Publications by authors named "Robert Eller"

35 Publications

Left Subclavian Pseudoaneurysm: A Case of Palsies in the Recurrent Laryngeal Nerve, Phrenic Nerve, and Brachial Plexus.

Ear Nose Throat J 2021 Feb 9:145561321993371. Epub 2021 Feb 9.

University of South Carolina School of Medicine Greenville, Greenville, SC, USA.

A patient developed a subclavian pseudoaneurysm following placement of an intravascular catheter for cancer treatment. The patient presented with palsies in the phrenic nerve, brachial plexus, and recurrent laryngeal nerve. This is a rare presentation, similar to Ortner's syndrome, which has not been previously presented in the literature. Furthermore, this case highlights the importance of early laryngoscopy in patients with persistent voice change, especially after a neck procedure.
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http://dx.doi.org/10.1177/0145561321993371DOI Listing
February 2021

Mandated wrapping of airway cart instruments: Limited access without the intended safety benefits.

Laryngoscope 2019 03 13;129(3):715-719. Epub 2018 Dec 13.

Greenville Voice Center, Greenville ENT Associates, Greenville Health System, Greenville, South Carolina, U.S.A.

Objectives/hypothesis: Isolated case studies have shown improper sterilization or contamination of equipment from anesthesia carts can lead to transmission of disease and even death. Citing this literature, national accrediting agencies mandated all instruments in the otolaryngology airway carts at San Antonio Military Medical Center be packaged to prevent contamination. This study sought to determine the infection and safety implications of packaged airway cart instruments.

Study Design: Retrospective chart review.

Methods: A review of upper aerodigestive tract procedures, some of which penetrated mucosa, was performed by analyzing 100 patient records during the unpackaged period and 100 during the packaged period. A comparison of infections, deaths, and length of stay in the hospital was included in the analysis. Additionally, a timed simulation to setup a simple group of instruments for an emergency airway situation from both the unpackaged and packaged airway carts was performed using a total of 11 surgical technologists and nurses.

Results: Each group had a total of four airway infections and neither had any deaths. The average length of hospital stay was 0.36 days for the unpackaged period and 0.44 days from the packaged period. None of these variables reached statistical significance. The average time to find and set out the correct instruments for the two groups was 46.6 and 95.5 seconds for the unpackaged and packaged airway carts, respectively (P = .004).

Conclusions: This study suggests individually packaging of instruments used for emergency airway cases may put lives at risk when time matters and fails to decrease the risk of infection.

Level Of Evidence: 3 Laryngoscope, 129:715-719, 2019.
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http://dx.doi.org/10.1002/lary.27503DOI Listing
March 2019

Laryngocardiac Reflex: A Case Report and Review of the Literature.

J Voice 2018 Sep 24;32(5):633-635. Epub 2017 Oct 24.

San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas. Electronic address:

Introduction: The vagus nerve has sensory and motor function in the larynx, as well as parasympathetic function in the thorax and abdomen. Stimulation of the superior laryngeal nerve can cause reflexive bradycardia.

Case: We describe a case of a 45-year-old man with pre-syncopal symptoms while exercising, and bradycardia found during cardiology workup. Radiography and flexible laryngoscopy showed evidence of a right-sided, vascular laryngeal mass. Exercise testing before and after superior laryngeal nerve block showed reversal of the symptoms with the block. Subsequent resection of the lymphovascular malformation with CO laser eliminated the patient's symptoms.

Discussion: This is the first case reported of the laryngocardiac reflex producing symptomatic bradycardia as a result of exercise-induced engorgement of a supraglottic lymphovascular malformation, which was then cured by surgical excision. We discuss this case and the literature regarding lymphovascular malformations in the airway and the neural pathways of the laryngocardiac reflex.
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http://dx.doi.org/10.1016/j.jvoice.2017.07.022DOI Listing
September 2018

Conservative or radical surgery for pediatric papillary thyroid carcinoma: A systematic review of the literature.

