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Objective: Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features. Methods: Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre‐ and post‐treatment VHI‐10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality. Results: One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty‐five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty‐five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI‐10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post‐treatment, (p <.001). 57/111 patients reported high voice demand professions or recreational activities. The average self‐reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in‐office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%). Conclusions: In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs. Level of evidence: Level 3: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Objective: Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet‐rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function. Methods: In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one‐month post‐fourth injection videostroboscopy and CAPE‐V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated. Results: In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar. There was an average reduction of 8.7 points in post‐treatment VHI‐10 scores (p = 0.007). The raters observed an improvement in post‐treatment voice in 73.4% of cases, and CAPE‐V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post‐PRP exams to be better in 56.7% of cases. Conclusions: PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs. Level of Evidence: 3: Prospective cohort study, with blinded analysis Laryngoscope, 134:5021–5027, 2024 [ABSTRACT FROM AUTHOR]

Objective: Safe home tracheostomy care requires engagement and troubleshooting by patients, who may turn to online, AI‐generated information sources. This study assessed the quality of ChatGPT responses to such queries. Methods: In this cross‐sectional study, ChatGPT was prompted with 10 hypothetical tracheostomy care questions in three domains (complication management, self‐care advice, and lifestyle adjustment). Responses were graded by four otolaryngologists for appropriateness, accuracy, and overall score. The readability of responses was evaluated using the Flesch Reading Ease (FRE) and Flesch–Kincaid Reading Grade Level (FKRGL). Descriptive statistics and ANOVA testing were performed with statistical significance set to p <.05. Results: On a scale of 1–5, with 5 representing the greatest appropriateness or overall score and a 4‐point scale with 4 representing the highest accuracy, the responses exhibited moderately high appropriateness (mean = 4.10, SD = 0.90), high accuracy (mean = 3.55, SD = 0.50), and moderately high overall scores (mean = 4.02, SD = 0.86). Scoring between response categories (self‐care recommendations, complication recommendations, lifestyle adjustments, and special device considerations) revealed no significant scoring differences. Suboptimal responses lacked nuance and contained incorrect information and recommendations. Readability indicated college and advanced levels for FRE (Mean = 39.5, SD = 7.17) and FKRGL (Mean = 13.1, SD = 1.47), higher than the sixth‐grade level recommended for patient‐targeted resources by the NIH. Conclusion: While ChatGPT‐generated tracheostomy care responses may exhibit acceptable appropriateness, incomplete or misleading information may have dire clinical consequences. Further, inappropriately high reading levels may limit patient comprehension and accessibility. At this point in its technological infancy, AI‐generated information should not be solely relied upon as a direct patient care resource. [ABSTRACT FROM AUTHOR]

Objective: Tracheal resection (TR) and cricotracheal resection (CTR) are performed for patients with airway stenosis, tracheal tumor, and tracheoesophageal fistula. Post‐operative complications include airway edema requiring reintubation, hematoma, anastomotic dehiscence, restenosis, and death. Although these complications and associated risk factors have been well described, the time where clinical suspicion should be highest post operatively has not been characterized. Methods: Patients who underwent TR or CTR at a single center between 2015 and 2022 were reviewed. Variables including demographics and comorbidities were recorded. Rate, nature, and time in days of post‐operative complications were evaluated. Results: Sixty‐nine cases were reviewed. Average patient age was 46.8 years old and 63.8% were male. The average follow‐up period was 625 ± 724 days. 19 (27.5%) patients experienced one or more major complications including four (5.8%) who died. Eight (11.6%) patients required reintubation and 4 (5.8%) patients underwent revision tracheostomy. Most complications occurred within 8 days of surgery. Restenosis was noted an average of 42.6 days after surgery, with no new restenosis occurring after 3 months. Conclusions: In this single‐center study, most post‐operative complications after TR or CTR, including hematoma and anastomotic dehiscence, occurred within 8 days post‐operatively. Restenosis was noted approximately 1–3 months after surgery. This may inform clinical decision‐making regarding patient monitoring and surveillance after open airway surgery. Level of Evidence: 4 Laryngoscope, 134:3527–3531, 2024 [ABSTRACT FROM AUTHOR]

