Faculty Bibliography

OBJECTIVES/HYPOTHESIS:Fiberoptic laryngoscopy is dependent on accurate descriptions of examination findings. Traditional recording methods can be impractical for inpatient consults. Therefore, we aim to determine the utility of a smartphone-coupled portable recording system with flexible laryngoscopy for transmitting information between resident and attending physicians in a real-time setting. STUDY DESIGN:Pilot prospective study in a tertiary academic hospital. METHODS:This is a prospective study of inpatient consultations in a tertiary referral hospital over a 3-month period from April 2015 to June 2015. Flexible laryngoscopy was performed by a resident physician, and mobile recordings were relayed to an attending physician. Concordance of laryngoscopy interpretations between resident and attending physicians as well as changes in management were documented. RESULTS:Seventy-nine fiberoptic examinations were recorded and compared. Each consult was categorized as follows: airway evaluation (AE) (43%, 34/79), voice evaluation (VE) (3.7%, 3/79), dysphagia (D) (24%, 19/79), and aerodigestive tract mass/pathology (ADM) (29.1%, 23/79). Nine examinations showed discordance between resident and attending interpretations. Inter-rater agreement was good, with a kappa value of 0.747 (95% confidence interval: 0.643-0.851). The frequency of discordant exams within each group was as follows: AE (15%, 5/34), VE (33%, 1/3), D (11%, 2/19), and ADM (4.3%, 1/23). In five patients, changes in laryngoscopy interpretation changed clinical management. Seven nondiscordant exams had a change in management after attending review. Of the 79 exams, only one required repeat flexible laryngoscopy by the attending physician. CONCLUSIONS:Portable recording of flexible laryngoscopy is an effective tool for timely management of inpatient consultations. LEVEL OF EVIDENCE:4. Laryngoscope, 128:818-822, 2018.

OBJECTIVE:Singers need good hearing; however, they may be exposed to loud noises during their musical activities. The objectives of this study were to describe the incidence and type of hearing loss (HL) in singers. STUDY DESIGN/METHODS:Retrospective case cohort. METHODS:Billing records identified patients who had undergone videostroboscopy and audiogram during the same visit over a 3 year period. A singer was defined as anyone who self-identified as a singer (professional or avocational). Age and gender matched nonsingers were used as controls. Patients with otologic diagnoses, surgery, or complaints were excluded. Retrospective chart review was conducted for the presence of HL, type of HL, and pure tones audiogram results. Statistical analysis included descriptive statistics, Students t test, chi-square test, and Fisher exact test. RESULTS:Of 172 singers (44.7 years, 37.8% male), 31 (17.5%) had HL. Pure tone thresholds for the singers with HL subgroup at 3, 4, and 6 kHz were 21.0, 26.5, and 34.4 dB in the right, and 22.8, 30.3, and 38.8 dB in the left ear, respectively. Older age (P = 0.000000000000001), male gender (P < 0.001), longer number of years of singing (P = 0.0000000003), and baritone voice (P < 0.001) were associated with HL. There was no association with genre of music. When compared with controls, the incidence of HL (19.8%) was not significantly different (χ2 = 0.300, P = 0.58). Pure tones at 3, 4, and 6 kHz were not significantly different than controls with HL. Most common type of HL in singers was bilateral sensorineural (83.9%), which was significantly higher than controls (39.0%, χ2 = 14.6, P < 0.001). CONCLUSIONS:The incidence of HL in singers was 17.5%, which was not significantly different from controls. Bilateral sensorineural HL was most common.

OBJECTIVES/OBJECTIVE:To present a novel design for a stent for management of a traumatic supraglottic web. METHODS:Case report and literature review (PubMed 1964-2013). RESULTS:A 48-year-old man was presented after penetrating laryngeal trauma. He had severe dysphonia and was tracheotomy dependent. He had been treated previously with open reduction and fixation of laryngeal fracture. On examination, we identified an avulsed left vocal fold and a supraglottic web. He initially underwent reapproximation of the avulsed left vocal fold, and subsequently, the supraglottic web was treated using a stent designed by the senior author (R.T.S.). In addition, he underwent later resection of scar tissue to improve dysphonia and then he was decanulated. CONCLUSIONS:There are a few techniques presented in the literature and mostly are adaptations of subglottic stenosis management techniques. Individualized treatment is needed for these difficult cases. We present our experience with supraglottic web treatment to expand the literature on this uncommon disorder.