Int J Pediatr Otorhinolaryngol 2015 Oct 10;79(10):1620-4. Epub 2015 Aug 10.

Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

Background: Pediatric papillary thyroid carcinoma (PTC) is characterized by an aggressive clinical course. Early diagnosis is a challenge and treatment consists principally of partial or total thyroidectomy±neck dissection and radioactive iodine therapy. Due to the rarity of PTC in children, there is no consensus on optimal surgical treatment.

Methods And Results: A literature search was carried out using PubMed, Embase, Medline, Cochrane and Web of Science. Seven studies (489 patients) investigating the outcome of surgically managed pediatric PTC were identified. No clear advantage in survival or recurrence rate was found for total thyroidectomy compared to other surgical approaches.

Conclusion: Despite the aggressive behavior of PTC, prognosis is good, with low mortality. After removal of disease and prevention of recurrence, reduction of iatrogenic complications are a priority in this age group. Due to the paucity of available evidence, this review cannot recommend conservative or radical surgery for pediatric papillary thyroid carcinoma. To answer this question, we recommend the establishment of a randomized controlled trial with adequately matched baseline variables.
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http://dx.doi.org/10.1016/j.ijporl.2015.08.004DOI Listing
October 2015

Geniotubercle advancement with a uvulopalatal flap and its effect on swallow function in obstructive sleep apnea.

Laryngoscope 2015 Mar 24;125(3):758-61. Epub 2014 Sep 24.

Department of Otolaryngology , San Antonio Military Medical Center, San Antonio, Texas, U.S.A.

Objectives/hypothesis: Evaluate swallowing characteristics before and after geniotubercle advancement (GTA) with a uvulopalatal flap (UPF).

Study Design: Prospective case control series in an academic military practice.

Methods: Fourteen patients with apnea-hypopnea index (AHI) >10 scheduled for GTA were enrolled consecutively, eight of whom completed all aspects of the study for evaluation. Video fluoroscopic swallow study was performed preoperatively and 4 months postoperatively. National Institute of Health freeware ImageJ64 software was used to measure hyolaryngeal elevation and displacement. Video recordings assessed vallecular pooling, aspiration, and bolus movement. Studies were reviewed by a speech pathologist and an otolaryngologist.

Results: Preoperatively, the mean AHI was 48.3 ± 48.45 events per hour, with a median of 48.5 (range, 12.4-76). Postoperatively the mean AHI was 11.6 ± 10.7 events per hour, with a median of 10.75 (range, 3.8-29) (P = .003). There was no reported pre- or postoperative dysphagia or aspiration. No radiographic evidence of silent aspiration was seen. Hyolaryngeal movements were measured as a percentage of C2-C4 reference distance. The superior elevations were pre- and postoperatively 40% and 37% (P = .85), anterior displacement changes 18.9% and 18.8% (P = .23), and total motion 49% and 42% (P = .26), respectively.

Conclusions: GTA with UPF surgery did not significantly affect the hyolaryngeal function of patients.
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http://dx.doi.org/10.1002/lary.24939DOI Listing
March 2015

Quantifying the cepstral peak prominence, a measure of dysphonia.

J Voice 2014 Nov 29;28(6):783-8. Epub 2014 Aug 29.

Department of Speech Pathology and Audiology, Western Michigan University, Kalamazoo, Michigan.

Objective: The purpose of this study is to establish normative values for the smoothed cepstral peak prominence (CPPS) and its sensitivity and specificity as a measure of dysphonia.

Study Design: Prospective cohort study.

Methods: Voice samples of running speech were obtained from 835 patients and 50 volunteers. Eight laryngologists and four speech-language pathologists performed perceptual ratings of the voice samples on the degree of dysphonia/normality using an analog scale. The mean of their perceptual ratings was used as the gold standard for the detection of the presence or absence of dysphonia. CPPS was measured using the CPPS algorithm of Hillenbrand, and the cut-off value for positivity that has the highest sensitivity and specificity for discriminating between normal and severely dysphonia voices was determined based on ROC-curve analysis.

