TRANSACTIONS
AMERICAN LARYNGOLOGICAL ASSOCIATION
2019
VOLUME ONE HUNDRED FORTIETH
“DOCENDO DISCIMUS”
ONE HUNDRED FORTIETH ANNUAL MEETING
JW MARRIOTT - AUSTIN
AUSTIN, TEXAS
MAY 1-3, 2019
PUBLISHED BY THE ASSOCIATION NASHVILLE, TENNESSEE DINESH K. CHHETRI, MD, EDITOR
Table of Contents
Annual Photographs………………………………………………………………………………………………10
Officers 2017-2018……………………………………………………………………………………………….13
Registration of Fellows…………………………………………………………………………………………...14
Minutes of the Executive Sessions Reports Secretary, Lucian Sulica, MD…………………………………………………………………………...16 Treasurer, Clark A. Rosen, MD…………………………………………………………………………16 Editor, Dinesh K. Chhetri, MD……………………….…………………………………………………17 Historian, Michael S. Benninger, MD……..……………………………………………………………17
Recipients of De Roaldes, Casselberry and Newcomb Awards………………………………………..…………18
Recipients of Gabriel F. Tucker, American Laryngological Association, and Resident Research Awards………………………………………………………………………………19
Recipients of Young Faculty Research Awards…………………………………………………………………..20
The Memorial and Laryngological Research Fund...……………………………………………………………...21
Presidential Address C. Blake Simpson, MD...……………………………………………………………………………………..22
Presidential Citations Robert Bastain, MD; Jamie A. Koufman, MD; James Netterville, MD; Clark A. Rosen, MD, Robert T. Sataloff, MD, DMA...……………………………………………………....28
Introduction of Guest of Honor, Robert H. Ossoff, DMD, MD C. Blake Simpson, MD...……………………………………………………………………………………...33
Presentation of the American Laryngological Association Award to Peak Woo, MD Presented by William Armstrong, MD...……………………………………………………………………...34
Presentation of the Gabriel F. Tucker Award to Marshall E. Smith, MD Presented by Ahmed M.S. Soliman, MD...…………………………………………………………………...35
Introduction of the Forty-Fourth Daniel C. Baker, Jr., MD Memorial Lecturer, C. Blake Simpson, MD...……………………………………………………………………………………...36
Daniel C. Baker, Jr., MD, Memorial Lecture: Topic: Mentoring in a Changing World Gregory Postma, MD...………………………………………………………………………………………..37
Introduction of the State of the Art Lecturer C. Blake Simpson, MD...……………………………………………………………………………………...38
State of the Art Lecture: "The Laryngologist as Deglutologist" Peter C. Belafsky, MD, MPH, PhD...………………………………………………………………………....39
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SCIENTIFIC SESSIONS
A Separation of Innate and Learned Vocal Behaviors Defines the Symptomatology of Spasmodic Dysphonia Alexis Worthley, BA; Samantha Guiry, BA; Kristina Simonyan, MD………………………………………40 Effectiveness of Unilateral vs. Bilateral Botulinum Toxin Injections in Patients with Adductor Spasmodic Dysphonia: A Retrospective Review Steven Bielamowicz, MD; Ishaan Dharia, BA ……………………………………………………………...40 Selective Intraoperative Stimulation of Human Intrinsic Laryngeal Muscles: Analysis in a Mathematical Three Dimensional Space Michael Broniatowski, MD; Sharon Grundfest-Broniatowski, MD; Matthew Schiefer, PhD; David H. Ludlow, MD; David A. Broniatowski, PhD; Harvey M. Tucker, MD……………………………41 Botox in Management of Non-Dystonic Laryngeal Disorders Benjamin J. Rubinstein, MD; Diana N. Kirke, MD; Andrew Blitzer, MD, DDS; Peak Woo, MD …….…..41 Enhanced Abductor Function in Bilateral Vocal Fold Paralysis with Muscle Stem Cells Randal C. Paniello, MD, PhD; Sarah Brookes, DVM; Hongil Zhang, PhD; Stacey L. Halum, MD ……….42 Increased Expression of Estrogen Receptor Beta in Idiopathic Subglottic Stenosis Ross Campbell, MD; Elizabeth Direnzo, PhD; Sonja Darwish, MS …………………………………….….42 The Impact of Social Determinants of Health on the Development and Outcomes of Laryngotracheal Stenosis Sabina Dang, BA; C. Gaelyn Garrett, MD, MMHC; Christopher Wootten, MD; Alexander Gelbard, MD ……………………………………………………….43 Multilevel Upper Airway Measurements in Adults: Glottis Is Not Always the Narrowest Yousef Atjathlany, MBBS; Abdullah Aljasser. MBBS; Abdullah Alhilai, MBBS; Manal Bukhari, MBBS; Moahammed Almohizea, MBBS; Adeena Khan, MBBS; Ahmed Alammar, MBBS ………………………………………………………….43 Natural History of Vocal Fold Cysts Diana N. Kirke, MD, MPhil; Lucian Sulica, MD ………………………………………………………….44 Understanding the Vocal Fold Cyst – A 10 Year Retrospective Study of the Etiopathogenesis of Cysts Excised at a Tertiary Center with a Study of the Presence and Distribution Pattern of Seromucinous Glands in 40 Fresh Frozen Cadaver Vocal Folds Nupur Kapoor Nerurkar, MS; Trishna Chitnis, DNB; Vani Krishana Gupta, MS, DNB; Girish Mujumdar, MD; Keyuri Patel, MD; Pritha Bhuiyan, MS …………………………………………..44 Improvement of Diagnostic Clarity: Combination Treatment Using Voice Rest and Steroids Lesley F. Childs, MD; Ted Mau, MD, PhD ………………………………………………………………..45 The Role of Voice Rest on Voice Outcomes Post-Phonosurgery: A Randomized-Controlled Trial Kevin Fung, MD; Sandeep Shaliwal, MD; Philip Doyle, PhD …………………………………………….45 Force Metrics and Suspension Times for Microlaryngoscopy Procedures Allen L. Feng, MD; Matthew Naunheim, MD, MBA; Phillip C. Song, MD ………………………………46 A Phase II, Randomized, Double-Blind, Placebo- Controlled Multi-Institutional Study to Evaluate the Safety and Efficacy of Autologous Cultured Fibroblasts for Treatment of Vocal Fold Scarring and Atrophy Yue Ma, MD; Jennifer Long, MD, PhD; Stratos Achlatis, MD; Milan Amin, MD; Ryan Branski, PhD; Edward Damrose, MD; Chih-Kwang Sung, MD, MS; Ann Kearney, CScD; Dinesh Chhetri, MD ………………………………………………………………...46 Does Systemic Dehydration Adversely Affect Vocal Fold Tissue Physiology? Abigail C. Durkes. DVM, PhD; Steven Oleson, BS; Chenwai Duan, BS; Ku-Han Lu, MS; Zhongming Liu, PhD; Sarah Calve, PhD; Preeti M. Sivasankar, PhD, CCC-SLP …………………………47
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Optimized Quantification of Altered Vocal Fold Biomechanical Properties Gregory R. Dion, MD; Teka Guda, PhD; Shigeyuki Mukudai, MD, PhD; Renjie Bing, MD; Jean-Francois Lavoie, PhD; Ryan C. Branski, PhD …………………………………...…47 Effect of Sex Hormones on Extracellular Matrix of Lamina Propria in Rat Vocal Fold Byungjoo Lee, MD, PhD; Ji-Min Kim, PhD; Sung-Chan Shin, MD, PhD …………………………………..48 Idiopathic Vocal Fold Paralysis May Not Be Caused by a Focal Axonal Lesion Ted Mau, MD, PhD; Solomon Husain, MD; Lucian Sulica, MD ……………………………………………48 Effects of Trial Vocal Fold Injection Material & Operative Location on Predicting Thyroplasty Outcomes Kevin Tie, BS; Rupali N. Shah, MD; Robert A. Buckmire, MD …………………………………………….49 Effect of Vocal Fold Implant Placement on Depth of Vibration and Vocal Output Simeon L. Smith, BS, MS; Ingo R. Titze, PhD; Claudio Storck, MD; Ted Mau, MD, PhD ………………...49 The Effects of Implant Stiffness on Vocal Fold Medial Surface in an Ex-Vivo Hemilarynx Model ` Brian H. Cameron, BA; Zhaoyan Zhang, PhD; Dinesh K. Chhetri, MD …………………………………….50 Development of an Innovative Surgical Technique for Vocal Fold Reconstruction Using an Autologous Vascularized Pedicled Fat Flap in a Rabbit Model Seung Won Lee, MD, PhD …………………………………………………………………………………...50 Voice Outcome of Preservation of the External Branch of Superior Laryngeal Nerve Using Attachable Magnetic Nerve Stimulator under Intraoperative Neuromonitoring System during Thyroidectomy Eui-Suk Sung, MD, PhD; Sung-Chan Shin, MD, PhD; Hyun-Keun Kwon, MD Jin-Choon Lee, MD, PhD; Byung-Joo Lee, MD, PhD ……………………………………………………….51 Chronic Inflammatory Response in the Rat Lung to Commonly Used Contrast Agents for Videofluoroscopy Rumi Ueha, MD, PhD;Nogah Nativ-Zeltzer, PhD; Taku Sato, MD; Takao Goto, MD; Takaharu Nito, MD, PhD; Peter Belafsky, MD, MPH, PhD; Tatsuya Yamasoba, MD, PhD ……………….51 Improved Reflux Symptom Index in Patients Treated for Dysphonia Hannah Kavookjian, MD; Thomas Irwin, MM; James D. Garnett, MD; Shannon Kraft, MD ………………52 Comparison of Staple-Assisted Diverticulotomy, Laser-Assisted Diverticulotomy, and Transcervical Diverticulectomy for Zenker’s Diverticulum: A Systematic Review and Meta-Analysis Neel K. Bhatt, MD; Joshua Mendoza, BM; Angela C. Hardi, MLIS; Joseph P. Bradley, MD ……………...52 The Prevalence of Dysphonia and Dysphagia Symptoms in Patients on Statin Therapy Elie Khalifee, MD; Abdul-Latif Hamdan, MD, EMBA, MPH; Nader El Souky, MD; Bakr Saridar, MD; Sami Azar, MD ……………………………………………………………………….….53 The Use of the Ethicon Enseal for Transoral Rigid Zenker's Diverticulotomy: A Retrospective Review of Device Safety, Complication, and Short Term Outcomes Krishna Bommakanti, BA; William Moss, MD; Robert Weisman, MD; Philip Weissbrod, MD …..……….53 KTP Versus CO2 Laser Surgery for Early Glottic Cancer: Randomized Controlled Trial Comparing Survival and Function Yonatan Lahav, MD; Oded Cohen, MD; Yael Shapira-Galitz, MD; Doron Halperin, MD; Hagit Shoffel-Havakah, MD ………………………………………………………….54 MU-Opioid Receptor Expression in Laryngeal Normal and Carcinoma Specimens and the Relation with Survival Hagit Shoffel-Havakuk, MD; Huszar Monica, MD; Iris Levy, MD; Oded Cohen, MD; Doron Halperin, MD; Yonatan Lahav, MD ……………………………………………..54 A Novel and Personalized Voice Restoration Alternative forPatients with Total Laryngectomy Amais Rameau, MD, MPhil ………………………………………………………………………………….55 CT Lung Screening in Patients with Laryngeal Cancer Krzysztof Piersiala, MD; Alexander T. Hillel, MD; Lee M. Akst, MD; Simon R. A. Best, MD…………….55 Laryngocele, Rethinking the Prevalence by Exposing Radiographic Mimickers Guy Slonimsky, MD; Elnat Slonimsky, MD; David Goldenberg, MD ……………………………………...56 Sulcus Vocalis: Results of Excision without Reconstruction Katerina Andreadis, BA; Debra D’Angelo, BS; Katherine Hoffman, MS; Lucian Sulica, MD …………….56
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Recurrence of Benign Phonotraumatic Vocal Fold Lesions after Microlaryngoscopy Mark Lee, BS, BA; Lucian Sulica, MD ……………………………………………………………………...57 The Role of Steroid Injection for Vocal Fold Benign Lesions in Professional Voice Users Mohamed Al-Ali, MBBS; Jennifer Anderson, MD, MSc ……………………………………………………57 Measuring Upper Aerodigestive Tract Forces during Operative Laryngoscopy Peter Kahng, BA; Xiaotin (Dennis) Wu, BSE; Aravind Ponukumati, BSE; Eric Eisen, MD; Christiaan Rees, PhD; David Pastel, MD; Ryan Halter, PhD; Joseph Paydarfar, MD ………………………58 The Prevalence of Cognitive Impairment in Laryngology Treatment Seeking Patients Andree-Anne Leclerc, MD; Amanda I. Gillespie, PhD; Stasa D. Tadic, MD, MS; Libby J. Smith, DO; Clark A. Rosen, MD …………………………………………………………………...58 Utility of Audiometry in the Evaluation of Patients Presenting with Dysphonia Justin Ross, DO; David Bigley, BS; William Valentino, MS; Alyssa Calder, BS; Sammy Othman, BA; Brian McKinnon, MD; Robert T. Sataloff, MD, DMA ………………………………59 Validation of a Simplified Patient-Reported Outcome Measure for Voice Matthew Naunheim, MD, MBA; Jennifer Dai, BS; Benjamin Rubinstein, MD; Leanne Goldberg, MS, CCC-SLP; Mark S. Courey, MD ……………………………………………………59 Mental Health and Dysphonia: Which Comes First, and Does That Change Care Utilization? Victoria Jordan, MD; Scott Lunos, MS; Gretchen Seiger, BA; Keith J. Horvath, PhD; Seth M. Cohen, MD, MPH; Stephanie Misono, MD, MPH …………………………………………………60 Health Conditions Associated with Chronic Voice Problems in the United States Aaron M. Johnson, MM, PhD, CCC-SLP; Charles Lenell, MS ……………………………………………..60 Current Opioid Prescribing Patterns after Microdirect Laryngoscopy Molly Naunheim Huston, MD; Rouya Kamizi; Tanya K. Meyer, MD; Albert L. Merati, MD; J. P. Gilberto, MD ……………………………………………………………………61
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POSTER PRESENTATIONS
A Case of Laryngeal Injury after Gunshot to Left Temple Abhay Sharma, MD; Katherine Hall, MD; Michael Carmichael, MD; Matt Mifsud, MD; Sepehr Shabani, MD ……………………………………………………………………61 A Case Series of Posterior Glottic Stenosis Type I Nima Vahidi, MD; Lexie Wang, MD; Jaime Moore, MD ………………………………………………….62 A Novel Approach for Treating Vocal Fold Mucus Retention Cysts: Awake KTP Laser Assisted Cyst Drainage and Marsupialization William Z. Gao, MD; Sara Abu-Ghanem, MD; Lindsey S. Reder, MD; Milan R. Amin, MD; Michael M. Johns III, MD ……………………………………………………………62 A Novel, Simple, Surgical Technique for Endoscopic Laryngeal Suturing and Securing Laryngeal, Subglottic, and Tracheal Stents Edward Westfall, MD; Steven Charous, MD ………………………………………………………………..63 A Recipe for a Successful Awake Tracheostomy Shayanne A. Lajud, MD; Jaime Aponte, BS; Jeamarie Pascual, MD, MPH; Miguel Garraton, MD; Antonio Riera, MD ………………………………………………………………….63 A Unique Presentation and Etiology of Paradoxical Vocal Fold Motion Matt Purkey, MD; Taher Valika, MD ………………………………………………………………………..64 Acute Airway Obstruction from Rapidly Enlarging Reactive Myofibroblastic Lesion of the Larynx - Limitations of In-Office Treatment Yin Yu, MD; Victoria Yu, BA; Michael J. Pitman, MD ……………………………………………………..64 Adult Laryngeal Trauma in United States Emergency Departments Elisa Berson, MD; Elliot Morse, BS; Jonathan Hanna, BS; Saral Mehra, MD, MBA ………………………65 Airway Obstruction Caused by Redundant Postcricoid and Aryepiglottic (AE) Mucosa in Patients with Obstructive Sleep Apnea (OSA): Cases Series and Review of the Literature Jee-Hong Kim, MD; Lindsay Reder, MD; Tamara N. Chambers, MD; Karla O’dell, MD ………………….65 An Updated Approach to In-Office Balloon Dilation for Nasopharyngeal Stenosis: A Case Report Jeffrey Straub, MD; Laura Matrka, MD ……………………………………………………………………...66 Bilateral Type I Laryngoplasty for Presbylaryngis: Assessing the Depth and Location of Medialization Sarah Tittman, MD; Mark R. Gilbert, MD; David O. Francis, MD, MS; Kimberly N. Vinson, MD; Alexander Gelbard, MD; C. Gaelyn Garrett, MD, MMHC ……………………..66 Botulinum Toxin A (BoNT-A) for the Treatment of Motor and Phonictics Nikita Kohli, MD; Andrew Blitzer, MD, DDS ………………………………………………………………67 Contribution of Voice-Specific Health Status on General Quality of Life Elliana Kirsh, BM, BS; Thomas Carroll, MD; Jennifer J. Shin, MD, SM …………………………………..67 Cricoarytenoid Joint Abscess Associated with Rheumatoid Arthritis Megan Foggia, MD; Henry T. Hoffman, MD ……………………………………………………………….68 Delayed Laryngeal Implant Infection and Laryngocutaneous Fistula: A Rare Complication after Medialization Laryngoplasty Joseph B. Meleca, MD; Paul C. Bryson, MD ……………………………………………………………….68 Development of an In Vitro Model of Rat Vocal Fold Epithelium Keisuke Kojima, MD; Tatsuya Katsuno, PhD; Masanobu Mizuta, MD, PhD; Ryosuke Nakamura, PhD; Yo Kishimoto, MD, PhD; Yasuyuki Hayashi, MD; Masayoshi Yoshimatsu, MD; Shinji Kaba, MD; Hideaki Okuyama, MD; Toru Sogami, MD; Hiroe Ohnishi, PhD; Atsushi Suehiro, MD, PhD; Tomoko Tateya, MD, PhD; Koichi Omori, MD, PhD; Ichiro Tateya, MD, PhD ………………………………………………………….69 Endoscopic Lateralization of the Vocal Fold Ihab Atallah, MD, PhD; Paul F. Castellanos, MD …………………………………………………………...69
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Exercise-Induced Vocal Fold Dysfunction: A Quality Initiative to Improve Timely Assessment and Appropriate Management Emma S. Campisi; Jane Schneiderman, PhD; Theo Moraes, MD, PhD; Paulo Campisi, MD ………………70 False Vocal Fold (FVF) Botulinum Toxin Injection for Central Nervous System (CNS) Related Supraglottic Spasticity Causing Severe Vocal Strain: A Preliminary Study Victoria Yu, BA; Yin Yu, MD; Michael J. Pitman, MD …………………………………………………….70 Flexible VS. Rigid Laryngoscopy: A Randomized Crossover Study Comparing Patient Experience Bhavishya S. Clark, MD; William Z. Gao, MD; Caitlin Bertelsen, MD; Lindsay S. Reder, MD; Edie R. Hapner, PhD; Michael M. Johns III, MD ……………………………………………………………71 Gold Laser Removal of a Large Ductal Cyst on the Laryngeal Surface of the Epiglottis Pranati Pillutla, BS; Evan Nix, BS; Joehassin Cordero, MD; Brooke Jensen, BS …………………………...71 Hematologic Malignancies of the Larynx: A Single Institution Review Karuna Dewan, MD; Ross Campbell, MD; Edward J. Damrose, MD …………………………………….…72 Implementing Efficient Peptoid-Mediated Delivery of RNA-Based Therapeutics to the Vocal Folds Shigeyuki Mukudai, MD, PhDL; Iv Kraja, BS; Renjie Bing, MD; Danielle Nalband, PhD; Malika Tatikola, BS; Nao Hiwatashi, MD, PhD; Kent Kirshenbaum, PhD; Ryan C. Branski, PhD …….…..72 Injection Laryngoplasty as a New Treatment for Recalcitrant Muscle Tension Dysphonia: Preliminary Findings Daniel Novakovic, MPH, MBBS; Cate Madill, PhD, CPSP; Duy Duong Nguyen, MD, PhD ……………...73 Interarytenoid Botulinum Toxin A Injection for the Treatment of Vocal Process Granuloma Elie Khalifee, MD; Hussein Jaffal, MD; Anthony Ghanem, MD; Abdul-Latif Hamdan, MD, EMBA, MPH …………………………………………………………………....73 Is Nasogastric Tube Feeding Necessary after Surgery for Hypopharyngeal Diverticula? Alisa Zhukhovitskaya, MD; David Weiland, BS; Sunil Verma, MD ………………………………….….…74 Laryngeal and Airway Surgery under Apneic and Intermittent Apneic Anesthesia Mausumi Syamal, MD; Jill Hanisak, CRNA ………………………………………………………….……..74 Mycosis Fungoides of the True Vocal Folds Jesse R. Qualliotine, MD; Rohan Ahluwalia, MD; Dmitrios Tzachanis, MD, PhD; Philip A. Weissbrod, MD …………………………………………….….…75 Non-Caseating Granulomatous Disease of the Paraglottic Space: A Case of Laryngeal Sarcoidosis William S. Tierney, MD, MS, MS; Paul C. Bryson, MD …………………………………………….………75 Objective Measurement of Adductor Spasmodic Dysphonia Severity through Novel Laryngoscopic Image Analysis Yue Ma, MD; Avraham Mendelsohn, MD; Gerald S. Berke, MD ……………………………………….….76 Office-Based Percutaneous Injection Laryngoplasty with Calcium Hydroxylapatite:A 10-Year Experience Minhyung Lee, MD; Doh Young Lee, MD, PhD; Seuiki Song, MD; Young Kang, MD; Tack-Kyun Kwon, MD, PhD …………………………………………………………….76 Pediatric Tracheotomy in Infants: Based on 8 years of Experience at a Pediatric Tertiary Center in South Korea Eui-Suk Sung, MD, PhD; Jin-Choon Lee, MD, PhD; Byung-Joo Lee, MD, PhD; Dong-Jo Kim, MD; Da-Hee Park, MD ……………………………………………………………………….77 Post-Operative Complications in Obese Patients after Tracheostomy Shelby Barrera, BS; C. Blake Simpson, MD; Jay Ferrel, MD; Laura Dominguez, MD ……………………..77 Presence of Augmentation Material Does Not Impact Interpretation of Laryngeal Electromyography Libby J. Smith, DO; Michael A. Belsky, MSII; R. Jun Lin, MD; Clark A. Rosen, MD; Michael C. Munin, MD ……………………………………………………………….78 Prevalence, Incidence, and Characteristics of Dysphagia in Those with Unilateral Vocal Fold Paralysis Benjamin Schiedermayer, MS, CCC-SLP; Katherine Kendall, MD; Zhining Ou, MS; Angela P Presson, PhD; Julie Barkmeier-Kraemer, PhD, CCC-SLP ………………………………………..78
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Prognostic Role of Singular Lymph-Node Level Involvement in Patients with Laryngeal Cancer Rare Extrusion of Silastic Block after Type 1 Thyroplasty after Glomus Vagale Excision Lara Reichert, MD, MPH; Michael Underbrink, MD, MBA; Grant Conner, MD; Jingfeng Liang, BA; Peter A. Pellionisz, BS; Dinesh K. Chhetri, MD; Maie St. John, MD, PhD …………79 Rare Extrusion of Silastic Block after Type 1 Thyroplasty after Glomus Vagale Excision Lara Reichert, MD, MPH; Michael Underbrink, MD, MBA; Grant Cronner, MD …………………………79 RAT Recurrent Laryngeal Nerve Regeneration Using Self-Assembling Peptide Hydrogel Masayoshi Yoshimatsu, MD; Ryosuke Nakamura, PhD; Yo Kishimoto, MD, PhD; Yasuyuki Hayaski, MD; Keisuke Kojima, MD; Shinji Kaba, MD; Toru Sogami, MD; Hiroe Ohnishi, PhD; Tatsuya Katsuno, PhD; Atsushi Suehiro, MD, PhD Tomoko Tateya, MD, PhD; Ichiro Tateya, MD, PhD; Koichi Omori, MD, PhD ……………………………80 Results of the Adhere Upper Airway Stimulation Registry and Predictors of Therapy Efficacy Erica Thaler, MD; Richard Schwab, MD; Ryan Soose, MD; Courtney Chou, MD; Patrick Strollo, MD; Eric Kezirian, MD; Stanley Chia, MD; Clemens Heiser, MD; Benedikt Hofauer, MD; Karl Doghramji, MD; Maurits Boon, MD; Colin Huntley, MD; Armin Steffen, MD; Joachim Maurer, MD; Ulrich Sommer, MD; Kirk Withrow, MD; Mark Weidenbecher, MD; Kingman Strohlm, MD ………………...... 80 Risk Factors for Pneumonia in Patients with Head and Neck Cancer Daniel J. Cates, MD; Lisa Evangelista, CScD. CCC-SLP; Nogah Nativ-Zeltzer, PhD; Peter Belafsky, MD, MPH, PhD ………………………………………………..81 Subglottic Elastofibroma: A Case Report Emily M. Kamen, MD; Cheng Z. Liu, MD, PhD; Seth E. Kaplan, MD ……………………………………..81 Subglottic Squamous Cell Carcinoma – A Survey of the National Cancer Database Lucy Shi, MD; Caitlin McMullen, MD; Kathryn Vorwal, MD, DDS; Anthony Nichols, MD; S. Danielle MacNeil, MD; Krupal B. Patel, MD ……………………………………82 Surgical vs. Non-surgical Outcomes in the Treatment of Tonsilloliths Catherine Loftus, MS; Justin Cole, BS; Josh Hanau, BA; Craig Zalvan, MD …………………….…………82 The Health Utility of Mild and Severe Dysphonia Matthew Naunheim, MD, MBA; Elliana Kirsh, BM, BS; Mark Shrime, MD, MPH, PhD; Eve Wittenberg, MPP, PhD; Ramon Franco, MD; Phillip Song, MD ……………………………………….83 Thyroplasty with Real-Time Acoustic Analysis Tsuyoski Kojima, MD, PhD; Shintaro Fujimura., MD; Yusuke Okanoue, MD; Hiroki Kagoshima, MD; Atsushi Taguchi, MD; Masato Inoue, MD, PhD; Kazuhiko Shoji, MD, PhD; Ryusuke Hori, MD, PhD ……………………………………………………….83 Tracheal Pressure Exerted by High-Flow Nasal Cannula in 3D-Printed Pediatric Nasopharyngeal Models Alan J. Gray, BS; Katie R. Nielsen, MD, MPH; Laura E. Ellington, MD; Kaalan Johnson, MD; Yichen Zhang, BS; Hongjian Shi, BS; Lincoln S. Smith, MD; Rob DiBlasi, RRT-NPS ……………………84 Tracheal Resection in a Paraplegic: The Importance of the Cough Reflex Shaunak Amin, BS; Alexander Gelbard, MD; Jennifer Rodney, MD ……………………………………….84 Tracheotomy Avoided in Laryngeal Mucous Membrane Pemphigoid Treated with Rituximab Daniela A. Brake, BS, BA; Benjamin P. Anthony, MD ……………………………………………………..85 Trauma Informed Care in Laryngology Robert T. Cristel, MD; H. Stephen Sims, MD ……………………………………………………………….85 Vocal Fold Injection to Improve Post-Airway Reconstruction Dysphonia Mathieu Bergeron, MD; Alessandro de Alarcon, MD; John Paul Gilberto MD …………………………….86 Vocal Fold Medialization Forces Using a Dynamic Micromechanically Controlled Thyroplasty Device Christopher Kaufmann, MD; Parker Reineke, BS; Henry T. Hoffman, MD ………………………………..86 Vocal Fold Paresis: Subjective and Objective Patient Presentation Raluca Tavaluc, MD; Dinesh K. Chhetri, MD ………………………………………………………………87 Zenker's Diverticulum: Toward a Unified Understanding of Its Etiopathogenesis David A. Kasle, MD; Sina J. Torabi, BA; Clarence T. Sasaki, MD …………………………………………87
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Memorials Paul Chodosh, MD...... 88 Nels R. Olson, MD….……………………………….……..………………………………...... 89 Myron Shapiro, MD….……..………………………………………………………………...... …..90 Anthony Maniglia, MD………………………………………………………………………...…...91 Arnold Noyek, MD ……………………………………………………………………………...…92
Officers 1879-2012...... 93
Deceased Fellows …………………………………………………………………...... 97
Roster of Fellows 2019……..…………………………………………………………...... 102
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ALA Council – 2019
ALA Fellows - 2019 11
ALA Council and Post-Graduate Members - 2019 12
OFFICERS 2018-2019 OFFICERS 2019-2020
President…...... C. Blake Simpson, MD President…………..…………...... Paul W. Flint, MD San Antonio, Texas Portland, Oregon Vice President/ Vice President/ President-Elect………………...... Paul W. Flint, MD President-Elect…………...... Clark A. Rosen, MD Portland, Oregons San Francisco, California
Secretary…..….…………...….… Lucian Sulica, MD Secretary…..….…………...….… Lucian Sulica, MD New York, New York New York, New York
Treasurer……………....….……Clark A. Rosen, MD Treasurer……………....…Michael M. Johns III, MD San Francisco, California Los Angeles, California
Editor…………...…………...Dinesh K. Chhetri, MD Editor…………...…………...Dinesh K. Chhetri, MD Los Angeles, California Los Angeles, California
Historian….…………...... Michael S. Benninger, MD Historian….…………...... Michael S. Benninger, MD Cleveland, Ohio Cleveland, Ohio
First Councilor...... Peak Woo, MD First Councilor...... Kenneth Altman, MD, PhD New York, New York Houston, Texas
Second Councilor...... Kenneth Altman, MD, PhD Second Councilor...... Gady Har-El, MD Houston, Texas Houston, Texas
Third Councilor...... Gady Har-El, MD Third Councilor……………...C. Blake Simpson, MD Hollis, New York San Antonio, Texas
Councilor-at-Large…….....Michael M. Johns III, MD Councilor-at-Large………..……Joel H. Blumin, MD Los Angeles, California Milwaukee, Wisconsin
Councilor-at-Large………....…. Joel H. Blumin, MD Councilor-at-Large….………….Karen M. Kost, MD Milwaukee, Wisconsin Montreal, QB,CANADA
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REGISTRATION OF FELLOWS
Active Associate ABAZA, Mona METSON, Ralph BRANSKI, Ryan AKST, Lee MEYER, Tanya JIANG, Jack ALTMAN, Kenneth MIRZA, Natasha MURRY, Thomas ARMSTRONG, William MYER, Charles III SIMONYAN, Kristina BAREDES, Soly NETTERVILLE, James BELAFSKY, Peter O’MALLEY, Bert Post-Graduate BENNINGER, Michael ONGKASUWAN, Julina BERKE, Gerald MYSSIOREK, DaviD ALLEN, Clint BIELAMOWICZ, Steven PANIELLO, Randy BENSON, Brian BLITZER, Andrew PERSKY, Mark BEST, Simon BLUMIN, Joel PITMAN, Michael BRADLEY, Joseph BOCK, Jonathan RAHBAR, Reza BRISEBOIS, Simon BRADFORD, Carol RICE, Dale CATES, Daniel BRYSON, Paul ROSEN, Clark CLARY, Matthew BUCKMIRE, Robert SASAKI, Clarence COLLINS, Alissa BURNS, James SATALOFF, Robert CRAWLEY, Brianna CARROLL, Thomas SCHAEFER, Steven DANIERO, James CHHETRI, Dinesh SIMPSON, C. Blake DE ALARCON, Alessandro CHILDS, Lesley F. SMITH, Libby DEWAN, Karuna COHEN, Seth SMITH, Marshall DOMINQUEZ, Laura COUREY, Mark SOLIMAN, Ahmed FINK, Daniel CRUMLEY, Roger SONG, Phillip FRIEDMAN, Aaron DAILEY, Seth SULICA, Lucian GELBARD, Alexander DAMROSE, Edward THOMPSON, Dana GUARDIANI, Elizabeth DONOVAN, Donald VARVARES, Mark LOWELL, Gurey EISELE, David WEISMAN, Robert HATCHER, Jeanne EKBOM, Dale WOO, Peak HOWELL, Rebecca FLINT, Paul ZEITELS, Steven HUSAIN, Inna FRANCO, Ramon ZUR, Karen INGLE, John FRIEDMAN, Ellen JAMAL, Nausheen GARRETT, C. Gaelyn Corresponding KIRKE, Diana GARDNER, Glendon DIKKERS, Frederik KUHN, Maggie GENDEN, Eric HAMDAN, Abdul KUPFER, Robbi HAR-EL, Gady KWON, Seong Keun KWAK, Paul HILLEL, Alexander OMORI, Koichi LERNER, Michael HINNI, Michael NERURKAR, Nupur LIN, R Jun HOFFMAN, Henry VOKES, David MALLUR, Pavan HU, Amanda CM WANG, Chi-Te MATRKA, Laura JAMAL, Nausheen SATO, Kiminori MCWHORTER, Andrew JOHNS, Michael M II MISONO, Stephanie JOHNSON, Romaine Emeritus MOORE, Jaime KENDALL, Katherine MORTENSEN, Melissa KENNEDY, Thomas BRONIATOWSKI, Michael NAUNHEIM, Matthew KHOSLA, Sid HILLEL, Allen NOVAKOVIC, Daniel KLEIN, Adam OSSOFF, Robert PATEL, Amit KOST, Karen PEARSON, Bruce RAMEAU, Anais KOUFMAN, Jamie PILLSBURY, Harold III RANDALL, Derrick LONG, Jennifer REDER, Lindsay MAU, Ted RICKERT, Scott MERATI, Albert ROSOW, David RUTT, Amy SHOFFEL-HAVAKUK, Hagit
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SILVA MEREA, Valeria VINSON, Kimberly SINCLAIR, Catherine WANG, Hailun TAN, Melin WOOD, Megan W THEKDI, Apurva YOUNG, VyVy TIBBETTS, Kathleen YUNG, Katherine VERMA, Sunil ZALVAN, Craig
15
MINUTES OF THE EXECUTIVE SESSIONS
REPORT OF THE SECRETARY
The membership prior to the April 2019 election These totals also reflect that we were notified that included 122 Active members, 69 Emeriti members, 38 4 members who passed away prior to this report. Corresponding members, 2 Honorary members, 11 Associate members and 95 Post-Graduate Members for Dr. Sulica reported that a total of 200 ballots a total membership of 336 Fellows and members. were mailed to all eligible fellows for receipt 30 days prior to the 141st Annual Meeting. Eighty-four (84) Drs. Paul Bryson, Dale Ekbom, Alexander Hillel, Fellows voted which was an increase of 20 from the Amanda Hu, Nausheen Jamal, Romaine Johnson, 2018 balloting. Among the voting, there was three Katherine Kendall, Phillip Song, Libby Smith, Karen Fellows who abstained in voting for a variety of Zur, were elected to Active Fellowship; Drs. Seong candidates. He also reported that the Council has Keun Kwon, Nurpur Nerurkar,and Chi-Te Wang were recommended electronic voting to reduce printing and elected to Corresponding Fellowship; and Drs. Allen mailing costs for 2020. Hillel, Bruce Jafek, Jésus Medina, Robert Miller, Robert Ossoff, Harold Pillsbury, William Potsic, and Dr. Sulica reported that the ALA’s footprint for Eugene Rontal were elevated to Emeritus status. several years will include a third half-day session.
This allows for additional podium presentations, panel This year,we had a very large number (15) and guest lecturers. Previously, the third session was approved for Post-Graduate membership. They were combined with the ABEA; however, the COSM SLC Drs. Simeon Brisebois, Daniel Cates, Anissa Collins, approved the permanent addition. Mark Fritz, Inna Husain, Brandon Kim, Diana Kirke, Maggie Kuhn, Paul Kwak, Matthew Naunheim, Anju Patel, Valerie Silva Merea, Anais Rameau, Haliun Dr. Sulica concluded his report by thanking the Wang, and Mi Jin Yoo. Fellowship and Council for the assistance he has received as secretary. After election of the nominees, the 2019 roster reflects 124 Active members, 73 Emeriti members, 38 Respectfully submitted, Corresponding members, 2 Honorary members, 11 Lucian Sulica, MD Associate and 96 Post-Gradaute members, for a total Secretary membership of 344 Fellows and members.
REPORT OF THE TREASURER
Dr. Rosen reported to the Fellowship that the Revenues from the Laryngoscope provide transition with Association Management Executives opportunities for future research aklthough the major (AME) continues to be smooth. Ms. Cunningham source of income is members’ dues. We continue to processes all payments, including deposits into the bank encourage our Fellows to contribute to the Sustainers accounts and forwarded the receipts to AME. Fund. Again, this year, there will be a donors’ campaign Dr. Rosen reported that the finances of the with all funds being earmarked for education and Association continues to show great improvement research. especially in the areas of payment of dues and the growth The Council continues to practice good money of the Sustainers’ Fund. For collectible dues in 2019, management as we review practices that will result in 81.6% remitted payment. The 18.4% includes reduced expenditures at meetings and operational approximately $6K in delinquencies. After several expense. attempts to reach out to several active fellows and post- This is my final terns as Treasurer and I am honored graduate members to encourage them to bring their dues to have served in this position. Dr. Michael Johns III will current, suspensions were issued to those who were three assume this role and I am sure he will provide a high level + year delinquent. of service, along with our administrator, moving forward. Since it had been two years since the Council initated a financial review, the firm of Siem Johnson was Respectfully submitted, contracted to review our records for the years 2017 and Clark A. Rosen MD 2018. Treasurer
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REPORT OF THE EDITOR
Transactions continue to reduce expenses in printing and mailing The 2018 Transactions were provided on the information to our membership, we have begun to notify website and the traffic for members and non-members you via email of new content. If your email address is has been significant. As we continue to move toward a not accurate, you will not receive information such as the paperless society and to an increased digital format, you newsletter, and other notifications related to the will begin to notice that many of the lectures are now the Association’s events. Beginning in 2020, the actual presentation slides. Candidates’ Ballot Book will be made available to everyone with an email address. For those who do not ALA Website have access to email, we will mail a copy but our goal is The traffic during the past year continues to to reduce printing and mailing expenses by at least 75%. increase dramatically. There are new links to the To obtain a user name and temporary password, laryngology curriculum and patient education. Our Post- please contact our administrator, Maxine Cunningham at Graduate members have taken the lead in researching [email protected]. and downloading topics that we feel are not only beneficial to practitioners but to patients as well. We Publication encourage you to visit the site on a regular basis as new Dr. Chhetri reported there the number of abstracts content is frequently added. submitted for the 2019 also resulted in a high percentage of manuscripts published in the Journal. Posters have also continued to be of excellent quality that increases Members Access the value to the contributor. If you have not logged on to the site to create or update your profile, you are encourage to do so. To
Respectfully submitted, Dinesh K. Chhetri, MD Editor
REPORT OF THE HISTORIAN
Dr. Benninger reported that the Sustainers’ Fund Dr. Benninger presented an “In Memoriam” of experienced growth as a result of the 2018 Campaign. fellows who were reported deceased since our last annual Several contributions were from first time donors meeting. In honor of their service to the Association, a including several post-graduate members. During the moment of silence was observed for Drs. Paul Chodosh, Spring Council meeting, it was suggested by Ms. Anthony Maniglia, Nels Olson, and Myron Shapiro. It Cunningham that future campaigns should begin during was noted that Dr. Chodosh passed away in 2008, Dr. th first week of November to allow those who wish to Olson passed in 2012, Dr. Shapiro passed in 2014; claim the tax-exempt donation for tax purposes. Maniglia in 2017; and Dr. Noyek passed in 2018.
