Faculty Bibliography

Cough is the most common presenting complaint in adults seeking medical treatment in an ambulatory setting. Chronic cough (persisting greater than 3 weeks) can be associated with myriad diseases that may overlap multiple medical specialties. For this reason, a thorough assessment of the patient with chronic cough relies on a multidisciplinary approach and close cooperation between pulmonary medicine, gastroenterology, and otolaryngology. Despite this daunting task, success can be achieved in up to 90% of patients with chronic cough if a systematic and thorough approach is used. The purpose of this review is to summarize the state-of-the-art in the diagnosis and treatment of chronic cough for the practicing otolaryngologist

A diagnostic method is presented that provides for analyzing pitch 'jitter' in running speech. 'Jitter' is typically measured with explicit voice tasks, namely sustained vowel phonation. However, some voice pathologies cannot be detected with sustained phonation. Further, it is not possible to ensure explicit voice productions from certain patients, including pediatric populations. In contrast, windowed relative deviation reports instantaneous pitch 'jitter' as well as the overall 'jitter' statistic commonly reported. Also, the width of the analysis window is related to the rate of pitch deviation, which provides a unique form of selectivity. Voice productions from a normal adult speaker and from an adult speaker with a known voice pathology were analyzed with this method. Voice productions from the normal speaker exhibited less than 1% pitch deviation during phonetic portions of the signal that were akin to sustained phonation. On the other hand, the speaker with a known pathology exhibited greater than 10% pitch deviation at quasi-periodic intervals within sustained phonation

To emphasize the utility of office-based transnasal esophagoscopy (TNE) in the evaluation of patients with swallowing complaints, we present 2 case reports and a review of the literature. The 2 patients both presented with complaints of chronic dysphagia, globus sensation, and a sensation of 'food sticking' with swallowing. The patients were counseled to undergo esophagoscopy. Informed consent was obtained. The nasal cavities and pharynx were anesthetized with topical 4% lidocaine hydrochloride solution. Transnasal esophagoscopy was performed. The procedure was well tolerated by the patients. Esophagoscopy revealed diverticuli in various segments of the esophagus, including the midesophageal and distal areas. The cause of the patients' complaints could be well attributed to the endoscopic findings. No morbidity was associated with the TNE examination. A review of the literature concerning office-based TNE was performed. We found no published reports of middle or distal esophageal diverticuli detected on routine office TNE. We conclude that transnasal esophagoscopy is a relatively safe and efficient tool that can be used in the office setting for evaluation of swallowing complaints