Results: The cut-off value for normal for CPPS was set at 4.0 or higher, which gave a sensitivity of 92.4%, a specificity of 79%, a positive predictive value of 82.5%, and a negative predictive value of 90.8%. The area under the receiver operating characteristic (ROC) curve was 0.937 (P < 0.05).

Conclusions: CPPS is a good measure of dysphonia, with the normal value of CPPS (Hillenbrand algorithm) of a running speech sample being defined as a value of 4.0 or higher.
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http://dx.doi.org/10.1016/j.jvoice.2014.05.005DOI Listing
November 2014

Effect of vocal fold injection of cidofovir and bevacizumab in a porcine model.

JAMA Otolaryngol Head Neck Surg 2014 Feb;140(2):155-9

Department of Otolaryngology, San Antonio Military Medical Center, Ft Sam Houston, Texas6Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Importance: Recurrent respiratory papillomatosis (RRP) is a common and often chronic disorder. Intralaryngeal bevacizumab has gained recent interest as an adjuvant therapy for RRP. However, no histologic model has been published describing the effects of bevacizumab on the vocal fold.

Objective: To investigate the histologic effects of bevacizumab injections into the vocal fold and compare these findings with those for cidofovir and saline control injections.

Design And Setting: In vivo animal study involving eighteen 1-year-old Yorkshire crossbreed pigs, with a blinded review of pathologic findings conducted in a veterinary research laboratory.

Interventions: The pigs were randomly divided into six study groups receiving 2.5 or 5.0 mg of cidofovir or bevacizumab alone or in combination. Each pig received an injection of 0.5 mL of the test drug in the right vocal fold and 0.5 mL of saline in the left vocal fold. These injections were performed 4 times during the course of 8 weeks. One pig from each group was killed humanely and the larynges harvested 2 weeks after the last injection. The remaining pigs were killed 4 months after the last injection on the remaining pigs. The vocal folds were fixed and stained with hematoxylin-eosin and trichrome and reviewed for histologic changes by 3 blinded pathologists.

Main Outcomes And Measures: Histologic changes to the vocal folds.

Results: Minimal inflammation, edema, and atypia were found in all treatment groups. No appreciable histologic differences were found among the 3 treatment groups and their controls. No difference was seen in the vocal folds that were harvested late (4 months) vs early (2 weeks) after last injection. No fibrosis was found in any of the specimens.

Conclusions And Relevance: No histologic evidence suggests that intralaryngeal cidofovir or bevacizumab alone or in combination resulted in significant changes to the porcine vocal fold. Future studies may build on this model to test higher dosages and/or may combine injections with potassium titanyl phosphate laser therapy.
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http://dx.doi.org/10.1001/jamaoto.2013.5853DOI Listing
February 2014

Hemodynamic changes during otolaryngological office-based flexible endoscopic procedures.

Ann Otol Rhinol Laryngol 2012 Nov;121(11):714-8

Department of Otolaryngology-Head and Neck Surgery, Voice, Airway, and Swallowing Center, Georgia Health Sciences University, Augusta, Georgia, USA.

Objectives: A preponderance of literature supports the safety of office-based flexible endoscopic procedures of the upper aerodigestive tract; however, until recently there were no data regarding hemodynamic stability during these procedures. A recent study showed intraprocedure changes in patients' hemodynamic parameters, raising the concern that perhaps patients should be monitored during these procedures. The aim of our study was to determine whether physiologically significant alterations in vital signs occur during office-based flexible endoscopic procedures.

Methods: We performed a retrospective review of 100 consecutive patients who underwent office-based flexible endoscopic procedures of the upper aerodigestive tract from July 2010 to October 2011. Baseline values and the maximal changes in systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded and compared.