Respectfully submitted, Michael S. Benninger, MD Historian
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RECIPIENTS OF THE DE ROALDES AWARD
1928 Chevalier L. Jackson 1999 Jerome C. Goldstein 1931 D. Bryson Delavan 2000 Thomas C. Calcaterra 1934 Harris P. Mosher 2001 Eugene N. Myers 1937 Lee Wallace Dean 2002 Robin T. Cotton 1943 Ralph A. Fenton 2003 Gayle E. Woodson 1949 George M. Coates 2004 Robert H. Ossoff 1951 Arthur W. Proetz 2006 Stanley M. Shapshay 1954 Louis H. Clerf 2007 W. Frederick McGuirt, Sr. 1959 Albert C. Furstenberg 2008 Robert T. Sataloff 1960 Dean M. Lierle 1988 DeGraaf Woodman 2009 Andrew Blitzer 1961 Frederick T. Hill 1989 John F. Daly 2010 Marshall Strome 1966 Paul H. Holinger 1990 Joseph L. Goldman 2011 Gerald Healy 1970 Francis E. LeJeune 1991 William W. Montgomery 2012 Robert T. Sataloff 1973 Lawrence R. Boies 1992 M. Stuart Strong 2013 James L.Netterville 1976 Anderson E. Hilding 1993 Douglas P. Bryce 2014 Marvin P. Fried 1979 Joseph H. Ogura 1994 Paul H. Ward 2015 C. Gaelyn Garrett 1982 John J. Conley 1995 Hugh F. Biller 2016 Steven M. Zeitels 1985 John A. Kirchner 1996 Byron J. Bailey 2017 Steven Gray (Posthumously) 1985 Charles M. Norris 1997 George A. Sisson Sr. 2018 Michael S. Benninger 1987 Walter P. Work 1998 Stanley M. Blaugrund 2019 Bruce Pearson
RECIPIENTS OF THE CASSELBERRY AWARD
1923 George Fetterolf 1940 French K. Hansel 1998 Steven M. Zeitels and Herbert Fox 1941 Noah D. Fabricant 1999 Clarence T. Sasaki 1928 Ralph A. Fenton 1946 Paul H. Holinger 2006 Kiminori Sato and O. Larsell 1949 Henry B. Orton 2009 Randal C. Paniello 1929 Richard A. Kern 1962 Hans von Leden 2010 Priya Krishna and Harry P. Schenck 1966 John A. Kirchner 2017 Ted Mau 1929 Edward H. Campbell and Barry D. Wyke 2018 Seong Keun Kwon 1931 Arthur W. Proetz 1968 Joseph H. Ogura 1934 Anderson C. Hilding 1985 H. Bryan Neel III 1936 Francis E. LeJeune 1987 Joseph J. Fata and Joel J. Pressman 1991 James L. Koufman 1939 H. Marshall Taylor 1993 Frank E. Lucente and Brien T. King 1994 Ira Sanders
RECIPIENTS OF THE GABRIEL F. TUCKER AWARD
1987 Seymour R. Cohen 1998 Philippe Narcy 2009 William Crysdale 1988 Charles F. Ferguson 1999 Bernard R. Marsh 2010 Charles M Myer, III 1989 Blair Fearon 2000 Trevor J. I. McGill 2011 Mark Richardson 1990 Gerald B. Healy 2001 Donald B. Hawkins 2012 George Zalzal 1991 John A. Tucker 2002 James S. Reilly 2013 Andrew Inglis 1992 Bruce Benjamin 2003 Ellen M. Friedman 2014 Linda Brodsky 1993 John N. G. Evans 2004 C. Martin Bailey 2015 Dana Thompson 1994 Joyce A. Schild 2005 William P. Potsic 2016 Michael Rutter 1995 Robin T. Cotton 2006 Amelia F. Drake 2017 Paolo Campisi 1996 Haskins K. Kashima 2007 Colin Barber 2018 Noel Garabedian 1997 Lauren D. Holinger 2008 Seth Pransky 2019 Marshall Smith
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RECIPIENTS OF THE NEWCOMB AWARD
1941 Burt R. Shurly 1969 John A. Kirchner 1995 Mark I. Singer 1942 Francis R. Packard 1970 Louis H. Clerf 1996 H. Bryan Neel III 1943 George M. Coates 1971 Daniel C. Baker, Jr 1997 Haskins K. Kashima 1944 Charles J. Imperatori 1972 Alden H. Miller 1998 Andrew Blitzer 1947 Harris P. Mosher 1973 DeGraaf Woodman 1999 Hugh F. Biller 1948 Gordon Berry 1974 John J. Conley 2000 Robert W. Cantrell 1949 Gordon B. New 1975 Francis W. Davison 2001 Byron J. Bailey 1950 H. Marshall Taylor 1976 Joseph L. Goldman 2002 Gerald B. Healy 1951 John D. Kernan 1977 F. Johnson Putney 2003 Steven D. Gray 1952 William J. McNally 1978 John F. Daly 2004 Charles W. Cummings 1953 Frederick T. Hill 1979 Charles F. Ferguson 2005 Roger L. Crumley 1954 Henry B. Orton 1980 Charles M. Norris 2006 Charles N. Ford 1955 Thomas C. Galloway 1981 Stanton A. Friedberg 2007 Robert H. Ossoff 1956 Dean M. Lierle 1982 William M. Trible 2008 Gayle E. Woodson 1957 Gordon F. Harkness 1983 Harold G. Tabb 2009 Marvin P Fried 1958 Albert C. Furstenberg 1984 Daniel Miller 2010 Diane Bless 1959 Harry P. Schenck 1985 M. Stuart Strong 2011 Jamie A. Koufman 1960 Joel J. Pressman 1986 George A. Sisson 2012 Steven M. Zeitels 1961 Chevalier L. Jackson 1987 John S. Lewis 2013 Lauren Holinger 1962 Paul H. Holinger 1988 Douglas P. Bryce 2014 Marvin P. Fried 1963 Francis E. LeJeune 1989 Loring W. Pratt 2015 Robert T. Sataloff 1964 Fred W. Dixon 1990 William W. Montgomery 2016 Nicholas Maragos 1965 Edwin N. Broyles 1991 Seymour R. Cohen 2017 Gerald Berke 1966 Lyman G. Richards 1992 Paul H. Ward 2018 Peak Woo 1967 Joseph H. Ogura 1993 Eugene N. Myers 2019 Robert T. Sataloff 1968 Walter P. Work 1994 Richard R. Gacek
RECIPIENTS OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION AWARD
1988 Frank Netter 2000 M. Stuart Strong 2011 Lawrence DeSanto 1989 Shigeto Ikeda and Geza J. Jako 2012 Minoru Hirano 1990 Hans Littmann 2001 Eugene N. Myers 2013 Harvey Tucker 1991 Arnold E. Aronson 2002 Catherine D. DeAngelis 2014 Robert T. Sataloff 1992 Michael Ter-Pogossian 2003 William W. Montgomery 2015 Robert H. Ossoff 1993 C. Everett Koop 2004 David Bradley 2016 Gerald Berke 1994 John C. Polanyi 2005 Herbert Dedo 2017 Roger Crumley 1995 John G. Batsakis 2006 Christy L. Ludlow 2018 Eiji Yanagisawa 1996 Ingo Titze 2007 John A. Kirchner 2019 Peak Woo 1997 Matina Horner 2008 Gerald B. Healy 1998 Paul A. Ebert 2009 Stanley M. Shapshay 1999 Bruce Benjamin 2010 Clarence T Sasaki
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RECIPIENTS OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION RESIDENT RESEARCH AWARD
1990 David C. Green 2000 James C. L. Li 2012 Lowell Gurey 1991 Timothy M. McCulloch 2001 Andrew Verneuil 2013 Yaniv Hamzany 1991 Ramon M. Esclamado 2002 Dinesh Chhetri 2014 Boris Paskhover 1992 David H. Henick 2003 Andrew Karpenko 2015 Andrea Park 1993 Gregory K. Hartig 2004 Ichiro Tateya 2016 Andrew M. Vahabzadeh- 1994 Sina Nasri 2005 Samir Khariwala Hagh 1995 Saman Naficy 2007 Idranil Debnath 2017 Ian-James Malm, MD 1996 Manish K. Wani 2008 Tara Shipchander 2018 Molly Naunheim 1997 J. Pieter Noordzij 2009 David O. Francis 2019 Justin Ross 1998 Michael E. Jones 2010 David O. Francis 1999 Alex J. Correa 2011 Jeffreey Houlton
RECIPIENTS OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION YOUNG FACULTY RESEARCH AWARD
1991 Paul W. Flint 2012 Mika Nomoto 1992 Yasuo Hisa 2006 Suzy Duflo 2013 Seung Won Lee 1993 Jay F. Piccirillo 2007 Tack-kyun Kwon 2014 Jennifer Long 1994 Hans J. Welkoborsky 2008 Bernard Rousseau 2015 Nao Hiwatashi 1995 Nancy M. Bauman 2009 Tsunehisa Ohno 2016 Ryo Suzuki 1997 Ira Sanders 2010 I-Fan Theodore Mau 2017 Astha Malhotra 1998 Kiminori Sato 2011 David Francis 2018 Catherine Sinclair 2000 Steven Bielamowicz 2019 Yue Ma 2001 John Schweinfurth 2005 Dinesh Chhetri
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THE MEMORIAL AND LARYNGOLOGICAL RESEARCH FUNDS
The Council earnestly requests that Fellows of the Association give consideration to making a special bequest to these important funds, or to becoming a Benefactor.
MEMORIAL FUND DONORS
Daniel C. Baker, Jr George Fetterolf Lyman G. Richards John F. Barnhill Joseph L. Goodale Myron J. Shapiro August L. Beck William E. Grove Burt R. Shurly Gordon Berry Gordon F. Harkness Mark I. Singer Stanley M. Blaugrund Frederick T. Hill Lester T. Sunderland William E. Casselberry George E. Hourn H. Marshall Taylor Cornelius G. Coakley Samuel Johnston Walter H. Theobald Lee Wallace Dean John S. Lewis John A. Tucker Arthur W. De Roaldes H. Bryan Neel III Francis L. Weille Fred W. Dixon James E. Newcomb Eiji Yanagisawa Charles F. Ferguson Henry B. Orton
BENEFACTORS
Sally Sample Aall Thomas C. Galloway Harry P. Schenck Mrs Daniel C. Baker, Jr Joseph L. Goldman Oliver W. Suehs Edwin N. Broyles Robert L. Goodale William M. Trible Louis H. Clerf Edley H. Jones Gabriel F. Tucker, Jr Seymour R. Cohen A. P. Marchessini DeGraaf Woodman John J. Conley Francis H. McGovern Zelda Radow John F. Daly Charles M. Norris Weintraub Cancer Fund, Inc Francis W. and Mrs Davison Samuel Salinger Stanton A. Friedberg Sam H. Sanders
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PRESIDENTIAL ADDRESS
C. Blake Simpson, MD San Antonio, Texas
First of all, I want to thank the ALA for allowing me to be your president this year. It is an honor to represent a distinguished and historical surgical society such as this. My presidential address is entitled: Rock Stars of the ALA: Past, Present and Future.
Rock Star: it's a term we use in many ways nowadays. In the traditional sense of the word, it refers to a “famous performer of rock music”. From my young days growing up in Sherman, TX I wanted to be a rock star. I wanted to be on stage, playing guitar, selling out stadiums with my bandmates. The walls of my room were adorned with multiple posters of the bands I admired. Before I get into how this applies to the ALA, I would like to give you a little background about my early years.
When I was in grade school I actually My set lists were longer than anybody wanted to be a football player, like my else's and by 1979 I was headlining. But dad who played college ball. The only I really wanted more. By the time I was problem was, I was too short, too slow 14 or 15, I was ready to form a rock band. and had no athletic ability. So these I learned to play by ear instead of using dreams were shattered early on. When I sheet music, which was necessary to play realized there was no hope for me on the rock and roll. gridiron, I turned my attention to becoming a rockstar. Although my Although there were no books or dream was to play guitar, I decided on pamphlets piano because we had an upright in our on how to become a rockstar, I knew hard gameroom. work was involved. According to Katie Morton, “aspiring musicians show up day My early efforts were not necessarily in and day out. They put their head down appreciated by my band teacher Mr. and enjoy the process of hard work. Parnell, as you can see from my report Because let's face it, no one is guaranteed card (“capable of better work”), but I to become a rock star. So you might as buckled down and practiced in earnest well make sure you enjoy the work”. And and by 1978, I was well known within the I really loved what I was doing; I lived world of children's piano recital halls. and breathed music. I taught myself
22 PRESIDENTIAL ADDRESS
C. Blake Simpson, MD San Antonio, Texas guitar and set up a little recording studio heroes in the flesh. It reminded me of my in my bedroom. By my senior year, my younger days when I attended summer rock band played to a sold out crowd at music festivals like the Texas Jam. All our school auditorium. Actually it was an the major bands were on one stage, and it all school assembly and attendance was was just a parade of rockstars . One of the mandatory, but still - for just a little while primary differences was that when it got I felt like a rockstar. But my goals of rock too hot at the Texas Jam, they would stardom were not realistic - I was not spray the audience with a firehose, talented enough to make it in the music whereas at the Academy meeting they biz. just gave us free samples of Flonase. So I bought my t-shirt, armed with a book on So, I decided to pursue medicine, how to be a rockstar doctor and of course, following in the footsteps of my dad, and the red cover version of KJ Lee in 1990 I graduated with a degree in medicine from the University of Texas The first Rockstar Laryngologist that I Medical Branch in Galveston. I began met was Dr. Robert Sataloff. I call him my residency at the University of Bob nowadays, but that's the privilege of Oklahoma in 1991, under the guidance of knowing a rockstar. I attended his Jesus Medina and our laryngologist Keith academy course –“Professional Singers: Clark. Coincidently, this is the year that The Science and Art of Clinical Care”. Merriam-Webster first documented the After the talk, Bob's fans lined up to meet use of the term rockstar for someone who him. I waited until the end so I could was not actually in rock music. Steven monopolize his time. I'm pleased to say King was described in an article as a my first meeting with a card-carrying "rock star of an author". The definition ALA member was truly awesome. Dr. had morphed, and it could now be applied Sataloff was the consummate ambassador to a person who has achieved the status of for the world of laryngology: gracious, celebrity in a particular field. In other friendly, charming and most of all, he words, you no longer had to be a rockstar encouraged me to pursue training in to be a rockstar. laryngology. Although I think I maintained my composure, I felt like a 14 So, I put my head down and enjoyed the year-old kid who had just met his idol. process of hard work, much like I had Dr. Sataloff is a rockstar for so many approached music in my younger years. I reasons: has more top 40 hits than read as much as I could and my interest virtually anybody in the field. He has turned to academic medicine. To me, written 65 books, published over 1,000 rock stars were the academic publications, is the editor in chief of two otolaryngologists of the world - and the journals and is chairman of the board of academy bulletin was my copy of Rolling directors of the Voice Foundation. Not to Stone. The game changer was the 1992 mention he was a former president of this AAO meeting, the first Academy meeting prestigious organization. Rockstar. I attended. I flew to DC, eager to see what the academy meeting was all about. According to Slash "being a rockstar is When I arrived at the convention hall, I the intersection of who you are and who was amazed to see all of my academic you want to be" I'm not sure what that
23 PRESIDENTIAL ADDRESS
C. Blake Simpson, MD San Antonio, Texas means, but I definitely wanted to be a instantly clicked with Jamie. I was laryngologist. So I wrote my personal impressed how Dr. Koufman had an statement. And to quote from this amazing command of laryngology and a masterpiece: "Laryngology represents an dedication, drive and enthusiasm that I area where I feel that I can make a had never seen. In my eyes -a Rockstar. difference and contribute something to Although Jamie has contributed in the field. I view laryngology as a wide multiple ways to our field including early open discipline, where there is much to be adoption and refinement of thyroplasty, learned. I would like to be a part of this." lipoinjection, laryngeal EMG and the For those of you who don't know what concept of vocal fold paresis and it's the playing field looked like in the early- many clinical manifestations, she is best to-mid nineties, there weren't a lot of known for her trio thesis on fellowships out there. I was only aware extraesophageal reflux disease and it's of two fellowships and one of these was relationship to the larynx and upper at Wake Forest with Jamie Koufman. airway. This work was groundbreaking and transformed the way we look at Many of you might not realize this, but reflux disease. It has been referenced Dr. Koufman was in the band Boston. almost 2000 times in the literature. This Not that Boston, but Boston University new concept was a bit daring at the time, Otolarynoglogy Program where a number and went against the grain of some of our of laryngology superstars were trained. well-accepted ideas of laryngeal disease. The program was legendary with Charlie I like this quote from Anthony Cerullo Vaugh, Geza Jako, laser scientist Tomas from his piece "How to be a Rockstar", Polanyi, and department chairman, Stuart because I think it applies to Jamie. Strong. For you youngsters in the crowd "Once you've mastered your instrument, this was ground zero for modern day your energy will be best spent putting endoscopic laryngology. The faculty at maximum effort into what you believe. BU were responsible for a number of You need to be bold, dedicated and firsts that we now take for granted: the devoted to taking risks" That's exactly first 400m lens for binocular laryngeal how Dr. Koufman became a Rockstar surgery, first microlaryngeal instrumentation and the first CO2 laser My next fellowship interview was at microlaryngeal surgery. Vanderbilt with Dr. Robert Ossoff, who As far as you are concern they invented is my guest of honor today. I've always the electric guitar. They were even referred to him as "The Boss" and like written up in Time Magazine in 1973 for Springsteen, he has distinguished himself their work with the endoscopic CO2 with a long career full of hits. Plus, he laser. Media attention for rocks. Interestingly, my sister, who knew otolaryngologists was not common in the I was interested in laryngology, was 70s - they were way ahead of their time. reading People Magazine and came across an article about Dr. Ossoff. She Jamie Koufman graduated from the BU cut out the article and mailed it to me with program in 1978 and went to Wake a post it note that said: "you should get a Forest, carving out a laryngology job with this guy". As it turns out, I did practice. At my fellowship interview, I get a job with this guy. I was fortunate he
24 PRESIDENTIAL ADDRESS
C. Blake Simpson, MD San Antonio, Texas offered me a fellowship position - this is the actual offer letter. The position paid Let’s not forget one of the essential $30,000 salary which is $50,000 in faculty in the training of all these fellows. today's dollars, not a rock star salary but Jim Netterville is, I believe, one of the pretty reasonable at the time. In the letter, greatest laryngeal framework surgeons of he states "we may hire a second fellow for all time. I owe him a great debt of the academic year", and that second gratitude for teaching me medialization fellow was Greg Postma, who would go laryngoplasty and arytenoid adductions - on to become a rock star in his own right. some of the most difficult surgeries we do. And I still use his techniques today. My time at Vanderbilt was well spent, Jim, embrace your inner rockstar. and I had the honor of not only training with Dr. Ossoff, but two other rockstar I finished my fellowship in 1996 and faculty, Mark Courey and Gaelyn Garrett. accepted a position at the UT Health All three of them would serve as Science Center in San Antonio. When I presidents of this organization. As many arrived, one of the first things I wanted to of you know, I'm a student of philosophy do was learn office-based laryngeal and I often look to the great minds of the procedures. These were not widely past to help me put things in perspective. practiced at the time, and the leader in this It has been said by a very wise woman area was Robert Bastian, another rockstar (Kim Kardashian) "you don't become a hero of mine. My interest in office-based rock star for no reason". Which poses the procedures actually preceded my question: what makes you a rockstar in fellowship training. I received a academic larynogology? Was it Dr. supplement in the mail as a chief resident Ossoff's 174 published articles? His in 1994 and I saw my future. In this contributions to laser laryngology and supplement, Dr. Bastian details what was laser safety? His innovative possible in an office setting, which was laryngoscope designs that have saved the quite revolutionary for the time. Not just lives of countless patients with difficult injections, but tracheobronchoscopy, anatomy? biopsies, you name it. I attended his Those are great, but what makes Dr. course at the Academy right after I Ossoff a rockstar is the legacy he has finished my fellowship, and armed with created. the knowledge from that course, performed my first office injection in Dr. Ossoff envisioned and launched the 1997. He has been one of my mentors fellowship era. He has trained over 50 ever since. If Dr. Bastian were to have laryngologists who have gone on to build been in a hard rock band, I think it would their own academic programs all over the have been Rush. He is a technically US and abroad. He is the proud papa to gifted surgeon - I don’t think many all of us Vanderbilt grads. Further people play their instrument better than extending this legacy is 60+ of his him. Although there is complexity to "grandchildren" - that is laryngologists what he is doing, he makes it look simple. who have trained with one of Dr. Ossoff's And, like the band - I think he is a bit former fellows. He's created an under appreciated. If there were a incredible community.
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C. Blake Simpson, MD San Antonio, Texas
Laryngology Hall of Fame, Dr. Bastian We have been fortunate to have these deserves to be in it. giants in our field who have blazed a path for us. The second rockstar from the BU program was Peak Woo, who graduated Which brings us to the rockstars of my in 1983. (Pictures of Peak at his resident generation, the fellowship generation. I graduation and current day are shown). am fortunate to have been here to witness I would say he has aged pretty well. He a transformation of the specialty by my maintains a youthful energy and has friends and colleagues. What has the never been complacent with his approach fellowship generation contributed? I can to laryngeal disease. He is a surgical cite specific examples such as the innovator of the highest order. And even advancement of office based procedures, today this former President of the ALA is and expanding the understanding and not afraid to throw the heavy metal horns treatment of dysphagia, but in a more every now and again. general sense there have been greater accomplishments. In the words of Al Another rockstar from the BU program, Merati, we worked to demystify Steve Zeitels was an early mentor and laryngology, to establish it as a real and supporter of my career. Dr. Zeitels’ body unique subspecialty. of work is extensive. His trio thesis on To take it from a cottage industry to a dysplasia is terrific. As you can see from mature commercial enterprise, with the cover, Dr. Zeitels has a reverence for textbooks, surgical atlases, dissection the pioneers in our field. He also helped manuals, validated outcome measures further refine mircorlaryngoscopy and and curricula to provide structure to our framework surgical techniques. He is training and research. We defined what a perhaps best known as the first proponent laryngologist is and created a common for the pulsed KTP laser that we all use language that laryngologists speak. We today. developed community and collegiality, and increased collaboration between Rob Halford of Judas Priest once said to institutions. Over 20 fellowship training be a rockstar you've "got to be in it for the programs have been created, and under love and passion that you have for the the leadership of Clark Rosen and Al music". I think this really encapsulates Merati, we have established a match to what Steve is all about. give the candidates an edge on finding He has a passion and love of laryngology their ideal training program. Many of us that few possess. I strongly believe this were elected to the ALA, and are is what drives him. increasingly moving into leadership roles in our societies. Although we are only I can't possibly mention all my heroes in 30% of the current ALA membership, in this talk, but I have your 8 tracks, your coming years, the fellowship generation albums, your posters, LPs and singles. will comprise the majority of the I've attended your concerts and made mix membership. tapes to celebrate you. What about our future rock stars? The members of the post-graduate ALA are
26 PRESIDENTIAL ADDRESS
C. Blake Simpson, MD San Antonio, Texas the future of our specialty. This group “If you want to change the world of consists of a number of forward thinkers, music, that’s not going to be done by just clinician scientists and innovators. They being the best- people also need to are pushing us forward with basic recognize your creativity and science, clinical trials and translational individuality… …By approaching your research. music in a unique and thoughtful way, you don’t even have to be an amazing What about our women in rock? The player. You can see examples like this all female membership of the ALA has over the music industry. …Take the steadily grown, and although only 10% of Beatles, for example. None of them were the current membership are female, the virtuosos at their individual instruments, Post Graduate ALA - which represents but they did something no one else did, the future of our organization - is made up and they will be remembered forever for of almost 50% women, as Pat Benatar is it.” The Beatles were a legendary band pointing out. In the future, the specialty and I'll tell you why: because they were is going to be shaped by the female greater than the sum of their parts. They rockstars of the ALA. And future stars, were fantastic writers and arrangers and don't forget to get from here to here (Post their creative output to this day is still Graduate ALA to full member), you need unmatched. to finish your trio thesis. That's probably the most important message I can give In the future, Great work in our field will you. likewise require collaboration between the laryngologists in this room. We are a For the future generations of the ALA, small field and have to band together to Bono provides some pretty sound advice. move our discipline forward. “As a rock star, I have two instincts, I Multiinstutional trials, academic want to have fun, and I want to change the collectives like NoACC, and teaming world. I have a chance to do both”. We with other disciplines are going to be are privileged to be part of such an necessary to maximize our impact in engaging specialty - laryngology is medicine. My advice? Metaphorically vibrant, gratifying field. It's fun. That we speaking: Be innovative. Come up with also have an opportunity to make a a new genre of music that nobody has significant impact on clinical medicine is ever heard. Push the envelope with icing on the cake. technology and creativity. Make great music that we can all celebrate. And I'll leave you with a quote by Anothony hopefully, it can change the world. Cerullo.
27 Presidential Citations
Robert Bastian, MD Downer’s Grove, Illinois
Dr. Bastian received his B.A. from Greenville College, and M.D. from Washington University (St. Louis). Otolaryngology residency was completed at Washington University’s Barnes and affiliated hospitals. Dr. Bastian is a diplomate of the American Board of Otolaryngology-Head and Neck Surgery and the Royal College of Physicians and Surgeons (Canada).
After serving as Assistant Professor Otolaryngology at Washington University, Dr. Bastian joined the faculty of Loyola University – Chicago, where he attained the rank of Professor of Otolaryngology in 2000. He established Bastian Voice Institute in 2003, devoted to patient care, teaching, and clinical research. He has contributed over 50 articles and Dr. Bastian’s work focuses exclusively chapters to the literature of his specialty, on voice, airway, and swallowing and has presented well over a hundred disorders, along with sensory lectures as invited speaker / visiting disturbances such as sensory neuropathic professor not only in the United States, cough, and inability to belch. but also in Australia, Belgium, Canada, France, Ireland, Mexico, Poland, and Turkey.
I am pleased to introduce Dr. Bastian and present him with this Presidential Citation.
28 Presidential Citations
Jamie Koufman, MD New York, New York
Dr. Jamie Koufman is one of America’s leading laryngologists and experts on acid reflux. She has lectured widely both nationally and internationally. With almost four decades of clinical and scientific research focused on the diagnosis, treatment, and cell biology of reflux, Dr. Koufman is one of the world’s authorities; she personally coined the terms laryngopharyngeal reflux, silent reflux, airway reflux, and respiratory reflux.
Dr. Koufman is a New York Times best selling author of Dropping Acid: The Reflux Diet Cookbook & Cure, the first book that offered refluxers an understanding of reflux that emphasized the importance of (low-acid) diet and lifestyle changes to achieve a natural cure. She has also authored The Chronic Cough Enigma and Dr. Koufman's Acid Dr. Koufman has received many awards Reflux Diet, and Acid Reflux in Children: including the Honor Award and the How Healthy Eating Can Fix Your Distinguished Service Awards of the Child's Asthma, Allergies, Obesity, Nasal American Academy Otolarynglogy— Congestion, Cough & Croup. Head and Neck Surgery, The Newcomb Award of the American Laryngological Dr. Koufman is the Founder and Director Association (a lifetime achievement of the Voice Institute of New York, a award for research in laryngology), the comprehensive acid reflux and voice Broyles-Maloney of the American treatment center. She was a pioneer of Bronch-Esophagological Association laryngeal framework (reconstructive) (ABEA); and most recently (2017), she surgery, minimally-invasive laryngeal won the Chevalier Jackson Award of the laser surgery, reflux testing, laryngeal ABEA on the 100th Anniversay of the electromyography, and transnasal Asssociation. She is the past-president of esophagoscopy. the ABEA and the New York Laryngology Society. Dr. Koufman has been listed among the Top Doctors in America every year since 1994.
29 Presidential Citations
James Netterville, MD Nashville, Tennessee
A co-founder of Vanderbilt's Department of Otolaryngology, James L. Netterville, M.D. is also its Executive Vice Chair and Director of Head and Neck Oncologic Services, as well as the Associate Director of the Bill Wilkerson Center for Otolaryngology and Communication Sciences. As the Mark C. Smith Professor of Otolaryngology, he promotes education and research in skull base, voice disorders and all aspects of head and neck oncologic surgery. He is also a Co-Director of the Vanderbilt Sisson/Ossoff Workshop held in Colorado each year.
He has been actively involved in improving the healthcare infrastructure in low-resource countries since 1999, leading and participating in surgical educational camps in Haiti, Kenya, Nigeria, and Uganda. ENT doctors come from these and nearby countries, including Ethiopia and Tanzania, to Very active professionally, Dr. Netterville is attend his camps. He has published a member of the review boards of six papers on his humanitarian educational professional journals, and has published work in African Journal of Reproductive over 150 papers in peer-reviewed scientific Health, Head & Neck, The Journal of journals like Cancer, Head & Neck, and The Laryngology & Otology, Laryngoscope, New England Journal of Medicine. He is a OTO Open, Otolaryngology–Head and Past-President of the AAO-HNS and the Neck Surgery, and Springerplus. He won Tennessee Academy of Otolaryngology– the Distinguished Award For Head and Neck Surgery. He has received Humanitarian Efforts from the American many honors and awards in his career, Academy of Otolaryngology–Head and including the deRoaldes Award from the Neck Surgery (AAO-HNS) in 2004, and American Laryngological Association. the Award of Honour for contributions to the growth of the Nigerian Christian Hospital in 2016.
30 Presidential Citations
Clark A. Rosen, MD San Francisco, California
Clark Rosen, MD is a Co-Director of the UCSF Voice and Swallowing Center, Chief of the Division of Laryngology, Professor of Otolaryngology-Head and Neck Surgery at the University of California, San Francisco and the Lewis Francis Morrison MD endowed chair in Laryngology
Dr. Rosen inaugurated modern Laryngology at the University of Pittsburgh beginning in 1995 creating a dedicated center of excellence in Laryngology, University of Pittsburgh Voice Center. Dr. Rosen originated the outstanding Fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh in 2002 and since has trained over 15 fellows in Laryngology and numerous visiting Otolaryngologists from around the world. Dr. Rosen has been a sought after speaker Dr. Rosen has had amazing productivity internationally and has many leadership as a clinician scientist. He has authored roles to multiple publications and over 160 peer reviewed publications, 30 professional societies. He is a founding book chapters, 5 books including being member of the Fall Voice Conference, is the the co-editor for Bailey’s Head and Neck Vice Chair of the Annual Meeting Program Surgery-Otolaryngology which is one of Committee for the American Academy of two main textbooks in our field. Dr. Otolaryngology-Head and Neck Surgery Rosen also authored (with Blake Simpson (AAOHNS), and is the Treasurer of the MD) a key operative atlas, Operative American Laryngological Association Techniques in Laryngology which has (ALA). international reach and has been translated into to Mandarin and Spanish.
Dr. Rosen has been a Co-Investigator on numerous NIH grants as well as grants from the Triological Society, the VA, and private industry.
31 Presidential Citations
Robert T. Sataloff, MD, DMA Philadelphia, Pennsylvainna
Dr. Robert T. Sataloff currently serves as Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery and Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine. He is also Adjunct Professor in the department of Otolaryngology – Head and Neck Surgery at Thomas Jefferson University, as well as Adjunct Clinical Professor at Temple University and the Philadelphia College of Osteopathic Medicine; and he is on the faculty of the Academy of Vocal Arts. He serves as Conductor of the Thomas Jefferson University Choir. Dr. Sataloff is also a professional singer and singing teacher. He holds an undergraduate degree from Haverford College in Music Theory and Composition; graduated from Jefferson Medical College, Thomas Jefferson University; received a Doctor of Musical Arts in Voice Performance from Combs College of Music; and he completed Residency in Otolaryngology -
Head and Neck Surgery and a Fellowship in He is recognized as one of the founders of the field of Otology, Neurotology and Skull Base Surgery at voice, having written the first modern comprehensive the University of Michigan. article on care of singers, and the first chapter and Dr. Sataloff is Chairman of the Boards of book on care of the professional voice, as well as Directors of the Voice Foundation and of the having influenced the evolution of the field through American Institute for Voice and Ear Research. his own efforts and through the Voice Foundation for He also has served as Chairman of the Board of nearly 4 decadesDr. Sataloff has developed numerous Governors of Graduate Hospital; President of the novel surgical procedures including total temporal American Laryngological Association, the bone resection for formerly untreatable skull base International Association of Phonosurgery, the malignancy, laryngeal microflap and mini-microflap Pennsylvania Academy of Otolaryngology – procedures, vocal fold lipoinjection, vocal fold Head and Neck Surgery, and The American lipoimplantation, and others. . Society of Geriatric Otolaryngology, and in It is my honor to present Dr. Sataloff with this numerous other leadership positions. Dr. Sataloff Presidential Citation with my gratitude for his is Editor-in-Chief of the Journal of Voice; Editor- outstanding contributions to our subspecialty, in-Chief of Ear, Nose and Throat Journal; Laryngology. Associate Editor of the Journal of Singing; on the Editorial Board of Medical Problems of Performing Artists, and on the editorial boards of numerous otolaryngology journals.
32
INTRODUCTION OF THE GUEST OF HONOR
ROBERT H. OSSOFF, DMD, MD Nashville, Tennessee
C. Blake Simpson, MD San Antonio, Texas
In July 1986, Dr. Robert H. Ossoff, along with three other faculty members established the Department of Otolaryngology – Head and Neck Surgery at Vanderbilt University School of Medicine. As the Founding Guy M. Maness Professor and chair, the residency program and fellowships, with most sub- specialties was established a year late. In 1991, Dr. Ossoff founded the Vanderbilt Voice Center, a multidisciplinary center for patients who use their voices professionally in 1991. This center continues to care for teachers, clergy, business leaders, actors, singers, songwriters and many others.
Dr. Ossoff contributed to developing the subspecialty of laryngology though offering the first modern fellowship in the field, establishing the concept of a multidisciplinary center to care for voice patients, developing and/or modifying instruments to facilitate new surgical approaches to microsurgery of the larynx, and teaching these techniques in the United Stated and abroad.
In addition to serving as chair of the department for twenty-two years, he also served as associate vice- chancellor for health affairs and assistant vice- chancellor for compliance and corporate integrity. On a national level, Dr. Ossoff served as a director of the American Board of Otolaryngology, and as president of the American Society for Laser Medicine Indeed, my time at Vanderbilt was well spent during and Surgery, American Bronchoesophageal my training with Dr. Ossoff and two other rockstar Association, the American Laryngology Association, faculty, Mark Courey and Gaelyn Garrett. I am the Triological Society, Society of University deeply honored to present to you, my BOSS, Dr. Otolaryngologists, and the American Academy Robert H. Ossoff, as my Guest of Honor. Departments of Otolaryngology.
33
PRESENTATION OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION AWARD
Peak Woo, MD New York, New York
William Armstrong, MD Orange, California
Peak Woo is Clinical Professor of Otolaryngology at the Icahn School of Medicine. He is a graduate of the Boston University 6-year BA-MD program. He did his post graduate training at the University of Pennsylvania Hospital and his residency training in the Combined Boston University Tufts University Otolaryngology program. While in residency, he came under the influence of Drs. M Stuart Strong, Charles Vaughan, and Stanley Shapshay. The Boston group of laryngologists stimulated in Dr. Woo an interest in laryngology that has been long lasting. From 1983 through 1994, he was on the academic faculty at the State University of New York Upstate Medical Center. From 1994-1996 he was the vice-Chairman of the Otolaryngology department at Tufts University. In 1996, he became the Grabscheid Professor of Otolaryngology and the director of the Grabscheid Voice Center at the Mount Sinai School of Neck Surgery. Since 2008, he has been in clinical practice with academic appointment as clinical professor and associate director of laryngology fellowship training program at the Icahn School of Medicine.Medicine, Department of Otolaryngology, Head and using High speed videography to investigate Dr. Woo was a past president of the American problems related to vocal fold vibration in normal Laryngological Association. and diseased states.
He was the recipient of the James Newcomb He has lectured extensively on diagnosis and Award from the ALA in 2018. management of voice disorders. He has His main clinical and research interests are in the participated in laryngology fellowship training of medical and surgical treatment of laryngeal international and national fellows since 1996. diseases. He continues his research interests in He lives with his wife Celia in Tenafly, New laryngeal imaging in diseases of the larynx by Jersey.
34
INTRODUCTION OF THE GABRIEL F. TUCKER AWARD
Marshall E. Smith, MD Salt Lake City, Utah
Ahmed M.S. Soliman, MD Philadelphia, Pennsylvania
Dr. Marshall Smith is a professor of Laryngology and Pediatric Otolaryngology in the Division of Otolaryngology-Head & Neck Surgery at the University of Utah. He completed his residency in Otolaryngology at UCLA followed by a fellowship in Pediatric Otolaryngology in Cincinnati in 1991. He was very fortunate to train under and study laryngology and pediatric laryngology from Drs. Gerald Berke and Seymour Cohen during his residency, and Drs. Robin Cotton and Charles Myer in his fellowship. He followed the lead of his friend and mentor, the late Steven Gray and combined his interests in laryngology & pediatrics, and has been able to maintain clinical practices in both adult and pediatric laryngology, first at the University of Colorado and in Utah since
1997. On a personal note, I have had a chance to get He is an NIH funded investigator and to know Marshall and his son Alden over the participates in research on various voice and past few years. Alden was one of our medical airway disorders, and is currently an students at Temple who is currently an investigator or co-investigator on eight otolaryngology resident. I would have to say funded projects. He is also medical director that in addition to being a great clinician and of the Voice Disorders Center, co-director of researcher, he is man of character and the Airway Disorders Center at the integrity. University Hospital, and a member of the
Esophageal-Airway Team at Primary Please join me in congratulating Dr. Smith. Children’s Hospital.
35
INTRODUCTION OF THE FORTY-FOURTH DANIEL C. BAKER, JR., MD, MEMORIAL LECTURER
Gregory Postma, MD Augusta, GA
C. Blake Simpson, MD San Antonio, Texas
It may be said that Greg Postma and I became “joined at the hip” by way of our fellowship training at Vanderbilt University. Since that time in 1995, we have remained brothers and friends throughout the many years. Dr. Gregory Postma is a Professor and Vice Chairman of the Department of Otolaryngology-Head and Neck Surgery at the Medical College of Georgia of Augusta University and is the Director of the Center for Voice, Airway and Swallowing Disorders since 2005. In 1984, Dr. Postma received his medical degree from Hahnemann University in Philadelphia and he completed his residency in Otolaryngology at the University of North Carolina at Chapel Hill in 1993. He took a fellowship in laryngology and professional voice at Vanderbilt University and joined the faculty at Wake Forest in 1996. He is the author or co-author of more than 110 peer- reviewed publications, edited 3 books, and has I was elated when the Baker Lecture written 60 chapters and invited articles. He has Committee proposed Greg to present this given more than 600 presentations on a wide outstanding lecture as I knew he would bring array of laryngologic topics. He has been selected “words of wisdom” to us that is inspirational and as one of America’s Top Doctors for the past 15 motivational at the same time. I present our 2019 years. Daniel C. Baker MD Lecturer, Gregory N. Postma, MD
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FORTY-FOURTH DANIEL C. BAKER, JR., MD MEMORIAL LECTURE
Topic: Mentoring in a Changing World
Gregory Postma, MD Augusta, GA
To Access the 2019 Daniel C. Baker Jr. MD Address, please click on the link, .
37
INTRODUCTION OF THE 2019 STATE OF THE ART LECTURER PAUL C. BELAFSKY, M.D., PH.D., M.P.H
Peter C. Belafsky is currently a Professor and the Director of the Voice and Swallowing Center at the University of California, Davis. He also holds the position of Vice-chair of Academic Affairs of the Department of Otolaryngology at the UC Davis School of Medicine and is a Professor in the Department of Medicine and Epidemiology at the UC Davis School of Veterinary Medicine. He completed his undergraduate degree at Vassar College in 1990 majoring in Biology. He received his medical degree at Tulane University School of Medicine and a Masters of Public Health with a concentration in Epidemiology in 1994. After completing his residency also at Tulane, Dr. Belafsky was a fellow in Laryngology and Bronchoesophagology at Wake Forest and has also pioneered numerous treatments for University in 2001. small animals (cats/dogs) with profound His research interests are focused on the swallowing and breathing problems. His team development and application of innovative has saved countless suffering animals and his translational treatments for complex voice, work has led to innovations in both humans and swallowing, and airway disorders. While as UC animals. His trans-disciplinary approach has Davis, Dr. Belafsky has dedicated his career to resulted in 4 first-in-human surgeries and 6 first- building an internationally recognized in-canine surgeries. He has over 150 Swallowing Center. The trans-disciplinary publications, numerous patents, and has helped Center at UC Davis brings together outstanding initiate 3 start-up companies based on physicians, speech and language pathologists, technology he has developed at UC Davis. Dr. veterinarians, nutritionists, radiology Belafsky remains restless with current treatment technicians, general surgeons, limitations and has dedicated his career to the gastroenterologists, and translational scientists to development of innovative therapies to help our provide innovative approaches to the diagnosis suffering dysphagia patients and management of quaternary voice, I am elated that Peter accepted the swallowing, and airway disorders. invitation to present this year’s State of the Art Dr. Belafsky has a dual appointment at Lecture and without hesitating further, I present the UC Davis School of Veterinary Medicine Dr. Paul Belafsky to you.
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THE 2019 STATE OF THE ART LECTURER
"The Laryngologist as Deglutologist"
Peter C. Belafsky, MD, MPH, PhD Sacramento, California
To access the 2019 State of the Art Lecture, please click on the link
39 SCIENTIFIC SESSIONS
A Separation of Innate and Learned Vocal Behaviors Defines the Symptomatology of Spasmodic Dysphonia
Alexis Worthley, BA; Samantha Guiry, BA; Kristina Simonyan, MD
Objective: Spasmodic dysphonia (SD) is a neurological disorder characterized by involuntary spasms in the laryngeal muscles. It is thought to selectively affect speaking, while other vocal behaviors remain intact. However, the patients’ own perspective on their symptoms is largely missing, leading to partial understanding of the full spectrum of voicealterations in SD. Methods: A cohort of 178 SD patients rated their symptoms on the visual analog scale based on the level of effort required for speaking, singing, shouting, whispering, crying, laughing, and yawning. Statistical differences between the effort for speaking and the effort for other vocal behaviors were assessed using nonparametric Wilcoxon rank-sum tests within the overall SD cohort as well as within different subgroups of SD. Results: Speech production was found to be the most impaired behavior, ranking as the most effortful type of voice production in all SD patients. In addition, singing required nearly similar effort as speaking, ranking as the second most altered vocal behavior. Shouting showed a range of variability in its alterations, being especially difficult to produce for patients with adductor form, co-occurring voice tremor, late-onset of disorder, and a familial history of dystonia. Other vocal behaviors, such as crying, laughing, whispering, and yawning, were within the normal ranges across all SD patients. Conclusion: Our findings widen the symptomatology of SD, which has predominantly been focused on selective speech impairments. We suggest that a separation of SD symptoms is rooted in selective aberrations of the neural circuitry controlling learned but not innate vocal behaviors.
Effectiveness of Unilateral vs. Bilateral Botulinum Toxin Injections in Patients with Adductor Spasmodic Dysphonia: A Retrospective Review
Steven Bielamowicz, MD; Ishaan Dharia, BA
Background/Objectives: The primary treatment of adductor spasmodic dysphonia is repeated injections of Botulinum toxin type A (Botox) into the thyroarytenoid muscles. Dosing can be performed into either one or both thyroarytenoid muscles. The objective of this study is to evaluate the treatment effect and side effect profile across a large number of injections. This study is a continuation of a study by our group in 2002 on 45 patients. Methods: This is retrospective study of all patients with adductor spasmodic dysphonia with and without tremor treated by the senior laryngologist at The George Washington University. In the current study, 272 patients (214 females and 58 males) were included in the current analysis. Duration of effect and side effects (vocal weakness and liquid dysphagia) were recorded after each injection into a database for each patient. This data was analyzed using Chi-square analysis. Results: A total of 4025 injections (2709 bilateral and 1316 unilateral) were evaluated in this study. Optimal effect duration (greater than or equal to 3 months) was more commonly seen in the bilateral injection patients (55%) compared to the unilateral injection patients (47%) with a p=0.000. Optimal side effect duration (less than or equal to 2 weeks) was also better for the bilateral injection patients (73%) compared to the unilateral injection patients (76%) with a p=0.023. Having both optimal effect and side effect in the same injection was more commonly seen in the bilaterally injected patients (36%) compared to the unilateral patients (33%) with a p=0.0228. Conclusions: This study shows that bilateral injections of Botox are more effective in producing optimal effect/side effect profile.
