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Background: Report the development of onabotulinumtoxinA neutralizing antibodies in patients treated consecutively for 20 years or longer for benign essential blepharospasm (BEB), hemifacial spasm (HFS), and Meige Syndrome., Methods: Prospective, randomized, cross-sectional study of 12 randomly selected patients from a single clinical practice that have been treated consecutively for 20 or more years with onabotulinumtoxinA for BEB, HFS, or Meige Syndrome. Serum samples were collected from each subject and analyzed for neutralizing antibody formation using the Mouse Protection Assay., Results: None of the tested patients (0%) displayed neutralizing antibodies to onabotulinumtoxinA. The mean duration of treatment was 27.5 years (range 22.1-34.1, SD 3.1, 95% confidence interval 25.45-29.50). Nine of the patients had a diagnosis of BEB, 2 HFS, and one Meige. Eleven of the 12 patients were women. There was no statistically significant difference in treatment dosage or interval over the course of treatment., Conclusions: The data support previous studies showing low incidence of antibody formation for botulinum A toxins with this subset of long-term treated patients. The results also provide further evidence for studies that have suggested increased onabotulinumtoxinA treatment volumes and/or decreased intervals between treatments are not due to neutralizing antibody formation and secondary non-response, but rather study designs that do not consider the titration phase of initial treatments. This study is specific to long-term treated patients, and the results cannot be generalized to patients naive to treatment., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by North American Neuro-Ophthalmology Society.)

Background: Electronic health records provide clinically rich data for research and quality improvement work. However, the data are often unstructured text, may be inconsistently recorded and extracted into centralized databases, making them difficult to use for research., Objectives: We sought to quantify the variation in how key laboratory measures are recorded in the Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW) across hospitals and over time. We included 6 laboratory tests commonly drawn within the first 24 hours of hospital admission (albumin, bilirubin, creatinine, hemoglobin, sodium, white blood cell count) from fiscal years 2005-2015., Results: We assessed laboratory test capture for 5,454,411 acute hospital admissions at 121 sites across the VA. The mapping of standardized laboratory nomenclature (Logical Observation Identifiers Names and Codes, LOINCs) to test results in CDW varied within hospital by laboratory test. The relationship between LOINCs and laboratory test names improved over time; by FY2015, 109 (95.6%) hospitals had >90% of the 6 laboratory tests mapped to an appropriate LOINC. All fields used to classify test results are provided in an Appendix (Supplemental Digital Content 1, http://links.lww.com/MLR/B635)., Conclusions: The use of electronic health record data for research requires assessing data consistency and quality. Using laboratory test results requires the use of both unstructured text fields and the identification of appropriate LOINCs. When using data from multiple facilities, the results should be carefully examined by facility and over time to maximize the capture of data fields.

Purpose of Review: Using optical coherence tomography (OCT) to image the larynx during diagnosis and treatment of a vast array of laryngeal disorders continues to develop along with innovative surgical techniques. Precise delineation of vocal fold-layered microstructure allows for better understanding of the impact of benign and malignant lesions on laryngeal function, and optical coherence is uniquely suited to provide detail of the interface between these lesions and adjacent normal tissue. This review provides the reader with a timely update on current clinical and research applications of OCT., Recent Findings: Recent advances in OCT include adaptation of these modalities to obtain images of moving vocal folds and provide real-time information during procedures. Additionally, an augmented form of OCT called polarization-sensitive optical coherence tomography (PS-OCT) shows promise in further characterizing benign and malignant lesions and in delineating areas of normal pliability from scar. PS-OCT can quantify areas of increased collagen (scar) and three-dimensional PS-OCT imaging can visualize the extent and location of lesions within vocal folds., Summary: Imaging the layered microstructure of vocal folds to precisely delineate boundaries between normal pliability and scar provides valuable information during diagnosis and treatment of benign and malignant disorders. Current OCT imaging techniques are guiding phonomicrosurgical interventions and improving patient care.

Purpose of Review: Office-based laryngeal laser surgery is a recent innovation. It is emerging as a reliable and practical method of treating a number of laryngeal lesions, which is increasingly popular in the US and abroad. The 532-nm pulsed-potassium-titanyl-phosphate laser has become our laser of choice in treating vocal-fold lesions and diseases for a number of transparent and practical reasons., Recent Findings: Fiber-based lasers and distal-chip flexible endoscopy have facilitated a new style of surgery. Epithelial diseases such as dysplasia and papillomatosis are well suited for this treatment. Although the initial angiolytic laser used in the larynx was a 585-nm pulsed-dye laser, the solid-state 532-nm pulsed-potassium-titanyl-phosphate laser has been demonstrated to be more effective clinically, more reliable structurally and less expensive., Summary: Technologies to enhance laryngoscopic imaging and lasers, along with socioeconomic forces, should lead to increasing numbers of laryngeal procedures being done in the office with local anesthesia. The 532-nm pulsed-potassium-titanyl-phosphate laser has emerged thus far as the optimal technology for treating phonatory mucosa although further development is likely.

Because fewer stapedectomies are performed today, concern has focused on whether or not residents are adequately trained in stapedectomy techniques. A retrospective study was done of patients undergoing stapedectomy over the last 11 years. This series represents primary resident-assisted cases performed under direct supervision of the attending surgeon. For 102 consecutive stapedectomies, the air-bone gap was closed to within 10 dB in 91 (89%), and no serious complications occurred. These results are compared with other published results, and our philosophy of teaching stapedectomy in residency is discussed.