Results: One hundred consecutive patients were included in the study. Twenty-one patients (21%) had severe hypertension and 40 patients (40%) had tachycardia during the procedure. The mean change overall in systolic blood pressure was 26.2 mm Hg (p < 0.001), the mean change in diastolic blood pressure was 13.9 mm Hg (p < 0.001), the mean change in heart rate was 16.6 beats per minute (p < 0.001), and the mean change in oxygen saturation was 1.6% (p < 0.001). These changes were significant. On further breakdown into groups, patients over 50 years of age and patients who were undergoing esophageal or laser procedures had significant elevations in heart rate (p = 0.01 and p = 0.04, respectively). An elevation in diastolic blood pressure was also significant in patients who were undergoing esophageal or laser procedures (p = 0.04 for both).

Conclusions: These data concur with those of the previous report that found potentially significant hemodynamic changes during office-based procedures. Although preliminary, our findings suggest that it may be wise to monitor vital signs in patients over 50 years of age and patients who are undergoing an esophageal or laser procedure who are at risk for complications that could arise from tachycardia and hypertension.
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http://dx.doi.org/10.1177/000348941212101103DOI Listing
November 2012

Total airway reconstruction.

Laryngoscope 2013 Feb 10;123(2):537-40. Epub 2012 Sep 10.

Department of Otolaryngology, Head and Neck Surgery, Wilford Hall Medical Center, Lackland AFB, Texas, USA.

We present a case of obstructive sleep apnea (OSA) that required multilevel surgical correction of the airway and literature review and discuss the role supraglottic laryngeal collapse can have in OSA. A 34-year-old man presented to a tertiary otolaryngology clinic for treatment of OSA. He previously had nasal and palate surgeries and a Repose tongue suspension. His residual apnea hypopnea index (AHI) was 67. He had a dysphonia associated with a true vocal cord paralysis following resection of a benign neck mass in childhood. He also complained of inspiratory stridor with exercise and intolerance to continuous positive airway pressure. Physical examination revealed craniofacial hypoplasia, full base of tongue, and residual nasal airway obstruction. On laryngoscopy, the paretic aryepiglottic fold arytenoid complex prolapsed into the laryngeal inlet with each breath. This was more pronounced with greater respiratory effort. Surgical correction required a series of operations including awake tracheostomy, supraglottoplasty, midline glossectomy, genial tubercle advancement, maxillomandibular advancement, and reconstructive rhinoplasty. His final AHI was 1.9. Our patient's supraglottic laryngeal collapse constituted an area of obstruction not typically evaluated in OSA surgery. In conjunction with treating nasal, palatal, and hypopharyngeal subsites, our patient's supraglottoplasty represented a key component of his success. This case illustrates the need to evaluate the entire upper airway in a complicated case of OSA.
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http://dx.doi.org/10.1002/lary.23591DOI Listing
February 2013

Diagnosing aerodynamic supraglottic collapse with rest and exercise flexible laryngoscopy.

J Voice 2012 Nov 19;26(6):779-84. Epub 2012 Jun 19.

Department of Otolaryngology, Head & Neck Surgery, Brooke Army Medical Center, San Antonio, Texas, USA.

Objective: Laryngomalacia is best known as a self-resolving infantile disorder characterized by inspiratory stridor with occlusion of the larynx by collapse of arytenoid tissues due to Bernoulli forces. Adult laryngomalacia has been sporadically described in the literature. We identified a series of patients with aerodynamic supraglottic collapse mimicking laryngomalacia in our Otolaryngology clinic.

Study Design: Case series.

Methods/patients: A series of five patients from our Otolaryngology clinic with aerodynamic supraglottic collapse presented with complaints ranging from noisy breathing to dyspnea with exertion. Diagnosis was made using rest and exercise flexible laryngoscopy.

Results: Symptoms resolved in all patients who underwent traditional or modified supraglottoplasty.