40 SCIENTIFIC SESSIONS
Selective Intraoperative Stimulation of Human Intrinsic Laryngeal Muscles: Analysis in a Mathematical Three Dimensional Space
Michael Broniatowski, MD; Sharon Grundfest-Broniatowski, MD; Matthew Schiefer, PhD; David H. Ludlow, MD; David A. Broniatowski, PhD; Harvey M. Tucker, MD
Objective/hypothesis: Standard stimulating methods using square waves do not appropriately restore physiological control of individual intrinsic laryngeal muscles (ILMs). To further expand our earlier study of evoked orderly recruitment by quasi-trapezoidal (QT) currents, we integrated the contribution of the cricothyroideus (CT) with attention to mutual activation in an additional patient, based on recent studies of responses via strict recurrent laryngeal nerve (RLN) stimulation. Study Design: The patient received functional electronic stimulation (FES) with QT pulses (5 Hz, 60- 2000 µA, 100-500 µsec width, 0-500 µsec decay). Ipsilateral electromyography (EMG) responses were calculated using the average and root mean square of rectified amplitude waveforms. The thyroarytenoideus (TA), posterior cricoarytenoideus (PCA), lateral cricothyroideus (LCA) and the CT were interrogated via bipolar electrodes, and digitized responses were analyzed. Individual and combined recruitment configurations and activation delays were explored using multiple regression and Exploration Factor Analysis (EFA). Results: A total of 868 EMG data points based on 18 trials and 1-11 subtrials captured each of the 4 individual ILMs. Various combinations of pulse amplitude, width and exponential decay produced significant (p ≤ 0.001) individual ILM responses. EFA yielded three factors after applying standard goodness- of-fit measures. Factor loadings were consistent with CT mirroring LCA while TA and PCA exhibited antagonistic interactions along trajectories in a tridimensional space. Conclusions: FES calibrated to individual and coupled ILMs offers promise for restoring normal contraction patterns for dystonias via strict RLN stimulation.
Botox in Management of Non-Dystonic Laryngeal Disorders
Benjamin J. Rubinstein, MD; Diana N. Kirke, MD; Andrew Blitzer, MD, DDS; Peak Woo, MD
Objective: The treatment of dystonia with Botox injections is well established. This reviews our experience of Botox in disorders of dyspnea on exertion: aberrant reinnervation (n=21, 27%), paradoxical vocal fold motion (PVFM) (n=8, 10%), and multi-system atrophy (MSA) (n=3, 4%); dysphonia: muscle tension dysphonia (n=10, 13%), spasticity (n=7, 9%), puberphonia (n=4, 5%), and mutational falsetto (n=2, 3%), chronic cough (n=10, 13%), and vocal process granuloma (n=8 (10%)). Methods: Multi-institutional case series with chart review of 73 patients with Botox laryngeal injections over 10 years. Injection characteristics, treatment effectiveness, treatment duration, and the need for laryngeal surgery were recorded. Results: For aberrant reinnervation, 100% of unilateral paralysis (UVFP) patients and 50% of bilateral paralysis (BVFP) patients improved. Ultimately, 9/10 BVFP patients required definitive airway surgery, compared with 1/11 UVFP patients. All patients with PVFM experienced benefit. Some have continued treatment. Botox was an adjunct in successful management of multiply recurrent vocal process granuloma in all 8 patients. Botox was also helpful in all patients with spasticity, puberphonia, and muscle tension dysphonia. Botox was not as helpful in mutational falsetto or chronic cough. Conclusions: Botox injection of the TA/LCA complex is useful in the management of dyspnea on exertion caused by inappropriate laryngeal adduction. Patients with BVFP should be counseled that eventual transition to airway surgery is generally preferred. Treatment is beneficial of a variety of non-SD causes of dysphonia. Response rates in patients with chronic cough are less promising.
41 SCIENTIFIC SESSIONS
Enhanced Abductor Function in Bilateral Vocal Fold Paralysis with Muscle Stem Cells
Randal C. Paniello, MD, PhD; Sarah Brookes, DVM; Hongil Zhang, PhD; Stacey L. Halum, MD
Introduction: Patients with bilateral vocal fold paralysis (BVFP) experience airway obstruction due to loss of abductor function of posterior cricoarytenoid (PCA) muscles. We recently reported that implantation of autologous muscle progenitor (stem) cells into thyroarytenoid muscles during reinnervation resulted in improved adductor function. In this study, that same approach was applied to treating PCA muscles in a canine model of BVFP. Design: animal study Methods: Two canines underwent baseline measures of glottal resistance (GR), then complete transection and suture repair of both recurrent laryngeal nerves. Muscle stem cells were isolated from skeletal muscle and cultured. Two months later, GR was measured, and then 10^7 stem cells were implanted into one PCA muscle of each animal. After four more months, GR and glottal opening force (GOF) were measured and the muscles were harvested for histologic study. Results: GR increased by 21-25% over baseline at 2 months, but after stem cell implantion, improved to 10-14% over baseline at 6 months. PCA muscle strength, as determined by GOF, was 61-65% on control sides (no stem cells), and 78-83% on treated sides (with stem cells). Histology confirmed survival of stem cells and a 50% higher rate of innervation of motor endplates in the stem cell treated sides. Conclusion: Autologous muscle progenitor (stem) cells show promise as a potential new therapy for patients with bilateral vocal fold paralysis. Additional studies are needed to determine the optimal number of cells, timing of implantation, and other variables before launching a clinical trial.
Increased Expression of Estrogen Receptor Beta in Idiopathic Subglottic Stenosis
Ross Campbell, MD; Elizabeth Direnzo, PhD; Sonja Darwish, MS
Background/Objectives: Idiopathic subglottic stenosis (ISGS) predominantly affects younger females of child-bearing age. It has, therefore, been hypothesized that estrogen is involved in its pathogenesis. There are two main isotypes of estrogen receptors: ER-a and ER-ß. Abnormal variants of ER- ß have previously been shown to be associated with poor wound healing. Estrogen receptors have recently been identified in subglottic tissue samples, with elevated levels of ER-a and progesterone receptors, and no expression of ER-ß, in stenotic specimens reported in one study. The objective of this study was to confirm the presence of estrogen receptors in the subglottis and investigate levels of expression and isotypes of estrogen receptors in normal and stenotic subglottic tissue. Methods: Micro-direct laryngoscopy and biopsies of the subglottis were performed in three healthy females, one healthy male, and five female patients with ISGS. Immunofluorescence stains for ER- a and ER-ß were performed on specimens. Staining patterns were compared qualitatively between normal and abnormal specimens. Results: Immunofluorescence stains demonstrated the presence of both ER-a and ER-ß in subglottic tissue. More samples exhibited positive epithelial immunofluorescence staining for ER-a and ER-ß in patients with ISGS than normal subjects. All patients with ISGS in which ducts and glands were identified demonstrated strong expression of ER-ß in glands and ducts, compared to only one case in normal subjects. Conclusions: This study confirms the presence of estrogen receptors in the subglottis. Increased expression of ER-ß in glands and ducts in ISGS compared to controls may explain the predisposition to scarring in these individuals.
42 SCIENTIFIC SESSIONS
The Impact of Social Determinants of Health on the Development and Outcomes of Laryngotracheal Stenosis
Sabina Dang, BA; C. Gaelyn Garrett, MD, MMHC; Christopher Wootten, MD; Alexander Gelbard, MD
Objective: Social determinants of health are conditions in which people live, learn, and work that affect a wide range of health outcomes. Laryngotracheal stenosis following endotracheal intubation is the most common indication for airway surgery in tertiary referral centers. To date, there have been no studies evaluating the impact of social determinants of health on airway stenosis. We sought to describe the social determinants of health for the population of patients with laryngotracheal stenosis requiring surgical intervention. Methods: We reviewed charts of adult patients with airway stenosis undergoing open reconstructive surgery between 2014-2018 at Vanderbilt University Medical Center. Socioeconomic data was obtained from the American Community Survey. SatScan geographic analysis, Wilcoxon-Rank-Sum, Chi-Squared, and logistic regression statistical tests were used as appropriate to characterize our study population. Results: 123 patients met inclusion criteria. Laryngotracheal stenosis patients had higher rates of obesity (p=0.04), advanced age (p<0.001), tobacco use (p<0.001), and diabetes (p<0.001) compared to the population of Tennessee. They had lower rates of college education (p<0.01). Tracheostomy dependence was associated with higher rates of public insurance (p<0.001). Public insurance continued to be significant in multivariate analysis when adjusted for income, body-mass-index, tobacco use, and age. Conclusions: Disparities in the social determinants of health are prevalent in the laryngotracheal stenosis population and may affect the development of laryngotracheal stenosis as well as long-term outcomes. Further mechanistic studies may facilitate patient centered care and limit injury development.
Multilevel Upper Airway Measurements in Adults: Glottis Is Not Always the Narrowest
Yousef Atjathlany, MBBS; Abdullah Aljasser. MBBS; Abdullah Alhilai, MBBS; Manal Bukhari, MBBS; Moahammed Almohizea, MBBS; Adeena Khan, MBBS; Ahmed Alammar, MBBS
Objectives: We aimed to comprehensively study and measure the upper airway segments in adults, to evaluate the predicting factors of airway size, and select endotracheal tube (ETT) sizing accordingly. Methods: In our retrospective chart review, all patients older than 18 years who underwent computed tomography scan (CT) of the neck from September 2014 to September 2018 were screened. Patients with existing tumors, trauma or any pathology that may alter the normal anatomy of the airway, and patients who were intubated, tracheostomized, or had nasogastric tubes were excluded. Using the CT scan software, anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) were measured for four segments; glottis, six millimeters below the vocal cords, at the lower cricoid, and at the level of the first tracheal ring. Multiple regression analysis was used to identify predictors of airway size. Results: One hundred patients were recruited. The mean CSA and TD of the glottis (170mm2, 11.3mm) represent the narrowest level. However, 15% and 33% of the patients have glottic CSA and TD equal to or larger than the proximal subglottic area; respectively. Multiple regression analysis showed that height and gender were predominant predictors of airway measurements of the four segments. In addition, age was associated with TD and CSA of distal subglottic and tracheal segments. Conclusion: Contrary to popular belief a third of the patients had a proximal subglottic region equal to or smaller in diameter than the glottis. Patient’s height and gender inform appropriate ETT sizing.
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Natural History of Vocal Fold Cysts
Diana N. Kirke, MD, MPhil; Lucian Sulica, MD
Objective: The fate of untreated vocal fold cysts, important when considering intervention, has not been described. The goal of this study is to describe the natural history of vocal fold cysts by retrospective analysis of cases from a single center. Methods: All patients diagnosed with vocal fold cysts from January 2006 to June 2018 were identified. Patients that elected not to have surgery or who had an interval of observation greater than 90 days prior to surgical intervention constitute the study group. Medical records and stroboscopic exams were reviewed. The primary outcome was whether the cyst remained unchanged, enlarged, reduced or resolved. Cyst characteristics (Epidermoid or mucus retention by gross appearance; inflammation; location), voice therapy and duration of follow up (≤⁄> 300 days) were further analyzed for impact upon natural history. Results: Eighty-six patients (64F:22M; age 47±17 years) had a mean duration of follow up of 595 days (Range: 21 – 4523 days). The majority of cysts did not change (70.93%). The rest enlarged (12.79%), reduced in size (6.98%) or resolved (9.30%). Neither presence/absence of inflammation (p=0.340) nor voice therapy (p=0.416) affected natural history. However, mucus retentions cysts were less likely than epidermoid cysts to change (p=0.029) and change was more likely the longer the follow up (p=0.006). Conclusion: Most vocal fold cysts remain stable if untreated. Of the remaining third, approximately equal numbers grow in size, or shrink or resolve.
Understanding the Vocal Fold Cyst – A 10 Year Retrospective Study of the Etiopathogenesis of Cysts Excised at a Tertiary Center with a Study of the Presence and Distribution Pattern of Seromucinous Glands in 40 Fresh Frozen Cadaver Vocal Folds
Nupur Kapoor Nerurkar, MS; Trishna Chitnis, DNB; Vani Krishana Gupta, MS, DNB; Girish Mujumdar, MD; Keyuri Patel, MD; Pritha Bhuiyan, MS
Background: An increasing number of vocal fold cysts excised, as compared to polyps, over the last decade, led us to review these cases. We found a statistically significant increase in cysts excised as compared to polyps, over the latter 5-year period (2013-2017). This prompted us to analyze possible factors responsible for this increase. We also performed a histological study of the normative distribution pattern of seromucinous glands in the apparently normal vocal folds. Methods: A retrospective review of all cysts and polyps excised over a 10-year period was performed. Patient demographics, air-pollution levels, videostroboscopic findings and histologic analysis of the pathology were reviewed. Findings were compared between the initial and latter five-year period. A histological study of the presence and distribution pattern of seromucinous glands in 40 apparently normal fresh frozen cadaver vocal folds was performed. Results: There was a statistically significant (p=0.0355) increase of mucous retention cysts excised as compared to polyps over the latter five-year period. Vocal abuse and decreased laryngeal hydration were significant associated findings over the decade. Pollution had significantly increased in India over the latter 5-year period. Vocal fold histology in cadavers revealed a presence of seromucinous glands in 32.5 % (13/40) with 25% (10/40) present in the Superficial Lamina Propria (SLP). Conclusion: Decreased laryngeal hydration, vocal abuse and mucous glands present in the SLP may be predisposing factors towards mucous retention cyst formation. Increase in the number of mucous retention cysts being excised over the latter 5 years may be attributed to increased air-pollution.
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Improvement of Diagnostic Clarity: Combination Treatment Using Voice Rest and Steroids
Lesley F. Childs, MD; Ted Mau, MD, PhD
Background/Objectives: The objectives of this study are (1) to describe a combination voice rest and steroid regimen to clarify ambiguous diagnoses in singers who present with phonotraumatic lesions and (2) to determine which videostroboscopic parameters show the most consistent response to this regimen. Methods: A chart review was performed of 351 singers with phonotraumatic vocal fold lesions seen at a tertiary care voice center over a 10-year period. Singers whose formal diagnosis was uncertain on initial presentation were prescribed a combination of voice rest and steroids. The treatment effect was assessed by auditory perceptual ratings, and by ratings of pre- and post-treatment videostroboscopy examinations. Whether the combination treatment clarified diagnosis was noted. Results: 64 singers were treated with a combination of voice rest and steroids, 35 of whom had follow-up stroboscopic examinations to allow analysis. 15 of the 35 singers were prescribed the combination regimen with the intent to clarify the diagnosis. In 73.3% (11/15) of these singers, the regimen helped clarify diagnosis, e.g. ruling in or ruling out specific lesions, confirming areas of scar, or distinguishing acute from chronic phonotraumatic injury. The stroboscopic parameter that improved most consistently was the mucosal wave. Interestingly, 22% (8/35) of the post-treatment stroboscopic exams were overall unchanged. Auditory perceptual ratings also did not improve in 40% (14/35) of patients. Conclusions: Treatment with a combination of voice rest and steroids in singers with phonotraumatic lesions can improve diagnostic clarity. This combination regimen should be considered when the initial diagnosis is unclear.
The Role of Voice Rest on Voice Outcomes Post-Phonosurgery: A Randomized-Controlled Trial
Kevin Fung, MD; Sandeep Shaliwal, MD; Philip Doyle, PhD
Objective: Voice rest is prescribed following phonosurgery by most surgeons despite limited empiric evidence to support its practice. The purpose of this prospective, randomized-controlled trial was to assess the effect of post-phonosurgery voice rest on vocal outcomes. Methods: Patients with unilateral true vocal fold lesions undergoing phonosurgery were recruited in a prospective manner and randomized into one of two groups: 1) an experimental arm consisting of 7 days of absolute voice rest, or 2) the control arm consisting of no voice rest. The primary outcome measure was the Voice Handicap Index-10 (VHI-10) questionnaire. Secondary outcomes included the Voice Related Quality of Life (V-RQOL) measure in addition to acoustic variables (fundamental frequency, jitter, shimmer, and harmonic-to-noise ratio). Primary and secondary outcomes were assessed preoperatively, and reassessed postoperatively at one and 3 month follow-up. Patient compliance to voice rest instructions were controlled for using subjective and objective parameters. Results: A total of 30 patients were enrolled with 15 patients randomized to each arm of the study. Statistical analysis for the entire cohort of patients showed a significant improvement in the mean VHI measured preoperatively compared to postoperative assessments at 1 month (19.0 vs 7.3, p < 0.05) and 3 months (19.0 vs 6.2, p < 0.05) follow-up. However, between group comparisons showed no significant difference in postoperative VHI at either time points. Secondary outcome measures, including the V- RQOL, and all acoustic measurements, similarly yielded no significant difference in between-group comparisons. Conclusions: Our study shows no significant benefit to voice rest.
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Force Metrics and Suspension Times for Microlaryngoscopy Procedures
Allen L. Feng, MD; Matthew Naunheim, MD, MBA; Phillip C. Song, MD
Background: Force metrics measured by the laryngeal force sensor (LFS) are associated with the development of postoperative complications from suspension microlaryngoscopy (SML). However, variation in these forces based on type of procedure has not been described. Methods: The LFS is a force sensor designed for SML procedures. In this study, prospectively enrolled patients had dynamic recordings of maximum force, average force, suspension time, and total impulse. Procedures for excision of striking zone lesions, non-striking zone lesions, endoscopic cancer surgery with margin control, and airway dilation were grouped to determine differences in underlying force metrics. Results: In total, 110 patients completed the study. Across all procedures, the mean maximum and average forces were 37.1 lbf (95%CI, 33.6–40.6) and 21.9 lbf (95%CI, 19.5–24.4), respectively. The mean suspension time was 31.1 minutes (95%CI, 26.5–35.8) and mean total impulse was 16.2 tons (95%CI, 12.8–19.6). There was no significant difference in average force across different procedures, however a significant difference was seen for maximum force (p=0.025), suspension time (p<0.001), and total impulse (p=0.002). In all cases, the highest values were seen for endoscopic cancer surgeries with margin control with a mean maximum force of 49.4 lbf (95%CI, 37.1–61.7), mean suspension time of 60.2 minutes (95%CI, 40.5–79.9), and mean total impulse of 31.3 tons (95%CI, 15.2–47.3). Conclusions: Significant differences in force metrics exist between various SML procedures. Endoscopic cancer surgery is associated with higher force metrics, suggesting a higher propensity for postoperative complications after these procedures.
A Phase II, Randomized, Double-Blind, Placebo- Controlled Multi-Institutional Study to Evaluate the Safety and Efficacy of Autologous Cultured Fibroblasts for Treatment of Vocal Fold Scarring and Atrophy
Yue Ma, MD; Jennifer Long, MD, PhD; Stratos Achlatis, MD; Milan Amin, MD; Ryan Branski, PhD; Edward Damrose, MD Chih-Kwang Sung, MD, MS; Ann Kearney, CScD; Dinesh Chhetri, MD
Objective: The objective of this study was to assess the safety and efficacy of autologous cultured fibroblasts in treating dysphonia related to vocal fold scars and age-related atrophy. Study- Design: Randomized, double-blinded, placebo-controlled, multi-institutional, phase II trial. Methods: Autologous fibroblasts were expanded in cell culture from punch biopsies of the post- auricular skin. Treatment subjects received three doses of 1–2x107 cells/mL while the control group received saline injections to the lamina propria compartment in four weeks intervals. Follow-up examinations were performed at four, eight and twelve months. All safety events were reported. The primary efficacy measure was an objective evaluation of the mucosal wave grade; patient‐completed voice handicap index (VHI) survey, and perceptual analysis using the GRBAS scale as assessed by blinded expert and non-expert listeners. Treatment and control groups were compared using the Wilcoxon Rank- Sum test. Results: Fifteen subjects received autologous fibroblasts while six subjects received saline. At smithmucosal wave (p=0.5). VHI decreased 12 in the treatment group and 10 in the control group (p=0.3). GRBAS improved in 26.7% of the treatment group and 33.3% of the control (p=1). No significant safety events were reported. Conclusion: This study demonstrates that injection of autologous fibroblasts into vocal fold lamina propria is safe. At four months post-injection interval assessment, no significant difference in outcomes were found between the treatment and control groups. Analysis of follow-up data at eight and twelve months post-injection is ongoing.
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Does Systemic Dehydration Adversely Affect Vocal Fold Tissue Physiology?
Abigail C. Durkes. DVM, PhD; Steven Oleson, BS; Chenwai Duan, BS; Ku-Han Lu, MS; Zhongming Liu, PhD; Sarah Calve, PhD; Preeti M. Sivasankar, PhD, CCC-SLP
Background/Objective: The role of systemic dehydration in adversely affecting vocal fold physiology is a central dogma in laryngology. We investigated whether systemic dehydration induces vocal fold dehydration and whether key molecular markers of vocal fold hydration and mechanical stress are altered. Methods: This in vivo prospective design incorporated proton density weighted MRI (PDW-MRI), gene expression and protein level studies. Male and female Sprague Dawley rats (N = 42) were imaged at baseline and following water withholding to body weight loss levels (<6%; >6%; >10%) or control (no water withholding). Gene expression levels of mucins, elastin, collagen, aquaporin, and hyaluronic acid synthase were quantified in >10% dehydration and control (N=8). Hyaluronic acid levels were quantified using a protein assay in >10% dehydration and control (N=3). Results: There were no significant differences in male versus female normalized vocal fold image intensity at baseline or following dehydration (p>0.05). Normalized vocal fold image intensities reduced after dehydration and were correlated with the magnitude of dehydration with a mean reduction of 36% at >10% (p<0.01); 14.5% at >6% (p<0.01); and 5.33% at <6% (p> 0.05). The image intensity correlation coefficient between vocal fold and salivary gland was 0.65 (p< 0.01). There were no significant differences in gene expression levels or protein levels. Conclusions: Systemic dehydration to greater than a 6% change in body weight induced dehydration in vocal fold tissue as detected by PDW-MRI. However, the dehydration was not accompanied by adverse tissue changes. Further research will include chronic dehydration models.
Optimized Quantification of Altered Vocal Fold Biomechanical Properties
Gregory R. Dion, MD; Teka Guda, PhD; Shigeyuki Mukudai, MD, PhD; Renjie Bing, MD; Jean-Francois Lavoie, PhD; Ryan C. Branski, PhD
Objectives/Hypothesis. The development of novel vocal fold (VF) therapeutics is limited by the lack of standardized, meaningful preclinical outcomes. We hypothesized that automated microindentation based VF biomechanical property mapping with matched histology is ideal for comprehensive, quantitative assessment. Study Design. Ex vivo Methods. Twelve rabbits underwent endoscopic, unilateral VF injury. Larynges were harvested at day 7, 30, or 60 (n=4/group), with four uninjured controls. Biomechanical measurements (normal force, structural stiffness, and displacement at 1.96mN) were calculated using automated microindentation mapping (0.3mm depth, 1.2mm/s, 2mm spherical indenter) with a grid overlay (>50 locations weighted towards VF edge, separated into 14 zones). Specimens were marked/fixed/sectioned, and slides matched to measurement points. Results. In the injury zone, normal force/structural stiffness (mean, SD/mean, SD) increased from uninjured (2.2mN, 0.64/7.4mN/mm, 2.14) and day 7 (2.7mN, 0.75/9.0mN/mm, 2.49) to day 30 (4.3mN, 2.11 / 14.2mN/mm, 7.05), and decreased at 60 days (2.7mN, 0.77/9.1mN/mm, 2.58). VF displacement decreased from control (0.28mm, 0.05) and day 7 (0.26mm, 0.05) to day 30 (0.20mm, 0.05), increasing at day 60 (0.25mm, 0.06). One-way ANOVA was significant; Tukey’s post hoc test confirmed day 30 samples differed from other groups (P<0.05), consistent across adjacent zones. Zones far from injury remained similar across groups (P=0.143 to 0.551). These measurements matched qualitative histologic variations. Conclusions. Quantifiable wound healing VF biomechanical properties can be linked to histology. This technological approach is the first to simultaneously correlate functional biomechanics with histology and this multi-parameter analysis is ideal for preclinical studies.
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Effect of Sex Hormones on Extracellular Matrix of Lamina Propria in Rat Vocal Fold
Byungjoo Lee, MD, PhD; Ji-Min Kim, PhD; Sung-Chan Shin, MD, PhD
Background The role of sex hormones in modulating changes in vocal quality in men and women is presently unknown. Our objective was to measure deviations in vocal fold lamina propria extracellular matrix (ECM) in orchiectomized and ovariectomized rats to determine if changes in sex hormones alter tissue structure. Materials and Methods: Male and female Sprague-Dawley rats were divided into sham-operated male rats, orchiectomized rats (ORX), sham-operated female rats and ovariectomized rats (OVX). Testosterone and estradiol E2 levels decreased in ORX and OVX group, respectively. Results: In general morphological finding, there were no significant changes in vocal fold thickness and important ECM constituents in ORX rats but thickness of lamina propria in the OVX group was larger compared with control group. Hyaluronic acid was decreased for OVX group compared with control group. Collagen I density of OVX group was lower than control group and collagen III levels were elevated at one month for the OVX group, but was diminished at three months for OVX group. Elastin fibers in the ECM were less dense for the OVX group compared with controls. mRNA expression of HAS- 1 and 2 decreased in the OVX group compared with controls. Moreover, the expression MMP1, 2 and 9 showed differences for the OVX groups compared to the control group. Conclusion: The ECM components of lamina propria of vocal fold change with decreased estrogen levels. These results indicate the vocal fold is an estrogen sensitive target organ and decreased estrogen, not testosterone, can affect the expression of several ECM molecules of vocal fold.
Idiopathic Vocal Fold Paralysis May Not Be Caused by a Focal Axonal Lesion
Ted Mau, MD, PhD; Solomon Husain, MD; Lucian Sulica, MD
Introduction: Spontaneous vocal recovery from idiopathic vocal fold paralysis (VFP) appears to differ in time course from recovery in iatrogenic VFP. This study aimed to determine if this difference could be explained by a difference in the mechanism causing RLN dysfunction, specifically whether a focal RLN axonal lesion is consistent with idiopathic VFP. Methods: A review of 1267 cases of unilateral VFP over a 10-year period yielded 114 subjects (35 idiopathic, 79 iatrogenic) with a discrete onset of spontaneous vocal recovery. The time-to-recovery data were fit to a previously described two-phase model that incorporates the Seddon classification of neuropraxia and higher grades of axonal injury. Alternatively, the data were fit to a single phase model that does not assume a focal axonal lesion. Results: Time to vocal recovery in iatrogenic VFP can be reliably modeled by the assumption of a focal axonal lesion, with an early recovery group corresponding to neuropraxia and a late recovery group with more severe nerve damage. Time to recovery in idiopathic VFP can be more simply modeled in a single phase, with a time course that mirrors those in diverse biological processes such as cell proliferation and transcription. Conclusions: Idiopathic VFP may not be caused by a focal axonal lesion. Neuritis (with or without viral mediation) may be a compatible mechanism. The iatrogenic VFP data lend further support to the concept that the severity of RLN injury, not the length of axon to regenerate, is the chief determinant of recovery time after iatrogenic injury.
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Effects of Trial Vocal Fold Injection Material & Operative Location on Predicting Thyroplasty Outcomes
Kevin Tie, BS; Rupali N. Shah, MD; Robert A. Buckmire, MD
Introduction: Inhalation injury is an independent risk factor in burn mortality, imparting a 20% increased risk of death. Yet there is little information on the natural history, functional outcome, or pathophysiology of thermal injury to the laryngotracheal complex, limiting treatment progress. Methods: Case series (n=3) of significant thermal airway injury. Results: In all cases, the initial injury was far exceeded by the subsequent immune response and aggressive fibro-inflammatory healing. Serial examination demonstrated progressive epithelial injury, mucosal inflammation, airway remodeling, and luminal compromise. Histologic findings in the first case demonstrate an early IL-17A response in the human airway following thermal injury. This is the first report implicating IL-17A in the airway mucosal immune response to thermal injury. Our 2nd and 3rd patients received Azithromycin targeting IL-17A and had showed clinical responses. The third patient also presented with exposed tracheal cartilage and underwent mucosal reconstitution via split-thickness skin graft over an endoluminal stent in conjunction with tracheostomy. This was associated with rapid abatement of mucosal inflammation, resolution of granulation tissue and return of laryngeal function. Conclusion: Patients who present with thermal inhalation injury should receive a thorough multidisciplinary airway evaluation, including early otolaryngologic evaluation. New early endoscopic approaches (scar lysis, and mucosal reconstitution with autologous grafting over an endoluminal stent), when combined with targeted medical therapy aimed at components of mucosal airway inflammation (local corticosteroids and systemic Azithromycin targeting IL-17A) may have potential to limit chronic cicatrical complications.
Effect of Vocal Fold Implant Placement on Depth of Vibration and Vocal Output
Simeon L. Smith, BS, MS; Ingo R. Titze, PhD; Claudio Storck, MD; Ted Mau, MD, PhD
Introduction: Most type 1 thyroplasty implants and some common injectable materials (e.g. CaHA) are mechanically stiff. Placing them close to the supple vocal fold mucosa can potentially dampen vibration and adversely impact phonation, yet this effect has not been systematically investigated. This study aims to examine the effect of implant depth on vocal fold vibration and vocal output. Methods: Voice production was simulated in a fiber-gel finite element computational model that incorporates a three-layer vocal fold composition (superficial lamina propria, vocal ligament, and TA muscle). Implants of various depths were simulated, with a “deeper” or more medial implant positioned closer to the VF mucosa and replacing more TA muscle elements. Trajectories of within-tissue nodal points during vibration were traced as a measure of vibrational amplitude. Outcome measures were the vibrational amplitude, fundamental frequency, and sound pressure level (SPL) of the generated sound as a function of implant depth. Results: Implants that extended medially beyond 50% of the TA muscle depth began to impact phonation, with progressive reduction of vibrational amplitude, reduction in SPL, and an exponential increase in fundamental frequency. Implant placement immediately deep to vocal ligament reduced the amplitude at the vibratory edge to less than 10% of normal. Conclusions: Commonly used implants can dampen vibration “from a distance”, i.e., even without being immediately adjacent to VF mucosa. This damping effect should be kept in mind when using stiff injectables such as CaHA and when performing thyroplasties in atrophied VFs, for example in chronic denervation or severe age-related atrophy.
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The Effects of Implant Stiffness on Vocal Fold Medial Surface in an Ex-Vivo Hemilarynx Model `
Brian H. Cameron, BA; Zhaoyan Zhang, PhD; Dinesh K. Chhetri, MD
Objectives: Vocal fold geometry and stiffness are determinant variables in voice production. Medialization laryngoplasty (ML) is the primary treatment modality for glottic insufficiency. However, the effects of ML on the vocal fold medial surface shape are not well understood. In this study, the effects of laryngoplasty implant stiffness on the shape of the medial surface of the vocal fold was investigated. Methods: In an ex-vivo human hemilarynx, India ink was used to mark the medial surface of the vocal folds in a grid-like pattern. Unilateral MLs were then performed with silicone implants of varying stiffness at rest with and without arytenoid adduction. Images of the medial surface were taken using a high- speed camera through a right-angled prism, which provided two stereoscopic views of the medial surface for 3D reconstruction of the surface contour. 3D images were created of the vocal fold medial surface shape at rest and with arytenoid adduction. The shape of the medial surface was compared for each implant. Results: ML with the stiffer implants had higher point of maximal medialization of the vocal folds compared to softer implants. However, while softer implants achieved lower point of maximal medialization, they resulted in the medialization of a greater area of the medial surface of the vocal fold. Conclusions: Differences in implant stiffness can result in different shape and degree of medialization of the vocal fold after implantation. Further investigation is required to understand the effects on voice production and the clinical implication of these findings.
Development of an Innovative Surgical Technique for Vocal Fold Reconstruction Using an Autologous Vascularized Pedicled Fat Flap in a Rabbit Model
Seung Won Lee, MD, PhD
Objectives: We evaluated the usefulness of a vocal fold reconstruction technique using an autologous vascularized pedicled fat flap in a rabbit model of vocal fold paralysis Methods: The study included 30 male New Zealand white rabbits: 20 received vocal fold reconstructions, and 10 served as normal controls. The right recurrent laryngeal nerve (RLN) was resected and a simultaneous autologous pedicled fat flap reconstruction was performed. The fat flap, including the pre-epiglottic fat, was elevated and implanted through a window at the inferior border of the thyroid cartilage. The histological study and high-speed video analysis of vocal fold vibration (Phantom v2611, Vision Research, USA) were performed 1-month post reconstruction. The maximum amplitude of vocal fold vibration and the dynamic glottal gap were used to assess vocal fold vibration Results: The histological findings showed that the lamina propria ratio (lamina propria pixel/total vocal fold pixel) and the total number of vocal fold pixels after the vocal fold reconstruction were similar to those of the normal control. The vocal fold vibration analysis revealed that the maximum amplitude of the vibration was slightly decreased in the reconstruction group; however, the dynamic glottal gap of the vocal fold was not significantly different from that of the controls (P > 0.05) Conclusions: Autologous pedicled fat flap vocal fold reconstruction technique could maintain the vocal fold area without a significant reduction in vocal fold vibration in a rabbit model of vocal fold paralysis
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Voice Outcome of Preservation of the External Branch of Superior Laryngeal Nerve Using Attachable Magnetic Nerve Stimulator under Intraoperative Neuromonitoring System during Thyroidectomy
Eui-Suk Sung, MD, PhD; Sung-Chan Shin, MD, PhD; Hyun-Keun Kwon, MD Jin-Choon Lee, MD, PhD; Byung-Joo Lee, MD, PhD
Background: External branch of superior laryngeal nerve (EBSLN) is difficult to visually identify during surgery and EBSLN injury tend to be underestimated. The attachable magnetic nerve stimulator has the advantage of performing electrical stimulation at the same time as performing surgery without exchanging between the dissecting surgical instruments and nerve stimulators. Metallic surgical instruments with an attachable magnetic nerve stimulator may provide surgeons with real-time cricothyroid muscle twitching feedback. The purpose of this study is to determine if the magnetic nerve stimulator could be used to preserve EBLSN and reduce the frequency of post-operative high pitch voice problem. Methods: All patients followed the same preoperative and postoperative (2 weeks and 2 months after surgery) voice evaluations. Each evaluation included fiberoptic laryngoscopy, acoustic analysis, and thyroidectomy-related voice questionnaire (TVQ). After exclusion, 57 patients were divided into two groups; magnetic nerve stimulator group (n=28) and control group (conventional technique, n= 29). Results: The preoperative acoustic parameters and TVQ scores were not significantly different. In the control group, postoperative acoustic parameters including speech fundamental frequency, shimmer, maximum phonation time, TVQ total score and TVQ high pitch score were worse than preoperative results. But there were no significant differences in acoustic parameters and TVQ score between preoperative and postoperative outcomes in the magnetic nerve stimulator group. Conclusion: The magnetic nerve stimulator helps to reduce EBSLN damage and can help reduce postoperative voice problem making high-pitch.
Chronic Inflammatory Response in the Rat Lung to Commonly Used Contrast Agents for Videofluoroscopy
Rumi Ueha, MD, PhD;Nogah Nativ-Zeltzer, PhD; Taku Sato, MD; Takao Goto, MD; Takaharu Nito, MD, PhD; Peter Belafsky, MD, MPH, PhD; Tatsuya Yamasoba, MD, PhD
Objectives: Contrast agent aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological mechanisms of chronic response to contrast agent (CA) aspiration in the respiratory organs remain unclear. The aims of this study were to elucidate the histological and biological influences of three kinds of CAs on the lung and to clarify the differences in chronic responses. Study Design: Animal model Methods: Eight-week-old male Sprague Dawley rats were divided into 5 groups (n = 6, each group). Three groups underwent tracheal instillation of one of three CAs: Barium sulfate (Ba), ionic iodinated contrast agent (ICA), and non-ionic iodinated contrast agents (NICA). A sham group was instilled with air and a control group was instilled with saline. All animals were euthanized 30 days after treatment and histological and gene analyses were performed. Results: No animal died after CA or sham/control aspiration. Ba particles remained after 30 days and caused histopathologic changes and inflammatory cell infiltration. Iodinated ICA & NICA did not result in perceptible histologic change. Expression of Tnf, an inflammatory cytokine was increased in only Ba aspirated rats (p = 0.0076). Other inflammatory cytokines and fibrosis-related genes did not alter between groups. Conclusion: Barium caused significantly more chronic lung inflammation in a rodent model than ionic and non-ionic iodinated contrast agents. Our study highlights the importance of considering chronic pulmonary inflammation after barium aspiration.
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Improved Reflux Symptom Index in Patients Treated for Dysphonia
Hannah Kavookjian, MD; Thomas Irwin, MM; James D. Garnett, MD; Shannon Kraft, MD
Background: The reflux symptom index (RSI) is a validated quality of life instrument that quantifies symptoms associated with laryngopharyngeal reflux (LPR). Due to symptom overlap between LPR and other laryngeal pathologies, many dysphonic patients are managed empirically for “reflux.” In this study we examine changes in RSI for patients undergoing management of dysphonia. Methods: This is an IRB-approved retrospective cohort study. All patients presented to a tertiary care voice center between January 2011 and June 2016 with a chief complaint of dysphonia. Patients were divided into three groups for treatment of dysphonia: surgery, medical, and voice therapy (VT). Data collected included pre- and post-intervention survey data, as well as demographic and clinical information. Statistical analysis was performed using SPSS. Results: 270 patients were included in the study. 99 required surgery for dysphonia, 78 were medically managed, and 93 were treated with VT alone. There were significant differences in referral patterns between treatment groups. 12% of the surgery group, and 26.9% of the VT group had undergone empiric medical treatment for presumptive LPR prior to referral evaluation. 42% of patients who ultimately required surgery had never been evaluated by an otolaryngologist prior to referral. All three treatment groups, regardless of pathology, demonstrated statistically and clinically significant improvement in RSI post-treatment (surgery = p<0.000, VT = p<0.000, medical = p<0.000). Conclusions: In patients with dysphonia, RSI scores improved with all treatments, regardless of etiology or presence of LPR. This highlights the importance of a comprehensive workup for patients with voice disorders.
Comparison of Staple-Assisted Diverticulotomy, Laser-Assisted Diverticulotomy, and Transcervical Diverticulectomy for Zenker’s Diverticulum: A Systematic Review and Meta-Analysis
Neel K. Bhatt, MD; Joshua Mendoza, BM; Angela C. Hardi, MLIS; Joseph P. Bradley, MD
Objectives: Zenker’s diverticulum (ZD) can cause weight loss, regurgitation, and dysphagia. The study was performed to compare three surgical techniques and determine if the rate of recurrence, persistent disease, and post-operative dysphagia differed between groups. Methods: A search strategy was applied to multiple databases. Inclusion criteria were cohort studies or randomized trials comparing three techniques: endoscopic laser-assisted diverticulotomy, endoscopic stapler-assisted diverticulotomy, and transcervical diverticulectomy with cricopharyngeal myotomy. Studies that incorporated cases of recurrent ZD or alternative transcervical techniques were excluded. Results: The search generated 508 studies. After applying inclusion/exclusion criteria, 13 cohort studies remained consisting of 1020 patients treated with stapler-assisted diverticulotomy (n= 507), laser- assisted diverticulotomy (n=332), or transcervical diverticulectomy (n=181). Stapler-assisted surgery had the highest rate of recurrent/persistent symptoms 17.8% (95%CI:13.8-22.5%), followed by laser-assisted surgery 11.9% (95%CI:9.2-15.1%), then transcervical approach 2.0% (95%CI:0.5-6.2%). The pooled relative risk of persistent/recurrent symptoms following staple-assisted diverticulotomy was 1.5 (95% CI:1.1-2.1) compared to laser-assisted surgery. The I2 overall was 58.4%. Five dysphagia assessments showed significant improvement with each surgical technique. Conclusions: This meta-analysis is the first to compare the three most common techniques for ZD. Stapler-assisted diverticulotomy was associated with the highest rate of recurrent/persistent symptoms. Dysphagia assessments were varied and demonstrated significant improvement with all techniques.
52 SCIENTIFIC SESSIONS
The Prevalence of Dysphonia and Dysphagia Symptoms in Patients on Statin Therapy
Elie Khalifee, MD; Abdul-Latif Hamdan, MD, EMBA, MPH; Nader El Souky, MD; Bakr Saridar, MD; Sami Azar, MD
Introduction: To investigate the effect of statin therapy on swallowing and phonation Methods: A group of patients on statin therapy and another group not on statins (controls) presenting to the endocrinology clinic between January 2018 and April 2018 were asked to participate. All patients filled Voice handicap Index (VHI-10), Eating Assessment Tool (EAT-10) and likert scales for vocal fatigue and hoarseness. Demographic data included age, gender, allergy, and history of smoking. Results: A total of 160 patients were recruited, 75 patients on statin therapy and 85 not on statin therapy. The mean age of the study group was 55.00 years, while that of the control group was 45.70 years. The mean duration of statin treatment was 74.92 months. The mean VHI-10 and EAT-10 scores were significantly higher in the statin group compared to the control group (P value<0.05). Although there was no significant difference in the mean likert scale for vocal fatigue, the mean likert scale for hoarseness was significantly higher in the statin group compared to the control group (p-value<0.05). Conclusion: This investigation revealed a significantly higher prevalence of laryngopharyngeal symptoms in patients on statin therapy vs a control group.
