Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadImportance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, setting, and participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main outcomes and measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.Patient-Centered Outcomes Research Institute - PCOR

Spontaneous laryngeal reinnervation following chronic recurrent laryngeal nerve injury

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99610/1/lary24049.pd

Implementation of a novel otolaryngology clinic for indigent patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99640/1/lary23880.pd

Voice‐Related Quality of Life Is Associated with Postoperative Change in Subglottic Stenosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166191/1/lary29156_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166191/2/lary29156.pd

Impact of the COVID-19 Pandemic on the 2021 Otolaryngology Residency Match: Analysis of the Texas STAR Database

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172858/1/lary29860_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172858/2/lary29860.pd

Management of intractable chronic cough during awake craniotomy: illustrative case.

BACKGROUND: Chronic cough is a common but challenging clinical condition that can adversely affect the safety of awake surgical endeavors such as awake craniotomy (AC). This case lesson highlighted a patient with severe refractory chronic cough undergoing AC for resection of a recurrent left frontal, insula, anterior temporal anaplastic ependymoma of the eloquent cortex. OBSERVATIONS: The patient was successfully managed using a multifaceted medical treatment regimen combined with preoperative and intraoperative cough suppression therapy with a speech-language pathologist. The patient coughed only once intraoperatively and had a positive outcome. LESSONS: Chronic cough is often multifactorial and requires a multifaceted treatment approach. Despite this challenge, select patients can successfully be navigated through AC with appropriate treatment for their condition. A review of neurogenic cough and modern treatments, which were used in this patient and would be helpful to neurologists or neurosurgeons, are also discussed.http://deepblue.lib.umich.edu/bitstream/2027.42/191979/2/Management of intractable chronic cough during awake craniotomy illustrative case.pdfPublished versionDescription of Management of intractable chronic cough during awake craniotomy illustrative case.pdf : Published versio

Assessment of Artificial Intelligence Performance on the Otolaryngology Residency In‐Service Exam

Abstract Objectives This study seeks to determine the potential use and reliability of a large language learning model for answering questions in a sub‐specialized area of medicine, specifically practice exam questions in otolaryngology–head and neck surgery and assess its current efficacy for surgical trainees and learners. Study Design and Setting All available questions from a public, paid‐access question bank were manually input through ChatGPT. Methods Outputs from ChatGPT were compared against the benchmark of the answers and explanations from the question bank. Questions were assessed in 2 domains: accuracy and comprehensiveness of explanations. Results Overall, our study demonstrates a ChatGPT correct answer rate of 53% and a correct explanation rate of 54%. We find that with increasing difficulty of questions there is a decreasing rate of answer and explanation accuracy. Conclusion Currently, artificial intelligence‐driven learning platforms are not robust enough to be reliable medical education resources to assist learners in sub‐specialty specific patient decision making scenarios

Immunohistologic analysis of spontaneous recurrent laryngeal nerve reinnervation in a rat model

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142497/1/lary27004_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142497/2/lary27004.pd

Serial Intralesional Steroid Injection for Subglottic Stenosis: Systemic Side Effects and Impact on Surgery-Free Interval

Objectives In-office serial intralesional steroid injections (SILSIs) have become a commonly used treatment for subglottic stenosis. We characterized the impact of SILSIs on the time between operating room visits and incidence of glucocorticoid systemic side effects. Study Design Retrospective case series. Setting Academic tertiary care center. Methods All patients with subglottic stenosis receiving SILSIs at 1 institution from 2016 to 2020 were included. Surgery-free interval was compared using paired t tests. Side effect incidence was calculated with Kaplan-Meier methodology for visualization. Results Nineteen patients and 207 procedures were included. The majority of patients were White (95%) and female (95%) and had idiopathic subglottic stenosis (53%). Mean surgery-free interval for all patients was 8.7 months (95% CI, 5.6-11.8) before initiating SILSIs. Of 11 patients with calculable surgery-free interval, 10 experienced improvement, with a mean surgery-free interval increase of 4.6 months (95% CI, 2.4-6.7). Seven patients have not required surgery since initiation of SILSIs, with a mean follow-up time of 28 months (95% CI, 25-31). Noncutaneous systemic side effects occurred at a mean 3.2 months (95% CI, 2.4-4.0) from first injection and included Cushing’s syndrome, increased intraocular pressure, central serous chorioretinopathy, and new insulin requirement in the setting of diabetes. Conclusions Ninety-one percent of patients who initiated SILSIs and had a subsequent return to the operating room experienced a mean 4.6-month increase in surgery-free interval. Systemic side effects of glucocorticoids occurred in 32% of patients after initiating SILSIs. This should be considered in preprocedure counseling and side effect monitoring during treatment

Discordant SARS‐CoV‐2 Detection in the Nasopharynx Versus Trachea for Patients With Tracheostomies

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/170263/1/lary29617.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170263/2/lary29617_am.pd