Conclusions: These patients, all with abnormal corniculate/cuneiform motion occluding the airway during forceful inspiration, reinforce the diagnostic role of rest and exercise flexible laryngoscopy in patients with dyspnea and stridor. These results may suggest that aerodynamic supraglottic collapse is an underdiagnosed clinical entity.
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http://dx.doi.org/10.1016/j.jvoice.2012.01.004DOI Listing
November 2012

Bilateral vocal fold polyps with occult sulcus mucosal bridge.

Ear Nose Throat J 2011 Jun;90(6):248

Otolaryngology Service, Malcolm Grow Hospital, Andrews Air Force Base, MD, USA.

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http://dx.doi.org/10.1177/014556131109000603DOI Listing
June 2011

Vibratory asymmetry in mobile vocal folds: is it predictive of vocal fold paresis?

Ann Otol Rhinol Laryngol 2011 Apr;120(4):239-42

Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center-San Antonio, 78229, USA.

Objectives: The purpose of this study was to determine whether the videostroboscopic finding of vibratory asymmetry in mobile vocal folds is a reliable predictor of vocal fold paresis. In addition, the ability of experienced reviewers to predict the distribution (left/right/bilateral) of the paresis was investigated.

Methods: This is a retrospective chart review of all patients who presented to our clinic during a 3-year period with symptoms suggestive of glottal insufficiency (vocal fatigue or reduced vocal projection) accompanied by the videostroboscopic findings of bilateral normal vocal fold mobility and vibratory asymmetry. Twenty-three of these patients underwent diagnostic laryngeal electromyography of the thyroarytenoid and cricothyroid muscles to determine the presence of vocal fold paresis.

Results: Nineteen of the 23 patients (82.6%) were found to have electrophysiological evidence of vocal fold paresis, either unilaterally or bilaterally, when videostroboscopic asymmetry was present in mobile vocal folds. However, the three expert reviewers' ability to predict the distribution (left/right/bilateral) of the paresis was poor (26.3%, 36.8%, and 36.8%, respectively).

Conclusions: The videostroboscopic finding of vibratory asymmetry in mobile vocal folds is a reliable predictor of vocal fold paresis in most cases. However, the ability of expert reviewers to determine the distribution (left/right/bilateral) of the paresis using videostroboscopic findings is poor. This study highlights the value of laryngeal electromyography in arriving at a correct diagnosis in this clinical situation.
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http://dx.doi.org/10.1177/000348941112000404DOI Listing
April 2011

Traumatic airway management in Operation Iraqi Freedom.

Otolaryngol Head Neck Surg 2011 Mar 24;144(3):376-80. Epub 2011 Jan 24.

Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236-9908, USA.

Objectives: To examine the role of head and neck surgeons in traumatic airway management in Operation Iraqi Freedom and to understand the lessons learned in traumatic airway management to include a simple airway triage classification that will guide surgical management.

Study Design: Case series with chart review.

Setting: Air Force Theater Hospital at Balad Air Base, Iraq.

Subjects And Methods: The traumatic airway experience of 6 otolaryngologists/head and neck surgeons deployed over a 30-month period in Iraq was retrospectively reviewed.

Results: One hundred and ninety-six patients presented with airway compromise necessitating either intubation or placement of a surgical airway over the 30-month timeframe. Penetrating face trauma (46%) and penetrating neck trauma (31%) were the most common mechanisms of injury necessitating airway control. The traumatic airways performed include 183 tracheotomies, 3 cricothyroidotomies, 9 complicated intubations, and 1 stoma placement. Red or emergent airways were performed in 10% of patients, yellow or delayed airways in 58% of patients, and green or elective airways in 32% of patients. Lastly, surgical repair of the laryngotracheal complex was performed in 25 patients with 16 thyroid cartilage repairs, 4 cricoid repairs, and 8 tracheal repairs.