The Use of the Ethicon Enseal for Transoral Rigid Zenker's Diverticulotomy: A Retrospective Review of Device Safety, Complication, and Short Term Outcomes
Krishna Bommakanti, BA; William Moss, MD; Robert Weisman, MD; Philip Weissbrod, MD
Introduction: Zenker's diverticulum (ZD) is an outpouching of mucosa and submucosa through Killian triangle, defined by the inferior constrictor and the cricopharyngeus muscles. Surgical treatment of ZD has evolved and endoscopic approach has gained popularity, most commonly endoscopic staple or laser diverticulostomy. In this study we review our experience with endoscopic Enseal-assisted diverticulotomy. Methods: This is a retrospective review of all patients with ZD who underwent endoscopic treatment with the Enseal device between between 2011 and 2018 at the University of California, San Diego. Measurement of ZD size was based on barium esophagram and endoscopic estimation. Outcomes included evaluation of patient demographics, assessment of adverse events, and reporting of short term outcomes. Results: Twenty patients underwent Enseal-assisted treament of ZD. The average age was 71.2 years and 74.1% were male. The mean diverticulum size was 3.0 cm. There were no postoperative complications recorded. Conclusion: Enseal diverticulotomy is a safe alternative to typical endoscopic surgical techniques for transoral Zenker's diverticulotomy.
53 SCIENTIFIC SESSIONS
KTP Versus CO2 Laser Surgery for Early Glottic Cancer: Randomized Controlled Trial Comparing Survival and Function
Yonatan Lahav, MD; Oded Cohen, MD; Yael Shapira-Galitz, MD; Doron Halperin, MD; Hagit Shoffel-Havakah, MD
Objectives: CO2 laser has been the working-horse in glottic cancer surgery for decades. Pioneering studies proved the ability of KTP Laser in curative treatment in glottic cancer. This study aims to compare, for the first time, the results of traditional CO2 laser cordectomy with photoangiolytic KTP laser tumor ablation. Methods: A randomized-control study between 2013-2018 enrolling patients with Tis-T1 glottic cancer. Stroboscopy, GRBAS, VHI scores and acoustic analysis were performed preoperatively, and then 6 months and 3 years post-operatively Results: 24 patients were randomly assigned, 12 in each group. CO2 patients had average (range) of 1.33(1-4) operations per patients compared to 1.75(1-3) in KTP (p-value=0.204). 50% CO2 patients had type I-II cordectomy, and 50% CO2 patients had type III or more. 91.6% KTP patients had subepithelial or sub-ligamental ablation, comparable to type I-II cordectomy. By the end of the follow-up period, all patients were free of disease. Both groups had comparable improvement of GRBAS and VHI scores. KTP was superior to CO2 in 6 months postoperative maximal phonation time average (SD) delta, -4.25(11.08) sec for CO2, +1.23(5.09) sec for KTP (p-value=0.052). One year postoperatively mucosal wave propagation was normal in 0% of the CO2 patients and 58.3% of the KTP patients (p-value=0.02); the average non-vibrating portion was 50% in CO2 and 10% in KTP (p-value=0.043). Conclusions: KTP offers comparable cure rates as CO2 laser for T1 glottic cancer, and allows more superficial resection and better preservation of vocal fold vibration. KTP should be considered a legitimate surgical tool for early glottic cancer.
MU-Opioid Receptor Expression in Laryngeal Normal and Carcinoma Specimens and the Relation with Survival
Hagit Shoffel-Havakuk, MD; Huszar Monica, MD; Iris Levy, MD; Oded Cohen, MD; Doron Halperin, MD; Yonatan Lahav, MD
Objectives: Opioid consumption and tumoral Mu-opioid receptors(MOR) expression were suggested as carcinogenic factors. A previous study of ours showed an increased rate of IV-drug-abusers (IVDA) among Supraglottic-SCC (SGSCC) patients. This study aims to assess MOR expression in malignant and normal tissue from Laryngeal-SCC (LSCC) patients. Methods: 64 malignant and adjacent normal tissue specimens from 32 patients with LSCC were evaluated. Patients were categorized into three matched groups by IVDA status and tumors' site: 8 IVDA SGSCC, 12 non-IVDA SGSCC, and 12 non-IVDA Glottic-SCC. Matching was based on demographics, pack-years and alcohol-use. Immunohistochemistry staining with monoclonal antibodies to MOR was applied and examined by semi-quantitative analysis for staining intensity and stained cell rate. Results: MOR staining intensity was significantly increased for LSCC specimens (SG and G) compared to normal tissue (p=0.019). MOR stained cell rate in normal supraglottic tissue was significantly higher compared to normal glottic tissue (p=0.022). There were no significant differences between carcinoma specimens from IVDA and non-IVDA patients. Kaplan-Meir analysis on all SGSCC patients demonstrated significantly better survival for patients with increased MOR staining (p=0.007). All SGSCC patients with tumors negative for MOR did not survive 5 years. Conversely, patients with high staining score had the best survival, 80% at 5 years. Conclusions: LSCC specimens have increased density of MOR. MOR are more abundant in the normal supraglottis compared to the glottis, suggesting supraglottic susceptibility to this possible carcinogenic pathway. SGSCC patients with increased MOR staining demonstrated better survival.
54 SCIENTIFIC SESSIONS
A Novel and Personalized Voice Restoration Alternative for Patients with Total Laryngectomy
Amais Rameau, MD, MPhil
Background – The main modalities of voice restoration after total laryngectomy are esophageal speech, the electrolarynx and the tracheoesophageal puncture. Each of these methods offer limited prosodic range for alaryngeal speech. Objective - To describe a novel and personalized method of voice restoration using machine learning applied to EMG signal from articulatory muscles for the recognition of silent speech in patients with total laryngectomy. Methods- Surface electromyographic (sEMG) signals of articulatory muscles were recorded from the face and neck of a patient with total laryngectomy who was articulating words silently. These sEMG signals were then used for automatic speech recognition via machine learning. This allowed to translate the patient’s silent mouthed speech into text or synthesized speech via portable devices as an alternative means of communication. Sensor placement was tailored to the patient’s unique anatomy, following radiation and surgery. A personalized wearable mask covering the sensors was designed using 3D scanning and 3D printing. Results – Using 6 sEMG sensors on the patient’s face and neck, we recorded EMG data while he was mouthing “Tedd” and “Ed.” With data from 75 utterances for each of these words, we discriminated the sEMG signal with 86.6% accuracy using an XGBoost machine learning model. Conclusion - This pilot study demonstrates the feasibility of sEMG-based alaryngeal speech recognition, using tailored sensor placement and a personalized wearable device. Further refinement of this approach could allow translation of silently articulated speech into a synthesized voiced speech via portable devices.
CT Lung Screening in Patients with Laryngeal Cancer
Krzysztof Piersiala, MD; Alexander T. Hillel, MD; Lee M. Akst, MD; Simon R. A. Best, MD
Background: Many patients with laryngeal cancer (LC) meet the age and smoking criteria of the U.S. Preventive Services Task Force (USPSTF) for annual CT lung screening but were excluded from clinical trials based on their history of malignancy. The frequency of incidental findings on CT screening such as pulmonary nodules (PN) and secondary lung cancer (SLC) in this select group of high-risk patients has not been reported. Methods: Retrospective chart review of LC patients treated at Johns Hopkins Hospital from January 2010 to December 2017. The study population included patients who met USPSTF criteria by age and smoking history for annual chest screening and were followed for at least 3 consecutive years. Results: A total of 998 LC patients’ records were reviewed, of which 153 met the inclusion criteria. Inadequate follow-up period (37%) was the most common reason for exclusion, followed by not meeting USPSTF age criteria (27%). In seventy-eight patients (51%) PN were reported. Nine (6%) were diagnosed with SLC. A smoking history over 40 pack-years (p=0.023) and age over 70 (p=0.003) were independent predictors of malignancy. White race was a univariate predictor of pulmonary nodule detection (p=0.021). Conclusion: The incidence of PN and SLC in patients with LC is high compared to smokers in general (24.2% rate of PN and 3.6% lung cancer in The National Lung Screening Trial). Many patients with laryngeal cancer meet the formal guidelines for USPSTF screening, and should be screened annually according to evidence-based medicine for the early detection of secondary lung cancers.
55 SCIENTIFIC SESSIONS
Laryngocele, Rethinking the Prevalence by Exposing Radiographic Mimickers
Guy Slonimsky, MD; Elnat Slonimsky, MD; David Goldenberg, MD
Purpose: To reevaluate the actual prevalence of laryngoceles using computed tomography (CT) and to identify and rule out potential mimickers. Materials and methods: A retrospective search of CT studies with the diagnosis of ‘laryngocele’ over a period of ten years. All studies were evaluated by two readers for the presence of laryngocele defined as saccular herniation extending above the superior margin of the thyroid cartilage. Additional evaluated factors included mimickers in cases of incorrect diagnosis. 3D laryngeal reconstructions were performed to better evaluate and demonstrate the major mimickers found. Inter-reader agreement between radiological report and revision of studies and readers bias were calculated using Cohen’s Kappa. Detected prevalence of laryngocele was calculated using a denominator comprised of all relevant CT scans in the study period. Results: One hundred and twelve patients were included; average age was 54 (±18) years (range 16-90). Re-read of scans with 3D reconstructions resulted in detecting 58 (51.8%) true laryngoceles with 19.5% bilateral laryngoceles. Laryngocele mimickers included 26(23.2%) ventricles, 19(17%) saccules not meeting criteria for laryngocele, 8(7.1%) deep pyriform sinuses and 1 tracheal diverticulum. Inter-reader agreement was moderate on the right and fair on the left. Calculated laryngocele prevalence was 0.638 per 1,000 patients. The addition of IV contrast did not reduce the rate of incorrect diagnosis. Conclusions: In the era of rapidly growing CT utilization, the historical estimation of the prevalence of laryngocele (1:2.5 million) may be obsolete. However, care should be exercised to prevent over diagnosis of laryngocele due to anatomical mimickers.
Sulcus Vocalis: Results of Excision without Reconstruction
Katerina Andreadis, BA; Debra D’Angelo, BS; Katherine Hoffman, MS; Lucian Sulica, MD
Background/Objective: Sulcus vocalis is an epithelial invagination of the membranous vocal fold. Its phonatory effects are usually attributed to fibrosis, thinning and/or absence of the superficial lamina propria (SLP). Surgical treatment is typically focused on reconstruction of the SLP. The purpose of this study is to assess the effects of excision without SLP reconstruction or replacement Methods: Records of patients who underwent surgical treatment of sulcus vocalis by excision without reconstruction were reviewed for demographic and historical information. Pre- and post-operative stroboscopic examinations were evaluated blindly by fellowship-trained laryngologists using a modified Voice-Vibratory Assessment with Laryngeal Imaging (VALI) assessment. A Wilcoxon signed-rank test was used to compare pre- and post-operative amplitude, mucosal wave, non-vibrating portion, regularity, erythema and vascularity. Results: Examinations of 16 vocal folds in 13 patients (8F:5M; mean age = 30y, range 13-48y) were evaluated by seven raters each, yielding 224 sets of observations. Statistically significant improvement was seen in amplitude (95% CI 3.3,14.2), mucosal wave (95% CI 6.7, 18.3), non-vibrating portion (95% CI 21.0, 3.3), and erythema (95% CI 24.2, 1.7). The parameters of regularity and vascularity, although improved, did not prove to be significant. Conclusions: Excision alone appears to be an adequate and generally successful treatment for sulcus vocalis. In contrast to established paradigms, restoration of the SLP does not appear to be essential to meaningful clinical improvement. Significant pathologic effects of sulcus vocalis may result from epithelial abnormalities alone.
56 SCIENTIFIC SESSIONS
Recurrence of Benign Phonotraumatic Vocal Fold Lesions after Microlaryngoscopy
Mark Lee, BS, BA; Lucian Sulica, MD
Background/objectives: To determine recurrence rates for benign phonotraumatic vocal fold lesions after microlaryngoscopic surgery. Methods: Records of adults who underwent microlaryngoscopy between 2006 and 2017 for vocal fold cysts, fibrous masses, varices, polyps, pseudocysts, and sulcus vocalis were reviewed for demographics, medical history, vocal demand, treatment, and lesion recurrence. Patients operated for non-phonotraumatic lesions (e.g., granuloma, keratosis/leukoplakia, papilloma) were excluded. Stroboscopic examinations were reviewed to confirm diagnosis and outcome. Results: 511 adults (224M:287F; mean age 40.4±15.0 years) were included. Overall, 63/511 (12.3%) recurred (median time to recurrence: 15.8 months). Of these, 44 (63.5%) recurred to the same lesion type as the initial lesion. Recurrence rates by initial lesion type were as follows: cysts, 2/92 (2.2%); fibrous masses, 4/20 (20%); polyps, 26/234 (11.1%); pseudocysts, 30/145 (20.7%); sulcus vocalis, 1/18 (5.6%); and varices, 0/2 (0%) (χ2=21.6, df =5, p=0.001). No significant difference in recurrence existed between males (22/224, 9.8%) and females (41/287, 14.3%). However, young adults (17/86, 19.8%) had significantly higher recurrence rates compared to middle-aged (13/155, 8.4%, p=0.014) and older adults (3/61, 4.9%, p=0.038). Performers tended to recur at a higher rate (28/151, 18.5%) than routine voice users (19/219, 8.7%), but the difference was not significant. Of 63 recurrences, 18 were re-operated and 4 re-recurred. Conclusions: Benign phonotraumatic vocal fold lesions recur at variable rates. This variation suggest pathophysiologic differences between categories that are not entirely explained by behavioral factors.
The Role of Steroid Injection for Vocal Fold Benign Lesions in Professional Voice Users
Mohamed Al-Ali, MBBS; Jennifer Anderson, MD, MSc
Background: There are different vocal folds benign lesions like nodules, polyps, cysts, granuloma, scar, inflammation, and fibrosis. The treatment can be voice therapy with vocal hygiene or surgical intervention (cold steel or laser), or a combination of both. There are patients with small benign vocal folds lesions who are refractory to voice therapy and vocal hygiene and yet are not with bad enough voice quality to justify surgical excision and its associated side effects. Objective: to assess the role of steroid injection on VHI-10 in benign vocal folds lesions. Method: This study is a retrospective assessment of Voice Handicap Index-10 before and after the steroid injection to the vocal folds benign lesions in professional voice users for the period July 2014- July 2018. The billing code for laryngeal injection procedure was used to identify the patients. The following patient data were collected: demographics (age/gender/Profession); previous vocal folds surgery; date of steroid injection; length of follow-up and pre and post procedure VHI-10. Results: 20 patients were included. The post steroid injection voice outcome was variable between significant improvement in VHI-10 and no improvement. There is no worsening in VHI-10 Conclusion: Steroid injection for vocal fold benign lesions is a safe and well tolerated procedure. We believe it can be considered as a management option for the benign vocal fold lesions or to delay the surgical intervention in the professional voice users.
57 SCIENTIFIC SESSIONS
Measuring Upper Aerodigestive Tract Forces during Operative Laryngoscopy
Peter Kahng, BA; Xiaotin (Dennis) Wu, BSE; Aravind Ponukumati, BSE; Eric Eisen, MD; Christiaan Rees, PhD; David Pastel, MD; Ryan Halter, PhD; Joseph Paydarfar, MD
Introduction: Difficulty in performing laryngoscopy depends on patient, treatment, and equipment factors. In this pilot study we present a unique system for measuring forces generated during operative laryngoscopy. Understanding these forces and correlating with patient factors may help to predict complications, contribute to improved laryngoscope design, and add to understanding of upper aerodigestive tract tissue deformation. Methods: Patients undergoing diagnostic or therapeutic laryngoscopy were recruited. Patient characteristics included airway anatomic features, indication, and prior treatments. A 3D printed force sensor array designed to measure forces at points of contact at the maxilla, oral cavity, oropharynx, and larynx was fashioned to a Lindholm operating laryngoscope. A suspension arm force sensor was placed over the chest. Results: Eight patients aged 35 to 83 were recruited, 2 females and 6 males. Indications included respiratory papilloma (1), vocal cord lesion (2), cancer staging (4), laser cancer resection (1). Surgery duration was 10 - 156 minutes. Maximum force at points of contact: laryngoscope 32 – 73 pound-force (lb- f), maxilla 34 – 59 lb-f, chest 5 – 15 lb-f. Time constant for force decay over first 2.5 minutes of suspension laryngoscopy: laryngoscope and maxilla 50 – 155 seconds, chest 41 –154 seconds. Conclusions: This is the first study to demonstrate that forces generated during operative laryngoscopy can be accurately measured and at multiple points of laryngoscope contact. There is a wide range in measured force where the scope contacts the maxilla, oral cavity, oropharynx, larynx, and chest. Correlation of these measurements to patient factors will be explored.
The Prevalence of Cognitive Impairment in Laryngology Treatment Seeking Patients
Andree-Anne Leclerc, MD; Amanda I. Gillespie, PhD; Stasa D. Tadic, MD, MS; Libby J. Smith, DO; Clark A. Rosen, MD
Background: The incidence of cognitive impairment (CI) in the elderly general population is 10- 20%. The incidence of CI in elderly laryngology treatment seeking population is unknown and CI may impact decision making for elective medical/surgical treatment and negatively impact the outcome of voice/swallowing therapy. Objective: We sought to determine the prevalence of CI in elderly patients, who are seeking laryngology care and to evaluate the feasibility of administering a cognitive screening instrument. Methods: One-hundred-fifty patients (>65 years) without a previous diagnosis of CI who were seeking laryngology evaluation were administered the Montreal Cognitive Assessment test (MoCA©). Results: Twenty-five percent of our participants obtained a score diagnostic for at least mild CI. The results showed a correlation between the MoCA© scores and: 1) the time needed to complete the test (rs -0.65), 2) the age of participants (rs -0.43) and 3) the level of education (rs 0.33). There were no differences between gender (p 0.633), alcohol consumption (p 0.801), or use of medications that can affect cognition (p 0.398). Conclusion: One in four elderly laryngology patients were found to have undiagnosed cognitive impairment. We believe that this finding warrants consideration for CI screening for these patients being considered for elective surgery and voice therapy. Treatment consideration in this population may benefit from further family involvement in decision making.
58 SCIENTIFIC SESSIONS
Utility of Audiometry in the Evaluation of Patients Presenting with Dysphonia
Justin Ross, DO; David Bigley, BS; William Valentino, MS; Alyssa Calder, BS; Sammy Othman, BA; Brian McKinnon, MD; Robert T. Sataloff, MD, DMA
Introduction: Hearing loss has been implicated in dysphonia secondary to voice misuse, although the data supporting an association are scant. Determining the prevalence of hearing loss in patients with dysphonia and related self-perception of vocal handicap may clarify the efficacy of routine audiometry in the evaluation of patients with dysphonia. Methods: This is a retrospective chart review of all new patients (n=423) who presented to the primary investigator’s office between 2015 and 2018 for dysphonia. Main outcomes measures include prevalence, type and severity of hearing loss, and Voice Handicap Index 10 (VHI-10). Chi-square, linear regression, and Independent Kruskall-Wallis Test and Mann-Whitney U-Test were used to compare categorical variables, continuous variables, and categorical versus continuous variables, respectively Results: Of the 423 subjects (mean age = 49.4, Female 61.1%, Male 38.9%) included in this study, 21.0% had hearing loss (>25 db), which was similar to national census data (22.7%). Bilateral hearing loss (11.6%) was more common than unilateral (9.9%). Average VHI-10 (n=301) was 18.3 (SD=10.3. Presence of hearing loss (>25 db) was correlated positively with increasing age (p=0.000), but not VHI-10 (p=0.069). When comparing the linear relationship of worse ear pure tone averages and VHI-10 while selecting for patients under 65 years, a significant correlation was found (p=0.031). Conclusions: Abnormal VHI-10 scores may suggest a concurrent hearing loss in patients under 65.
Validation of a Simplified Patient-Reported Outcome Measure for Voice
Matthew Naunheim, MD, MBA; Jennifer Dai, BS; Benjamin Rubinstein, MD* Leanne Goldberg, MS, CCC-SLP; Mark S. Courey, MD
Objectives: Though patient-reported outcome measures (PROMs) can be useful for assessing quality of life, they can be both needlessly complex and cognitively burdensome. In this study, we aimed to prospectively design and validate a simple patient-reported voice assessment measure on a visual analogue scale (VAS) and compare it with the Voice Handicap Index (VHI-10). Methods: An abbreviated PROM was designed by a team of otolaryngologists, speech pathologists, patients, and a statistician that consisted of four VAS questions related to (1) overall bother regarding voice, (2) physical function, (3) functional issues, and (4) emotional handicap. All English- speaking patients presenting to an academic voice center for a voice complaint were included. VHI-10 and demographics were recorded. Internal consistency and validity were assessed using Cronbach’s alpha, linear regression, and factor analysis, which was also used for variable reduction. Results: 139 patients were enrolled. 94% of patients reported understanding the survey. Internal consistency for the 4 questions was high (alpha 0.94). Factor analysis reduction demonstrated the one latent variable explained 84.6% of total variance, and that one question (“How much does your voice bother you?”) was most closely correlated with this latent variable (correlation 0.97). Therefore, this single question was compared to the overall VHI-10, and correlation was strong (0.76, p<0.0001), further verifying construct validity. Age, gender, and diagnosis were not associated with either the VAS or VHI-10 tool. Conclusion: The use of a single-question VAS question for assessment of voice-related quality of life is feasible, valid, and expedient. It may offer advantage.
59 SCIENTIFIC SESSIONS
Mental Health and Dysphonia: Which Comes First, and Does That Change Care Utilization?
Victoria Jordan, MD; Scott Lunos, MS; Gretchen Seiger, BA; Keith J. Horvath, PhD; Seth M. Cohen, MD, MPH; Stephanie Misono, MD, MPH
Background: Voice patients have a high prevalence of distress, but it is unknown to what extent distress precedes or follows voice disorder diagnoses. Understanding this difference is important for optimizing care for patients with voice disorders. Objectives: (1) Measure prevalence of mental health (MH) diagnoses in voice patients, (2) determine proportions receiving MH vs. voice diagnoses first, and (3) compare voice-related diagnoses and care utilization in these groups. Methods: Patients with voice and MH diagnoses were identified using ICD-9/10 codes in a large health system data repository from 1/2005-7/2017. Sociodemographics, comorbidities, MH and voice- related diagnoses and dates, and voice-related care utilization were analyzed using descriptive statistics and multivariable regression modeling. Results: 24,672 patients had ≥1 voice diagnosis. Of these, 47% (n=11,419) had ≥1 MH diagnosis, compared to 14% in the overall repository (p <0.0001). Among those with both voice and MH diagnoses, 63% (n= 7,251) had MH diagnoses prior to voice diagnoses, compared with 37% with a voice diagnosis first (p <0.0001). The latter group received more specific voice-related diagnoses (e.g., laryngeal cancer (OR 4.27), benign laryngeal neoplasm (OR 1.60)) and were more likely to see an otolaryngologist than those receiving MH diagnoses first (p <0.0001). Conclusions: Nearly half of patients with voice diagnoses also had MH diagnoses, and most received a MH diagnosis first. Patients who receive MH diagnoses first appear to have a different path through the voice health care system than those who receive voice diagnoses first.
Health Conditions Associated with Chronic Voice Problems in the United States
Aaron M. Johnson, MM, PhD, CCC-SLP; Charles Lenell, MS
Introduction/Purpose: Although many health conditions have been associated with the development of a voice disorder, many comorbidities that interact with the vocal mechanism have not been evaluated. The purpose of this research study was to evaluate the relationship between chronic voice problems and health conditions that potentially interact with the vocal mechanism. Methods/Procedures: Using the 2012 National Health Institute Survey data, we evaluated if individuals who reported swallowing, respiratory, hormonal, or activity-related problems were more likely to report a chronic voice problem (lasting over 7 days). We used multivariate logistic regression analyses to evaluate the likelihood of reporting a chronic voice disorder given the other health conditions controlling for both age and sex. Results: Individuals were more likely to report a voice problem lasting over 7 days if also reporting a swallowing problem (27x more likely), respiratory problem (2x more likely), hormonal problem (2x more likely), or activity-related problem (6x more likely). These results indicate a positive association between these health conditions and chronic voice problems. Conclusions: Individuals who have swallowing, respiratory, hormonal, or activity-related health conditions may be at increased risk for developing a chronic voice problem. These individuals may benefit from voice screening and vocal health education in their standard of care.
60 SCIENTIFIC SESSIONS
Current Opioid Prescribing Patterns after Microdirect Laryngoscopy
Molly Naunheim Huston, MD; Rouya Kamizi; Tanya K. Meyer, MD Albert L. Merati, MD; J. P. Gilberto, MD
Background: The prevalence of opioid use has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure; postoperative pain medicine management is likely quite variable. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-seven of 205 registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed a median of 10 MDLs per week. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 5% of surgeons never prescribe opioids. Midwestern practitioners were more likely to prescribe 10 or less tablets, significantly less than surgeons in other regions (p<0.02). Ninety-one percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non- opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: Opioid stewardship should be a consideration for MDL. In this study, over 90% of practicing physicians are prescribing opioids after MDLs, though many are also prescribing non-opioid analgesia.
POSTER PRESENTATIONS
A Case of Laryngeal Injury after Gunshot to Left Temple
Abhay Sharma, MD; Katherine Hall, MD; Michael Carmichael, MD; Matt Mifsud, MD; Sepehr Shabani, MD
Introduction: The incidence of laryngeal trauma is relatively rare in the civilian setting. As a result, the otolaryngologist plays a key role in its management given the need for rapid and definitive action. Methods: Here we present a case report of a 32 year old male who was shot in the left temple, and subsequently had the bullet lodged in his right supraglottis. Results: Exam findings for laryngeal trauma can be deceiving, and despite minimal concerning symptoms at presentation, the decision was made to proceed emergently to the OR. The bullet was extracted with suspension laryngoscopy, and the patient recovered well postoperatively. Conclusions: Astute recognition and proper diagnosis by the otolaryngologist can ultimately determine the outcome for a patient with laryngeal injury.
61 SCIENTIFIC SESSIONS
A Case Series of Posterior Glottic Stenosis Type I
Nima Vahidi, MD; Lexie Wang, MD; Jaime Moore, MD
Introduction: Posterior glottis stenosis (PGS) is classified into four subtypes. Type I involves an interarytenoid scar band between the vocal folds that is separate from the posterior interarytenoid mucosa. PGS type I is an uncommon clinical entity and the current literature is limited. Methods: Our study examines, three cases of PGS type I who presented to our otolaryngology clinic. We reviewed demographics information, comorbidities, intubation details, and post-operative course with photo-documentation of all cases. Results: This report comprises experience from three patients with PGS type 1 with surgical intervention. All patients were females between the ages of 47-64 years old. Two patients reported dysphonia pre-operatively, which improved following surgery, and all patients had an improvement in vocal fold motion on follow-up laryngoscopy. One patient remained tracheotomy dependent due to underlying neuromuscular disorder despite lysis of the scar band. Conclusion: Within our case series, one patient was not successfully decannulated; meanwhile, the two with dysphonia reported an improvement in voice quality following surgery. This study provides a review of current literature and our experiencing managing PGS type I.
A Novel Approach for Treating Vocal Fold Mucus Retention Cysts: Awake KTP Laser Assisted Cyst Drainage and Marsupialization
William Z. Gao, MD; Sara Abu-Ghanem, MD; Lindsey S. Reder, MD; Milan R. Amin, MD Michael M. Johns III, MD
Objective: To describe and introduce a novel option for treating vocal fold mucus retention cysts. Background: Vocal fold mucus retention cysts are benign lesions that arise secondary to obstructed mucus glands. Often they present with consequent dysphonia, which serves as an indication for treatment. The standard of treatment has traditionally centered on microlaryngologic surgery under general anesthesia with en bloc removal or marsupialization of the cyst. We present an alternative treatment that we utilized in awake patients under local anesthesia. Methods: Retrospective chart review of four cases was performed. Results: Four patients were diagnosed with vocal fold mucus retention cysts based on videostroboscopy and offered KTP laser treatment either as primary intervention or secondary after previous surgery. Reasons included older age and desire to avoid surgery/general anesthesia. Patients underwent awake KTP laser assisted drainage and marsupialization of their vocal fold mucus retention cysts, which were well tolerated. Follow-up was obtained ranging from 2 to 10 months without evidence of recurrence. Improvement of vocal quality was noted in all patients at follow-up, with mean pre-procedural VHI-10 of 20 improving to mean post-procedural VHI-10 of 8.25. Conclusions: Awake KTP laser treatment serves as a potential modality for addressing vocal fold mucus retention cysts in selected patients with favorable outcomes. This approach may be especially useful in the geriatric population and in patients who wish to avoid or are at high risk for surgery under general anesthesia.
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A Novel, Simple, Surgical Technique for Endoscopic Laryngeal Suturing and Securing Laryngeal, Subglottic, and Tracheal Stents
Edward Westfall, MD; Steven Charous, MD
Background: Securing laryngeal, subglottic and tracheal stents to prevent migration can be technically difficult and a barrier to their utilization. Various techniques to secure stents have been developed over the years, none of which have gained large popularity. Objectives: To describe a novel surgical technique to secure endoscopic stents and prevent their migration. Summary of Technique: A hypodermic needle loaded with a suture is inserted transcutaneously through the airway and stent. Endoscopic visualization permits the surgeon to grasp the suture with forceps. A second transcutaneous puncture site is performed attached to a 10cc syringe (plunger removed) with a blue tip suction within the empty syringe – creating an air tight suctioning tool. The intraluminal end of the suture is gently introduced into the eye of the newly introduced needle and quickly travels into the 10cc syringe because of the suction assist. Both extracorporeal ends of the suture are sutured together subcutaneously. Results: This technique has been employed on 3 patients 5 times with consistent, successful retention of the silicone stent. A laboratory model evaluated optimal sutures for various gauge needles. Braided sutures performed optimally in contrast to monofilaments such as nylon and prolene, which performed poorly. Conclusions – We present a novel, simple, surgical technique to secure stents in the larynx and subglottis. This technique can be applied to other clinical situations in which endoscopic suturing to secure grafts, stents or keels is needed.
A Recipe for a Successful Awake Tracheostomy
Shayanne A. Lajud, MD; Jaime Aponte, BS; Jeamarie Pascual, MD, MPH; Miguel Garraton, MD; Antonio Riera, MD
Background/Objectives: Awake tracheostomies (AT) are indicated for patients with airway obstruction when other methods of securing the airway have failed or are inappropriate. Scant protocols have been described to address the challenge of performing a tracheostomy in a conscious patient. The purpose of this study is to describe a standardized AT protocol for the management of a difficult airway. In addition, we review the most common indications as well as overall outcomes. Methods: A retrospective chart review was performed using the University of Puerto Rico’s Otolaryngology – Head and Neck Surgery surgical database. All patients who underwent an AT between January 2011 and December 2015 were included in the study. Institutional review board approval was obtained for this study. Results: A total of 181 patients underwent an AT during the study period. The majority of patients were males (87.8%) with a median age of 59 years of age (4 – 88 years). The most common indication was cancer (78.5%). The next most common overall indications were deep neck space abscesses (7.2%) and subglottic/tracheal stenosis (5%). The most common subsite of cancer was supraglottis (24.6%), followed by oropharynx (21.%) and glottis (19.0%). Among the deep neck space infections, retropharyngeal abscesses were the most common indication (38.5%). The immediate complication rate was 1.7% with a successful cannulation rate of 99.4%. Conclusions: Our AT protocol offers a safe method to secure the airway with minimal complications. To our best knowledge, this study represents one of the largest samples of AT with its outcomes.
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A Unique Presentation and Etiology of Paradoxical Vocal Fold Motion
Matt Purkey, MD; Taher Valika, MD
Background: Paradoxical vocal fold motion (PVFM) describes the episodic, unintentional adduction of the vocal folds on inspiration and abduction on expiration. Defining the underlying etiology is vital for successful therapy. While commonly seen in teenaged females, we describe a unique case of PVFM in a newborn, presenting as the diagnostic symptom for a previously unidentified neuromuscular disorder. Methods: Case presentation. Results: An otherwise healthy female born at 40 weeks developed episodes of apnea triggered by stimulation on day of life 1. Each episode began with high-pitched crying and progressed to apnea, cyanosis, and bradycardia. These episodes would spontaneously resolve after several minutes. Flexible laryngoscopy demonstrated sustained paramedian position of the vocal folds while the patient was symptomatic. Laryngoscopy and bronchoscopy were unrevealing. Imaging was negative for neurologic etiology. Genetic testing was subsequently performed which revealed Paramyotonia Congenita (PC) caused by a previously undescribed mutation (C2110A>G). Conclusion: We present a unique case of PVFM resulting in the diagnosis of an underlying neuromuscular disorder. PC is caused by mutations of the sodium channel gene SCN4A, which results in prolonged intracellular flow of depolarizing current after muscle firing and failure to regenerate a resting membrane potential. Patients traditionally present with decreased mobility in their arms or face. Our patient was found to have a previously unrecognized mutation in SCN4A, potentially leading to its atypical presentation and diagnosis. This unique presentation stresses the importance of comprehensive history and physical exams and multidisciplinary collaboration.
Acute Airway Obstruction from Rapidly Enlarging Reactive Myofibroblastic Lesion of the Larynx - Limitations of In-Office Treatment
Yin Yu, MD; Victoria Yu, BA; Michael J. Pitman, MD
Introduction: The nomenclature of space-occupying inflammatory lesions of the larynx is imprecise, and pathologic analysis is often inconclusive. A variety of such lesions have been described in case reports and series, however authors have not described the potential for or outcomes of in-office treatment. Methods: We present a case of a 70-year-old male with a benign appearing lesion of the glottis that, after in-office laser treatment, swiftly progressed to obstruct the airway necessitating emergent surgical intervention. Results: The patient presented with an anterior vocal fold lesion with characteristics consistent with a polyp or granuloma. Initial biopsy diagnosed a vocal fold polyp with inflammation. He underwent uneventful in-office KTP laser ablation but presented to the emergency department two weeks later with dyspnea. Laryngoscopy confirmed massive proliferation of the lesion with near-complete airway obstruction, and emergent microlaryngoscopy was required for debulking. Pathologic analysis revealed extensive inflammation with myofibroblastic proliferation consistent with pseudotumor or inflammatory myofibroblastic tumor. The patient underwent repeat microlaryngoscopy with CO2 laser excision when the lesion proceeded to enlarge despite medical therapy and intralesional steroid injections. Final histopathology and immunohistochemistry work-up favored a reactive post-operative inflammatory lesion. Conclusions: Definitive diagnosis of progressive inflammatory laryngeal lesions can be challenging. In-office laser treatment may exacerbate the inflammation and stimulate exuberant progression. A low threshold for decisive operative intervention must be maintained when encountering aggressive inflammatory lesions.
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Adult Laryngeal Trauma in United States Emergency Departments
Elisa Berson, MD; Elliot Morse, BS; Jonathan Hanna, BS; Saral Mehra, MD, MBA
Objectives: Laryngeal trauma involves potentially life-threatening injuries. Yet, studies are often limited in scope due to few cases at a single institution. This study aims to classify the prevalence and characteristics of laryngeal trauma amongst adults in emergency departments (EDs) throughout the United States. Methods: A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) database was performed on visits reported during 2009-2014. The analysis focused on ED encounters for adult patients with a primary or secondary diagnosis of laryngeal trauma as determined using relevant International Classification of Diseases, Ninth Revision codes. Weighted estimates for patient and facility characteristics were obtained, and length of stay and procedures performed in the ED were assessed. Results: A weighted total of 5836 patients was identified. The average age was 42.1, and laryngeal trauma was predominant amongst men (83.9%). 12.6% incidents involved motor vehicle accidents, and 38.9% of patients were treated at Level I trauma centers. Of the patients in the cohort, 1% died in the ED, and 1.3% subsequently died in the hospital. 59.4% of patients were admitted to the hospital. Laryngoscopy (42.7%), tracheotomy (35.8%), and laryngeal repair (19.8%) were the most common procedures of inpatients. An increased injury severity score was associated with increased length of stay and cost for inpatients (p<0.01). Incidence remained consistent over time (p<0.01). Conclusions: This represents the largest analysis of laryngeal trauma. Analysis of trends from 2009 to 2014 demonstrates continuity in the utilization of EDs by patients with laryngeal trauma.
Airway Obstruction Caused by Redundant Postcricoid and Aryepiglottic (AE) Mucosa in Patients with Obstructive Sleep Apnea (OSA): Cases Series and Review of the Literature
Jee-Hong Kim, MD; Lindsay Reder, MD; Tamara N. Chambers, MD; Karla O’dell, MD
Objectives: (1) Present 2 rare cases of redundant postcricoid and AE mucosa causing airway obstruction in patients with OSA. (2) Review literature for this specific disease entity. Methods: Case Series/Literature Review Two patients, both with history of OSA, obesity and gastroesophageal reflux disease presented with inspiratory and expiratory stridor and worsening dyspnea. The first patient required nocturnal BiPAP for severe hypoxia pre-operatively. Flexible laryngoscopy revealed a Shar-Pei dog like appearance of the supraglottic mucosa and redundant AE folds and postcricoid tissue creating flaps that ball-valve obstruct with inspiration. The redundant tissue was resected using the CO2 laser and imbricated with suture. The pathology revealed benign squamous epithelium. A follow-up procedure was performed 3 months later to further debulk using “pepper-pot” laser photoreduction with complete resolution of dyspnea. The second patient presented with severe airway obstruction requiring tracheostomy. He was found to have redundant AE fold and postcricoid mucosa, also ball valving and obstructing the glottis. The patient went through CO2 excision followed by laser photoreduction prior to successful decannulation. Discussion: The literature reviewed yielded a small pool of case reports. Our case series supports the hypothesis that pharyngeal negative pressure secondary to OSA contributes to increasing transluminal volume of AE folds and postcricoid tissues. Conclusions: This rare disease entity can present with acute airway obstruction and can be safely managed with endoscopic interventions. Our case series further support OSA as an underlying cause of this disease.
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An Updated Approach to In-Office Balloon Dilation for Nasopharyngeal Stenosis: A Case Report
Jeffrey Straub, MD; Laura Matrka, MD
Objective: Describe a modified approach to in-office balloon dilation for nasopharyngeal stenosis after chemoradiation for T2N2bM0 tonsil malignancy. Methods: The patient is seated upright and nasal cavities are sprayed with oxymetazoline/lidocaine solution. A 28-French nasal trumpet coated in viscous lidocaine is inserted in one side and a flexible laryngoscope in the other. A controlled radial expansion balloon dilator is passed through the trumpet and positioned within the stenotic area under visualization. The balloon is inflated serially until appropriate resistance is met, followed by deflation and removal. The nasal trumpet and scope are removed, concluding the procedure. This is repeated at 2- to 4-week intervals. Results: The patient presented with nasal obstruction, anosmia, ageusia, and hyponasal speech. There was a 6-7 mm nasopharyngeal stenosis and severe trismus related to oropharyngeal scar banding, making nasal or oral intubation impossible. 3 dilations were performed at 0, 2, and 6 weeks, initially to 8mm and ultimately reaching 18 mm. There was good tolerance with no complications and no loss of patency between visits. The patient noticed significant improvement in nasal breathing, taste, smell, and quality of speech. Trismus also improved by 3 mm, although it is unclear if this is related to the dilations. The patient was cleared for nasotracheal intubation rather than elective tracheostomy for an upcoming hernia repair. Conclusion: Placement of a nasal trumpet for balloon passage and utilization of a single laryngoscope insertion distinguish our technique from previously-described methods, mitigating unnecessary trauma and improving patient tolerance of this potentially life-saving intervention.
Bilateral Type I Laryngoplasty for Presbylaryngis: Assessing the Depth and Location of Medialization
Sarah Tittman, MD; Mark R. Gilbert, MD; David O. Francis, MD, MS; Kimberly N. Vinson, MD; Alexander Gelbard, MD; C. Gaelyn Garrett, MD, MMHC
Background/Objective: Presbylaryngis remains a common cause of dysphonia in our aging population, and medialization laryngoplasty can improve glottic closure and vocal quality by correcting the vocal fold bowing. While bilateral type I laryngoplasties have been shown to be safe and effective, the depth and location of maximal medialization have not previously been described. Methods: A retrospective review of all bilateral type I laryngoplasties between March 2007 and February 2017 at our institution’s voice center was performed. Clinical records and operative reports were reviewed with specific attention paid to silastic implant height and the location of maximal medialization. Results: There were 16 patients in the study population which included 11 males (68.8%) and 5 females (31.2%) with an average age of 74.75 (range 59 to 87) years. The average height of each implant was 4.27 (+/- 0.67) mm, with a range from 3-6 mm. The average location for maximal medialization from midline was 9.98 (+/-3.02) mm, and the average location from the inferior border of the thyroid cartilage was 3.31 (+/- 1.09) mm. The point of maximal medialization from midline in males (10.90 +/- 3.03 mm) is more posterior than females (7.95 +/- 1.8 mm) where p=0.008. There were no cases of post-operative hematoma, respiratory complications, or worsened dysphagia. Conclusions: Bilateral type I laryngoplasty offers patients a safe option in the treatment of symptomatic vocal fold bowing, and the tendency is to medialize more inferiorly to achieve infraglottic fullness. For many patients, the left and right implants vary in size and location, demonstrating the value of intraoperative customization of silastic implants.
