Faculty Bibliography

OBJECTIVES/HYPOTHESIS: The purpose of this study was to investigate the prevalence of vocal pathology among first-year acting students. STUDY DESIGN: A retrospective review of 30 first-year graduate-level drama students between 2009 and 2011 was performed. METHODS: Stroboscopy, Voice Handicap Index-10 questionnaires, and acoustic measures were analyzed. RESULTS: The prevalence of incomplete glottal closure, laryngeal hyperfunction, and decreased mucosal wave was 62%, 59%, and 55%, respectively. Laryngoscopic findings consistent with laryngopharyngeal reflux (LPR) were demonstrated in 48% of subjects. Subgroup analysis of laryngeal hyperfunctioning (HF) and nonhyperfunctioning drama students revealed an increased prevalence of all videostroboscopic abnormalities in the HF group. The increased prevalence of LPR stigmata in HF actors reached statistical significance (P = 0.04). CONCLUSIONS: The vocal demands of actors are unique, requiring the effective use of volume, pitch control, and endurance. This is the first study that systematically analyzes the prevalence of vocal pathology in actors. This study will continue throughout their education, anticipating that our feedback along with their vocal training will improve outcomes.

OBJECTIVES: We used a retrospective chart review to analyze revision endoscopic carbon dioxide (CO2) laser and staple repairs of recurrent Zenker diverticulum (ZD). METHODS: The medical records of patients with recurrent ZD after primary endoscopic repair were selected. The chart data included method of repair (CO2 laser or stapler), demographics (age and sex), defect size (in centimeters), preoperative and postoperative symptoms, and complications. Patients' dysphagia was graded on a modified Functional Oral Intake Scale from 1 to 4 (1 being normal intake and 4 being severely limited intake or gastrostomy tube dependence). Regurgitation was also graded on a 1-to-4 scale (1 being no regurgitation and 4 being aspiration). RESULTS: A total of 148 consecutive patients with ZD were treated with endoscopic repair between 2000 and 2010. Twelve of these patients had revisions after failed primary endoscopic management procedures, all done with the stapler. Eight revision surgeries were performed by CO2 laser, and 4 by stapler repair. No difference was noted in patient age or defect size (laser, 3.06-cm defects; stapler, 2.75-cm defects). The length of hospital stay and the time to oral intake for the patients who had a revision stapler procedure were significantly greater (p values of 0.029 and 0.009) than those for the patients in the primary stapler procedure group. Better postoperative regurgitation scores were noted for patients who had a CO2 laser procedure. CONCLUSIONS: Secondary endoscopic repair for ZD recurrence is an effective treatment method. Better symptom outcomes were observed with secondary CO2 laser repair than with stapler revision. Patients with revision stapling had longer hospital stays and a longer time to oral intake than did patients with primary staple repairs.

IMPORTANCE: We describe a case of nasal gout presenting as nasal obstruction, a rare etiology for a common presentation. OBSERVATIONS: We report a single case of a 56-year-old man with history of multiple nasal traumas, obstructive sleep apnea, referred for nasal obstruction and congestion, having failed attempts at medical management. He had severe septal deviation, elements of external and internal nasal valve collapse, and a nasal dorsal mass suspicious for gouty tophus. He was brought to the operating room for septorhinoplasty through an open incision with nasal tip reconstruction, which exposed a 4 x 3-cm mass on the nasal dorsum, extending to the tip, supertip, and into the septal plane at the level of the upper lateral cartilages. Final pathologic findings revealed gouty tophus. He has done well since, and breathing and sleep are significantly improved. CONCLUSIONS AND RELEVANCE: This case demonstrates a rare etiology for nasal obstruction that may complicate the workup, evaluation, and management of such a patient. It highlights the ways in which a rare diagnosis adds complexity to the workup and management of a patient with nasal obstruction, and serves as an important reminder about rarer pathologies that can present in an everyday clinic.