Conclusions: The role of the deployed otolaryngologist in traumatic airway management was crucial. Potentially lifesaving airways (red/yellow airways) were placed in 68% of the patients. The authors' recommended treatment classification should optimize future traumatic airway management by stratifying traumatic airways into red (airway less than 5 minutes), yellow (airway less than 12 hours), or green categories (airway greater than 12 hours).
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http://dx.doi.org/10.1177/0194599810392666DOI Listing
March 2011

Mass casualty response of a modern deployed head and neck surgical team.

J Craniofac Surg 2010 Jul;21(4):987-90

Brooke Army Medical Center, Fort Sam Houston, Texas, USA.

Background: The battlefields of the Global War on Terror have created unique demands on deployed surgical teams. Modern high-energy fragmentation devices often inflict complex head and neck injuries. This series analyzes the role of the head and neck surgical team during 3 separate single explosive events that led to civilian multiple casualty incidents (MCIs) treated at a military theater hospital in Iraq from February to April 2007.

Methods: All MCIs occurring between February and April 2008 with triage and treatment at the 332nd Air Force Theater Hospital in Balad, Iraq, were identified and reviewed. Injury Severity Score, admission injury pattern, length of hospital stay, head and neck procedures, non-head and neck procedures, and clinical duties performed by the otolaryngology surgeon were recorded and analyzed.

Results: Three MCIs occurring during the period of February to April 2008 were reviewed and described as incidents A, B, and C. A total of 50 patients were involved. Eighteen patients (36%) were treated for head and neck trauma. The average ISS for the non-head and neck trauma group was 15.8 (range, 1-43), whereas the head and neck trauma group average ISS was 23.6 (range, 2-75) (P < 0.06). The most commonly performed head and neck procedures included repair of facial lacerations, maxillomandibular fixation, and operative reduction internal fixation of facial fractures. The head and neck surgeon also performed airway triage and assisted with procedures performed by other specialties.

Conclusions: : By reviewing 3 MCIs and the operative log of the involved otolaryngologist, this review illustrates how the otolaryngologist's clinical knowledge base and surgical domain allow this specialist to uniquely contribute in response to a mass casualty incident.
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http://dx.doi.org/10.1097/SCS.0b013e3181e1e8deDOI Listing
July 2010

Unsuccessful frontal balloon sinuplasty for recurrent sinus barotrauma.

Aviat Space Environ Med 2010 May;81(5):514-6

Department of Otolaryngology, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), 2200 Bergquist Dr., Ste. 1, Lackland AFB, TX 78236, USA.

The standard of care treatment for diffuse recurrent sinus barotrauma (RSB) is an endoscopic sphenoethmoidectomy with a complete frontal dissection. Successful healing leaves the RSB patient with no ethmoid sinuses and endoscopically patent frontal, sphenoid, and maxillary ostia. In persistent cases, patients with small frontal ostia will go on to require a frontal drillout. Patients presenting for surgical management of RSB generally have minimal sinus disease despite significant symptoms during flight and the prospect of extensive surgical management can be unappealing. With the advent of balloon sinuplasty, military otolaryngologists anticipated this technology would permit therapeutic dilation of sinus ostia without the extensive surgical dissection and prolonged recovery typical for standard of care management. This case report is a cautionary note to the wider flight community to recognize a mechanism for recurrence of the underlying pathology when balloon sinuplasty is used that is not possible after properly performed standard of care sinus surgery for RSB.
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http://dx.doi.org/10.3357/asem.2716.2010DOI Listing
May 2010

Flexible laryngoscopy: a comparison of fiber optic and distal chip technologies-part 2: laryngopharyngeal reflux.

J Voice 2009 May 29;23(3):389-95. Epub 2009 Jan 29.

USAF Aerodigestive and Voice Center, Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center, San Antonio, TX 78236, USA.