66 SCIENTIFIC SESSIONS
Botulinum Toxin A (BoNT-A) for the Treatment of Motor and Phonictics
Nikita Kohli, MD; Andrew Blitzer, MD, DDS
Background: Motor and phonic tics are treated with neuroleptic agents or BoNT. Data regarding BoNT treatment is scarce and has yielded equivocal results. We report three cases of motor and phonic tics successfully treated with BoNT-A. Methods: Case series with chart review Results: A 28 year-old male presented with refractory Tourette’s that progressed into loud screams and coprolalia causing depression and inpatient psychiatric care. He was treated with 1.25 units (u) BoNT-A to each thyroarytenoid titrated to 3.75u with a 27-gauge Teflon-coated monopolar EMG needle. He rated himself as “much better” and experienced a 50 percent reduction in tic loudness. Social impairments and tic intensity decreased from marked-severe to moderate on the Yale Global Tic Severity Scale (YGTSS.) A 26 year-old male presented with motor and phonic tics including grunting and coughing. He received 2.5u to the facial musculature and 2.5u to each supraglottic musculature via a transthyrohyoid membrane approach under fiberoptic visualization. He experienced reduction in the tic frequency, intensity, and interference with daily life on the YGTSS. A 14 year-old female with Tourette’s experienced phonic tics including loud screams. She received 1u to each thyroarytenoid titrated up to 2.5u with a decrease in tic loudness. Conclusions: We present three patients with validated subjective decreases in tic severity including the first report to our knowledge of successful treatment of phonic tics with a supraglottic injection. Results suggest a novel approach in treatment of phonic tics and bolster data regarding safe and effective use of BoNT for tics.
Contribution of Voice-Specific Health Status on General Quality of Life
Elliana Kirsh, BM, BS; Thomas Carroll, MD; Jennifer J. Shin, MD, SM
Objective: National initiatives and funding agencies may deprioritize voice disorders relative to conditions such as malignancy or cardiac disease. It is unknown whether the impact of voice problems is subsumed by other potentially more serious disease states. Our objective was to quantify the extent to which voice contributes to general health status when adjusting for concurrent, more life-threatening comorbidities. Methods: Adults presenting to a tertiary care academic center with a primary voice complaint completed the Voice Handicap Index-10 (VHI-10) and the Patient-Reported Outcomes Measurement Information System 10-item global health instrument (PROMIS). Medical comorbidities were categorized according to the Deyo modification of the Charlson Comorbidity Index (CCI). Multivariate regression models were constructed to compare the concurrent predictive validity of voice and comorbid conditions on general health status scores. Results: Mean scores were 11.9 (95%CI 10.8-13.0) for VHI-10, and 49.1 (95%CI 48.2-50.0), 51.6 (95%CI 50.7-52.5), 3.4 (3.3-3.5) and 3.7 (3.6-3.8) for PROMIS physical and mental health domain T- scores, and the global and social items, respectively. The most prevalent comorbidities were pulmonary disease, malignancy, and connective tissue disorders. In all multivariate analyses, voice-related quality of life was a significant predictor of general health status even when adjusting for comorbid conditions (physical health β= -0.051, p<0.001; mental health β= -0.042, p<0.001; global item β= -0.036, p<0.001; social item β= -0.063, p<0.001). Conclusions: Voice health has a significant, multi-dimensional impact on general health status, which is not subsumed by the presence of comorbid conditions.
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Cricoarytenoid Joint Abscess Associated with Rheumatoid Arthritis
Megan Foggia, MD; Henry T. Hoffman, MD
Background: The cricoarytenoid joint (CAJ) is a diarthrotic joint that, when affected by rheumatoid arthritis (RA), may present with stridor, dysphonia, and dysphagia. The endoscopic findings of edema of the arytenoid and aryepiglottic folds, as well as impaired vocal cord mobility, have been attributed to acute inflammation of the joint, with rare reports of septic involvement. Although series from the 1960s suggest that 26% to 31% of patients with RA have CAJ involvement, contemporary medical management of RA has markedly decreased laryngeal involvement. We report management of a rare case of a CAJ abscess in the setting of RA. Case: A 68 year-old woman with RA was hospitalized for epiglottitis, which resolved under medical therapy. Subsequent evaluation at our institution revealed an adequate but diminished airway associated with bilateral vocal cord edema and hypomobility of the left vocal cord. Four months later, she was re-admitted to her local hospital with increased odynophagia, dysphagia, and shortness of breath. CT imaging showed a new ring-enhancing lesion of the lateral aspect of the right CAJ. Following transfer to our institution, transnasal laryngoscopy showed a swollen, immobile right arytenoid. She underwent micro- direct laryngoscopy with drainage of a right cricoarytenoid abscess and tracheostomy. Gradual resolution of the edema and restoration of vocal cord mobility permitted decannulation, with a stable airway and good voicing identified at her most recent follow up two years after the surgery. Conclusions: This case demonstrates the first published report in the CT era of successful management of a cricoarytenoid joint abscess arising in a patient with chronic rheumatoid arthritis.
Delayed Laryngeal Implant Infection and Laryngocutaneous Fistula: A Rare Complication after Medialization Laryngoplasty
Joseph B. Meleca, MD; Paul C. Bryson, MD
Background: Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula. Methods: Case report. Results: A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability. The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression. Conclusions: Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.
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Development of an In Vitro Model of Rat Vocal Fold Epithelium
Keisuke Kojima, MD; Tatsuya Katsuno, PhD; Masanobu Mizuta, MD, PhD; Ryosuke Nakamura, PhD; Yo Kishimoto, MD, PhD; Yasuyuki Hayashi, MD; Masayoshi Yoshimatsu, MD; Shinji Kaba, MD; Hideaki Okuyama, MD; Toru Sogami, MD; Hiroe Ohnishi, PhD; Atsushi Suehiro, MD, PhD; Tomoko Tateya, MD, PhD; Koichi Omori, MD, PhD; Ichiro Tateya, MD, PhD
Background/Objectives: The vocal fold epithelium acts chiefly as a functional barrier. It is important to create an in vitro model of epithelial cells in order to provide a robust system in which to test novel treatments of vocal fold injury. The purpose of the current study is to establish an in vitro model of rat vocal fold epithelium for further genetic research to restore vocal fold epithelium barrier function after injury. Methods: Rat larynges were enzymatically treated to isolate vocal fold epithelial cells and submucosal fibroblasts. After 7-10 days, they were passaged onto cell culture inserts and measured transepithelial electrical resistance (TEER) for the evaluation of barrier function. Additionally morphological analysis and properties of in vitro vocal fold epithelium and submucosa were performed by using electron microscopy, staining with epithelial and extracellular matrix (ECM) markers. Results: Observation with an electron microscope showed an epithelial cell multilayer and the epithelial cell markers and the tight junction proteins were expressed in the epithelium. The staining of submucosal layer showed the presence of fibronectin and hyaluronic acid, which was similar to that in the vocal fold tissue. TEER showed increase on the fourth day after passages and then became stable at around 2000 to 3000Ω*cm2 Conclusions: In vitro model of rat vocal fold epithelium was successfully established in this study. This model will contribute to better understanding of the mechanism of vocal fold injury and to develop novel treatment.
Endoscopic Lateralization of the Vocal Fold
Ihab Atallah, MD, PhD; Paul F. Castellanos, MD
Objective: Vocal fold paralysis in adduction can result in dyspnea. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve respiratory function in this setting. These techniques require an open approach or specific instruments. The authors describe an original vocal fold lateralization technique performed exclusively via an endoscopic approach. Methods: Patients with dyspnea secondary to unilateral or bilateral vocal fold paralysis in adduction were included in our study. In all patients, a transoral lateralization of the vocal fold was performed through exclusive endoscopic approach under laryngosuspension. A supraglottic laryngotomy is performed with CO2 laser with dissection in the paraglottic space as far as the inner perichondrium of the thyroid lamina and a lateralization suture is passed through the thyroid cartilage to the vocal process of the vocal fold with the desired tension allowing lateralization of the arytenoid and corresponding vocal fold under direct visual control. The supraglottic laryngotomy is finally closed by endoscopic sutures. Results: Twenty patients were included in our study. Twenty percent of cases had a tracheostomy and were successfully decannulated. All patients without a tracheostomy had significant improvement of their respiratory symptoms on the Dyspnea Index (mean delta =15.6; P value < 0.001). Conclusion: Our transoral lateralization technique allows enlargement of the glottic aperture in case of laryngeal dyspnea secondary to vocal fold paralysis in adduction. This technique optimally preserves laryngeal structures, especially the mucosa. It is reproducible and reliable for all laryngologists experienced in reconstructive transoral laser microsurgery.
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Exercise-Induced Vocal Fold Dysfunction: A Quality Initiative to Improve Timely Assessment and Appropriate Management
Emma S. Campisi; Jane Schneiderman, PhD; Theo Moraes, MD, PhD; Paulo Campisi, MD
Background: Exercise-induced vocal fold dysfunction (EI-VFD) affects 2-3% of the general population and 5.1% of elite athletes. Symptoms arise during high-intensity exercise and resolve at rest. EI- VFD is often misdiagnosed as exercise-induced asthma as both conditions present with dyspnea, chest tightness and cough. The purpose of this quality initiative was to identify patient characteristics that predict a higher likelihood of EI-VFD, streamline referrals for exercise-endoscopy testing and avoid unnecessary medications. Methods: A retrospective chart review included patients referred to a pediatric tertiary center between 2013 and 2018 for suspected EI-VFD. Data was collected from the patient chart and referral letters included age, sex, physical activity, medications, symptoms, and results of pulmonary and cardiac function tests. Results: Between 2013 and 2018, 35 patients (9 males and 26 females, aged 5-18 years) were referred. Only 18 patients developed symptoms during exercise. The majority were female (15/18), older than 10 years (18/18) and were involved in competitive sports (16/18). Stridor was the most common patient complaint (24/35) and many reported anxiety and high stress (15/35). The majority (63%) were previously treated with asthma medication. Pulmonary and cardiac function testing was not predictive of EI-VFD. Conclusions: EI-VFD is typically present in adolescent females involved in competitive sports. Anxiety and high stress was commonly noted. The majority were treated with asthma medication even though pulmonary function testing was normal. Recognition of this patient profile should improve timely access to appropriate diagnostic assessments, and avoid unnecessary medical treatment.
False Vocal Fold (FVF) Botulinum Toxin Injection for Central Nervous System (CNS) Related Supraglottic Spasticity Causing Severe Vocal Strain: A Preliminary Study
Victoria Yu, BA; Yin Yu, MD; Michael J. Pitman, MD
Background: Several previous case reports and series have described the use of FVF botulinum toxin injection to treat muscle tension dysphonia, ventricular dysphonia, and adductor spasmodic dysphonia. We propose a new application in patients with dysphonia from laryngeal spasticity due to CNS dysfunction. Methods: We present five patients who received in-office FVF botulinum injections for recalcitrant dysphonia and severe supraglottic hyperfunction in the context of CNS insult. We report post- injection outcomes, including change in perceived voice using subjective evaluation and/or validated dysphonia rating scales, as well as visualized change in supraglottic hyperfunction on videostroboscopy. We also dissect the rationale and technical considerations for this approach. Results: The underlying CNS diseases in these patients included Parkinson’s disease, multiple cerebrovascular accidents, non-specific upper motor neuron disease, and tardive dyskinesia. All five patients reported improvement in subjective perceived voice and ease of phonation. Of the three patients who underwent pre- and post-injection videostroboscopy, two demonstrated decreased supraglottic compression after injection. Four of the five patients had previously failed trials of true vocal fold botulinum toxin injection but attained benefit from FVF injection. Conclusions: We report that FVF botulinum toxin injection improves dysphonia in patients with supraglottic spasticity in the setting of CNS disease. This technique could be a valuable adjunct therapy to primary treatment of patients’ CNS conditions. Knowledge accrued with treatment of more patients will help us to refine dosing and to understand the treatment’s limitations.
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Flexible VS. Rigid Laryngoscopy: A Randomized Crossover Study Comparing Patient Experience
Bhavishya S. Clark, MD; William Z. Gao, MD; Caitlin Bertelsen, MD; Lindsay S. Reder, MD; Edie R. Hapner, PhD; Michael M. Johns III, MD
Objectives: To compare various aspects of the patient experience for flexible distal-chip laryngoscopy (FDL) vs. rigid telescopic laryngoscopy (RTL). To evaluate ease of examination and contrast clinician assessment to patient experience. Background: Laryngeal videostroboscopy can be performed with either FDL or RTL. Both modalities provide excellent image quality with high inter-rater reliability of findings. However, no randomized studies comparing patient and clinician satisfaction during these two exam types have been performed. Methods: 23 normal adult subjects were recruited to undergo both FDL and RTL in a crossover study, in which initial exam type was randomized. Subjects and clinicians completed corresponding questionnaires after each exam. Results: 34.7% of subjects had not undergone prior laryngoscopy, 30.4% had previous FDL, 13% had previous RTL, and 21.7% had undergone both. Subjects reported greater discomfort during FDL (p = 0.014). Neither level of worry prior to exam nor discomfort during exam was associated with satisfaction or willingness to undergo FDL again. Degree of discomfort was negatively associated with satisfaction and willingness to undergo RTL again (p = 0.019). Although clinicians accurately estimated anxiety preceding FDL and RTL, they overestimated the comfort of subjects having undergone both. Satisfaction of subjects with FDL and RTL remained high, significantly greater than predicted by clinicians. Conclusions: Subjects undergoing FDL experience significantly greater discomfort compared to RTL, but do not demonstrate a preference of exam. Overall, clinicians overestimate the comfort of subjects undergoing FDL and RTL, but subjects maintain high satisfaction with both exam nonetheless.
Gold Laser Removal of a Large Ductal Cyst on the Laryngeal Surface of the Epiglottis
Pranati Pillutla, BS; Evan Nix, BS; Joehassin Cordero, MD; Brooke Jensen, BS
Laryngeal cysts are rare lesions of the larynx that are often described only on incidental discovery. We report an unusual presentation of a cyst located on the laryngeal surface of the epiglottis. The patient presented to the clinic after a difficult intubation during elective surgery, where a mass was reported to block the view to the glottis. His voice had peculiar low tone, yet he displayed bilateral normal appearing vocal cords with normal mobility. Initial CT scan showed a supraglottic mass, measuring 2.4 cm in craniocaudal dimension, 2.4 cm in transverse dimension and 1.2 cm in AP dimension. Flexible laryngoscopy showed a smooth and round mass, originating at the right laryngeal edge of the epiglottis extending to the right aryepiglottic fold based on the right lateral laryngeal surface of the epiglottis. The mass was excised surgically during microsuspension laryngoscopy with a contact gold laser at 10 W. Postoperatively, the patient saw no complications and his voice returned to baseline. We present a unique case of a large, asymptomatic mucocele located on the dorsal surface of the epiglottis. While unusual, masses on the dorsal surface of the epiglottis should be considered in patients that experience difficult intubations.
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Hematologic Malignancies of the Larynx: A Single Institution Review
Karuna Dewan, MD; Ross Campbell, MD; Edward J. Damrose, MD
Background: Primary hematologic malignancies of the larynx are rare diagnoses, accounting for fewer than 1% of all laryngeal tumors. They most commonly present as submucosal masses of the supraglottis, with symptoms including hoarseness, dysphagia, dyspnea and rarely cervical lymphadenopathy. Objectives: 1. To present a case series of primary hematologic malignancies of the larynx in patients treated in a tertiary care laryngology practice. 2. To review the literature on primary hematologic malignancy of the larynx. Methods: Retrospective case series of patients in a tertiary academic laryngeal practice with hematologic malignancy of the larynx; charts were reviewed for diagnosis, symptoms, treatment, and outcomes. Results: A submucosal mass was the most common finding, and hoarseness was the most common symptom. Local control of disease was high. Airway obstruction was managed with tracheostomy. Several patients required tube feeding prior to disease control. Most patients underwent radiation therapy and chemotherapy, although surgery alone was effective in patients with isolated disease. Conclusions: Hematologic malignancies of the larynx are rare but treatable. Biopsy is the mainstay of diagnosis, and imaging may be helpful to exclude diseases with a similar physical presentation (i.e., laryngocele). Prognosis depends on diagnosis but is generally favorable.
Implementing Efficient Peptoid-Mediated Delivery of RNA-Based Therapeutics to the Vocal Folds
Shigeyuki Mukudai, MD, PhDL; Iv Kraja, BS; Renjie Bing, MD; Danielle Nalband, PhD; Malika Tatikola, BS; Nao Hiwatashi, MD, PhD; Kent Kirshenbaum, PhD; Ryan C. Branski, PhD
Objectives/Hypothesis. We hypothesize that Smad3 mediates fibrosis in the vocal folds (VFs), and altered Smad3 expression via short interfering (si)RNA holds therapeutic promise. Delivery, however, remains challenging. We employed a novel synthetic peptoid oligomer, lipitoid L0, complexed with siRNA to improve stability and cellular uptake to increase efficiency of RNA-based therapeutics. Modifications of L0 were assayed to optimize siRNA-mediated alteration of gene expression. Study Design. In vitro/in vivo Methods. In vitro, Smad3 knockdown by various lipitoid variants was evaluated via quantitative real-time polymerase chain reaction in human VF fibroblasts. Cytotoxicity was quantified via colorimetric assays. In vivo, a rabbit model of VF injury was employed to evaluate the temporal dynamics of Smad3 knockdown following localized injection of the L0-siRNA complex. Results. In vitro, similar reductions in Smad3 expression were established by all lipitoid variants, with one exception. Sequence variants of L0 exhibited similar non-toxic characteristics; no statistically significant differences in cell proliferation were observed between these complexes. In vivo, Smad3 expression was significantly reduced in injured VFs following injection of L0-complexed Smad3 siRNA at 1 day post-injection. Qualitative suppression of Smad3 expression persisted at 2 and 3 days following injury, but did not achieve significance. Conclusions. In spite of the chemical diversity of these peptoid transfection reagents, the sequence variants generally provided consistently efficient reductions in Smad3 expression. L0 yielded effective, yet temporally limited knockdown of Smad3 in vivo. Peptoids may provide a versatile platform for the discovery of siRNA delivery vehicles optimized for clinical application.
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Injection Laryngoplasty as a New Treatment for Recalcitrant Muscle Tension Dysphonia: Preliminary Findings
Daniel Novakovic, MPH, MBBS; Cate Madill, PhD, CPSP; Duy Duong Nguyen, MD, PhD
Background: Primary muscle tension dysphonia (MTD) is a common voice disorder characterized by inappropriate peri-laryngeal muscle tension during phonation without obvious neurogenic, psychogenic, or structural pathologies. Standard treatment includes modifying phonation behaviours with voice therapy. Some people remain symptomatic despite voice therapy (recalcitrant MTD). Objective: To examine the effectiveness of injection laryngoplasty (IL) as an adjunct to voice therapy in the treatment of recalcitrant MTD. Methods: Retrospective review of 40 patients with primary diagnosis of MTD recalcitrant to voice therapy who underwent subsequent IL (Mean age = 42.9 years; standard deviation, SD = 13.1; range = 23 - 71). Patients completed the Voice Handicap Index-10 (VHI-10) and read the vowel /a/, Rainbow Passage, and the third CAPE-V phrase. Voice data were acoustically analysed for maximal phonation time, vowel fundamental frequency, harmonics-to-noise ratio (HNR) and smoothed cepstral peak prominence. Data were compared between baseline and 6-12 weeks after IL. Results: VHI-10 data was available for 37 patients, mean (SD) VHI-10 decreased from 25.4 (5.9) at baseline to 16.3 (9.4) after IL (t = 5.899, p < 0.001, Cohen’s d = 0.7). Acoustic analyses were performed in 26 patients with pre- and post-surgical voice recordings available. Mean (SD) of HNR (dB) increased from 20.4 (5.0) at baseline to 22.5 (4.6) after IL (t = -3.022, p = 0.006, Cohen’s d = 0.517). No statistically significant differences were observed in other acoustic measures. Conclusion: IL can be an effective adjunct to voice therapy in the treatment of recalcitrant MTD. Further studies are indicated to examine the effects of IL in the management of MTD.
Interarytenoid Botulinum Toxin A Injection for the Treatment of Vocal Process Granuloma
Elie Khalifee, MD; Hussein Jaffal, MD; Anthony Ghanem, MD; Abdul-Latif Hamdan, MD, EMBA, MPH
Introduction: To report the efficacy and adverse effects of Interarytenoid Botulinum Toxin A injection for the treatment of Vocal Process Granuloma Methods: A Retrospective chart review of patients with vocal process granuloma resistant to antireflux therapy and who underwent Interarytenoid Botulinum Toxin A injection was conducted. Total of eight patients were included. The mean dosage of Botulinum Toxin A injected was 6.56 Units. Results: Fifty percent of patients had complete regression of the lesion and fifty percent had partial regression. The main side effects were breathiness (n=4), voice breaks (n=1) and aspiration (n=1). Conclusion: Interarytenoid Botulinum Toxin A injection for the treatment of Vocal Process Granuloma is an effective mode of therapy with transient vocal and swallowing side effects.
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Is Nasogastric Tube Feeding Necessary after Surgery for Hypopharyngeal Diverticula?
Alisa Zhukhovitskaya, MD; David Weiland, BS; Sunil Verma, MD
Background/Objectives: Nasogastric tube (NGT) feeding often takes place after surgery for cricopharyngeal muscle pathology to reduce the risk of mediastinitis. The aim of this study was to examine if this practice is necessary. Our current practice is to monitor post-operative patients overnight for fever and crepitus-- clear liquid diet (CLD) is initiated if the examination is unremarkable following endoscopic surgery; patients who underwent open surgery additionally must demonstrate a negative radiographic leak study prior to starting an oral diet. We report on our experience. Methods: A retrospective chart review of individuals undergoing surgery for hypopharyngeal diverticula or cricopharyngeal bar from March 2014 to October 2018 was performed. Demographic data, type of surgery, initiation of oral feeding, and complications were recorded. Results: Forty-five surgeries (mean age 74.4 years) were performed: 36 for Zenker’s diverticula, 1 for Killian-Jamieson diverticulum, and 8 for cricopharyngeal bar. Procedures included 34 CO2 laser myotomies, 9 open diverticulectomies, and 2 endoscopic stapler diverticulotomies. 38 patients started clear liquid diet (CLD) on post-operative day (POD) 1; the remaining 7 were started on oral diet on POD 0 and 2-4. There were 4 complications: 1 post-operative fever and dysphagia requiring NGT placement and 3 cases of subcutaneous emphysema which resolved within 72 hours without NGT placement. Conclusions: Surgery for hypopharyngeal diverticula and cricopharyngeal bar does not require routine perioperative NGT placement. Oral diet may also be safely started very early in the post-operative period.
Laryngeal and Airway Surgery under Apneic and Intermittent Apneic Anesthesia
Mausumi Syamal, MD; Jill Hanisak, CRNA
Objective: The objective of this study was to assess the safety and efficacy of apneic and intermittent apneic anesthesia for laryngeal surgical cases Design: Prospective, observational study Methods: In a prospective study, 43 adults over the age of 18 underwent laryngeal surgeries from May to October 2018 at a tertiary referral institution. Of the 43 patients, those that have undergone intermittent apneic laryngeal surgery most commonly for vocal cord paralysis, glottic and subglottic stenosis were examined. Correlations between anesthetic agents, BMI, ASA Class, operating time and intraoperative events and complications within 30 days of surgery are being studied. Results: At the time of preparation, there are 25 patients enrolled in the study. Recruitment will end on February 1, 2019. The study will be concluded March 1, 2019. Preliminary data yields that our intermittent apneic anesthesia protocol is safe for BMI ranging from 19 to 40, ASA classes 2 to 4, Operating times range from 1 minute to 35 minutes with the threshold for ventilation being oxygen desaturations to 89%. Intra-operative events noted most commonly are arrhythmia, tachycardia and hypertension. Complications due to surgery have been limited to dysphagia or shortness of breath. Conclusions: The use of apneic or intermittent apneic anesthesia for laryngeal surgeries is safe and effective.
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Mycosis Fungoides of the True Vocal Folds
Jesse R. Qualliotine, MD; Rohan Ahluwalia, MD; Dmitrios Tzachanis, MD, PhD; Philip A. Weissbrod, MD
Laryngeal involvement of mycosis fungoides (MF) is a rare finding with few cases reported in the literature. Glottic, or true vocal fold involvement is even more unusual. The authors present the evaluation and treatment of a 76-year-old female with long-standing MF previously treated with Brentuximab Vedotin who developed persistent cough and dysphonia. The patient’s laryngeal disease burden was treated with KTP-laser ablation and further reduced with initiation of doxorubicin. This the first reported surgical laser treatment of laryngeal symptoms in this context.
Non-Caseating Granulomatous Disease of the Paraglottic Space: A Case of Laryngeal Sarcoidosis
William S. Tierney, MD, MS, MS; Paul C. Bryson, MD
Introduction: Sarcoidosis is a disease of aberrant chronic immunologic response that can form granulomas in nearly every organ. Intrathoracic disease is most common and laryngeal involvement is typically supraglottic. Granulomas have rarely been reported in the paraglottic space. In this case report we discuss presentation and management a case of paraglottic space sarcoidosis. Case Description: A 61yo male presented to laryngology clinic with a 6-month history of hoarseness. Videostroboscopic examination revealed subepithelial inflammation and decreased mucosal waves of the right vocal cord. Medical history was notable for pulmonary sarcoidosis with lymphatic involvement. Initial treatment with steroids yielded temporary improvement. However, symptoms recurred and worsened 3 months later and videostroboscopy revealed increased inflammation and ventricular effacement. Operative biopsy showed non-caseating granulomas consistent with the diagnosis of laryngeal sarcoidosis. Treatment/Results: 8mg of dexamethasone was injected into the right paraglottic space. Systemic therapy with steroids and steroid-sparing medical therapy guided by rheumatology were used to control further symptoms. Follow-up with repeat videostroboscopy proved useful in guiding medical therapy. Conclusion: Sarcoidosis can affect any organ and has diverse presentations in the head and neck. Paraglottic space sarcoidosis is a rare manifestation of this disease that the practicing laryngologist should be alert to. Following diagnosis, multidisciplinary medical treatment can be guided by endoscopic examination.
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Objective Measurement of Adductor Spasmodic Dysphonia Severity through Novel Laryngoscopic Image Analysis
Yue Ma, MD; Avraham Mendelsohn, MD; Gerald S. Berke, MD
Objective: To date, objective measurement of adductor spasmodic dysphonia severity has been limited due to acoustic fidelity requirements and dependence on grader assessments. The purpose of our study is to evaluate a novel image analysis methodology capable of assessing adductor spasmodic dysphonia (ADSD) severity. Methods: Case-control study performed utilizing laryngoscopy images from ten patients with established ADSD diagnosis confirmed by treatment response with botulinum toxin injection compared to laryngoscopy images from two non-ADSD patients. All subjects were asked to perform three vocal tasks at the same loudness: “e”, “a” and “we eat eggs every Easter”. Video review was performed and still images within a single phonatory utterance were captured: single image with vocal fold closure without supraglottic tension and a single image demonstrated the maximum excursion of adductory motion within the supraglottis. Change in visible true vocal fold surface area between the two images was calculated via image analysis software. Severity of disease was stratified in quartiles. Results: ADSD patients demonstrated an average vocal surface area change between relaxed and spasmodic phonation of 62% (range: 34-92%). Severity of clinical symptom correlated with change in surface area. The average change in vocal cord surface area for normal subjects was 3% (2-4%). Conclusion: We present a novel methodology for objective measurement of ADSD. Early experience suggests change in visible vocal fold surface area may provide objective measurement of dysphonia severity. Case collection is on-going and patient numbers and data will be updated.
Office-Based Percutaneous Injection Laryngoplasty with Calcium Hydroxylapatite: A 10-Year Experience
Minhyung Lee, MD; Doh Young Lee, MD, PhD; Seuiki Song, MD; Young Kang, MD; Tack-Kyun Kwon, MD, PhD
Objectives: To evaluate the safety of office-based percutaneous calcium hydroxylapatite (CaHA) injection laryngoplasty through an analysis of all procedures performed over a period of 10 years at a single institution Methods: In total, 962 office-based percutaneous CaHA injection laryngoplasty procedures were performed by a single physician at our institution between 2007 and 2016. From these, 955 procedures performed in 617 patients were included in our analysis. The medical records of all 617 patients were retrospectively reviewed. We classified all procedure-related complications according to the time of onset. Complications that occurred during the procedure were considered intraprocedural complications, while complications that developed within 1 week after injection and those that developed after 1 week and were recorded more than twice in the medical records were considered acute and delayed complications, respectively. And the failed cases were categorized separately as failure. Results: Failure had five cases (0.5%). Intraprocedural complications included superficial injection in eight cases (0.8%). Acute and delayed onset of dyspnea was observed in three (0.3%) and two (0.2%) cases, respectively. The incidence of failures and major complications requiring active intervention was 1.6%. Conclusions: Our findings suggest that office-based percutaneous CaHA injection laryngoplasty is as safe as conventional transoral injection laryngoplasty.
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Pediatric Tracheotomy in Infants: Based on 8 years of Experience at a Pediatric Tertiary Center in South Korea
Eui-Suk Sung, MD, PhD; Jin-Choon Lee, MD, PhD; Byung-Joo Lee, MD, PhD; Dong-Jo Kim, MD; Da-Hee Park, MD
Background/Objectives: The reasons for and outcomes of pediatric tracheostomy have changed over the decades. However, outcomes related to cause have not been studied in infants. The aim of this study is to report experiences about outcomes of infants who have undergone tracheostomy. Methods: A retrospective chart review was performed on 30 infants (<1 year old) that underwent tracheostomy from December 2008 to December 2016. Variables that could affect the outcomes were analyzed using correlation analysis. Results: The most common reasons of tracheostomy were ventilation weaning failure (26.7%) and prolonged intubation (23.3%). There were significant differences in duration of tracheostomy between indications (p=0.003). The duration of tracheostomy was short in upper airway obstruction (15.2±6.6 months), but relatively long in neurological impairments (47.9±15.3 months). The time of decannulation was correlated with the duration of tracheostomy(r = 0.528, p=0.003). Conclusions: The longer the duration of tracheostomy the slower the time of decannulation. Therefore, efforts are needed to reduce the duration of the tracheostomy to pull the time of successful decannulation in infant. For infants with no specific problems, such as prolonged intubation needs or ventilation weaning failure, periodic laryngeal and tracheal assessment under general anesthesia should be actively considered for decannulation by otolaryngologist.
Post-Operative Complications in Obese Patients after Tracheostomy
Shelby Barrera, BS; C. Blake Simpson, MD; Jay Ferrel, MD; Laura Dominguez, MD
Background: The prevalence of obesity in the U.S. is 39.8% with individuals with a body mass index (BMI) over 40 increasing by 70% over the past decade. The objective of this study is to determine the prevalence of obesity in patients undergoing tracheostomy and associated complication rates. Methods: A retrospective chart review was conducted for patients who underwent tracheostomy from 2012-2018 by the Otolaryngology department. Patients with a BMI>30 were subdivided into obese (BMI 30-39.9), morbidly obese (40-49.9), and super-morbidly obese (>50) categories. Patient demographic information, surgical indication and time, tracheostomy tube type, and post-operative complications were recorded. Results: A total of 548 patients underwent tracheostomy of which 142(25.9%) had a BMI>30. In patients with BMI>30(mean BMI 40.4), 61.8% were obese, 14.8% morbidly obese, and 23.2% super- morbidly obese. Respiratory failure was the most common indication (57% for entire cohort). A standard Shiley tracheostomy tube was placed in 80.7% of obese patients. Super-morbidly obese patients (80.7%) commonly required a Shiley Proximal XLT. Operative time did not differ significantly between the groups. The overall complication rate for the cohort was 35.9% with super-morbidly obese patients constituting 57.6% of these complications. The most common complication was accidental decannulation (11.3%) with morbidly obese patients demonstrating the highest rate. Conclusions: While the prevalence of obesity in our cohort was less than the general U.S. population, the prevalence of morbid and super-morbid obesity was greater. The super-morbidly obese patients had the highest complication rate and require appropriate peri-operative counseling.
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Presence of Augmentation Material Does Not Impact Interpretation of Laryngeal Electromyography
Libby J. Smith, DO; Michael A. Belsky, MSII; R. Jun Lin, MD; Clark A. Rosen, MD; Michael C. Munin, MD
Abstract: Temporary vocal fold injection (VFI) is a common treatment for acute vocal fold paralysis (VFP). Diagnostic laryngeal electromyography (LEMG) is useful in the care of patients with VFP. This study evaluates the impact of temporary VFI on the ability to perform and interpret LEMG in patients with acute VFP. Methods: Consecutive LEMG patients were prospectively enrolled. Patients with acute VFP (< 6 months) who underwent temporary VFI within 3 months preceding LEMG were evaluated. The LEMG team (electromyographer and otolaryngologist) descriptively rated the difficulty of the exam (0-10 scale) and their collective confidence (very, somewhat, not confident; based upon difficulty in performing the test and LEMG findings correlating to task) in interpreting the results. Results: Twenty of 111 patients had acute VFP (range 26-129 days; mean 78.6 days) and underwent VFI within 3 months (range 3-75 days; mean 35.0 days). Difficulty of completing the LEMG was rated as “very easy” (mean score 0.4/10) or “mildly challenging” (2.8/10) for 16/20 patients. Only 4 patients were rated as “moderately” (no numerical ratings) or “extremely challenging” (9/10). Difficulty was most often related to challenging surface neck anatomy, post-operative scarring, poor localization, and patient tolerance. Limited EMG signal (1 patient) and inconsistent LEMG tracings (2 patients) were uncommon. High confidence with LEMG data was rated for 16/20 patients, with fair/poor confidence in 4/20 patients. Conclusion: The presence of vocal fold injection augmentation material does not impact the ability to collect meaningful LEMG data in patients with acute vocal fold paralysis.
Prevalence, Incidence, and Characteristics of Dysphagia in Those with Unilateral Vocal Fold Paralysis
Benjamin Schiedermayer, MS, CCC-SLP; Katherine Kendall, MD; Zhining Ou, MS; Angela P Presson, PhD; Julie Barkmeier-Kraemer, PhD, CCC-SLP
Individuals with unilateral vocal fold paralysis (UVP) are at risk for dysphagia. A primary concern is that impaired laryngeal closure during swallowing due to UVP leads to aspiration. Yet, the prevalence, incidence, and characteristics of swallowing pathophysiology in those with UVP is not addressed within current literature. The purpose of this study was to determine the prevalence and incidence of dysphagia in those diagnosed with UVP in an outpatient specialty clinic. A secondary purpose was to use quantitative measures made from modified barium swallowing studies (MBS) and clinical record documentation to describe the signs and symptoms of dysphagia as well as underlying pathophysiology of dysphagia in UVP patients. A query (2013-2018) of the University of Utah medical center’s electronic medical record data warehouse was conducted. Patient demographic information was collected and cross-referenced with the clinic MBS database containing standard measurement outcomes. For the purposes of this study, all patients who underwent dysphagia evaluation with an MBS were considered to have dysphagia. A total of 371 individuals were diagnosed with UVP during the period under study with 35 completing a MBS study. A 9% five-year prevalence and an 11% average annual incidence of dysphagia occurred in those diagnosed with UVP. Thus, the majority of those diagnosed with UVP in our regional outpatient specialty clinic did not present with dysphagia. MBS outcomes (N = 35) will be summarized highlighting underlying dysphagia pathophysiology as will signs and symptoms of dysphagia documented within clinical records (N = 371) among individuals diagnosed with UVP.
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Prognostic Role of Singular Lymph-Node Level Involvement in Patients with Laryngeal Cancer
Jingfeng Liang, BA; Peter A. Pellionisz, BS; Dinesh K. Chhetri, MD; Maie St. John, MD, PhD
Background: Regarding laryngeal cancers, studies on the association between involved lymph node levels and survival prognosis has comprised of cases involving multiple lymph node levels, since singular involvement of certain lymph nodes (e.g., in level V) is rare. The purpose of this study is to examine cases of laryngeal cancers with metastasis to only one lymph node level and assess its relationship with overall (OS) and disease specific (DSS) survival outcomes. Methods: A population-based search for patients diagnosed with laryngeal cancer between 2004- 2015 was performed using the case-listing session protocol of the Surveillance Epidemiology and End Results (SEER) 18 database. Patients with laryngeal cancers that had spread to exactly one of lymph node levels I-VI were included (N = 4752). Statistical analysis on OS and DSS survival was performed with R software (significance p<0.05). Results: Lymph node level II (N = 2151) was most frequent, followed by III, IV, I, V and VI. Results from multivariate Cox regression show that when controlled for age, sex, race, T-stage and N-stage, level IV (OS: p < 0.001; DSS: p < 0.001), V (OS: p < 0.01; DSS: p < 0.01), and VI (OS: p < 0.01; DSS: p < 0.05) lymph nodes are associated with significantly worse survival prognosis compared to level I-III. Conclusions: Survival analysis via Kaplan-Meier plots and Cox regression indicate that in laryngeal cancer, singular involvement of lymph node levels IV-VI is associated with significantly worse OS and DSS compared to singular involvement of lymph node levels I-III.
Rare Extrusion of Silastic Block after Type 1 Thyroplasty after Glomus Vagale Excision
Lara Reichert, MD, MPH; Michael Underbrink, MD, MBA; Grant Conner, MD
Objectives: To demonstrate a rare case of internal silastic thyroplasty implant extrusion 10 months after thyroplasty. Methods: Case presentation Results: We present a case of a 53-year-old female with a history of right glomus vagale tumor resection necessitating sacrifice of the right vagus nerve and internal jugular vein. She had subsequent right-sided vocal cord paralysis and underwent a medialization thyroplasty with silastic block 6 months after her initial procedure. She was very happy with her voice and had no swallowing deficits. Her history was also significant for recurrent unexplained nausea and emesis. 9 months after her thyroplasty she called our office complaining of voice change after a severe bout of emesis. She noted she had vomited and coughed out a piece of plastic. She was seen in our office the next day, and brought the extruded plastic, which was confirmed to be her silastic block. Her voice was rough and breathy, and laryngoscopy showed the right vocal cord paralyzed in paramedian position with a defect along the right ventricle. A subsequent CT scan showed a small laryngocele with no evidence of abscess or infection. She is planned for a revision surgery in 3 months. Conclusions: Implant extrusion is extremely rare after type 1 thyroplasty utilizing silastic blocks. Our patient had right sided vocal cord paralysis from sacrifice of the vagus nerve during glomus vagale tumor resection. During a severe coughing and emesis episode the implant extruded and was coughed out of the body. Patients must be counseled on the real, but still very rare, risk of implant extrusion when counseled on risks of thyroplasty.
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RAT Recurrent Laryngeal Nerve Regeneration Using Self-Assembling Peptide Hydrogel
Masayoshi Yoshimatsu, MD; Ryosuke Nakamura, PhD; Yo Kishimoto, MD, PhD; Yasuyuki Hayaski, MD; Keisuke Kojima, MD; Shinji Kaba, MD; Toru Sogami, MD; Hiroe Ohnishi, PhD; Tatsuya Katsuno, PhD; Atsushi Suehiro, MD, PhD Tomoko Tateya, MD, PhD; Ichiro Tateya, MD, PhD; Koichi Omori, MD, PhD
Introduction: For regenerating the defect of the recurrent laryngeal nerves (RLNs), various methods have been developed. However, motor nerve recovery in the RLNs is still challenging because of insufficient functional recovery and the misdirected innervation. Recently, a self-assembling peptide (SAP), called RADA16-I, has been developed by Zhang et al. and they reported that the SAP serve as a scaffold supporting neurite outgrowth and functional synapse formation in vitro. The purpose of this study was to investigate the efficacy of RADA16-I hydrogel on peripheral nerve regeneration in rats. Methods: Nine adult male Sprague-Dawley rats were used in this study. The left RLN was exposed and resected under general anesthesia. The resulting 6-mm gap was bridged by using 8-mm silicone tube to all rats and then the RADA16-I hydrogel was injected into the silicone tube to five rats (RADA16-I group). Another four rats were without injection (control group). After eight weeks, laryngoscopy and electrophysiological examination were performed for the functional recovery. Histological examinations were performed on nerve regeneration. Results: The left vocal cord movement was recovered in one rat in the RADA16-I group. Electrophysiological examination revealed higher compound muscle action potential in the RADA16-I group than the control group. The immunohistological examination revealed that the greater area of neurofilament expression in the center of regenerated tissue was observed in the RADA16-I group than the control group. Conclusion: Our results suggest that the RADA16-I hydrogel was effective on peripheral nerve regeneration.
Results of the Adhere Upper Airway Stimulation Registry and Predictors of Therapy Efficacy
Erica Thaler, MD; Richard Schwab, MD; Ryan Soose, MD; Courtney Chou, MD; Patrick Strollo, MD; Eric Kezirian, MD; Stanley Chia, MD; Clemens Heiser, MD; Benedikt Hofauer, MD; Karl Doghramji, MD; Maurits Boon, MD; Colin Huntley, MD; Armin Steffen, MD; Joachim Maurer, MD; Ulrich Sommer, MD; Kirk Withrow, MD; Mark Weidenbecher, MD; Kingman Strohlm, MD
Background/Objectives: The ADHERE Registry is a multi-center registry following outcomes of upper airway stimulation (UAS) therapy, in patients who have failed continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this paper is to examine the outcomes of patients receiving UAS for treatment of OSA. Methods: Demographic and sleep study data collection occurred at baseline, implant visit, post- titration (6 months), and final visit (12 months). Patient and physician reported outcomes were also collected. Post-hoc univariate and multi-variate analysis was used to identify predictors of therapy response, defined as 50% or more decrease in AHI, and AHI <= 20 at the 12-month visit. Results: The registry has enrolled 706 patients from October 2016 through September 2018. Thus far, 504 patients have completed their 6-month follow-up, and 310 have completed the 12-month follow- up. After 12-months, AHI was reduced from 33.5 to 8.0. (Mean: 36.3±15.4 to 11.9 ± 12.9, p < 0.0001). ESS was similarly improved from 11.0 to 6.0 (11.6 ± 5.5 to 7.0 ± 4.8, p < 0.0001). In 75% of the patients, AHI was reduced to less than 15 events/hour. Therapy usage was 5.6 ± 2.1 hours/night after 12-months. In a multi-variate model, only female gender and lower baseline BMI remained as significant predictors of therapy response. Conclusions: Across a multi-institutional study, UAS therapy continues to show significant improvement in subjective and objective OSA outcomes. This analysis shows that the therapy effect is durable and adherence is high.
