach to patients unresponsive to PPI therapy. Educational Objectives: (1) Diagnose efficiently and effectively treat a patient who has LPR-like symptoms but is unresponsive to PPI management. (2) Describe the unified airway concept and how it alters the diagnostic and therapeutic approach to patients with LPR-like symptoms. (3) Implement treatment for postviral vagal neuropathy and irritable larynx syndrome.
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Abstract
OBJECTIVES/HYPOTHESIS To investigate the feasibility of an implantable electrical stimulation device to treat spasmodic dysphonia (SD) by neuromodulation of the muscle spindle gamma loop. STUDY DESIGN Prospective case series. METHOD Five subjects underwent daily stimulation of the left thyroarytenoid muscle (TA) below the level of α-motor neuron activation (AMNA) for 5 consecutive days. Professional and patient voice evaluations were performed. Transcartilagenous placement of an implantable stimulation device lead was investigated in anesthetized porcine and cadaveric human models. RESULTS Three of 5 subjects improved in all categories of evaluation. One subject improved in three of four categories. These four subjects described significant carryover of effect after treatment. The fifth subject evidenced improvement until contracting an upper respiratory infection on day 3. Transcartilagenous electrode placement into the porcine TA with muscle stimulation was successful. The electrode lead was passed from the cadaveric larynx to the mastoid tip in the subplatysma layer with an absence of tension. CONCLUSION The symptoms of SD improve after electrical stimulation of the TA at levels below AMNA. This is likely through neuromodulation of the muscle spindle gamma loop. Implantation of an electrode into the TA with a postauricular implanted stimulator is feasible with modifications of an already existing device. With further investigation, such a device has the potential to deliver an alternative treatment for SD. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Michael J Pitman
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A
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Pitman MJ, Rubino SM, Cooper AL. Temporalis fascia transplant for vocal fold scar and sulcus vocalis. Laryngoscope 2014; 124:1653-8. [DOI: 10.1002/lary.24536] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 10/24/2013] [Accepted: 11/25/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Michael J. Pitman
- Division of Laryngology; The Voice and Swallowing Institute, New York Eye and Ear Infirmary; New York, New York
| | | | - Amy L. Cooper
- Department of Communicative Disorders; The Voice and Swallowing Institute, New York Eye and Ear Infirmary; New York, New York
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Alli O, Berzofsky C, Sharma S, Pitman MJ. Development of the rat larynx: a histological study. Laryngoscope 2013; 123:3093-8. [PMID: 23918405 DOI: 10.1002/lary.24145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 02/11/2013] [Accepted: 03/18/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate and describe the cartilaginous and muscular development of the rat larynx. STUDY DESIGN Histologic evaluation. METHODS The larynges of Sprague Dawley rats of embryonic day (E) 13, 15, 17, 19, 21, postnatal day 0, 14, and adult of 250 gm were collected. Four larynges of each age were harvested, cut into 15-μm serial sections, stained with hematoxylin and eosin, and evaluated under light microscopy. Representative digital images were recorded and evaluated at the preglottic (supraglottic in humans), glottic, and postglottic (subglottic in humans) levels. RESULTS Brachial arches were observed at E13. At E17, immature structures of the larynx, including skeletal muscle, cartilage, and the lumen were identifiable. Chondrification and muscle formation were clearly seen by E19. The muscular and cartilagenous components of the larynx were well established by E21. During the span between birth and adult maturation, the size of the larynx increased from a height of 1.10 mm to 2.90 mm, and from a width of 1.80 mm to 5.40 mm, and from a length of 1.38 mm to 4.77 mm in the stained section. Although developed at E21, the laryngeal structures continued to grow by approximately 30%. CONCLUSION Rat laryngeal development parallels that in mice and humans. In the rat, at E17 immature structures of the larynx are identifiable, they are well developed at birth and grow by approximately 30% into adulthood. Understanding the chronology and morphology of the embryogenesis of the rat laryngeal musculature is essential and will allow for further evaluation of the embryologic innervation of these muscles.
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Affiliation(s)
- Opeyemi Alli
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York, U.S.A
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