Part 1 of this paper compared fiber optic (FO) and distal chip (DC) flexible technologies in the diagnosis of vocal fold masses and mucosal wave abnormalities. Part 2 of this study was designed to evaluate the usefulness of FO and DC flexible imaging in the diagnosis of laryngopharyngeal reflux (LPR) disease. Thirty-four consecutive patients were examined with either FO or DC flexible stroboscopy followed immediately by rigid stroboscopy. Rigid stroboscopy was considered the "gold-standard" for this study. All stroboscopy segments were evaluated by two laryngologists, an otolaryngologist, a laryngology fellow, and an otolaryngology resident for physical findings of LPR using the Reflux Finding Score (RFS) and Posterior Erythema Grade (PE grade). Both flexible systems underrepresented the physical findings of LPR compared to the rigid examination, but the FO system was frequently more accurate than the DC system. For PE grade, agreement with the rigid endoscope was 95% for the FO system and 73% for the DC system. Total RFSs for both flexible systems were significantly different than RFSs from the corresponding rigid examinations (P=0.001). Raters who used the RFS more often were more consistent. More severe PE grade scores correlated well with increasing RFSs. The number of patients diagnosed with LPR (RFS>7) showed that despite differences in the category scores, the FO and DC were almost identical in how much LPR was diagnosed compared with their matched rigid examination. Because both flexible platforms significantly underrepresented reflux signs, we recommend that a rigid laryngeal telescope be used when examining the larynx for signs of LPR. If this is not available, these data suggest that a high-quality FO endoscope may be more accurate than a DC endoscope for most otolaryngologists.
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http://dx.doi.org/10.1016/j.jvoice.2007.10.007DOI Listing
May 2009

Mucosal tear.

Ear Nose Throat J 2008 Oct;87(10):558

Department of Otolaryngology/Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.

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October 2008

Acute vocal fold hemorrhage after thyroplasty.

Ear Nose Throat J 2008 Aug;87(8):425

Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX, USA.

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August 2008

Reduction of anterior frontal sinus fracture involving the frontal outflow tract using balloon sinuplasty.

Otolaryngol Head Neck Surg 2008 Jul;139(1):170-1

Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Wilford Hall Medical Center, Brooke Army Medical Center, San Antonio, TX, USA.

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http://dx.doi.org/10.1016/j.otohns.2008.02.003DOI Listing
July 2008

Leukoplakia.

Ear Nose Throat J 2008 Apr;87(4):189

Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Tex, USA.

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April 2008

True vocal fold pseudocyst.

Ear Nose Throat J 2008 Feb;87(2):68

Department of Otolaryngology/Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.

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February 2008

Flexible laryngoscopy: a comparison of fiber optic and distal chip technologies. Part 1: vocal fold masses.

J Voice 2008 Nov 22;22(6):746-50. Epub 2008 Jan 22.

USAF Aerodigestive and Voice Center, Wilford Hall Medical Center, San Antonio, TX, USA.

This study was designed to evaluate the usefulness of fiber optic (FO) and distal chip (DC) flexible imaging platforms in the diagnosis of true vocal fold pathology when compared to the gold standard rigid transoral laryngeal telescopic examination. The recorded strobovideolaryngoscopic examinations of 34 consecutive patients were evaluated retrospectively by five raters. All stroboscopy segments were evaluated by two laryngologists, an otolaryngologist, a laryngology fellow, and an otolaryngology resident. Seventeen patients were examined with a high-quality, large-diameter, FO flexible laryngoscope (FO group) and 17 random patients were examined with a DC flexible laryngoscope (DC group). Each patient was also examined using rigid laryngeal videostroboscopy at the same sitting. Examinations of three patients from each group were presented twice to monitor internal consistency. Diagnoses of intrinsic vocal fold pathology made with the flexible laryngoscopes were compared for accuracy to the diagnoses provided using the rigid laryngeal telescope. The ability to make clinical diagnoses via stroboscopy was statistically equivalent with FO technology and DC technology. Rigid examination provided more information than the flexible examination in 27% of the FO examinations and in 32% of the DC examinations. DC technology did not add diagnostic information to the examination when compared to a high-quality, large-diameter, FO endoscope. Rigid endoscopy provides superior images of the true vocal folds and is necessary for precise diagnosis in patients with true vocal fold pathology. Thus, the most cost-effective means of evaluation of voice disorders remains FO flexible endoscopy for dynamic voice assessment and the neurolaryngologic examination followed by rigid stroboscopy for evaluation of the vocal fold edge and mucosal wave. Strobovideolaryngoscopy using high-quality FO or DC flexible equipment should be reserved for patients who cannot tolerate transoral rigid examination, such as children and those with a very strong gag reflex.
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http://dx.doi.org/10.1016/j.jvoice.2007.04.003DOI Listing
November 2008