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Risk Factors for Pneumonia in Patients with Head and Neck Cancer
Daniel J. Cates, MD; Lisa Evangelista, CScD. CCC-SLP; Nogah Nativ-Zeltzer, PhD; Peter Belafsky, MD, MPH, PhD
Background: Pneumonia and swallowing dysfunction are two of the most morbid complications of multimodality treatment of head and neck cancer (HNCA). Risk factors for pneumonia in this population have not been determined. This study’s purpose is to identify factors predictive of pneumonia in patients with HNCA. Methods: All individuals with HNCA undergoing a videofluoroscopic swallow study (VFSS) between 01/01/12 and 06/30/15 were identified from a database and followed historically for two years. Data abstracted included age, gender, 10-item Eating Assessment Tool (EAT10), penetration aspiration scale (PAS), functional oral intact score (FOIS), pharyngeal constriction ratio (PCR), smoking status, upper esophageal sphincter opening, laryngohyoid elevation, and pharyngeal bolus transit time. The 2-year incidence of pneumonia was obtained from medical records and telephone inquiry. Results: The mean age (+/-SD) of the cohort (N=56) was 65 (+/-14) years. The 2-year incidence of pneumonia was 38%. The mean PCR for people who developed pneumonia was 0.15 (+/-0.16) and 0.52 (+/-0.29) for those who did not (p=0.00). Pharyngeal transit time was significantly greater and laryngohyoid elevation and UES opening were both significantly less in persons who developed pneumonia (p=0.01). Multiple logistic regression demonstrated that PCR and presence of aspiration (PAS ≥6) on VFSS were significant predictors of incident pneumonia after adjusting for all variables. Conclusion: The 2-year incidence of pneumonia for patients with HNCA undergoing VFSS is high (38%). Objective VFSS measures significantly predict the incidence of pneumonia with elevated pharyngeal constriction ratio and presence of aspiration being most predictive.
Subglottic Elastofibroma: A Case Report
Emily M. Kamen, MD; Cheng Z. Liu, MD, PhD; Seth E. Kaplan, MD
Introduction: Elastofibromas are rare benign tumors that usually present as soft-tissue masses in the infrascapular region of the elderly. Only rare cases have documented these lesions in areas other than the lower neck and back, including recent reports in the oral cavity and in the orbit. No cases to date have been reported in the larynx. Objective: A 66-year-old woman presented with a subglottic lesion consistent with elastofibroma. This case report describes the presentation, clinic characteristics, treatment, and histopathologic features. Summary: The patient presented to clinic with a one-year history of tracheostomy dependence. Flexible laryngoscopy revealed a subglottic lesion occluding the airway. The patient underwent suspension microdirect laryngoscopy with excision of the subglottic lesion with balloon dilation. Pathology revealed multiple foci of elastic fibers of varying thickness with intervening collagen most consistent with elastofibroma, with confirmation on trichrome and elastic stains. Conclusion: Although the pathogenesis of these lesions is unclear, it is suggested that microtrauma may cause an increase in smooth muscle activity of myofibroblasts with resulting increase in elastic fiber production. There is a suggestion of both female predominance as well as genetic predisposition due to an enzymatic defect. In this patient’s case, the inflammatory process that resulted in the formation of granulation tissue resulted in unusual pathology for this anatomic location.
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Subglottic Squamous Cell Carcinoma – A Survey of the National Cancer Database
Lucy Shi, MD; Caitlin McMullen, MD; Kathryn Vorwal, MD, DDS; Anthony Nichols, MD; S. Danielle MacNeil, MD; Krupal B. Patel, MD
Objectives: Subglottic squamous cell carcinoma (SCC) represents less than 5% of all laryngeal cancers. The objective of this study was to determine 5-year overall survival (OS) with primary SCC. Methods: National Cancer Database (NCDB) registry was utilized for this study from 2004 – 2015. Patient demographics, primary therapy and survival outcomes were analyzed. Results: A total of 604 patients met the inclusion criteria, with majority of them being white, male and presenting between 55 – 64 years of age. 11.4% of patients presented with Stage 1 disease, 23.17% of patients presented with Stage 2 disease, 17.05% of patients presented with Stage 3 disease and 48.34% of patients presented with Stage 4 disease. 14.9% of patient underwent surgery alone, 23.02 patients underwent surgery plus adjuvant chemo/radiation (C/RT), and 62.09% patients underwent primary C/RT. 5 year OS for Stage 1 patients was noted to be 67.1%, for Stage 2 patients it was 56.09%, for Stage 3 patients it was 47.69% and for Stage 4 it was 40.5%. No statistical differences were noted between patients undergoing surgery alone, surgery plus adjuvant C/RT and primary CRT. Conclusions: SCC carries a poor prognosis. Majority of the patients were treated with primary C/RT. No statistically significant difference were observed in 5 year OS when stratified by stage.
Surgical vs. Non-surgical Outcomes in the Treatment of Tonsilloliths
Catherine Loftus, MS; Justin Cole, BS; Josh Hanau, BA; Craig Zalvan, MD
Background: Tonsil stones are concretions that can arise in the tonsillar crypts which may cause discomfort. The goal of this study was to determine the resolution of tonsillolith symptoms using a conservative approach of oropharyngeal hygiene and control of laryngopharyngeal reflux. The reflux symptom index (RSI) and eating assessment tool (EAT-10) were utilized to detect improvement. Patients who failed conservative measures were offered a tonsillectomy. Methods: A retrospective chart review of the senior author’s patients between 2010 to 2017 was performed. ICD-10 codes J35.01 “chronic tonsillitis”, J35.8 “other chronic diseases of tonsils” and J38.7 “other diseases of larynx” were used to identify patients from the electronic medical record system. Inclusion criteria included symptoms suggestive of tonsillolith and documented RSI and/or EAT-10 scores. Exclusion criteria included any co-morbid condition affecting the tonsils. Results: 14/46 patients attempting conservative therapy responded. 14/32 conservative non- responders opted to receive a tonsillectomy. A statistically significant difference of means (p=.02) was found between baseline RSI (12.43 +/- 8.84) and follow up (7.46 +/- 7.11) for conservative responders. In addition, tonsillectomy patients showed a significant difference (p=.02) between pre-tonsillectomy (18.58 +/- 11.13) and post-tonsillectomy (7.2 +/- 6.70) RSI scores. Conclusions: This study shows evidence of improved self-reported symptoms following conservative management of tonsil stones. 30% of patients improved with conservative therapy alone and were able to avoid the morbidity associated with a surgical intervention. Conservative therapy and tonsillectomy both showed symptomatic improvement.
82 SCIENTIFIC SESSIONS
The Health Utility of Mild and Severe Dysphonia
Matthew Naunheim, MD, MBA; Elliana Kirsh, BM, BS; Mark Shrime, MD, MPH, PhD; Eve Wittenberg, MPP, PhD; Ramon Franco, MD; Phillip Song, MD
Objectives: The impact of disease states can be measured using health state utilities, values which reflect economic preferences for health outcomes. Utilities for dysphonia have not been rigorously studied. The objective of this study was to establish the baseline health utilities of mild and severe dysphonia from a societal perspective. Methods: 4 health states (monocular blindness, binocular blindness, mild dysphonia, and severe dysphonia) were evaluated by a sample of adults recruited from the general public with 3 computer-aided estimation techniques (visual analogue scale [VAS], standard gamble [SG], and time-trade-off [TTO]). Standardized descriptions and voice recordings from multiple dysphonic patients were employed. Perfect health was defined as a utility of 1, with death 0. Analysis of variance with post-hoc pairwise comparison was used to calculate significant differences between health states (alpha=0.05). Results: 217 participants were surveyed, and 165 (76.0%) responses met quality thresholds. Severe dysphonia (VAS=0.459, SG=0.799, TTO=0.785) was rated significantly worse than monocular blindness (0.542, 0.826, 0.826) on the VAS (p<0.001) and equivalent on SG and TTO; it rated better than binocular blindness (0.246, 0.616, 0.611; p<0.001) with all methods. Mild dysphonia rated favorably with all methods to the other health states (0.767, 0.892, 0.899; p<0.001). Conclusions: Dysphonia has a substantial, measurable impact on utility, with severe dysphonia rated equivalent to monocular blindness. Mild dysphonia has a significant utility decrement from perfect health. These estimates are critical for quality of life assessment and could be used to assess cost- effectiveness of treatments for voice disorders.
Thyroplasty with Real-Time Acoustic Analysis
Tsuyoski Kojima, MD, PhD; Shintaro Fujimura., MD; Yusuke Okanoue, MD; Hiroki Kagoshima, MD; Atsushi Taguchi, MD; Masato Inoue, MD, PhD; Kazuhiko Shoji, MD, PhD; Ryusuke Hori, MD, PhD
Background: Thyroplasty is the surgical methods to improve the voice by changing a position of the thyroid cartilage. The induced subtle alteration of vocal cord influences voice quality. Usually, the surgery is performed under local anesthesia with sedation to adjust the position of the vocal cord while evaluating the quality of the voice by the surgeons and the patients themselves. It is common that the voice is subjectively evaluated intraoperatively rather than objectively. Therefore we reconsidered the thyroplasty using real-time acoustic analysis from a neutral perspective. Methods: We developed the acoustic analysis software "VA" which operates on the windows PC previously. We improved it as a highly accessible acoustic voice analysis system and installed on Android smartphones so that we can use it more easily and intuitively. It represented a real-time hoarseness index (real-time “Ra”: Rart), which is a derivative of the harmonics-to-noise ratio developed by Kojima and Shoji (Ra2). We investigated whether the real-time acoustic analysis is useful to detect the voice quality during thyroplasty. Results: Appropriate adjusting voices during thyroplasty showed high values in "Rart". This evaluation was also consistent with the evaluation of patients and surgeons. It is usually noisy in the operation room under the operation, however, there was no problem evaluating the change in the quality of the voice if it was the acoustic analysis performed in the same environment. Conclusion: The real-time acoustic analysis may be meaningful during thyroplasty and make thyroplasty more effective.
83 SCIENTIFIC SESSIONS
Tracheal Pressure Exerted by High-Flow Nasal Cannula in 3D-Printed Pediatric Nasopharyngeal Models
Alan J. Gray, BS; Katie R. Nielsen, MD, MPH; Laura E. Ellington, MD; Kaalan Johnson, MD; Yichen Zhang, BS; Hongjian Shi, BS; Lincoln S. Smith, MD; Rob DiBlasi, RRT-NPS
Background/Objective: Heated and humidified high flow nasal cannula (HFNC) is an increasingly used form of noninvasive respiratory support with the potential to generate significant airway pressure. Understanding the pressure generated by HFNC may be beneficial in CPAP-intolerant children with obstructive sleep apnea (OSA). The aim of this study was to quantify the pressure generated by HFNC in anatomically-correct, pediatric airway models. Methods: 3D-printed upper airway models of a preterm neonate, term neonate, toddler, and small child were connected to a spontaneous breathing computerized lung model at age-appropriate ventilation settings. Two commercially available HFNC systems were applied to each airway model at increasing flows and the positive end-expiratory pressure (PEEP) was recorded at the level of the trachea. Results: Increasing HFNC flow produced a quadratically curved increase in tracheal pressure in closed-mouth models. The maximum flow tested in each model generated a pressure of 7 cm H2O in the preterm neonate, 10 cm H2O in the term neonate, 9 cm H2O in the toddler, and 20 cm H2O in the small child. Tracheal pressure decreased by at least 50% in open-mouth models. Conclusions: HFNC was found to demonstrate a predictable flow-pressure relationship that achieved distending pressures which could effectively treat pediatric OSA in the closed-mouth models tested.
Tracheal Resection in a Paraplegic: The Importance of the Cough Reflex
Shaunak Amin, BS; Alexander Gelbard, MD; Jennifer Rodney, MD
Spinal cord injury can be associated with significant morbidity secondary to compromised respiratory function. We present a unique case of a paraplegic patient with tracheal stenosis who underwent tracheal resection and developed postoperative respiratory failure. A 24 year-old female was involved in a motor vehicle collision that resulted in a T4/5 spinal cord injury and emergent tracheotomy in the field. She became a paraplegic and was decannulated a year later. She presented 6 years after decannulation with a 2 year history of nonproductive cough and progressive dyspnea. Direct laryngoscopy demonstrated tracheal stenosis 3 cm in length. The patient subsequently underwent tracheal resection with anastomosis and was successfully extubated in the operating room. Over the next few days, the patient reported difficulty expectorating secretions. On post-operative day 3, the patient became acutely hypoxic and required emergent reintubation and bronchoalveolar lavage in the operating room. Post-operative chest radiographs were significant for bilateral pleural effusions and bibasilar atelectasis with white-out of the left lung. The patient improved after reintubation and aggressive pulmonary toilet and was extubated 2 days later. After extubation, she informed the surgical team that since her spinal cord injury, she has required a family member to push on her stomach when she coughs in order to provide extrathoracic pressure to effectively clear secretions. Cough assistance was promptly initiated by nursing staff without further complications. This case highlights the importance of the cough reflex and demonstrates the unique respiratory management necessary for patients with spinal cord injury.
84 SCIENTIFIC SESSIONS
Tracheotomy Avoided in Laryngeal Mucous Membrane Pemphigoid Treated with Rituximab
Daniela A. Brake, BS, BA; Benjamin P. Anthony, MD
An 80-year-old woman with an 8-year history of biopsy-proven ocular, pharyngeal, and sinonasal mucous membrane pemphigoid (MMP) was referred for laryngeal and upper aerodigestive tract progression. She complained of noisy breathing without dyspnea and could eat only soft foods. Flexible nasolaryngoscopy (FN) revealed severe swelling of the supraglottic mucosa, ulcerations of the epiglottis, and significant laryngeal scarring and stenosis that was concerning for need for tracheotomy in the near future. Treatment for three weeks with steroids in addition to her current mycophenolic acid yielded no change in breathing, and FN revealed scarring of the aryepiglottic folds to the epiglottis and no reduction in swelling. In order to avoid a tracheotomy, the decision was made to start rituximab. Following two infusions, the patient had greatly improved swallowing and stable breathing. FN seven weeks after presentation revealed resolution of prior laryngeal mucosal ulcerations, decreased swelling, and a vastly improved exam with increased patency. Currently, she is doing well with remission of her disease. Although numerous treatment modalities for MMP are described in the literature, reports describing successful treatment of laryngeal involvement with rituximab are limited and either failed to spare the patient from surgical intervention or make no mention of it. To our knowledge, our case is the first that specifically denotes the patient being spared a possibly imminent procedure by treatment with rituximab.
Trauma Informed Care in Laryngology
Robert T. Cristel, MD; H. Stephen Sims, MD
Background/Objectives: "Vocal cord dysfunction" (VCD) has been used by clinicians, primarily pulmonologists, to describe a variety of conditions in which the regulation and coordination of vocal fold movements are part of the explanation of cough or difficulty breathing. One specific manifestation is paradoxical vocal fold motion disorder (PVFM). Prior studies show an intersection of mental health issues- -primarily anxiety--and PVFM. We began incorporating mental health screening tools for these patients using the Life Events Checklist (LEC) and the PTSD Checklist (PCL) to gather more information about our patients. We seek to review the utility of these questionnaires for identifying patients who have experienced emotional trauma. We believe that many of the patients referred for evaluation of VCD would benefit from principles of Trauma-Informed Care. Appreciation of mental health, neural aspects of somatization, and trauma-informed treatment principles and strategies may benefit these patients. Methods: We incorporated mental health screening tools using the LEC and PCL for anyone referred to the Chicago Institute for Voice Care for “vocal cord dysfunction.” Results: A total of 13 subjects (11 F: 2 M) completed the LEC and PCL. 77% (10/13) disclosed prior traumatic events that they had not mentioned anywhere else during prior medical evaluations. 62% (8/13) of events were found to be physical and/or sexual assault, with sexual assault primarily among women. Conclusions: Using the LEC and PCL, we were able to practice trauma-informed care principles among patients initially referred for VCD that were found to have prior traumatic events.
85 SCIENTIFIC SESSIONS
Vocal Fold Injection to Improve Post-Airway Reconstruction Dysphonia
Mathieu Bergeron, MD; Alessandro de Alarcon, MD; John Paul Gilberto MD
Objectives. Post airway reconstruction dysphonia (PARD) is common and has a significant affect on the quality of life of patients. Vocal fold injection is one treatment that can be used to improve glottic insufficiency in some patients. The goal of this study was to characterize the use and outcomes of vocal fold injection for PARD. Methods. Retrospective chart review from January 2007- July 2018 was performed. All patients had a preinjection voice evaluation and a followup evaluation within 3 months after vocal fold augmentation (fat, carboxymethylcellulose gel, calcium hydroxyapatite) in our interdisciplinary voice clinic. Results. 34 patients (20 female) underwent vocal fold augmentation. The mean age at the time of the injection was 13.6 years (95%CI 11.6-15.7). Twenty patients (58.8%) had a history of prematurity and a mean of 1.8 open airway surgeries (95%CI 1.5-2.1). After injection, 29/34 patients (85.3%) noted a subjective voice improvement. The baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE- V) overall severity score decreased from 62.7 (95%CI 55.3-70.1) to 56.9 (95%CI 49.3-64.5, p<0.12). The total pediatric Voice Handicap Index (pVHI) trended to improve by 6.0 (95%CI 0.6-12.6) points, from 57.4 (95% 50.7-64.1) to 51.4 (95%CI 45.6-57.2, p<0.09). The functional pVHI subscore demonstrated the most improvement, with a decrease of 3.4 points (95%CI 0.9-5.9, p=0.02). All procedures were performed as an overnight observation and no complication occurred after injection. Conclusion. Patients with post-airway reconstruction dysphonia represent a complex subset of patients. Vocal fold injection is a straightforward intervention that may improve voice perception. Many subjects reported subjective improvement despite minimal objective measurement in voice measures. Further work is warranted to elucidate the role of injection in management of PARD.
Vocal Fold Medialization Forces Using a Dynamic Micromechanically Controlled Thyroplasty Device
Christopher Kaufmann, MD; Parker Reineke, BS; Henry T. Hoffman, MD
Background/Objectives: Current approaches for type 1 thyroplasty do not allow for precise implant positioning or post-surgical adjustment if vocal deterioration occurs. To address these issues, a novel wirelessly controlled micromechanical thyroplasty device was developed to remotely reposition a cadaveric vocal fold (VF). Using 3 different thyroplasty techniques, the prototype device was used to evaluate the forces required to dynamically modify VF position. Methods: Silastic thyroplasty was performed on cadaveric human larynges and a custom wirelessly-controlled micromanipulator system was employed to position the VF. A 12x6 mm thyroplasty window was created by three different techniques; 1) No separation of the internal thyroid perichondrium from the thyroid lamina; 2) Elevation of thyroid lamina 6 mm circumferentially; and 3) Elevation of lamina with incision of perichondrium. Each larynx was positioned orthogonal to a force sensor and the device medialized the VF at 0.5 mm/sec to generate force to displacement curves via video analysis (n=3 per technique). Results: The cadaver model demonstrated that elevation of perichondrium was required to permit meaningful movement of the VF. Incision of the perichondrium resulted in a lower medialization force at 1mm (incised: 39.4 ± 15 mN vs intact: 219.9 ± 12.2 mN). Forces generated by the micromechanical device were sufficient to reposition the VF – with medialization of 1.5 mm requiring 135 mN force. Conclusion: This report supports the concept that a remotely controlled thyroplasty implant may generate sufficient forces to modify vocal fold position and holds the potential for precise vocal fold manipulation and remote post-operative adjustments
86 SCIENTIFIC SESSIONS
Vocal Fold Paresis: Subjective and Objective Patient Presentation
Raluca Tavaluc, MD; Dinesh K. Chhetri, MD
Introduction: The significance of vocal fold paresis is debated in the literature. The diagnosis of vocal fold paresis is controversial, though most commonly accepted by laryngeal videostroboscopy. The clinical impact on the patient is not yet defined. And the treatment options are debated. Methods: Retrospective review of tertiary laryngology practice of the last 100 patients diagnosed with mucosal wave asymmetry as the sole videostroboscopic exam finding. Demographic, symptomatic complaints, index surveys and diagnostic tests were reviewed. Patients were excluded if they had prior surgery, head and neck cancer diagnosis, history of radiation, history of spasmodic dysphonia or other abnormality on videostroboscopic evaluation. Results: Ten percent of all comers were diagnoses with vocal fold paresis. Average age of presentation was 60 years old and ranged 21 to 88 years old. Distribution was 60% female with 75% left sided paresis. Symptomatic complaints include chronic cough in 38%, dysphonia in 20% of patients, anterior neck pain in 20% of the cohort. Voice Handicap Index-10 (VHI-10) mean was 6.75, with a range from 0-27. Reflux Symptom Index (RSI) average was elevated at 16.7, with a range of 3-23. Eating Assessment Tool (EAT-10) mean was 5.7, with a range 0-15. Screening functional fiberoptic swallow evaluation showed that 74% of patients had a normal evaluation, while 12% patients had trace residue and 14% had moderate vallecular and pyriform sinus residue. Conclusion: This is the first study to document the significance of vocal fold paresis in a cohort of patients presenting to a tertiary care practice.
Zenker's Diverticulum: Toward a Unified Understanding of Its Etiopathogenesis
David A. Kasle, MD; Sina J. Torabi, BA; Clarence T. Sasaki, MD
Objective: The etiology and pathogenesis of Zenker’s diverticulum (ZD) remain uncertain. Many theories have been proposed, including increased hypopharyngeal pressure, congenital upper esophageal sphincters, and dehiscence caused by acid and bile reflux. Our aim is to review the existing literature to explore these various pathogeneses. Additionally, we utilize a distinctive case and subsequent unique treatment method of a bilobed ZD to depict how an understanding of its etiopathogenesis should inform surgical treatment. Methods: A review of the English literature on PubMed and Google Scholar was performed to assess the possible proposed etiopathogenesis of ZD. Results: Dehiscence of mucosa through Killian’s triangle (KT) secondary to the inferior constrictor muscle’s (ICM) pharyngeal tubercle (midline) raphe is only one possible explanation for the formation of a ZD. Extraesophageal reflux is known to induce shortening of the esophagus and is associated with hiatal hernias. This shortening may play a prominent role in ZD formation as pulling the cricopharyngeal muscle (CPM) away from the anchored ICM allows for weakening of KT. Additionally, a bilobed diverticulum would likely originate from continuation of the fibrous raphe inferiorly to include the CPM. While this would partially explain a bilobed protrusion, shortening of the esophagus secondary to local extra-esophageal refluxate effects more strongly accounts for a bilobed ZD formation. Conclusions: The etiopathogenesis of ZD is likely multi-factorial, and an understanding of the various pathogeneses can help inform diagnostic and treatment methods.
87 MEMORIALS
PAUL CHODOSH, MD May 17, 1925- September 5, 2009
Paul L. Chodosh, M.D., an Emeritus Fellow students in all aspects of otolaryngology at of the American Laryngological the Eye and Ear Infirmary until just three Association, age 84 years old, died years ago. He was one of three doctors to peacefully at his home in Oquossoc, Maine receiv e the 2003 Physician of the Year on Friday, Sept. 5, 2008 surrounded by his Award for excellence in medicine from the wife of 61 years, Melba, at his side. Born in New York Eye and Ear Infirmary's Carteret, N.J., on May 17, 1924, to Anne Department of Otolaryngology in Head and and Abraham Chodosh, Dr. Chodosh was 84 Neck Surgery. The Paul L. Chodosh years old. Professorship, an endowed chair established in 2001 in head and neck surgery, honors his Unfortunately, the Association only learned service to the Infirmary. of his passing in August, 2018. Dr. Chodosh was inducted as an Active Fellow Dr. Chodosh was an avid golfer, fisherman in 1985 and elevated to emeritus status in and violinist. Whether it be Maine, New 1995. During his 55 years as a physician, Jersey or New York City, he was also an Dr. Chodosh served as an officer of several active and vocal member of his community. medical organizations and became a fellow He served in the United States Army during of every major otolaryngology society, World War II, and was a physician in the including the American Laryngological United States Air Force during the Korean Association and the American Triological War. Society. Dr. Chodosh attended high school in Known for his way with words, Dr. Rahway, N.J. He graduated from the Chodosh will be remembered for his wide University of Virginia Medical School in reach, his easy generosity and his insistent 1948 and began his distinguished career. He love for his family and his community. completed a residency in otolaryngology in 1956 at the New York Eye and Ear He is survived by his wife, Melba; his Infirmary, after which he became a vital brother, Richard; five children and 11 member of the Infirmary's teaching faculty, grandchildren, including daughter, Pamela, a surgeon director, and a renowned her son, Aaron Yowell, her husband, Paul practitioner in head and neck cancer surgery. Hausman; Aaron's father, Timothy Yowell; During his busy practice years in Elizabeth son Jonathan, his wife, Claire Seidl and their and Hillside, N.J., he was also on the staff of children, Eva, Rosie and Francie; son what was then called the Elizabeth General, Joshua, his wife Perrin Pleninger and their St. Elizabeth and Alexian Brothers hospitals. children, Max, Anya and Lydia; son James, his wife Abigail and their children, Otis and He also published in a multitude of major Ursula; son Hiram, his wife Priya Junnar, medical journals. Though Dr. Chodosh and their children, Saja and Caleb; nephews, retired from his private practice in 1988, he Ned Goldberg, Peter Goldberg and Michael continued teaching residents and medical Chodosh; nieces, Beth Goldberg, Kathy Bergmann, and Marilyn Kruegel.
88 MEMORIALS
Nels Robert Olson, MD May 6, 1933 – September 17, 2012
Nels Robert Olson, MD, an Emeritus Fellow of the American Laryngological Association, passed away on Monday, September 17, 2012 at his home after surviving many years with Alzheimer's disease. He was inducted as an Active Fellow in 1982 and elevated to emeritus status in 2002.
Dr. Olson was born on May 6, 1933, the younger of two children of Dorothy May Place and Olof Olson in Detroit, Michigan. His mother died when he was three years of who he married September 1, 1956, and age, and his father, an autoworker, raised raised their four children in Ann Arbor, him and his sister Greta in Detroit where Michigan. He was a devoted father and they attended St. Olaf Lutheran Church. provided his family a quiet example of perseverance, faithfulness, and subtle wit. After graduating from St. Olaf College in During his free time, he loved boating, dogs, Minnesota, he attended the University of golfing, and jogging. Most of all, he loved to Michigan Medical School and specialized in be with his family at the lake in the summer. ear, nose and throat surgery. He worked as a doctor primarily in private practice at St. In his final years of his illness, Dr. Olson Joseph's Hospital, where he was a pioneer in was lovingly cared for at home by family the study of acid reflux. His practice was and caretakers. He is survived by his wife, characterized by compassion for his patients, Mary, and children, Jon (Julie Vosper); a schedule that allowed him time to get to Lydie (Chris Raschka); Siri (Jonathan know them, and a preference for avoiding Strom); and Kari (Charles Tien). Six unnecessary intervention. He also worked at grandchildren, Ahna and Ezra Olson, Ingo the Veteran's Administration Hospital and Raschka, Solveig Olson-Strom, and taught at the University of Minnesota. Madeline and Kaia Tien have fond memories of him. While a student at St. Olaf College, Dr. Olson met another student, Mary Knutson
89 MEMORIALS
MYRON J. SHAPIRO, MD 1921 – September 27, 2014
The passing of one of our Emeritus Fellows, Myron J. Shapiro, MD, was discovered in Following post-doctoral studies in Chicago, late 2018. Dr. Shapiro passed away at the age Ill., and Philadelphia, Pa., Dr. Shapiro settled of 93 years in Morristown, New Jersey in New Jersey in 1949, where he built a surrounded by his family. medical practice and was one of the founding faculty members of the New Jersey Medical A renowned head and neck surgeon School of the University of Medicine and recognized for pioneering surgical Dentistry of New Jersey. He authored more techniques, Dr. Shapiro was inducted as an than 100 studies on tumors of the head and Active Fellow in 1979 and was elevated to neck and pioneered multiple surgical Emeritus status in 1990. Born in Toronto, procedures which continue to be used today. Canada, in 1921, he was one of the first He retired in 1990. After retirement, he Jewish students admitted to the University of volunteered for more than two decades Toronto's medical school, where he studied assisting elderly residents of the Morristown under Sir Frederick Banting, who won the area in woodworking and furniture Nobel Prize in medicine for the first use of restoration. insulin in diabetes. Following his service as a Royal Canadian Army captain during World He is survived by his longtime companion, War II in the medical corps, Dr. Shapiro’s Joan Goldman; his three children, Nancy J. medical career expanded for almost six Shapiro, Peter Shapiro and Margaret (Pooh) decades where built an international Shapiro and four grandchildren, Samuel reputation for both his clinical and academic Shapiro, Alexandra Hiatt, Joseph Hiatt, and Nathaniel Hiatt. work in the field of otolaryngology, with a particular focus on cancer surgery.
90
Anthony J. Maniglia, MD June 14, 1937 – July 16, 2017
A long-time Fellow of the American According to numerous colleagues, such as Laryngological Association, Dr. Anthony Dr. Jarrard Goodwin, “Dr. Maniglia was a Maniglia passed away on July 17, 2017 from devoted teacher, mentor, and then friend. I injuries sustained in a fall at his Bay Point was blessed to have him in my life.” Other home in Miami, Florida. Inducted into the tributes described “His technical talents in the ALA in 1989, Dr. Maniglia was elevated to operating room combined with his leadership Emeritus status in 2002. skills, thirst for knowledge and love for teaching made him a role model for others Dr. Maniglia, a graduate from Ribeirão Preto aspiring to be a professor and chairman of Medical School at the University of São otolaryngology at leading institutions here and Paulo, joined Dr. Ryan Chandler to become abroad,” (Dr. Barth Green, executive dean for the second senior faculty member in the Global Health and Community Service at the Department of Otolaryngology at the University of Miami Miller School of University of Miami in 1973. He taught and Medicine. practiced in the areas of ear, nose, throat, head and neck at UM for 12 years until 1985. This Case Western University issued the following was followed by his establishing similar statement, “Perhaps his most important department at Case Western Reserve accomplishment throughout his career, even in University and University Hospitals of retirement, was his diligent oversight of not Cleveland until his retirement in 2008. only the department but of all the faculty and residents and the mentorship he provided in In 1985, serving as the Secretary General and encouraging and at times demanding the President of the Pan-American Association of constant pursuit of excellence in clinical care, Otorhinolaryngology — Head and Neck scholarly activities and the betterment of the Surgery, Dr. Maniglia organized the 12th specialty,” World Congress of Otolaryngology in Miami Beach where the major focus was Electronic Dr. Maniglia leaves to cherish his memories, cochlear implants for the ear’s inner chamber his wife, Maria Teresa; son, Victor; to restore some hearing. He also is credited stepchildren, John Ludwick, Fernando, and with developing numerous surgical Maria Laura; sister, Rosa Monica; brothers innovations, including outpatient John and Jose Victor who followed him into tonsillectomy techniques and patenting early otolaryngology and practice in Brazil, and versions of implantable hearing aids, including three grandchildren. the cochlear implant.
91
Arnold Noyek, MD October 3, 1937 – December 12, 2018
The Association was notified of the passing of an Emeritus Fellow, Dr. Arnold Noyek, on December 12, 2018 in Toronoto, Canada at the age of 81 years. Inducted as an Active Fellow in 1986 and elevated to Emeritus status in 2015, Dr. Noyek was a renowned otolaryngologist known for championing mandatory hearing tests for newborns. and for founding an international charity that sought peace in the Middle East through academic exchanges in universities and medical centres. Born in Dublin Ireland, Dr. Noyek immigrated to Canada in 1940. He development and socialization, early attended the University of Toronto and identification and intervention helps graduated from medical school and later infants adapt more quickly. went on to be trained in otolaryngology — This screening procedure were specializing in ear, nose, throat, head and adopted as provincial health policy in neck surgery — at Manhattan Eye, Ear Ontario in 2001. To date more than 1 and Throat Hospital in New York City. He million babies have been screened. worked at Mount Sinai Hospital in Toronto Dr. Noyek was also a professor of since 1966 and was the hospital’s otolaryngology at the Dalla Lana School of otolaryngologist in chief for more than 10 Public Health, and a professor of years. Radiology at the University of Toronto. He While at Mount Sinai Hospital, Dr. worked as the Director of International Noyek and his team developed a Continuing Education for the Faculty of groundbreaking method to detect Medicine at the University of Toronto and deafness in babies by measuring was an adviser on global health education brainwave patterns. Because hearing loss to the Dalla Lana School of Public Health in babies can affect learning at the University of Toronto.