BACKGROUND: A 270-degree partially tubed pectoralis major myocutaneous flap (PMMF) is an excellent option for total circumferential pharyngoesophageal defects in patients who are not candidates for more complex reconstructions. METHODS: Patients undergoing circumferential pharyngoesophageal reconstruction with partially tubed PMMF were reviewed. End points were stricture, fistula, resumption of oral intake, perioperative death, and recurrence. RESULTS: Eleven patients underwent 270-degree PMMF for reconstruction: 6 (55%) were men and 5 (45%) were women (mean, 62 years; range, 42-78 years). Three patients (27%) developed fistulas and 2 (18%) developed stenosis. Ten patients (91%) were able to resume adequate nutrition via oral intake. There were no perioperative deaths. CONCLUSIONS: Patients with severe comorbidities, metastatic disease, a lack of donor vessels, or a potentially hostile abdomen may not be ideal candidates for free tissue transfer. For these patients, partially tubed PMMF using the prevertebral fascia provides a reliable alternative for reconstruction with excellent functional results.

The millimeter wave frequency spectrum offers unprecedented bandwidths for future broadband cellular networks. This paper presents the world's first empirical measurements for 28 GHz outdoor cellular propagation in New York City. Measurements were made in Manhattan for three different base station locations and 75 receiver locations over distances up to 500 meters. A 400 megachip-per-second channel sounder and directional horn antennas were used to measure propagation characteristics for future mm-wave cellular systems in urban environments. This paper presents measured path loss as a function of the transmitter - receiver separation distance, the angular distribution of received power using directional 24.5 dBi antennas, and power delay profiles observed in New York City. The measured data show that a large number of resolvable multipath components exist in both non line of sight and line of sight environments, with observed multipath excess delay spreads (20 dB) as great as 1388.4 ns and 753.5 ns, respectively. The widely diverse spatial channels observed at any particular location suggest that millimeter wave mobile communication systems with electrically steerable antennas could exploit resolvable multipath components to create viable links for cell sizes on the order of 200 m.

Propagation measurements at 28 GHz were conducted in outdoor urban environments in New York City using four different transmitter locations and 83 receiver locations with distances of up to 500 m. A 400 mega-chip per second channel sounder with steerable 24.5 dBi horn antennas at the transmitter and receiver was used to measure the angular distributions of received multipath power over a wide range of propagation distances and urban settings. Measurements were also made to study the small-scale fading of closely-spaced power delay profiles recorded at half-wavelength (5.35 mm) increments along a small-scale linear track (10 wavelengths, or 107 mm) at two different receiver locations. Our measurements indicate that power levels for small-scale fading do not significantly fluctuate from the mean power level at a fixed angle of arrival. We propose here a new lobe modeling technique that can be used to create a statistical channel model for lobe path loss and shadow fading, and we provide many model statistics as a function of transmitter-receiver separation distance. Our work shows that New York City is a multipath-rich environment when using highly directional steerable horn antennas, and that an average of 2.5 signal lobes exists at any receiver location, where each lobe has an average total angle spread of 40.3 degrees and an RMS angle spread of 7.8 degrees. This work aims to create a 28 GHz statistical spatial channel model for future 5G cellular networks.

In this paper, we present reflection coefficients and penetration losses for common building materials at 28 GHz for the design and deployment of future millimeter wave mobile communication networks. Reflections from walls and buildings and penetration losses were measured for indoor and outdoor materials, such as tinted glass, clear glass, brick, concrete, and drywall at 28 GHz in New York City. A 400 Mega-chip-per-second sliding correlator channel sounder and 24.5 dBi steerable horn antennas were used to emulate future mobile devices with adaptive antennas that will likely be used in future millimeter wave cellular systems [1]. Measurements in and around buildings show that outdoor building materials are excellent reflectors with the largest measured reflection coefficient of 0.896 for tinted glass as compared to indoor building materials that are less reflective. We also found that penetration loss is dependent not only on the number of obstructions and distance between transmitter and receiver, but also on the surrounding environment. The greatest penetration loss containing three interior walls of an office building was found to be 45.1 dB, with 11.39 m separation between the transmitter and receiver.