Posthemorrhagic polyp.

Ear Nose Throat J 2007 Aug;86(8):442

American Institute for Voice and Ear Research, USA.

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August 2007

Vocal fold scar/sulcus vocalis.

Ear Nose Throat J 2007 Jun;86(6):320

American Institute for Voice and Ear Research, Philadelphia, USA.

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June 2007

The innervation of the posterior cricoarytenoid muscle: exploring clinical possibilities.

J Voice 2009 Mar 16;23(2):229-34. Epub 2007 May 16.

USAF Aerodigestive and Voice Center, Department of Otolaryngology-Head and Neck Surgery, San Antonio, Texas, USA.

Manipulation of the nerve supply to the posterior cricoarytenoid (PCA) muscle has potential for ameliorating the symptoms of some neurologic conditions such as abductor spasmodic dysphonia. The anatomy of the nerve supply to the PCA is better understood than in previous eras, but the anatomical understanding has not translated to clinical application yet. Microscopic dissection allowed the identification and measurement of the branches from the recurrent laryngeal nerves (RLNs) to the PCA in 43 human cadaver larynges. The cricothyroid (CT) joint was the primary landmark for measurement. Other structural measurements were also made on the larynges. All of the PCA muscles received innervation from the anterior division of the RLN. The number of direct branches from the RLN ranged from 1 to 5 (average 2.3) More than 70% of PCA muscles also received 1-3 branches off of the branch to the interarytenoid (IA) muscle. Less than half of PCA muscles received any kind of nerve branches from the posterior division of the RLN. Branches to the PCA most commonly departed the main RLN in its vertical segment and all entered the muscle from its deep surface. All branches departed the RLN within an average of 9.5mm from the CT joint; the branch to the IA occurs distal to this point. The innervation to the PCA is complex and redundant, and the segment of the RLN supplying those branches is difficult to expose safely. For these reasons, selective denervation or reinnervation procedures limited to the nerve branches may be technically difficult. When needing only to denervate the PCA, this can be accomplished by removing a portion of the PCA and the underlying nerve supply. Surgical technique should be based upon the understanding of the anatomy of the PCA muscle and its nerve supply.
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http://dx.doi.org/10.1016/j.jvoice.2007.01.007DOI Listing
March 2009

Vocal process granuloma.

Ear Nose Throat J 2007 Apr;86(4):198

American Institute for Voice and Ear Research, Drexel University College of Medicine, Philadelphia, USA.

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April 2007

Asymmetric Reinke's edema.

Ear Nose Throat J 2007 Feb;86(2):76

American Institute for Voice and Ear Research, Philadelphia, USA.

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February 2007

Recalcitrant arytenoid granuloma.

Ear Nose Throat J 2007 Jan;86(1):16

American Institute for Voice and Ear Research, Philadelphia, USA.

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January 2007

Acute vocal fold hemorrhage during sensory testing.

Ear Nose Throat J 2006 Dec;85(12):802

American Institute for Voice and Ear Research, USA.

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December 2006

Overcoming the epiglottis when a good examination is critical.

Ear Nose Throat J 2006 Nov;85(11):702-3

American Institute for Voice and Ear Research, Drexel University College of Medicine and Graduate Hospital, Philadelphia, USA.

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November 2006