92
OFFICERS 1879 - 2017
Presidents
1879 Louis Elsberg 1923 J. Payson Clark 1973 G. Slaughter Fitz-Hugh 1880 J. Solis-Cohen 1226 Chevalier Jackson 1974 Daniel C. Baker Jr. 1881 F. I. Knight 1927 D. Bryson Delavan 1974 Joseph H. Ogura 1882 G. M. Lefferts 1928 Charles W. Richardson 1975 Stanton A. Friedberg 1883 F. H. Bosworth 1929 Lewis A. Coffin 1976 Charles M. Norris 1884 E. L. Shurly 1930 Francis R. Packard 1977 Charles F. Ferguson 1885 Harrison Allen 1931 George E. Shambaugh 1978 John F. Daly 1886 E. Fletcher Ingals 1932 George Fetterolf 1979 John A. Kirchner 1887 R. P. Lincoln 1933 George M. Coates 1980 Daniel Miller 1888 E. C. Morgan 1934 Dunbar Roy 1981 Harold C. Tabb 1889 J. N. Mackenzie 1935 Burt R. Shurly 1982 M. Stuart Strong 1890 W. C. Glasgow 1936 William B. Chamberlain 1983 John S. Lewis 1891 S. W. Langmaid 1937 John F. Barnhill 1984 Gabriel F. Tucker, Jr 1892 M. J. Asch 1938 George B. Wood 1985 Douglas P. Bryce 1893 D. Bryson Delavan 1939 James A. Babbitt 1986 Loring W. Pratt 1894 J. O. Roe 1940 Gordon Berry 1987 Blair Fearon 1895 W. H. Daly 1941 Thomas E. Carmody 1988 Seymour R. Cohen 1896 C. H. Knight 1942-43 Charles J. Imperatori 1989 Eugene N. Myers 1897 T. R. French 1944-45 Harold I. Lillie 1990 James B. Snow, Jr 1898 W. E. Casselberry 1946 Frank R. Spencer 1991 John M. Fredrickson 1899 Samuel Johnston 1947 Arthur W. Proetz 1992 William R. Hudson 1900 H. L. Swain 1948 Frederick T. Hill 1993 Byron J. Bailey 1901 J. W. Farlow 1949 Ralph A. Fenton 1994 H. Bryan Neel III 1902 J. H. Bryan 1950 Gordon B. New 1995 Paul H. Ward 1903 J. H. Hartman 1951 H. Marshall Taylor 1996 Robert W. Cantrell 1904 C. C. Rice 1952 Louis H. Clerf 1997 John A. Tucker 1905 J. W. Gleitsmann 1953 Gordon F. Harkness 1998 Lauren D. Holinger 1906 A. W. de Roaldes 1954 Henry B. Orton 1999 Gerald B. Healy 1907 H. S. Birkett 1955 Bernard J. McMahon 2000 Harold C. Pillsbury III 1908 A. Coolidge, Jr 1956 LeRoy A. Schall 2001 Stanley M. Shapshay 1909 J. E. Logan 1957 Harry P. Schenck 2002 Gerald S. Berke 1910 D. Braden Kyle 1958 Fred W. Dixon 2003 W. Frederick McGuirt, Sr. 1911 James E. Newcomb 1959 William J. McNally 2004 Robert H. Ossoff 1912 George A. Leland 1960 Edwin N. Broyles 2005 Robert T. Sataloff 1913 Thomas Hubbard 1961 Dean M. Lierle 2006 Gayle E. Woodson 1914 Alexander W. MacCoy 1962 Francis E. LeJeune 2007 Marshall Strome 1915 G. Hudson Makuen 1963 Anderson C. Hilding 2008 Roger l. Crumley 1916 Joseph L. Goodale 1964 Albert C. Furstenberg 2009 Marvin P. Fried 1917 Thomas H. Halsted 1965 Paul A. Holinger 2010 Andrew Blitzer 1918 Cornelius G. Coakley 1966 Joel J. Pressman 2011 Michael S. Benninger 1919 Norval H. Pierce 1967 Lawrence R. Boies 2012 Claremce T. Sasaki 1920 Harris P. Mosher 1968 Francis W. Davison 2013 C. Gaelyn Garrett 1921 Harmon Smith 1969 Alden H. Miller 2014 Mark S. Courey 1922 Emil Mayer 1970 DeGraaf Woodman 2015 Peak Woo 1924 Lee Wallace Dean 1971 F. Johnson Putney 2016 Kenneth Altman 1925 Greenfield Sluder 1972 Frank D. Lathrop 2017 Gady Har-El
93
Vice Presidents (First and Second)
1879 F.H. Davis 1929 William B. Chamberlin, Ralph A. Fenton 1880 W. C. Glasgow, J. O. Roe 1930 Harris P. Mosher, James A. Babbitt 1881 E. L. Shurly, W. Porter 1931 Joseph B. Greene, E. Ross Faulkner 1882 C. Seiler, E. F. Ingals 1932 Gordon Berry, Frank R. Spencer 1883 S. W. Langmaid, S. Johnston 1933 E. Ross Faulkner, Thomas S. Carmody 1884 J. H. Hartman, W. H. Daly 1934 Fordon B. New, Samuel McCullagh 1885 H.A. Johnson, G. W. Major 1935 Edward C. Sewall, H. Marshall Taylor 1886 E. C. Morgan, J. N. Mackenzie 1936 William P. Wherry, Harold I. Lillie 1887 J. N. Mackenzie, S. W. Langmaid 1937 Frank R. Spencer, Bernard J. McMahon 1888 W. C. Glasgow, C. E. DeM. Sajous 1938 Ralph A. Fenton, Frederick T. Hill 1889 F. Holden, C.E. Bean 1939 John H. Foster, Thomas R. Gittins 1890 J. O. Roe, J. H. Hartman 1940 Charles H. Porter, Gordon F. Harkness 1891 M. J. Asch, S. Johnston 1941 Arthur W. Proetz, Henry B. Orton 1892 S. Johnston, J. C. Mulhall 1942-3 Harold I. Lillie, Dean M. Lierle 1893 J. C. Mulhall, W. E. Casselberry 1944-5 John J. Shea, Thomas C. Galloway 1894 C.C.Rice, S. H. Chapman 1946 H. Marshall Taylor, C. Stewart Nash 1895 J. Wright, A. W. de Roaldes 1947 John J. Shea, Frederick A. Figi 1896 T. M. Murray, D. N. Rankin 1948 Henry B. Orton, Anderson C. Hilding 1897 A. W. MacCoy, H. S. Birkett 1949 LeRoy A. Schall, Fletcher D. Woodward 1898 J. W. Farlow, F.W. Hinkel 1950 W. Likely Simpson, Lyman, G. Richards 1899 T. A. DeBlois, M. R. Brown 1951 William J. McNally, Thomas C. Galloway 1900 H. L. Wahner, A. A. Bliss 1952 J. MacKenzie Brown, Edwin N. Broyles 1901 J. W. Gleitsmann, D. Braden Kyle 1953 Claude C. Cody, Daniel S. cunning 1902 G.A. Leland, T. Melville Hardie 1954 James H. Maxwell, Clyde A. Heatly 1903 J. H. Lowman, W. Peyre Porcher 1955 Robert L. Goodale, Paul H. Holinger 1904 Thomaso Hubbard, W. J. Freeman 1956 Henry M. Goodyear, Robert E. Priest 1905 J. L. Goodale, C. W. Richardson 1957 Frances H. LeJeune, Pierre P. Viole 1906 G. H. Makuen, A. R. Thrasher 1958 Charles Blassingame, Chevalier L. Jackson 1907 J. P. Clark, J. E. Rhodes 1959 James H. Maxwell, Oliver Van Alyea 1908 E. Mayer, F. R. Packard 1960 Walter Theobald, Anderson C. Hilding 1909 C. G. Coakley, H. O. Moser 1961 Julius W. McCall, P. E. Irlend 1910 Robert C. Myles, J. M. Ingersoll 1962 Paul M. Moore, Jerome A. Hilger 1911 F. C. Cobb, B. R. Shuly 1963 Paul M. Holinger, Lester A. Brown 1912 A. W. Watson, W. Scott Renner 1964 B. Slaughter Fitz-Hugh, Daniel C. Baker 1913 F. E. Hopkins, George E. Shambaugh 1965 C. E. Munoz-McCormick, Arthur J. Crasovaner 1914 Clement T. Theien, Lewis A. Coffin 1966 Lawrence R. Boies, G. Edward Tremble 1915 J. Gordon Wilson, Christian R. Holmes 1967 John F. Daly, Stanton A. Friedberg 1916 Thomas H. Halsted, Greenfield Sluder 1968 DeGraaf Woodman, John Murtagh
94
Vice Presidents (First and Second)
1917 John Edwin Rhodes, D. Crosby Greene 1969 Joseph P. Atkins, Stanton A. Friedberg 1918 George E. Shambaugh, John R. Winslow 1970 Robert B. Lewy, Oliver W. Suehs 1919 Francis R. Packard, Harmon Smith 1970 James A. Harrill, James D. Baxter 1920 Harmon Smith, W. B. Chamberlin 1972 Francis L. Weille, Sam H. Sanders 1921 Dunbar Roy,m Robert C. Lynch 1973 William H. Saunders, Blair Fearon 1922 George Fetterolf, Lorenzo B. Lockard 1974 Joseph H. Ogura, Douglas P. Bryce, John A. Kirchner 1923 Hubert Arrowsmith, Joseph B. Greene 1975 S. Lewis, Edwin W. Cocke, Jr. 1924 Ross H. Skillern, Gordon Berry 1976 Emanuel M. Skolnik, John T. Dickinson 1925 John E. Mackenty, Robert Levy 1977 J. Ryan Chandler, Herbert H. Dedo 1926 Lewis A. Coffin, William V. Mullin 1978 John E. Bordley, Lester A. Brown 1927 Charles W. Richardon, Hill Hastings 1979 Albert H.Andrews, Seymour R. Cohen 1928 Robert Cole Lynch, Francis P. Emerson 1980 John Frazer, George A. Sisson
Vice-Presidents (Presidents-Elect)
1981 M. Stuart Strong 1994 Paul H. Ward 2007 Roger L. Crumley 1982 JJohn S. Lewis 1995 Robert W. Cantrell 2008 Marvin Fried 1983 Gabriel F. Tucker, Jr 1996 John A. Tucker 2009 Andrew Blitzer 1984 Douglas P. Bryce 1997 Lauren D. Holinger 2010 Michael Benninger 1985 Loring W. Pratt 1998 Gerald B. Healy 2011 Clarence T Sasaki 1986 Blair Fearon 1999 Harold C. Pillsbury, III 2012 C. Gaelyn Garrett 1987 SSeymour R. Cohen 2000 Stanley M. Shapshay 2013 Mark S. Courey 1988 Eugene N. Myers 2001 Gerald S. Berke 2012 PeaklPeak Woo 1989 John B. Snow, Jr. 2002 W. Frederick McGuirt, Sr. 2014 Kenneth Altman 1990 J John M. Frederickson 2003 Robert H Ossoff 2015 Gady Har-El 1991 William R. Hudson 2004 Robert T. Sataloff 2016 C. Blake Simpson 1992 Byron Bailey 2005 Gayle Woodson 2017 1993 H. Bryan Neel III 2006 Marshall Strome
Secretaries and Treasurers
1879 G. M. Lefferts 1889 C. H. Knight 1900 P. E. Newcomb 1882 D. Bryson Delavan 1895 H. L. Swain 1911 Harmon Smith
95
Secretaries
1911 Harmon Smith 1947 Louis H. Clerf 1988 H. Bryan Neel III 1918 D. Bryson Delavan 1952 Harry P. Schenck 1993 Gerald B. Healy 1919 J. M. Ingersoll 1957 James H. Maxwell 1998 Robert H. Ossoff 1920 George M. Coates 1959 Lyman G. Richards 2003 Marvin P. Fried 1933 William V. Mullin 1968 Frank D. Lathrop 2008 C. Gaelyn Garrett 1935 James A. Babbitt 1972 John F. Daly 2012 Gady Har-El 1939 Charles J. Imperatori 1977 William M. Trible 2016 Lucian Sulica 1942 Arthur W. Proetz 1982 Eugene N. Myers
Treasurers
1912 J. Payson Clark 1953 Fred W. Dixon 1990 Robert W. Cantrell 1912 George Fetterolf 1958 Francis E. LeJeune 1995 Harold C. Pillsbury, III 1932 William V. Mullin 1962 Alden H. Miller 1999 Robert T. Sataloff 1933 James A. Babbitt 1969 Charles M. Norris 2005 Allen D. Hillel 1935 Charles J. Imperatori 1976 Harold G. Tabb 2006 Michael S. Benninger 1939 Frederick T. Hill 1981 Loring W. Pratt 2010 Kenneth W. Altman 1948 Gordon F. Harkness 1985 John M. Fredrickson 2014 Clark A. Rosen
Librarians
1879 F. F. H. Bosworth 1903 J. H. Bryan 1934 Burt R. Shurly 1883 T. T.R. French 1930 John F. Barnhill 1935 George M. Coates
Librarian and Historian
1936 George M. Coates 1944 Louis H. Clerf
Librarian, Historian and Editor
1947 Harry P. Schenck 1971 Charles F. Ferguson 1997 Stanley M. Shapshay 1952 Bernard J. McMahon 1977 Gabriel F. Tucker, Jr 2000 Gayle E. Woodson 1955 Edwin N. Broyles 1983 James B. Snow, Jr 2005 C. Gaelyn Garrett 1960 Francis W. Davison 1989 Paul Paul H. Ward 2008 Mark S. Courey 1964 F. Johnson Putney 1994 ErneErnest A. Weymuller, Jr
Historian
2010 Robert H. Ossoff 2015 Michael S. Benninger
96
DECEASED FELLOWS Dates indicate original election to the Association
Honorary Fellows
1946 Alonso, Justo M., Montevideo, Uruguay 1914 Levy, Robert, Denver, CO 1992 Aschan, Gunnar K., Linköping, Sweden 1918 Lewis, Fielding O., Media, PA 1908 Barnhill, John F., Miami Beach, FL 1933 Lierle, Dean M., Iowa City, IA 1983 Birkett, Herbert S., Montreal, CN 1883 Mackenzie, John N., Baltimore, MD 1878 Bosworth, Francke H., New York, NY 1881 Mackenzie, Sir Morell, London, ENG 1940 Broyles, Edwin N., Baltimore, MD 1910 Masser, Ferdinand, Naples, Italy 1917 Coates, George M., Philadelphia, PA 1904 Mosher, Harris P., Marblehead, MA 1925 Clerf, Louis H., St Petersburg, FL 1910 Moure, J. J. E., Bordeaux, France 1957 Conley, John J., New York, NY 1937 Nager, F. R., Zurich, Switzerland 1960 Daly, John F., Fort Lee, NJ 1930 Negus, Sir Victor E., London, ENG 1818 Dean, Lee Wallace, St Louis, MO 1818 Oliver, H. K., Boston, MA 1881 Delavan, D. Bryson, New York, NY 1957 Ono, Jo, Tokyo, Japan 1891 De La Sota y Lastra, Ramon, Seville, Spain 1906 Pierce, Norval Harvey, San Diego, CA 1893 de Roaldes, Arthur W., New Orleans, LA 1937 Portmann, Georges, Bordeaux, France 1923 Fenton, Ralph A., Portland, OR 1924 Proetz, Arthur C., St Louis, MO 1879 French, Thomas R., Brooklyn, NY 1957 Ruedi, Luzius, Zurich, Switzerland 1936 Galloway, Thomas C., Evanston, IL 1932 Schall, LeRoy A., Boston, MA 1880 Garcia, Manuel, London, ENG 1909 Semon, Sir Felix, Great Missenden, England 1986 Gould, Wilbur J., New York, NY 1878 Solis-Cohen, J., Philadelphia, PA 1903 Harris, Thomas J., New York, NY 1973 Som, Max L., New York, NY 1971 Harrison, Sir Donald F. N., Surrey, England 1889 Swain, Henry L., New Haven, CT 1943 Hilding, Anderson C., Duluth, MN 1914 Thomson, Sir St Clair, London, ENG 1928 Hill, Frederick T., Waterville, ME 1903 Tilley, Herbert, London, ENG 1948 Holinger, Paul H., Chicago, IL 1914 Wagner, Clinton, New York, NY 1957 Huizinga, Eelco, Groningen, the Netherlands 1948 Williams, Henry L., Rochester, MN 1907 Jackson, Chevalier, Schwenksville, PA 1951 Woodman, DeGraaf, New York, NY 1878 Johnston, Samuel, Baltimore, MD 1890 Wright, Jonathan, Pleasantville, NY 1878 Lefferts, George Morewood, Katonah, NY
Corresponding Fellows
1978 Arauz, Juan Carlos, Buenos Aires, Argentina 1902 Lermoyez, Marcel, Paris, France 1972 Arslan, Michele, Padua, Italy 1897 Luc, H., Paris, France 1942 Batson, Oscar V., Philadelphia, PA 1970 Macbeth, Ronald G., Oxford, England 1938 Blair, Vilray P., St Louis, MO 1896 MacDonald, Greville, Haslemere, England 1892 Browne, Lennox, London, England 1894 MacIntyre, John, Glasgow, Scotland 1968 Cawthorne, Sir Terence, London, England 1903 McBride, P., York, England 1964 Cleves, Carlos, Bogota, Colombia 1920 McKenzie, Dan, London, England 1940 Colledge, Lionel, London, England 1919 McKernon, James F., New Canaan, CT 1901 Collier, Mayo, Kearsney Abbey, Kent, England 1880 Meyer, Wilhelm, Copenhagen, Denmark 1893 Desvernine, Carlos M., Havana, Cuba 1896 Mygind, Holger, Copenhagen, Denmark 1966 Dohlman, Gösta, East Bradenton, FL 1950 Neil, James Hardie, Auckland, New Zealand 1943 Eggston, Andrew A., New York, NY 1919 Paterson, Donald Rose, Cardiff, Wales 1930 Emerson, Francis P., Franklin, MA 1941 Patterson, Norman, Herts, England 1961 Faaborg-Anderson, Kund, Nykobing, Denmark 1971 Rethi, Aurelius, Budapest, Hungary 2007 Fonseca, Rolando, Buenos Aires, Argentina 1919 Rogers, John, Jr, New York, NY 1936 Fraser, John S., Edinburgh,UK 1894 Sajous, C. E. DeM., Philadelphia, PA 1887 Gougenheim, A., Paris, France 1924 Schaefer, J. Parson, Philadelphia, PA 1901 Grant, Sir James Dundas, London, England 1896 Schmiegelow, Ernst, Copenhagen, Denmark 2017 Hirano, Minoru, Kurume, JAPAN 1946 Segura, Eliseo, Buenos Aires, Argentina 1984 Holden, Edgar, Newark, NJ 1940 Soto, E. Fernandez, Havana, Cuba 1970 Hutcheon, Jack R., Brisbane, Australia 1881 Thornton, Pugin, London, England 1985 Inouye, Tetsuzo, Saitama, Japan 1913 Turner, A. Logan, Edinburgh, UK 1919 Kelly, Adam Brown, Helensburgh, Scotland 1936 Vialle, Jacques, Nice, France 1978 Kleinsasser, Oskar, Marburg, Germany 1880 Whistler, W. McNeil, London, England 1881 Labus, Carlo, Milan, Italy 1901 Wingrave, Wyatt, Lyme Regis, England 1950 Larsell, Olof, Portland, OR 1894 Wolfenden, R. Norric, Kent, England 1931 LaSagna, Francesco, Parma, Italy 1926 Law, Frederick M., New York 1921 LeMaitre, Ferdinand, Paris
97
Deceased Fellows Emeritus Fellows
2018 Alford, Bobby, Houston, TX Hanckel, Richard W., Jr, Florence, SC 1962 Arnold, Godfrey E., Clinton, MS 1940 Hansel, French K., St Louis, MO 1969 Ausband, John R., Beaufort, SC 1896 Hardie, Thomas Melville, Chicago, IL 1936 Ballenger, Howard C., Winnetka, IL 1896 Hardie, Thomas Melville, Chicago, IL 1923 Barlow, Roy A., Nova Scotia, Canada 1960 Harris, Herbert H., Houston, TX 1915 Barnes, Hharry Aldrich, Kingston, MA 1959 Hart, Verling K., Charlotte, NC 1944 Beatty, Hugh G., Columbus, OH 1915 Hastings, Hill, Los Angeles, Ca 1928 Beck, Joseph C., Chicago, IL 1944 Havens, Fred Z., Rochester, MN 1921 Berry, Gordon, Worcester, MA 1942 Heatley, Clyde A., Rochester, NY 1975 Biller, Hugh, 1959 Henry, G. Arnold, Lagoon City, Canada 1944 Boies, Lawrence R., Minneapolis, MN 1955 Jerome A. Hilger, St. Paul, MN 1975 Boles, Roger 1888 Hinkel, Frank Whitehill, Buffalo, NY 1955 Bordley, John E., Baltimore, MD 1944 Hoople, Gordon D., Syracuse, NY 1941 Bowers, Wesley C., New York, NY 1895 Hopkins, Frederick E., Springfield, MA 1901 Brown, J. Price, Toronto, Canada 1930 Houser, Karl M., Ardmore, PA 1955 Brown, Lester A., Atlanta. GA 1927 Hubbard, Thomas, Toledo, OH 1891 Bryan, Joseph H., Washington, DC 1919 Hurd, Lee Maidment, Rowayton, CT 1963 Bryce, Douglas P, Toronto Canada 1920 Imperatori, Charles J., Essex, NY 1913 Butler, Ralph, Philadelphia, PA 1904 Ingersoll, John Marvin, Miami, FL 1930 Campbell, Edward H., Philadelphia, PA 1952 Ireland, Percy E., Toronto, Canada 1945 Campbell, Paul A., San Antonio, TX 1983 Jako, Geza, Melrose, MA 1942 Canfield, Norton, Miami, FL 1928 Jarvis, DeForest C., Barre, VT 1959 Cardwell, Edgar P., Newark, NJ 1939 Johnston, William H., Santa Barbara, CA 1897 Clark, J. Payson, Boston, MA 2010 Kashima, Haskins, Lutherville, MD 1968 Chandler, J. Ryan, Miami, FL 2018 Kelly, James, Baltimore, MD 2008 Chodosh, Paul, New York, NY 1942 Kelly, Joseph D., New York, NY 1899 Cobb, Frederick C., Bradenton, FL 1918 Kenyon, Elmer L., Chicago, IL 1939 Cocke, Edwin W. Jr., Memphis, TN 1921 Kernan, John D., New York, NY 1964 Cody, Claude C., Jr, Houston, TX 1965 King, James T., Atlanta, GA 1905 Cody, Claude C. III, Houston, TX 1929 Kistner, Frank B., Portland, OR 1957 Coffin, Lewis A., New York, NY 2011 Kirchner, John A., New Haven, CT 1893 Converse, John Marquis, New York, NY 1950 Kline, Oram R., Woodbury Heights, NJ 1959 Coolidge, Algernon, Boston, MA 1885 Knight, Charles H., New York, NY 1937 Cracovaner, Arthur J., New York, NY 1984 Krause, Charles W., Minneapolis, MN 1941 Crowe, Samuel H., Baltimore, MD 1975 Krichner, Fernando 1913 Cunning, Daniel S., New York, NY 1939 Large, Secord H., Cleveland, OH 1951 Dabney, Virginia, Washington, DC 1963 Lathrop, Frank D., Pittsford, VT 1882 Davison, Francis W., Danville, PA 1939 LeJeune, Francis E., New Orleans, LA 1966 De Blois, Thomas Amory, Boston, MA 1894 Leland, George A., Boston, MA 1968 Devine, Kenneth, Rochester, MN 1961 Lewy, Robert B., Chicago, IL 1941 DeWeese, David D., Portland, OR 1922 Lillie, Harold I., Rochester, MN 1947 Dixon, Fred W., Shaker Heights, OH 1943 Lincoln, William R., Cleveland, OH 1952 Eagle, Watt W., New Bern, NC 1949 Lindsay, John R., Evanston, IL 1892 Erich, John B., Rochester, MN 1976 Lingeman, Raleigh E., Indianapolis, IN 1964 Farlow, John W., Boston, MA 1973 Loré, John M., Buffalo, New York, NY 1963 Fearon, Blair W., Don Mills, Canada 1927 Lukens, Robert M., Wildwood Crest, NJ 1930 Ferguson, Charles F., Sarasota, FL 1928 Lyman, Harry Webster, St Louis, MO 1955 Figi, Frederick A., Rochester, MN 1886 MacCoy, Alexander W., Philadelphia, PA 1922 Fitz-Hugh, G. Slaughter, Charlottesville, VA 1928 MacPherson, Duncan, New York, NY 1933 Forbes, Henry H., New York, NY 2017 Manglia, Anthony, Cleveland, OH 2010 Foster, John H., Houston, TX 1941 Martin, Robert C., San Francisco, CA 1905 Frazer, John, Rochester, NY 1896 Mayer, Emil, New York, NY 1977 Frederickson, John, Vancouver, BC CANADA 1966 McCabe, Brian F., Iowa City, IA 1956 Freer, Otto T., Chicago, IL 1952 McCall, Julius W., Shaker Heights, OH 1932 Friedberg, Stanton A., Chicago, IL 1951 McCart, Howard W. D., Toronto, Canada 1940 Furstenberg, Albert C., Ann Arbor, MI 1939 McCaskey, Carl H., Indianapolis, IN 1928 Gatewood, E. Trible, Richmond, VA 1943 McCullagh, Samuel, New York, NY 1880 Gittins, Thomas R., Sioux City, IA 1963 McGovern, Francis H., Danville, VA 1959 Gleitsmann, Joseph W., New York, NY 1951 McHenry, Lawrence C., Oklahoma City, OK 1922 Goldman, Joseph L., New York, NY 1923 McKinney, Richmond, Memphis, TN 1898 Goldsmith, Perry G., Toronto, Canada 1933 McMahon, Bernard J., St Louis, MO 1940 Goodale, Joseph L., Ipswich, MA 1931 McNally, William J., Montreal, Canada 1965 Goodale, Robert L., Ipswich, MA 1952 Miller, Alden H., Glendale, CA 1932 Goodyear, Henry M., Cincinnati, OH 1965 Miller, Daniel, Boston, MA 1906 Graham, Harrington B., San Francisco, CA 1964 Montgomery, William W., Boston, MA 1917 Greene, D. Crosby, Jr, Boston, MA 1954 Moore, Paul McN., Delray Beach, FL 1950 Greene, Joseph B., Asheville, NC 1957 Munoz-MacCormick, Carlos E., Santurce, PR 1970 Hall, Colby, Encino, CA 1953 Murtagh, John A., Hanover, NH 1905 Halliday, Sir George C., Sydney, Australia 1939 Myers, John L., Kansas City, MO 1965 Halsted, Thomas H., Los Angeles, CA 1927 Myerson, Mervin C., New York, NY 98
Har
1937 Nash, C. Steward, Rochester, NY 2006 Sisson, George, Chicago, IL 1922 New, Gordon, B., Rochester, MN 1987 Skolnik, Emanuel M., Chicago, IL 1923 Newhart, Horace, Minneapolis, MN 1950 Smith, Austin T., Philadelphia, PA 2018 Noyek, Arnold, Toronto, CN 1908 Smith, Harmon, New York, NY 1958 O’Keefe, John J., Philadelphia, PA 2004 Soboroff, Burton, Chicago, IL 2012 Olson, Nels, Minneapolis, MN 1995 Sofferman, Robert, Burlington, VT 1903 Packard, Francis R., Philadelphia, PA 1954 Sooy, Francis A., San Francisco, CA 1961 Pang, Lup Q., Honolulu, HI 1923 Spencer, Frank R., Boulder, CO 1961 Pastore, Peter N., Richmond, VA 1963 Tabb, Harold C., New Orleans, LA 1972 Pennington, Claude Jr., Macon, GA 1947 Theobald, Walter H., Chicago, IL 1948 Phelps, Kenneth A., Burlington, NC 1954 Thornell, William C., Cincinnati, OH 1878 Porter, William, Ocean Springs, MA 1927 Tobey, Harold G., Boston, MA 1942 Potts, John B., Omaha, NE 1963 Tolan, John F., Seattle, WA 1951 Priest, Robert E., Edina, MN 1989 Toohill, Robert, Elm Grove, W I 2004 Putney, F. Johnson, Charleston, SC 1950 Tremble, G. Edward, Montreal, Canada 1951 Rawlins, Aubrey G., San Francisco, CA 1925 Tucker, Gabriel, Haverford, PA 1963 Reed, George F., Syracuse, NY 2016 Tucker, John A., Avalon, NJ 1903 Renner, W. Scott, Buffalo, NY 1943 Van Alyea, Oliver E., Chicago, IL 1897 Rhodes, John Edwin, Chicago, IL 1984 Vaughn, Charles W., Hingham, MA 1884 Rice, Clarence C., New York, NY 1941 Violé, Pierre, Los Angeles, CA 1905 Richards, George L., South Yarmouth, MA 1892 Wagner, Henry L., San Francisco, CA 1956 Richardson, John R., Searsport, ME 1974 Ward, Paul H., Pauma Valley, CA 2010 Ritter, Frank, Ann Arbor, MI 1892 Watson, Arthur W., Philadelphia, PA 1878 Robinson, Beverly, New York, NY 1948 Whalen, Edward J., Hartford, CT 1938 Salinger, Samuel, Palm Springs, CA 1922 White, Francis W., New York, NY 1959 Sanders, Sam H., Memphis, TN 1971 Williams, Russell I Jr., Madison, WI 1921 Sauer, William E., St Louis, MO 1939 Wilson, J. Gordon, Old Bennington, VT 1934 Schenck, Harry P., Philadelphia, PA 1905 Wood, George B. Wynnewood, PA 2010 Schild, Joyce, Alburquerque, NM 1935 Woodward, Fletcher D., Charlottesville, VA 1923 Sewall, Edward C., Palo Alto, CA 1953 Work, Walter, Green Valley, AZ 1930 Seydell, Ernest M., Wichita, KS 1907 Shambaugh, George E., Chicago, IL 2014 Shapiro, Myron, Morristown, NY 1558 Simonton, Kinsey Macleod, Ponte Vedra Beach, FL 1937 Simpson, W. Likely, Memphis,TN
99
1878 Adams, George L., Excelsior, MN 1939 Hourn, George E., St Louis, MO 2006 Alfaro, Victor R., Washington, DC 1901 Hunt, Westley Marshall, New York, NY 1958 Allen, Harrison, Philadelphia, PA 1925 Hyatt, Frank, Washington, DC 1880 Andrews, Albert H., Jr, Chicago, IL 1878 Iglauer, Samuel, Cincinnati, OH 1969 Arrowsmith, Hubert, Brooklyn, NY 1882 Ingals, E. Fletcher, Chicago, IL 1917 Asch, Morris J., New York, NY 1938 Ives, Frank L., New York, NY 1879 Ashley, Rae E., San Francisco, CA 1880 Jackson, Chevalier L., Philadelphia, PA 1942 Atkins, Joseph P., Philadelphia, PA 1878 Jarvis, William C., New York, NY 1958 Babbitt, James A., Philadelphia, PA 1879 Johnson, Hosmer A., Chicago, IL 1923 Ballenger, William L., Chicago, IL 1960 Johnson, Woolsey, New York, NY 1906 Bean, C. E., St Paul, MN 1961 Johnston, Kenneth C., Chicago, IL 1880 Beck, August L., New Rochelle, NY 1944 Jones, Edley H., Vicksburg, MS 1949 Berens, T. Passmore, New York, NY 1979 Jones, Marvin F., New York, NY 1904 Bigelow, Nolton, Providence, RI 1964 Kealhofer, R. H., St Louis, MO 1924 Blassingame, Charles D., Memphis, TN 1954 Keim, W. Franklin, Montclair, NY 1938 Bliss, Arthur Ames, Philadelphia, PA 1942 King, Edward D., North Hollywood, CA 1893 Boyden, Guy L., Portland, OR 1901 King, Gordon, New Orleans, LA 1951 Boylan, J. E., Cincinnati, OH 1878 Knight, Frederick Irving, Boston, MA 1895 Brown, John Mackenzie, Los Angeles, CA 1965 Knight, John S., Kansas City, MO 1932 Brown, Moreau R., Chicago, IL 1993 Komisar, Arnold, New York, NY 1892 Buckley, Robert E., New York, NY 1898 Kyle, D. Braden, Philadelphia, PA 1933 Canfield, R. Bishop, Ann Arbor, MI 1880 Langmaid, Samuel W., Boston, MA 1915 Carmack, John Walter, Indianapolis, IN 1953 Lederer, Francis L., Chicago, IL 1934 Carmody, Thomas E., Denver, CO 1878 Lincoln, Rufus P., New York, NY 1924 Casselberry, William E., Chicago, IL 1911 Lockard, Lorenzo B., Denver, CO 1889 Chamberlain, C. W., Hartford, CT 1913 Loeb, Hanau W., St Louis, MO 1883 Chamberlin, William B., Cleveland, OH 1897 Logan, James E., Kansas City, MO 1917 Chapman, S. Hartwell, New Haven, CT 1935 Looper, Edward A., Baltimore, MD 1882 Chappell, W. F., New York, NY 1888 Lowman, John H., Cleveland, OH 1896 Coakley, Cornelius G., New York, NY 1919 Lynah, Henry L., New York, NY 1902 Coffin, Rockwell C., Boston, MA 1952 Lynch, Mercer G., New Orleans, LA 1913 Cox, Gerald H., New York, NY 1915 Lynch, Robert Clyde, New Orleans, LA 1918 Cushing, E. W., Boston, MA 1914 Mackenty, John E., New York, NY 1880 Cutter, Ephraim, West Falmouth, MA 1881 Major, G. W., Montreal, Canada 1878 Daly, W. H., Pittsburgh, PA 1898 Makuen, G. Hudson, Philadelphia, PA 1880 Davis, F. H., Chicago, IL 1985 Mathog, Robert, Southfield, MI 1878 Davis, Warren B., Philadelphia, PA 1948 Maxwell, James H., Ann Arbor, MI 1941 Dennis, Frank Lownes, Colorado Springs, CO 1879 McBurney, Charles, New York, NY 1926 Dickerman, E. T., Chicago, IL 1927 McGinnis, Edwin, Chicago, IL 1901 Dickinson, John T., Pittsburgh, PA 1936 McGregor, Gregor, Toronto, Canada 1969 Donaldson, Frank, Baltimore, MA 1913 McKimmie, O. A., Washington, DC 1935 Equen, Murdock S., Atlanta, GA 1945 McLaurin, John G., Dallas, TX 1919 Eves, Curtis C., Philadelphia, PA 1885 McSherry, Clinton II, Baltimore, MD 1914 Faulkner, E. Ross, New York, NY 1954 Meltzer, Philip E., Boston, MA 1901 Fetterolf, George, Philadelphia, PA 1958 Montreuil, Fernand, Montreal, Canada 1995 Fisher, Samuel, Durham, NC 1881 Morgan, E. C., Washington, DC 1917 Freeman, Walter J., Philadelphia, PA 1950 Morrison, Lewis F., San Francisco, CA 1897 Friedberg, Stanton A., Chicago, IL 1940 Morrison, William W., New York, NY 1940 Frothingham, Richard, New York, NY 1886 Mulhall, J. C., St Louis, MO 1909 Fuchs, Valentine H., New Orleans, LA 1925 Mullin, William V., Cleveland, OH 1907 Getchell, Albert C., Worcester, MA 1914 Munger, Carl E., Waterbury, CT 1940 Gibb, Joseph S., Philadelphia, PA 1892 Murray, T. Morris, Washington, DC 1878 Gill, William D., San Antonio, TX 1881 Mynter, H., Buffalo, NY 1913 Glasgow, William Carr, St Louis, MO 1893 Newcomb, James E., New York, NY 1905 Goldstein, Max A., St Louis, MO 1895 Nichols, J. E. H., New York, NY 2001 Gray, Steven D., Salt Lake City, UT 1961 Ogura, Joseph H., St Louis, MO 1934 Grayson, Charles P., Philadelphia, PA 1927 Orton, Henry B., Newark, NJ 1995 Grove, William E., Milwaukee, WI 1894 Park, William H., New York, NY 1988 Gussack, Gerald S., Atlanta, GA 1892 Porcher, W. Peyre, Charleston, SC 1933 Hanson, David G., Chicago, IL 1927 Porter, Charles T., Boston, MA 1957 Harkness, Gordon F., Davenport, IA 1954 Pressman, Joel J., Los Angeles, LA 1878 Harrill, James A., Winston-Salem, NC 1908 Randall, B. Alexander, Philadelphia, PA 1945 Hartman, J. H., Baltimore, MD 1882 Rankin, D. N., Allegheny, PA 1879 Hickey, Harold L., Denver, CO 1934 Richards, Lyman G., Wellesley Hills, MA 1907 Holden, Edgar, Newark, NJ 1902 Richardson, Charles W., Washington, DC 1882 Holmes, Christian R., Cincinnati, OH 1930 Ridpath, Robert E., Philadelphia, PA 1893 Hooper, Franklin H., Boston, MA 1945 Robb, James M., Detroit, MI 1938 Hope, George B., New York, NY 1953 Roberts, Sam E., Kansas City, MO 1881 Robertson, J. M., Detroit, MI
100
1879 Roe, John O., Rochester, NY 1879 Tauber, Berhard, Cincinnati, OH 1948 Whalen, Edward J., Hartford, CT 1924 Taylor, Herman Marshall, Jacksonville, FL 1922 White, Francis W., New York, NY 1903 Theisen, Clement, F., Albany, NY 1939 Wilson, J. Gordon, Old Bennington, VT 1899 Thorner, Max, Cincinnati, OH 1935 Woodward, Fletcher D., Charlottesville, VA 1892 Thrasher, Allen B., Cincinnati, OH 1953 Work, Walter, Green Valley, AZ 1937 Tobey, George L. Jr., Boston, Ma 1913 Roy, Dunbar, Atlanta, GA 1967 Trible, William M., Washington, DC 1878 Rumbold, T. F., St Louis, MO 1925 Tucker, Gabriel F. Jr., Philadelphia, PA 1879 Seiler, Carl, Philadelphia, PA 1970 Tucker, Gabriel F. Sr., Chicago, IL 1928 Shea, John Joseph, Memphis, TN 1938 Vail, Harris H., Cincinnati, OH 1893 Shields, Charles M., Richmond, PA 1888 Van der Poet, S. O., New York, NY 1909 Shurly, Burt R., Detroit, MI 1936 Voislawsky, Antonie P., New York, NY 1878 Shurly, E. L., Detroit, MI 1954 Walsh, Theodore E., St. Louis, MO 1959 Silcox, Louis E., Punta Gorda, FL 1933 Wanamaker, Allison T., Seattle, WA 1892 Simpson, William Kelly, New York, NY 1896 Ward, Marshall R., Pittsburgh, PA 1919 Skillers, Ross H., Philadelphia, PA 1879 Ward, Whitfield, New York, NY 1909 Sluder, Greenfield, St. Louis, MO 1886 Westbrook, Benjamin R., Brooklyn, NY 1879 Smith, Andrew H., Geneva, NY 1924 Wherry, William P., Omaha, NE 1932 Smyth, Duncan Campbell, Boston, MA 1924 White, Leon E., Boston, MA 1928 Sonnenschein, Robert, Chicago, IL 1953 Wilderson, William W., Nashville, TN 1911 Staut, George C., Philadelphia, PA 1939 Williams, Horace J., Philadelphia, PA 1924 Stein, Otto J., Chicago, IL 1942 Wishart, D. E. Staunton, Toronto, Canada 1934 Stevenson, Walter, Quincy, IL 1922 Wishart, David J. G., Toronto, Canada 1934 Suchs, Oliver, W., Austin, TX 1896 Wollen, Green V., Indianapolis, IN 1940 Wood, V. Visscher, St. Louis, MO
101
ROSTER OF FELLOWS – 2019 Date indicates year admitted to active fellowship.
