Endoscopic inferior turbinate reduction; an outcomes analysis

Objectives/Hypothesis In a previous publication, we introduced an endoscopic technique for the treatment of nasal obstruction caused by inferior turbinate hypertrophy. The technique, a modification of the procedure popularized by Mabry, involves resecting the inferior and lateral aspects of the inferior turbinate with a microdebrider under endoscopic guidance. Our preliminary postoperative results were favorable. All 20 patients experienced improvement by postoperative day 5 and the incidence of complications over the first 6 months after surgery was low. The objective of this study is to perform a long-term outcomes analysis of patients undergoing the procedure. Study Design Follow-up survey questionnaire and analysis. Methods We sent questionnaires to 60 patients, ranging from 6 to 40 months after surgery, inquiring about continued use of nasal medications, need for further surgery, presence of adverse effects, and improvement in symptoms. Nasal airway obstruction was assessed on a subjective scoring scale from 1 (no obstruction) to 6 (complete obstruction). Results Of the 28 (47%) patients who returned questionnaires, the severity of daytime nasal obstruction was rated as 2.3 and nighttime nasal obstruction as 2.7. The use of nasal steroids and oral decongestants was 25% and 21%, respectively. Adverse effects were minimal and all but one patient (96%) experienced improvement in their nasal airway. Conclusion These results confirm the long-term effectiveness of this procedure for the relief of nasal obstruction. © 2001 The American Laryngological, Rhinological and Otalogical Society, Inc

Early arytenoid adduction for vagal paralysis after skull base surgery

Objectives To evaluate the efficacy of early arytenoid adduction in the management of vagal paralysis after skull base surgery. Study Design Retrospective evaluation at a tertiary care skull base center. Methods Aggressive surgical management of skull base lesions has become increasingly popular owing to advances in surgical technique and intraoperative monitoring. Temporary and permanent lower cranial neuropathies occur frequently, especially after the surgical management of lesions involving the vertebrobasilar system and the jugular foramen. An injury to the proximal vagus nerve is usually associated with dysphonia and swallowing dysfunction. An early arytenoid adduction has been employed in 26 patients with a vagal paralysis after skull base surgery. Most commonly, the neurosurgical patient underwent an arytenoid adduction under general anesthesia on postoperative day 2. Results Videostroboscopy after arytenoid adduction demonstrated 76% of patients had complete glottic closure. Of those with inadequate glottic closure, all demonstrated a well-medialized posterior glottis with a persistent anterior glottal gap. These patients were easily treated with a secondary type I thyroplasty under local anesthesia with sedation resulting in complete glottic closure. Despite excellent voice outcomes, 66% of these patients had dysphagia requiring enteral feedings for nutritional support. Conclusions An early arytenoid adduction is an excellent medialization technique that can be performed safely in the early postoperative period under general anesthesia after skull base surgery. © 2000 The American Laryngological, Rhinological and Otological Society, Inc

Supraglottic Activity: Evidence of Vocal Hyperfunction or Laryngeal Articulation?

False vocal fold (FVF) adduction and compression of the arytenoid cartilages to the petiole of the epiglottis in an anterior to posterior (A-P) direction have been thought to characterize voice disorders with abnormally increased muscle tension or effort, often termed hyperfunctional voice disorders. To further evaluate the association between hyperfunctional voice disorders and supraglottic activity, we compared the incidence of static and dynamic supraglottic activity in individuals with normal laryngeal mucosa, normal voice quality, and no voice complaints to Kvo populations: subjects with vocal fold nodules and subjects with complaints of dysphonia without visible vocal fold lesions, glottal incompetence, or impairment of arytenoid cartilage motion ( hyperfunctional group). Thirty-two subjects were assigned to one of these three groups (10 control, 12 nodule, and 10 hyperfunctional). Laryngeal movements were recorded using flexible videoendoscopy while a subject was performing speech tasks such as sustained phonation, syllable repetitions, sentence imitations, and conversation. Samples were randomized by subject and task and rated for presence or absence of A-P and FVF compression. Statistically significant group differences were found for FVF compression across speech tasks (chi-square, p \u3c 0.001). The control group had the smallest incidence (45%), nodule patients the next larger incidence (68%), and hyperfunctiona patients the largest incidence (80%). Statistically significant group differences were found for A-P compression across speech tasks (chi-square, p \u3c .05). The control group had the smallest incidence (74%), nodule patients the next larger incidence (78%), and hyperfunctional patients the largest incidence (92%). Statistically significant task differences were found for the presence of FVF compression in control subjects (chi-square, p \u3c .005), hyperfunctional patients (chi-square, p \u3c .025), and nodule patients (chi-square, p \u3c .001), but not for A-P compression for any of the groups. A higher incidence of FVF compression was present for the speech tasks that included glottal stops. This context-specific variation in supraglottic activity suggested a dynamic component to FVF compression and also explained the high proportion of FVF compression in the control group. Each video sample was also rated for consistency of FVF or A-P compression to explore the static and dynamic nature of supraglottic activity. For samples on which raters agreed, A-P compression was typically present consistently, suggesting a static component, and FVF compression inconsistently, suggesting a dynamic component, for all three groups (chi-square, p \u3c .001). These findings do not support previous suggestions that supraglottic activity may be a precursor to developing vocal fold nodules, as the nodule patients did not exhibit a higher incidence or consistency of A-P or FVF compression than patients with hyperfunctional voicing patterns in this study. Subjects in the hyperfunctional voice group were found to have static components of FVF and A-P compression. The presence of FVF compression in speech tasks that included glottal stops in the control group suggests an articulatory function at the laryngeal level