Active Fellows
Year Elected
2012 Abaza, Mona M., M.D., University of 2018 Bock, Jonathan, M.D., Medical College of Colorado-Denver, Dept. of Otolaryngology, Wisconsin, Dept. of Otolaryngology, 9200 W. 12635 E. 17th Ave., AO-1 Rm. 3103, Aurora Wisconsin Ave., Milwaukee, WI 53226 CO 80045 2012 Bradford, Carol R., M.D., Univ. of Michigan – 1994 Abemayor, Elliot, M.D., Univ of California, Ann Arbor, Dept. of Otolaryngology – HNS, L.A. Rm. 62-132 CHS, 10833 Le Conte 1500 E. Medical Center Dr., 1904 Taubman Ave., Los Angeles CA 90095-1624 Center, Ann Arbor, MI 48103-5312 2018 Lee, Akst, M.D., John Hopkins School of 2019 Bryson, Paul C., M.D., Cleveland Clinic Head Medicine, Outpatient Clinic, 6 01 N. and Neck Institute, 9500 Euclid Ave., A-71, Caroline St., 6th Floor, Baltimore, MD 2128 Cleveland, OH 44139 2006 Altman, Kenneth W., M.D., Ph.D., Dept of 2015 Buckmire, Robert, M.D., Univ. of North Otolaryngology, Baylor College of Carolina – Chapel Hill, Dept. of Medicine, One Baylor Plaze, #NA-102, Otolaryngology, POB Ground Floor, 170 Houston, TX 77030 Manning Dr., Chapel Hill, NC 27599-7070 2008 Armstrong, William B., MD, 525 S. Old 2011 Burns, James A., M.D., Harvard Medical Ranch Rd., Anaheim Hills, CA 92808-1363 School MA General Hospital, Dept. of 2001 Aviv, Jonathan, M.D., ENT and Allergy Otolaryngology, One Bowdoin Square, 11th Associates, 210 East 86th St., 9th Floor, New Floor, Boston, MA 02114 York NY 10028 1994 Caldarelli, David D., M.D., Dept. of 2010 Baredes, Soly, M.D., Univ of Medicine and Otolaryngology, Rush Presbyterian St. Luke’s Dentistry of New Jersey, Dept. of Medical Center, 1653 West Congress Otolaryngology, 90 Bergen St., Ste. 7200, Parkway, Chicago IL 60612 Newark, NJ 07103 2018 Carroll, Thomas L., M.D., Harvard Medical 2013 Belafsky, Peter C., M.D., Ph.D., Univ. of School, Brigham and Women’s Voice CA – Davis Medical Center, Dept. of Program, 45 Francis St., Boston, MA 02115 Otolaryngology, 2521 Stockton Blvd., Suite 2006 Carrau, Richard L, M.D., The Ohio State 7200, Sacramento, CA 95817 Univ. Medical Center, Dept. of 1999 Benninger, Michael S., M.D., The Cleveland Otolaryngology, 320 W. 10th Ave., Starling Clinic Foundation, Head & Neck Institute, Living Hall, Room B-221, Columbus, OH 9500 Euclid Ave., A-71, Cleveland, OH 43210 44139 1994 Cassisi, Nicholas J., D.D.S., M.D., Health 1993 Berke, Gerald S., M.D., Div. of Sciences Center, P.O. Box 100264, Otolaryngology - Head & Neck Surgery, Gainesville FL 32610-0264 UCLA School of Med., 10833 Le Conte, 2016 Castellanos, Paul F. M.D. Northern Light Los Angeles CA 90095-0001 ENT, 885 Union st., suite 145, Bangor, ME 2007 Bielamowicz, Steven, M.D., Dept. of 04401 Otolaryngology, Washington University 2011 Chhetri, Dinesh, M.D., UCLA School of Med., Hospital, 2150 Pennsylvania Ave. NE., Div. of Otolaryngology – Head & Neck Suite 6-301, Washington, DC 20037 Surgery, 200 Medical Plaza, Ste 500, Los 1987 Blitzer, Andrew, M.D., D.D.S., 425 W. 59th Angeles CA 90095-0001 St., 10th Fl., New York NY 10019 2014 Cohen, Seth M., M.D., MPH, Duke University 2012 Blumin, Joel H., M.D., Medical College of Medical Center, Dept. of Otolaryngology, Box Wisconsin, Dept. of Otolaryngology, 9200 3805, Durham, NC 27710 W. Wisconsin Ave., Milwaukee WI 53226
102
1992 Cotton, Robin T., M.D., Dept. of Pediatric 1995 Friedman, Ellen M., M.D., Dept. of Oto and Maxillofacial Surgery, Children’s Otolaryngology, Texas Children’s Hospital, Hospital Med. Ctr. ASB-3, 3333 Burnet One Baylor Plaza, Suite 206A, Houston TX Ave., Cincinnati OH 45229-2899 77030 2002 Courey, Mark S., M.D., Mt. Sinai School of 2016 Gardner, Glendon M. M.D., Henry Ford Medicine, Dept. of Otolaryngology, One Health Systems, Dept. of Otolaryngology, Gustave Levy Place, Box 1189, New York, 2799 W. Grand Blvd., Detroit, MI 48202 NY 10029 2002 Garrett, C. Gaelyn, M.D., VUMC Dept. of 1984 Crumley, Roger L., M.D., M.B.A., Head & Otolaryngology, 7302 MCE South, Nashville Neck Surgery, UC Irvine Medical Center, TN 37232-8783 101 City Dr. S., Bldg. 25, Orange CA 92868 2009 Genden, Eric M. M.D., Mt. Sinai School of 2011 Dailey, Seth, M.D., Medical College of Medicine, Dept. of Otolaryngology, One Wisconsin, Div. of Oolaryngology – 600 Gustave P. Levy Place, New York, NY 10029 Highland Ave., K4/719 CSC, Madison, WI 1999 Goding, George S. Jr., M.D., Dept. of 53792 Otolaryngology–HNS, Hennepin County 2015 Damrose, Edward J . M.D., Stanford Univ. Medical Center, 701 Park Ave., Minneapolis Medical Center, Dept. of Otolaryngology, MN 55414 801 Welch Rd., Stanford, CA 94305 2011 Gourin, Christine, M.D., John Hopkins Med. 2003 Donovan, Donald T., M.D., Baylor College Center, Dept. of Otolaryngology 601 N. of Medicine, One Baylor Plaza, SM 1727, Caroline St., #6260A, Baltimore, MD 21287 Houston TX 77005 2018 Grillone, Gregory A., M.D., Boston Medical 2002 Drake, Amelia F., M.D., Div. of Center, Dept. of Otolaryngology, 820 Harrison Otolaryngology–Head & Neck Surgery, Ave., FGH Bldg., 4th Floor, Boston, MA UNC School of Medicine 1114 02118 Bioinformatics Bldg., CB #7070, Chapel 1991 Gullane, Patrick J., M.D., Toronto General Hill NC 27599-7070 Hospital, 200 Elizabeth Street EN 7-242, 2003 Eisele, David W., M.D., John Hopkins Toronto, Ontario M5G 2C4, CANADA Univ. School of Medicine, Dept. of 1998 Har-El, Gady, M.D., 19338 Keno Ave., Hollis, Otolaryngology601 N. Caroline St., Suite NY 11423 6210, Baltimore, MD 21287 2015 Halum, Stacey L., M.D., The Voice Clinic of 2019 Ekbon, Dale, M.D., Mayo Clinic Dept. of Indiana, 1185 W. Carmel, D-1A, Carmel, IN Otolaryngology, 200 1st St. SW, Gonda 12, 46032 Rochester, MN 55905 2008 Hayden, Richard E., MD, Mayo Clinic – 2012 Ferris, Robert L., M.D., PhD, Univ. of Scottsdale, Dept of Otolaryngology, 5777 E. Pittsburgh Medical Center, Dept. of Mayo Blvd., #18, Scottsdale, AZ 85255 Otolaryngology, Eye and Ear Institute, 200 2009 Heman-Ackah, Yolanda, MD, Philadelphia Lothrop St., Ste. 519, Pittsburgh, PA 15213 Voice Center, 25 Bala Ave., Suite 200, Bala 2010 Flint, Paul W., M.D., Univ. of Oregon Cynwyd, PA 19004 Health Sciences Center, Dept. of 2019 Hillel, Alexander, M.D., John Hopkins Univ. Otolaryngology, 3181 SE Sam Jackson School of Medicine, Dept. of OTO, 601 Park Rd., (PV01), Portland, OR 97239 Caroline St., 6th Floor, Baltimore, MD 21287 2018 Francis, David O., M.D., M.S., Univ of 2014 Hinni, Michael L., M.D., Mayo Clinic, Dept. Wisconsin - Madison, Dept. of of Otolaryngology 5777 East Mayo Blvd., Otolaryngology, 600 Highland Ave., K4/7, Phoenix, AZ 85054 Madison, WI 53792 2007 Hoffman, Henry T. M.D., Dept. of 2011 Franco, Ramon Jr. MD, MA General Otolaryngology, University of Iowa Hospitals Hospital Dept. of Otolaryngology, 243 and Clinics, 200 Hawkins Drive., Iowa City, Charles St., 7th Floor, Boston, MA 02114 IA 52242 1989 Fried, Marvin P., M.D., Montefiore Med 2012 Hogikyan, Norman D., M.D., Univ. of Ctr., Green Med Arts Pavilion, 3400 Michigan – Ann Arbor, , Dept. of Bainbridge Ave., 3rd Fl., Bronx NY 10467- Otolaryngology – HNS, 1500 E. Medical 2404 Center Dr., 1904 Taubman Center, Ann Arbor, MI 48103-5312
103
2019 Hu, Amanda CM, M.D., Vancourer General 1991 Koufman, Jamie A., M.D., Voice Institute of Hospital, Diamond Health Care Center, New York, 200 W. 57th St., Ste. 1203, New Dept. of OTO, 2775 Laurel St., 4th Floor, York, NY 10019 Vancouver, BC, CANADA V5Z 1M9 2006 Kraus, Dennis H., M.D., New York Head & 2017 Jacobs, Ian, MD, The Children’s Hospital of Neck Instituter, Dept. of Otolaryngology, 130 Philadelphia, Dept. of Otolaryngology, 34th E. 77th St., Black Hall, 10th Floor, New York, & Civic Center Blvd, 1 Wood Center, NY 10075 Philadelphia, PA 19104 2011 Lavertu, Pierre, M.D., Univ. Hospital, Case 2019 Jamal, Nausheen M.D., Univ. of TX Rio Medical Ctr., Dept of Otolaryngology, 11100 Grande Valley, School of Medicine, 1210 Euclid Ave., Cleveland, OH 44106 W. Schunior, Edinburg, TX 78541 1981 Lawson, William, M.D., Mount Sinai School 2013 Johns, Michael M. III, M.D., Univ. of of Medicine, Dept. of Otolaryngology, One Southern California, Dept. of Gustave L. Levy Place, New York NY 10029 Otolaryngology, 1540 Alcazar St., Ste. 2018 Long, Jennifer, M.D., Ph.D., UCLA Medical 204M, Los Angeles, CA 90033 Center, Div. of Head& Neck Surgery, 200 1990 Johnson, Jonas T., M.D., Dept. of Medical Plz, Ste 550, Los Angeles, CA 90095 Otolaryngology, Eye & Ear Hospital, Suite 2015 Mau, I-Fan Theodore, M.D., Ph.D., Univ. of 500, 200 Lothrop Street, Pittsburgh PA Texas Southwestern Medical Center, Dept. of 15213 Otolaryngology, 5323 Harry Hines Blvd., 2019 Joohnson, Romaine F., M.D., M.P.H., Univ. Dallas, TX 75390 of Texas Southwestern Medical Center, 1989 McCaffrey. Thomas V., M.D., Ph.D., Dept of Dept. of OTO, 2750 N. Stemmons Fwy., Otolaryngology-HNS, Univ. of S. Florida, F6.206, Dallas, TX 75207 12902 Magnolia Dr., Ste. 3057, Tampa FL 2002 Keane, William M., M.D., Thomas Jefferson 33612 Univ. Medical College, Dept of 2007 Merati, Albert L. M.D., Div. of Otolaryngology, 925 Chestnut St., 6th Fl., Otolaryngology, Medical College of Philadelphia PA 19107 Wisconsin, 9200 W. Wisconsin Ave., 2019 Kendall, Katherine, M.D., Univ. of Utah Milwaukee, WI 53226 School of Medicine, Dept. of OTO, 500 1997 Metson, Ralph, M.D., Zero Emerson Place, Foothill Dr., Salt Lake City, UT 84148 Boston MA 02114 1999 Kennedy, David W., M.D., Univ of 2014 Meyer, Tanya K., M.D., M.S., Univ. of Pennsylvania Medical Center, 3400 Spruce Washington, Dept. of Otolaryngology St., Philadelphia, PA 19104-4274 1959 NE Pacific St., Box 356515, Seattle, WA 2000 Kennedy, Thomas L., M.D., Geisinger 98195-6515 Medical Center, Dept. of Otolaryngology, 2008 Mirza, Natasha , M.D., Hospital of the 100 N. Academy Ave, Danville PA 17822 University of Pennsylvania, 3400 Spruce St., 5 2009 Kerschner, Joseph M.D., Children’s Silverstein, Philadelphia, PA 19104 Hospital of Wisconsin, Dept of 2012 Meyer, III, Charles M., M.D., Univ. of Otolaryngology, 9000 Wisconsin Ave., Cincinnati College of Medicine, Children’s Milwaukee, WI 53226 Hospital Medical Center, Dept. of Pediatric 2014 Khosla, Sid, M.D., Univ. of Cincinnati Otolaryngology, 3333 Burnet Ave., Cincinnati, Academic Health Center, Dept. of OH 45229 Otolaryngology, 231 Albert Sabin Way, ML 2007 Myssiorek, David M.D., Jacobi Medical 0528, Cincinnati, OH 45267 Center, Dept. of Otolaryngology, 1400 Pelham 2017 Klein, Adam, M.D., Emory University Pkwy, Bronx, NY 10461 Voice Center, 550 Peachtree St. NE, MOT 1994 Netterville, James L., M.D., VUMC Dept of Suite 9-4400, Atlanta, GA 30308 Otolaryngology, 7209 MCE South, Nashville 2011 Kost, Karen M. M.D., Montreal General TN 37232-8605 Hospital, Dept. of Otolaryngology, 1650 2016 Noordzij, J. Pieter, M.D., Boston Univ. School Cedar St., Montreal, Quebec, H3G 1A4, of Medicine, Dept. of Otolaryngology, 820 Canada Harrison Ave., Boston, MA 02128
104
1995 Olsen, Kerry D., M.D., Mayo Medical Mile Rd., Ste 111, St. Clair Shores, MI 48081 Center, Dept. of Otolaryngology, 200 First 1981 Sasaki, Clarence T., M.D., Yale University Street SW, Rochester MN 55905-0001 School of Medicine, Dept of Surgery, PO Box 2005 O’Malley, Bert W., M.D., Univ. of 208041, New Haven CT 06520 Pennsylvania Health System, Dept of 1995 Sataloff, Robert T., M.D., D.M.A., Drexel Otolaryngology, 3400 Spruce Street, 5 Univ. College of Medicine, Dept. of Ravdin, Philadelphia, PA 19104 Otolaryngology, 219 N. Broad St., 9th Floor, 2017 Ongkasuwan, Julina, M.D., Univ. of Texas Philadelphia, PA 19107 Health Sciences Center, Dept. of 1992 Schaefer, Steven D., M.D., Dept. of ORL, Otolaryngology, 6701 Fannin St., MSC New York Eye and Ear Infirmary, 14th Street 640.10, Houston, TX 77030 at 2nd Avenue, New York NY 10003 1990 Ossoff, Robert H., D.M.D., M.D., VUMC 2009 Schweinfurth, John M. MD, Univ. of 2004 Paniello, Randal C., M.D., Ph.D., Dept of Mississippi, Dept. of Otolaryngology 2500 N. Otolaryngology, Washington University State, Jackson, MS 39912 School of Medicine, 660 S. Euclid, Campus 1990 Shapshay, Stanley M., M.D., University Ear, Box 8115, St. Louis MO 63110 Nose & Throat, Albany Medical Center, 43 1999 Parnes, Steven M., M.D., Albany Medical New Scotland Ave., MC 41, Albany, NY Center, Div. of Otolaryngology,. MC 41, 43 12208 New Scotland Ave., Albany, NY 12208- 2009 Simpson C. Blake, MD. Univ. of Texas – San 1998 Persky, Mark S., M.D., New York Univ. Antonio, Dept of Otolaryngology 7703 Floyd Medical Center, Dept. of Otolaryngology, Curl Dr., MSC 7777, San Antonio, TX 78229 160 E. 30th St., New York NY 10016 2019 Smith, Libby J., D.O., Univ. of Pittsburgh 2014 Pitman, Michael E., M.D., Columbia- Voice Center, UPC Mercy, 1400 Locust St., Presbyterian Medical Center, Dept. of Bldg B., Suite 11500, Pittsburgh, PA 15219 Otolaryngology, 180 Ft. Washington Ave., 2009 Smith, Marshall E., MD, Univ. of Utah, Dept Harkness Pavilion 8-863, New York, NY of Otolaryngology 50 N. Medical Dr., 3C120, 10032 Salt Lake City, UT 84132 2010 Rahbar, Reza MD, Children’s Hospital of 2014 Soliman, Ahmed M.S., MD, Temple Univ. Boston, Dept. of Otolaryngology, 300 School of Medicine, Dept. of Otolaryngology, Longwood Ave., LO367, Boston, MA 3440 N. Broad St., Kresge West 312, 02115 Philadelphia, PA 19140 1995 Reilly, James S., M.D., Dept. of 2019 Song, Phillip, M.D., Massachusetts Eye and Otolaryngology, Nemours-duPont Hospital Ear Infirmary, 243 Charles St., Boston, MA for Children, 1600 Rockland Road, PO Box 02114 269, Wilmington DE 19899 2006 Strome, Scott E., M.D., Univ. of Tennessee 1985 Rice, Dale H. M.D., Ph.D., Univ. of College of Medicine, 910 Madison Ave., Ste. Southern California, Health Consultation 1002,Memphis, TN 38163 Center II, 1510 San Pablo St., Ste. 4600, Los 2010 Sulica, Lucian, MD, Weil-Cornell Medical Angeles CA 90033 College, Dept. of Otolaryngology, 1305 York 1992 Richtsmeier, William J., M.D., Ph.D., Ave., 5th Floor, New York, NY 10021 Bassett Healthcare, 1 Atwell Rd., 2004 Terris, David J., M.D., 4 Winged Foot Drive, Cooperstown NY 13326 Martinez, GA 30907 1982 Rontal, Eugene, M.D., 28300 Orchard Lake 2008 Thompson, Dana M., M.D., M.S., Ann & Rd., Farmington MI 48334 Robert Lurie Children’s Hospital, Div. of 1995 Rontal, Michael, M.D., 28300 Orchard Lake Pediatric Otolaryngology, 225 E. Chicago Rd., Farmington MI 48334 Ave., Box 25, Chicago, IL 60611 2005 Rosen, Clark A., M.D., UCSF Voice and 2017 Varvares, Mark, M.D., PhD, Massachusetts Swallowing Center, 2330 Post St., 5th Floor, Eye and Ear Infirmary, 165 Beacon St., Unit San Francisco, CA 94115 10, Boston, MA 02116 2014 Rubin, Adam D., M.D., Lakeshore Ear, 1996 Weber, Randal S., M.D., Univ of Texas, Dept Nose & Throat Center, Lakeshore of Otolaryngology – HNS, Unit 441, 1515 Professional Voice Center, 21000 E. Twelve Holcombe Blvd., Houston, TX 77030
105
2003 Weinstein, Gregory S., M.D., Dept. of Otolaryngology, 34th St. & Civic Center Otorhinolaryngology –Head & Neck Blvd., Philadelphia PA 19104 Surgery, Univ of Pennsylvania, 3400 Spruce 1996 Woo, Peak, M.D., Peak Woo, MD, PLLC, 300 St., 5 Ravdin, Philadelphia, PA 19104-4283 Central Park West, New York, NY 10024 1995 Weissler, Mark C., M.D., Univ. of NC – 1995 Zeitels, Steven M., M.D., Harvard Medical Chapel Hill, Div. of Otolaryngology, G- School/Massachusetts General Hospital, Dept. 0412 Neurosciences Hospital, CB 7070, of Otolaryngology, One Bowdoin Sq., Boston, Chapel Hill NC 27599-7070 MA 02114 1994 Wenig, Barry L., M.D., Univ. of Illinois at 2019 Zur. Karen, .M.D., Children’s Hospital of Chicago, Dept. of OTO, 1855 W. Taylor St., Philadelphia,Dept. of OTO, 3401 Civic Center #242, Chicago, IL 60612 Blvd., 1 Wood ENT Wood, Philadelphia, PA 1997 Wetmore, Ralph F., M.D., The Children’s 19104 Hospital of Philadelphia, Div. of
Associate Fellows
2014 Branski, Ryan C., Ph.D., New York Univ. Levy Place, Box 1007, New York, NY Medical Center, Dept. of Otolaryngology, 10029-6574 345 E. 37th St., Ste #306, New York, NY 2006 Murry, Thomas, Ph.D., Loma Linda Univ. 10016 School of Medicine, Dept. of 2009 Cleveland, Thomas F., Ph.D., Vanderbilt Otolaryngology, 2462 Azure Coast Dr., Univ. Medical Center, Dept. of LaJolla, CA 92037 Otolaryngology, 7302 Medical 2013 Rousseau, Bernard, PhD., Vanderbilt Univ. Center East, Nashville TN 37232-8783 School of Medicine, Dept. of 2018 Hapner, Edie, Ph.D., USC Voice Center, Otolaryngology, 602 Oxford House, 830 S. Fowler St., Ste. 100, Los Angeles, Nashville, TN 37232-4480 CA 90017 2017 Simonyan, Kristina, M.D., Ph.D., Mt. Sinai 1996 Hillman, Robert E., Ph.D., Dept. of School of Medicine, Dept. of Neurology and Otolaryngology, Massachusetts General Otolaryngology, One Gustave Levy Place., Hospital, One Bowdoin Sq., Boston, MA Box 1180, New York, NY 10029 02114 2006 Thibeault, Susan L., Ph.D., Univ. of 2017 Jiang, Jack J., M.D., Ph.D., Univ. of Wisconsin – Madison, Dept. of Wisconsin – Madison, Biomedical Otolaryngology, 600 Highland Ave., K4/709 Engineering Research Center of the Division CSC, Madison, WI 53792-7375 of Otolaryngology, 1300 University Ave., 2013 Zealear, David, Ph.D., Vanderbilt Univ. 2735 MSC, Madison, WI 53706 School of Medicine, Dept. of 2013 Laitman, Jeffrey, Ph.D., Mt. Sinai School of Otolaryngology, 7209 MCE South, Medicine, Center for Anatomy and Nashville, TN 37232-8605 Functional Morphology, One Gustave L.
Honorary Fellows
1995 (1974) Snow, James B., Jr., M.D., Ph.D., 327 1999 Titze, Ingo R., Ph.D., The University of Greenbrier Lane, West Grove, PA Iowa, 330 WJSHC, Iowa City, IA 19390-9490 52242-1012
Corresponding Fellows
1999 Abitbol, Jéan, M.D., Ancien Chef de 1991 Andrea, Mario, M.D., Av. Rua das Clinique, 1 Rue Largilliere Paris, 75016 Amoreiras, 72 E-12°, 1250-024 Lisbon, FRANCE PORTUGAL 106
1995 Bridger, G. Patrick, M.D., 1/21 Kitchener 2010 Maune, Steffen, M.D., Ph.D. HNO-Klinik, Place, Bankstown 2200 NSW, Neufeder Str. 32, Koln, 51067, GERMANY AUSTRALIA 1985 Murakami, Yasushi, M.D., Ryoanji, 4-2 2015 Dikkers, Frederik, G., M.D., Ph.D., Goryoshita, U-KYO-KU, Kyoto, 616 Academic Medical Center Amsterdam, JAPAN Dept. of Otolaryngology, P O Box 22660, 2005 Nicolai, Perio, M.D., University of Brescia 1100 DD, Amsterdam, THE Dept of Otorhinolaryngology, Via Corfu 79, NETHERLANDS Brescia, 25100 ITALY 2017 Hamdan, Abdul Latif, M.D., American 2019 Nururkar, Nurpu Kapoor, MBBS, MPH, University of Beirut Medical Center, Dept. Bombay Voice and Swallowing Center, 12 of Otolaryngology, P OBox 110236, Beirut, New Marine Lines, MRC 2nd, Floor, LEBANON Mumbai 40020, INDIA 2012 Hartl, Dana M., M.D., Ph.D., Institut 2000 Omori, Koichi, M.D., Ph.D., Fukushima Gustave Roussy, Head & Neck Oncology, Med. Univ. Dept of Otolaryngology, 1 114 rue Edouard Vaillant, 94805, Villejuif, Hikarigaoka, Fukushima 960-1295 JAPAN FRANCE 1997 Perry, Christopher F., M.B.B.S., 4th Floor, 1995 Hasegawa, Makoto, M.D., Ph.D., 1-44-1- Watkins Medical Center, 225 Wickham 1101 Kokuryo-cho, Chofu, Tokyo, 182- Terrace, Brisbane, QLD, AUSTRALIA 0022, JAPAN 4000 2012 Hirano, Shigeru, M.D., Ph.D., Kyoto 1998 Remacle, Marc, M.D., Ph.D., CHL-EICH, Prefectural Univ., Dept. of Otolaryngology, Dept. of ORL, Voice & Swallowing 465 Kajii-cho, Kawaramachi-Hirokoji, Disorders, Rue d’eich 78, L-1460 Kamigyo-ku, Kyoto, 602-8566 JAPAN LUXEMBOURG 1991 Hisa, Yasuo, M.D., Ph.D., Kyoto Prefectural 2010 Sandhu, Guri, MBBS, Royal National TNE Univ. of Medicine, Dept. of Otolaryngology, and Charing Cross Hospitals, 107 Harley Kawaramachi-Hirokoji, Kyoto 602-8566, St., London, W1G 6AL, ENGLAND JAPAN 2001 Sato, Kiminori, M.D., Ph.D., Kurume Univ. 1999 Hosal, I. Nazmi, M.D., Mesrutlyet Cadesi, School of Medicine, Dept of No. 29/13 Yenisehir, Ankara, TURKEY Otolaryngology, 67 Asahi-nacgu, Kurume 1998 Kim, Kwang Hyun, M.D., Ph.D., Seoul 830-0011 JAPAN Nat’l. Univ. Hospital, Dept of 2011 Shionati, Akihiro, MD, PhD. National Otolaryngology, 28 Yongon-Dong, Congno- Defense Medical College, Dept. of gu, Seoul 110-744, KOREA Otolaryngology 3-2 Namiki, Tokorozawa, 2012 Kobayashi, Takeo, M.D., Ph.D., Teikyo Saitama, 359-8513, JAPAN Univ. Chiba Medical Center, Dept. of 2008 Vokes, David E., M.D., North Shore Otolaryngology, 3426, Anesaki Ichihara Hospital Dept of Otolaryngology, Private 299-0111, JAPAN Bag 93-503, Takapuna, North Shore City, 2019 Kwon, Seong Keun, M.D., Ph.D., Seoul 0740, NEW ZEALAND National Univ. Hospital, Dept. of 2019 Wang, Chi-Te, MD, MSc. PhD, No. 21, Sec. Otolaryngology, 101 Daehak-ro, Jongno-gu, 2, Nanaya S. Rd., Banciao District, New Seoul, REPUBLIC OF SOUTH KOREA Tapei City, 226, TAIWAN 2013 Kwon, Tack-Kyun, M.D., Ph.D., Seoul 1999 Wustrow, Thomas P.U., M.D., HNO- National Univ. Hospital, Dept. of Gemeinschafts-Praxis, Otolaryngology, 28 Yongon Dong, Jongno- Wittelsbacherplatz1/11 (ARCO - Palais) gu, Seoul, 110-744, KOREA Munich, GERMANY 80333 2003 Mahieu, Hans F., M.D., Ruysdael Voice 2017 Yilmaz, Taner, M.D., Hacettepe University Center, Labradorstroom57, 1271 DC, Faculty of Medicine, Dept. of Huizen, THE NETHERLANDS Otolaryngology, Hacettepe, TURKEY
107
Emeritus Fellows
1984 (2008) Applebaum, Edward L., M.D., 161 East 2018 (2000) Goodwin, W. Jarrard Jr., M.D., Chicago Ave., Apt. # 42B, Chicago, IL 9841 W. Suburban Dr., Miami FL 60611 33156 2006 (1975) Bailey, Byron J., M.D., 13249 Autumn 2016 (1985) Gross, Charles W., M.D., 871 Ash Dr., Conroe, TX 77302 Tanglewood Rd., Charlottesville, 2016 (1977) Blaugrund, Stanley, M.D., 44 W. 77th VA 22901-7816 St., Apt. 5W, New York, NY 10024 2013 (1983) Healy, Gerald B., M.D., 194 2013 (1984) Bone, Robert C., M.D., 460 Culebra St., Grove St., Wellesley, MA 02482 Del Mar, CA 92014 2019 (1998) Hillel, Allen D., M.D., Univ of 2003 (1995) Brandenburg, James H., M.D., 5418 Washington, Dept. of OTO, Box Old Middleton Rd, Apt. # 204, 356515, Seattle, WA 98195 Madison, WI 53705-2658 2016 (1986) Holinger, Lauren D., M.D., 70 E. Cedar St., 2015 (1994) Broniatowski, Michael, M.D., 2351 Chicago, IL 60611 East 22nd St., Cleveland OH 44115 2012 (1983) Johns, Michael M. E., M.D., 2006 (1979) Calcaterra, Thomas C., M.D., UCLA Emory University, 1648 Pierce 2499 Mandeville Canyon. Road, Los Dr., Ste 367, Atlanta, GA 30320 Angeles CA 90049 1990 (1979) LeJeune, Francis E., M.D., 334 2013 (1985) Canalis, Rinaldo F., M.D., 457 15th St., Garden Rd., New Orleans LA 70123 Santa Monica CA 90402 2017 (2000) Levine, Paul A., M.D., Univ of 2002 (1976) Cantrell, Robert W. Jr., M.D., 1925 Virginia Health Systems, Dept. of Owensville Rd, Charlottesville VA OTO, MC #800713, Rm. 277b, 22901 Charlottesville VA 22908 2016 (1980) Cummings, Charles W., M.D., Johns 2014 (1987) Lucente, Frank E., M.D.,SUNY Hopkins School of Medicine, Dept. of Downstate Medical Center, Dept. Otolaryngology–Head and Neck of Otolaryngology, 339 Hicks Surgery, 601 N. Caroline St., Baltimore St., Brooklyn NY 11201 MD 21287 2016 (1996) Lusk, Rodney P., M.D., 2276 1973 (2011) Dedo, Herbert H., M.D., 1802 Seven Lakes Dr., Loveland, CO Floribunda Ave., Hillsborough, CA 80536 94010 2016 (1996) Maragos, Nicholas E., M.D., 3625 2001 (1984) DeSanto, Lawrence W., M.D., 8122 E. Lakeview Ct. NE, Rochester, MN Clinton,.Scottsdale AZ 85260 55906 1993 (1973) Duvall, Arndt J. III, M.D., 2550 1999 (1990) Marsh, Bernard R. MD, 4244 Mt. Manitou Island, St. Paul, MN 55110 Carmel Rd., Upperco, MD 21155 2004 (2004) Eliachar, Isaac, M.D., 4727 Dusty Dage 1990 (2011) McGuirt, W. Frederick Sr. MD, Loop, Unit 81, Ft. C ollins, CO 80526 901 Goodwood Rd., Winston- 1992 (1968) Farrior, Richard T., M.D., 505 DeLeon Salem, NC 27106 Street #5, Tampa FL 33606 2019 (1993) Medina, Jésus E., M.D., F.A.C.S., 2013 (1982) Fee, Willard E. Jr., M.D., 3705 Brandy Dept. of Otorhinolaryngology, Rock Way, Redwood City, CA 94061 The University of Oklahoma, P.O. 2008 (1990) Ford, Charles N., M.D., UW-CSC, Box 26901, WP 1290, Oklahoma H4/320, 600 Highland Avenue, City OK 73190-3048 Madison WI 53792 1991 (1976) Miglets, Andrew W. Jr., MD, 998 1988 (1977) Gacek, Richard R., M.D., Div. of Sunbury Rd., Westerville, OH Otolaryngology, Univ. of MA., 55 Lake 43082 Avenue North, Worcester, MA 01655 2019 (1987) Miller, Robert H., M.D., 2616 2003 (1981) Gates, George A., M.D., 137 Wroxton Rd. Houston, TX 77005 Riverwood , Boerne, TX 78006 2017 (1986) Morrison, Murray, MD, PhD, 45- 1991 (2010) Gluckman, Jack L., M.D., 3 Grandin 45462 Tamihi Way, Chilliwack, BC, Lane, Cincinnati, OH 45208 V2R 0Y2, CANADA 2002 (1983) Goldstein, Jerome C., M.D., 4119 Manchester Lake Dr., Lake Worth FL 33467
108
2015 (1979) Myers, Eugene N., M.D., 5000 Fifth 2015 (1987) Schuller, David E., M.D., 2567 Avenue, Pittsburgh, PA 15232 Onandaga Dr., Columbus OH 43221 2008 (1981) Neel, H. Bryan III, M.D., Ph.D., 828 2018 (2008) Schweitzer, Vanessa G., MD, 28738 Eighth St SW, Rochester, MN 55902 Hidden Trail, Farmington Hill, MI 2015 (1986) Noyek, Arnold M., M.D., 34 Sultana 48334 Ave., Toronto, Ontario, CANADA, 2002 (1978) Sessions, Donald G., M.D., 1960 M6A 1T1 Grassy Ridge Rd., St. Louis MO 2002 (1982) Olson, Nels R., MD, 2178 Overlook 63122 Ct., Ann Arbor, MI 48103 1990 (1979) Shapiro, Myron J., M.D., Sand Spring 2015 (1990) Osguthorpe, John D., M.D., P O Box Road Morristown NJ 07960 718, Awendaw, SC 29429 2016 (1979) Spector. Gershon J., M.D., 7365 2019 (1990) Ossoff, Robert H., D.M.D., M.D., Westmoreland Dr., St. Louis, MO 2014 Farnsworth Dr., Nashville, TN 63110 37205 2016 (1991) Strome, Marshall, M.D., 19970 N. 1988 (2006) Pearson, Bruce W., MD, 24685 Misty 102nd Place, Scottsdale, AZ 85255 Lake Dr., Ponte Vedra Beach, FL 1990 (1975) Strong, M. Stuart, M.D., Carleton- 32082-2139 Willard Village, 306 Badger Terrace, 2019 (1989) Pillsbury, Harold C. III, M.D., Univ. Bedford, MA 01730 of North Carolina, Div. of 2002 (1979) Tardy, M. Eugene, M.D., 651 Jacana Otolaryngology, 170 Manning Dr., Cr., Naples, FL 34105 CB #7070, G-125 POB, Chapel Hill 2015 (1985) Thawley, Stanley, M.D., 648 Gaslite NC 27599-7070 Lane, St. Louis, MO 63122 2019 (1997) Potsic, William, M.D., Dunwoody 2003 (1980) Vrabec, Donald P., M.D., 2010 Village, 3500 West Chester Pk, Snydertown Rd., Danville PA 17821 Newtown Square, PA 19073 2015 (1991) Weisberger, Edward D., M.D., 1514 2015 (1995) Robbins, K. Thomas, M.D., 4830 Dominion Dr., Zionsville, IN 46077 Honey Ridge Lane, Merritt Island, FL 2018 (1997) Weisman, Robert A., M.D., Div. of 32952 ORL–Head & Neck, UCSD Medical 2018 (1982) Rontal, Eugene, M.D., 2 West Center, 200 W. Arbor Dr., San Diego Delaware Place, Unit. 102,Chicago, IL CA 92103-9891 60610-3408 2017 (1989) Weymuller, Ernest A. Jr., M.D., 2018 (1997) Ruben, Robert J., M.D., Montefiore Univ. of Washington Medical Center, Medical Ctr., 3400 Bainbridge Ave, Dept. of Otolaryngology–Head & 3rd Fl, Bronx NY 10467 Neck Surgery,. PO Box 356515, 2007 (1992) Schechter, Gary L., M.D., 1358 Seattle WA 98195-0001 Silver Lake Blvd., #83, Naples, FL 2016 (1994) Woodson, Gayle E., M.D., 4830 34114 Honey Ridge Lane, Merritt Island, FL 32952 2013 (1981) Yanagisawa, Eiji, M.D., 25 Hickory Rd., Woodbridge, CT 06525
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Emeritus Corresponding Fellows-
2011 (1991) Bradley, Patrick J., M.D., 37 2019 (1993) Howard, David, M.D., 3 Garson Lucknow Drive, Nottingham NG3 Lane, Wraysburg, Middlesex,TW! 2UH, ENGLAND 95F, ENGLAND 2011 (1980) Benjamin, Bruce, M.D., 19 Prince 2017 (2005) Nakashima, Tadashi, M.D., 3-17-12 Road, Killara, NSW, 2071, Kashiidai Higashi-ku, Fukuoka 830- AUSTRALIA 0014 JAPAN 2016 (2003) Friedrich, Gerhard, M.D., Dept. of 2011 (1984) Snow, Prof. Gordon B., M.D., Postbus Phoniatrics and Speech Pathology, 7057 1002 MB, 1081 HV Amsterdam, ENT-Hospital Graz, A-8036 Graz THE NETHERLANDS Auenbruggerplatz 2628, AUSTRIA .
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Post-Graduate Members
2016 Clary, Matthew, M.D., Univ. of Colorado 2018 Al Omari, Ahmad, M.D., Jordan School of Medicine, Dept. of University of Science and Technology, Otolaryngology, 12631 E. 17th Ave., B- Dept. of Otolaryngology, P O Box 3030, 205, Aurora, CO 80045 Inbid, 22110 JORDAN 2019 Collins, Alissa, M.D., Duke Univ. 2015 Ahmadi, Neda, M.D., 9000 Ewing Dr., Medical Center, Div. of Head & Neck Bethesda, MD 20817 Surgery, Box 3805, Durham, NC 27560 2009 Alarcón, Alessandro de, M.D., 2016 Crawley, Brianna W., M. D., Loma Linda Cincinnati Children’s Hospital Medical Univ. School of Medicine, Dept. of Center, Dept. of Pediatric Otolaryngology, 11234 Anderson ST., Otolaryngology, 333 Burnet Avenue, Room 2587A, Loma Linda, CA 92354 MLC 2018, Cincinnati, OH 45229-3039 2016 Daniero, James, J., M.D., Univ. of 2014 Allen, Clint T., M.D., 9918 Fleming Virginia Health Systems, Dept. of Ave., Bethesda, MD 20814 Otolaryngology, P O Box 800713, 2010 Andrus, M.D., Jennifer G. Billings Clinic Charlottesville, VA 22908-0713 Hospital, Dept. of Ear Nose & Throat, 2011 D’Elia, Joanna M.D., 2600 Netherland 2800 10th Ave. North, Billings, MY Ave., Suite 114, Bronx, NY 10463 59101 2016 Dominguez, Laura M., M.D., Univ. of 2014 Arviso, Lindsey C., M.D., ENT Texas Health System – San Antonio, Consultants of North Texas, 3900 Junius Dept. of Otolaryngology, 8300 Floyd St., Ste. 230, ,Dallas, TX 75246 Curl Dr., MC7777, San Antonio, TX 2016 Barbu, Anca M., M.D., Cedar-Sinai 78229 Medical Group, 8635 West 3rd St., 590 2010 Eller, Robert L. M.D., 313 Hampton W., Los Angeles, CA 90048 Ave., Greenville, SC 29601 2010 Benson, Brian E. M.D. Hackensack 2016 Fink, Daniel, M.D., Univ. of Colorado Univ. Medical Center, Dept. of School of Medicine, Dept. of Otolaryngology, 20 Prospect Ave., Otolaryngology, 12631 E. 17th ve., B- Ste. 907, Hackensack, NJ 07601 205, Aurora, CO 80045 2015 Best, Simon R. A., M.D., John Hopkins, 2010 Friedman, Aaron M.D., Northshore Univ. Univ. School of Medicine, Dept. of Health System, Div. of Otolaryngology, Otolaryngology, 601 N. Caroline St., 1759 Elmwood Dr., Highland Park, IL Room 6210, Baltimore, MS 21287 60035 2016 Bradley, Joseph P. M.D., Washington 2019 Fritz, Mark M.D., Univ. of Kentukcy University of St. Louis, Dept. of School of Medicine, Dept. of OTO, 800 Otolaryngology, 660 S. Euclid Ave., Rose St., Suite C-236, Lexington, KY Campus Box 8112, St. Louis, MO 63110 40536 2016 Meredith J. Montero Brandt, M.D., 2008 Garnett, J. David M.D., Univ. of Kansas, Michigan Otolaryngology Surgery Dept. of Otolaryngology, 3901 Rainbow Associates, 5333 McAuley Dr., Ste. Blvd., MS 3010, Kansas City, KS 66160 2017, Ypsilanti, MI 48104 2015 Gelbard, Alexander, M.D., Vanderbilt 2019 Brisebois, Simeon, M.D., MSc, Cenetre Medical Center, Dept. of Hospitalier Universitarie de Sherbrooke, Otolaryngology, 7302 MCE South, Div. of OTO, 580 rue Bowen Sud, Nashville, TN 37232-8783 Sherbrooke, QB, J1N 0X7, CANADA 2008 Grant, Nazaneen M.D., Georgetown 2019 Cates, Daniel, M.D., Univ. of California University Hospital, Dept. of OTO, 1 – Davis, Dept. of OTO, 2521 Stockton Gorman, 3800 Reservoir Road NW, Blvd., Suite 7200, Sacramento, CA Washington, DC 20007 95817 2014 Guardiani, Elizabeth, M.D., Univ. of 2011 Chandran, Swapna K. M.D., University Maryland School of Medicine, Dept. of of Louisville, Div. of Otolaryngology, Otolaryngology, 16 S. Eutaw, St., Ste. 529 S. Jackson St., 3rd Floor, Louisville, 500, Baltimore, MD 21201 KY 40202 2013 Gurey, Lowell, M.D., 1 Diamond Hill 2010 Chang, Jaime I. M.D., Virginia Mason Rd., Berkeley Heights, NJ 07922 Medical College, Dept. of 2010 Guss, Joel M.D. Kaiser Permanente Otolaryngology, 1100 Ninth Ave., MS: Medical Center, Dept of Head and Neck X10-ON, P O Box 900, Seattle, WA Surgery, 1425 S. Main St., 3rd Floor, 98111 Walnut Creek, CA 94596 2012 Childs, Lesley French, M.D., Univ. of 2015 Hatcher, Jeanne L., M. D., Emory Univ. Texas Southwest, Clinical Ctr for Voice Voice Center, 550 Peachtree St. NE, 9th Care, 5303 Harry Hines Blvd., Dallas, Floor, Ste. 4400, Atlanta, GA 30308 TX 75309
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2018 Howell, Rebecca, M.D., University of 2019 Merea, Valerie Silvia, M.D., Memorial Cincinnati College of Medicine, Dept. of Sloan-Kettering Cancer Center, Dept. of Otolaryngology, 231 Albert Sabin Way, OTO, 1278 York Ave., New York, NY ML #528, Cincinnati, OH 45267-0528 10065 2019 Husain, Inna, M.D., Rush Univ. Medical 2012 Misono, Stephanie, M.D., MPH, Univ. of Center, Dept. of OTO, 1611 W. Harrison Minnesota, Dept. of Otolaryngology, 420 Ave., Suite 550, Chicago, IL 60612 Delaware St. SE, MMC396, 2013 Ingle, John W., M.D., Univ. of Pittsburgh Minneapolis, MN 55455 Medical Center – Mercy, Dept. of 2015 Moore, Jaime Eaglin, M.D., Virginia Otolaryngology, 1400 Locust St., Ste. Commonwealth Univ. Health System, 2100, Pittsburgh, PA 15219 Dept. of Otolaryngology, 1200 E. Broad 2018 Kay, Rachel, M.D., Rugters New Jersey St., West Hospital, 12th Floor, South Medical School & University, Dept. of Wing, Ste. 313, P O Box 980146, Otolaryngology, 90 Bergen St., Newark, Richmond, VA 23298-0146 NJ 07103 2017 Mor, Niv, M.D., 215 E. 95th St., #330, 2019 Kim, Brandon, M.D., Eye and Ear New York, NY 10128 Institute, 915 Olentangy River Rd., Suite 2013 Morrison, Michele, M.D., Naval Medical 4000, Columbus, OH 43212 Center –Portsmouth, Dept. of 2019 Kirke, Diana, M.D., MPhil, IcahnSchool Otolaryngology, 620 John Paul Jones of Medicine at Mt. Sinai, Dept. of OTO, Cr., Portsmouth, VA 23708 1 Gustave Levy Place, Box 1189, New 2019 Naunheim, Matthew, M.D., MBA, York, NY 10029 Massachusette Eye and Ear Infirmary, 2019 Kuhn, Maggie, M.D., Univ. of CA – 243 Charles St., Boston, MA 02114 Davis, Dept. of OTO, 2521 Stockton 2011 Novakovic, Daniel, M.D., 35 Weemala Blvd., Ste. 7200, Sacramento, CA 95817 Rd., 25 Northbridge NSW 2063 2018 Kupfer, Robbi, M.D., Univ. of Michigan AUSTRALIA – Ann Arbor, Dept. of OTO, 1904 2017 O’Dell, Karla, M.D., 4006 Milaca Place, Taubman Center/SPC 5312, Ann Arbor, Sherman Oaks, CA 91423 MI 48109-5312 2017 Patel, Amit, M.D., 2649th St., Apt. 2A, 2019 Kwak, Paul, M.D., M.M., New York Jersey City, NJ 07302 Univ. Voice Center, 345 E. 37th St., Suite 2019 Patel, Anju, M.D., ENT and Allergy 306, New York, NY 10016 Associates, 9020 Fifth Ave., 3rd Floor, 2017 Lerner, Michael Z, M.D., Green Brooklyn, NY 11209 MedicalArts Pavilion, Dept. of 2013 Portnoy, Joel, M.D., ENT and Allergy Otolaryngology, 3400 Bainbridge Associates 3003 New Hyde Park Rd., Ave.,3rd Floor, Bronx, NY 10467 Lake Success, NY 11042 2017 Lin, R. Jun, M.D., Univ. of Pittsburgh 2013 Prufer, Neil, M.D., 2508 Ditmars Blvd., Medical Center, Dept. of Astoria, NY 11105 Otolaryngology, 1400 Locust St., Bldg. 2018 Rafii, Benjamin, M.D., Beach Cities B, Suite 11500, Pittsburgh, PA 15219 ENTs, 20911 Earl St., Ste. 340, 2013 Lott, David G., M.D., Mayo Clinic, Torrence, CA 90503 Dept. of Otolaryngology, 5777 E. Mayo 2019 Rameau, Anais, M.D., MPhil, The Sean Blvd., Phoenix, AZ 85054 Parker Institute for the Voice, Weill- 2016 Madden, Lyndsay L., D.O., Wake Forest Cornell Medicine, 240 59th St., New Baptist Medica Center, Dept. of York, NY 10021 Otolaryngology, Medical Center Blvd., 2017 Randall, Derrick, M.D., M.Sc., Univ. of Winston-Salem, NC 27157 Calgary, Alberta Heath Services, Dept. 2013 Mallur, Pavan S., M.D., Harvard Medical of Otolaryngology, 1632 14th Ave., NW, School, Dept. of Otolaryngology, 110 Ste. 262, Calgary, AB, T2N 1M7, francis St., Ste. 6E, Boston, MA 02215 CANADA 2014 Matrka, Laura, M.D., Ohio State Univ. 2016 Reder, Lindsay S., M.D., 2006 Preuss Voice and Swallowing Disorders Clinic, Rd., Los Angeles, CA 90033 915 Olentangy River Rd., Ste. 4000, 2012 Rickert, Scott, MD, New York Univ. Columbia, OH 43212 Lagone Medical Center, Dept. of 2017 Mayerhoff, Ross, M.D., Henry Ford Otolaryngology, 160 E. 32nd St, L3 Health Systems, Dept. of OTO, 2799 Medical, New York, NY 10016 West Grant Blvd., Detroit, MI 48202 2017 Rosow, David, M.D., University of 2013 McHugh, Richard K., M.D., Ph.D., 1061 Miami Miller School of Medicine, Dept. Pierce Lane, Davis, CA 95615 of Otolaryngology,1120 NW 14th St., 5th 2010 McWhorter, Andrew J. M.D., OLOL & Floor, Miami, FL 33136 LSU Voice Center, 7777 Hennessy Blvd., Ste 408, Baton Rogue, LA 70808 112
2017 Rutt, Amy, D.O., Mayo Clinic College of 2016 Tang, Christopher G., M.D., Kaiser Medicine, Dept. of Otolaryngology, 4500 Permanente – San Francisco Medical San Pablo, Jacksonville, FL 32224 Center, Dept. of OTO, 450 6th 2014 Sadoughi, Babak, M.D., Beth Israel Ave., 2nd Floor, San Francisco, CA Medical Center, Dept. of 94118 Otolaryngology, 10 Union Square East, 2013 Thekdi, Apurva, M.D., Texas ENT Ste. 41, New York, NY 10003 Consultants, 6550 Fannin St., Ste. 2001, 2015 Shah, Rupali N., M.D., Univ. of North Houston, TX 77030 Carolina – Chapel Hill, Dept. of 2017 Tibbetts, Kathleen, M.D., University of Otolaryngology, 170 Manning Dr., CB Texas Southwestern Medical Center, 70780, POB, Room G-137, Chapel Hill, Dept. of Otolaryngology, 5323 Harry NC 27599-7070 Hines Blvd., 7th Floor, Dallas, TX 75390 2018 Shoffel-Havakuk, Higit, M.D., Rabin 2011 Verma, Sunil P. M.D., Univ. of Medical Center, Dept. of California Medical Center - Irvine, Otolaryngology,Ze’veJabotinsky Rd., 39, Department of Otolaryngology, 101 The Petah Tikya, 4941492, ISRAEL City Drive South, Bldg. 56, Suite 500, 2013 Silverman, Joshua, M.D., 47 The Oaks, Orange, CA 92868 Roslyn, NY 11576 2018 Villari, Craig, M.D., Emory University 2013 Sinclair, Catherine F., M.D., St. Luke’s School of Medicine, Emory Voice Roosevelt Hospital, Div. of Head and Center, 550 Peachtree St. NE, 9th Floor, Neck Surgery, 125 Watts, 4th Floor, New Ste. 4400, Atlanta, GA 30308 York, NY 10013 2010 Vinson, Kimberly N. M.D., Vanderbilt 2010 Sok, John C. M.D., Ph.D., Kaiser Head Univ. Medical Center, Dept. of OTO, and Neck Institute, Dept. of 7203 Medical Center East – South Otolaryngology, 9985 Sierra Ave. Tower, Nashville, TN 37232-8783 2019 Wang, Hailun, M.D., ProHealth Fontana, CA 92335 Physicians, 21 South Road, Suite 112, 2008 Song, Phillip M.D., MA Eye & Ear Farmington, CT 06032 Infirmary, 243 Charles St., Boston, MA 2014 Wong, Adrienne W., M.D., Royal 02114 Victoria Regional Health Center, Dept. 2015 Sridharan, Shaum, S., M.D., Univ. of of OTO, 125 Bell Farm Rd., Ste # 302, South Carolina School of Medicine, Barrie, Ontario, L4M 6L2 CANADA Dept. of Otolaryngology, 135 Rutledge 2017 Wood, Megan W. M.D., The Voice Ave., MSC 550, Charleston, SC 29425 Clinic of Indiana, 1185 W. Carmel, D- 2010 Statham, Melissa McCarty S. M.D., 1A, Carmel, IN 46032 Atltanta Institute for ENT, 3400-C Old 2010 Young, Nwanmegha MD, Yale Milton Pkwy., Ste. 465, Alpharetta, GA University School of Medicine, Dept. of 30005 Surgery, Section of OTO, 800 Howard 2016 Taliercio, Salvatore J., M.D., ENT and Ave., 4th Floor, New Haven, CT 06519 Allergy Associates, 358 N. Broadway, 2013 Young, VyVy, M.D., Univ. of California Ste. 203, Sleepy Hollow, NY 10591 – San Francisco, Voice & Swallowing 2013 Tan, Melin, M.D., Montefiore Medical Center, 2330 Post St., 5th Floor, San Center, Dept. of Otolaryngology, 3400 rd Francisco, CA 94115 Bainbridge Ave., 3 , Floor, Bronx, NY 2010 Yung, Katherine C. M.D., San Franciso 10467 Voice and Swallowing, 450 Sutter St., Suite 939, San Francisco, CA 94108
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