Objective: Vocal fold injection medialization (VFIM) is widely used as an initial treatment for unilateral vocal fold paralysis (UVFP). Current practices employ materials that share the limitation of temporary clinical effect from variable resorption rates. A novel silk protein microparticle‐hyaluronic acid‐based material (silk‐HA) has demonstrated cellular infiltration and tissue deposition that may portend a durable medialization effect. We report on ≥12 months outcomes after VFIM with silk‐HA. Methods: Prospective open‐label study of patients with UVFP that elected treatment with VFIM with silk‐HA. Blinded experts rated laryngeal stroboscopic exams. Results: Seventeen patients with UVFP underwent VFIM with silk‐HA. Twelve of the 17 patients have ≥12 months follow‐up. Seven patients demonstrated durable treatment benefit ≥12 months after injection with median improvement of 19 (p = 0.0156) in VHI‐10. There was no significant change in VHI‐10 between 1 and 12 months for these patients. Blinded ratings indicated that 5/7 patients with sustained improvements in VHI‐10 exhibited complete or touch glottal closure at 12 months. Two of the seven patients exhibited a small (<1 mm) glottal gap at 12 months. Seven patients experienced initial benefit with later regression 3–4 months after injection. Conclusion: VFIM with silk‐HA can offer durable improvement in voice‐related outcomes for UVFP past 12 months. A subset of patients treated with silk‐HA experienced early loss of effect around 3–4 months postinjection. Clinical factors predictive of sustained treatment response to silk‐HA injection require further exploration. Level of Evidence: 3 Laryngoscope, 134:3679–3685, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Retrograde cricopharyngeal dysfunction (RCPD) is a newly described condition resulting from failure of cricopharyngeal sphincter relaxation during periods of esophageal distension that results in the inability to burp. Patients' perspectives on symptom experiences, barriers to care, and treatment benefits were investigated. Study Design: Qualitative semi‐structured interviews were conducted with patients diagnosed with RCPD who had been treated with botulinum toxin injection into the cricopharyngeus muscle. Interview questions centered on their experience living with RCPD. Conventional content analysis was performed on interview transcripts. Results: Thematic saturation was reached with 13 participants. All participants were diagnosed with RCPD by an otolaryngologist and underwent botulinum toxin injection into the cricopharyngeus muscle with or without dilation of the upper esophageal sphincter in the operating room. Participants described having no memories of ever being able to burp, and all started experiencing RCPD symptoms during adolescence. Patients with RCPD experienced increased social isolation, lost productivity, and worsened mental health. Unanimously, participants first learned about RCPD on social media. All patients were seen by physicians in non‐otolaryngology specialties regarding their symptoms prior to learning about their RCPD diagnosis and undergoing treatment by an otolaryngologist. Dilation and chemodenervation resulted in complete resolution of RCPD symptoms for 84.6% of participants. Participants emphasized a desire for more health providers to learn about RCPD and the impact it has on quality‐of‐life. Conclusion(s): The lived experience of patients with RCPD significantly impacts quality of life and is often met with diagnostic barriers in the medical community. Although social media plays a significant role in increasing awareness of RCPD, physician education about the impact of RCPD is essential to improve diagnosis and treatment. Level of Evidence: 4 Laryngoscope, 134:2136–2143, 2024 [ABSTRACT FROM AUTHOR]

Objective: Idiopathic subglottic stenosis (iSGS) is a rare condition involving the subglottic larynx and upper trachea, commonly affecting Caucasian females between 30 and 50 years of age. Despite its homogeneous presentation, clinical management for iSGS is yet to be standardized, leading to variability in outcomes between predominant interventions. In recognition of the heterogenicity in iSGS treatment and the need to improve patient outcomes, this study aimed to survey laryngologists to understand the factors influencing clinical decision‐making and the incorporation of new treatment modalities for iSGS. Methods: An online survey was sent to 145 academic laryngologists. The survey assessed respondents' professional backgrounds, experience treating iSGS, treatment algorithms, and how various patient factors affect management. Results: Of the 87 (60%) laryngologists who responded to the survey, the most common clinical assessments were tracheoscopy/bronchoscopy (96.8%) and pulmonary function tests (43.6%). Endoscopic dilation (ED) was the most common primary treatment offered (97.5%): 28.7% of surveyed laryngologists offer SISI as a primary treatment, and 74.7% perform SISI as a planned postoperative treatment. The most common SISI protocol was repeated injections every 4–6 weeks for a series of 1–3 total injections. Notably, 9.2% perform the Maddern procedure. Routine algorithms of care involving surgery were most often based on prior experience and prior patient outcomes (75.9%) and conversations with colleagues (64.4%). Only 31% report using the same protocol learned during their fellowship training. Conclusion: This survey highlights significant variation in the management of patients with iSGS. Understanding the factors that influence decision‐making may lead to potential standardization in heterogeneous treatment approaches and may improve clinical outcomes. Level of Evidence: 5 Laryngoscope, 134:865–872, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long‐term benefit of serial in‐office steroid injections (SISI) in the treatment of subglottic and proximal tracheal stenosis (SG/PTS). Evaluate cost of SISI compared to endoscopic dilation (ED). Study Design: Retrospective study and cost analysis. Methods: All patients with SGS/PTS with at least two consecutive in‐office steroid injections between 2013 and 2021 were evaluated. Patients with less than 2 years of follow‐up data after the initial SISI series were excluded. Demographics, etiology of stenosis, total injections performed, time between steroid series, surgery‐free interval (SFI) and adverse events were collected. For patients with known surgical history before SISI, pre‐SISI SFI was compared. Institutional billing records and the national CMS average reimbursement were evaluated. Total charges for three treatment strategies (ED alone, ED with post‐operative SISI and primary intervention with SISI) were also compared. Results: Forty‐nine patients were included; 29 (59%) idiopathic, 11 (22%) traumatic and 9 (18%) rheumatologic. Mean (SD) follow‐up time after the first SISI was 3.41 years (1.5), range (2.08–7.25 years). 79% (39/49) did not require additional surgery during the entire follow‐up period. The SFI improved from a mean 13.5 months (SD 12.6; range 2–42 months) pre‐SISI to a mean (SD) of 42 months (SD 20.2; range 10–87 months) (p < 0.0001) after SISI. Annual average charges for ED alone in our cohort was $15,383.28, compared to $7,070.04 for SISI. Conclusions: SISI are an effective treatment for patients with SG/PTS. In‐office steroid injections could offer cost savings for the patient. Level of Evidence: 4 Laryngoscope, 133:2673–2679, 2023 [ABSTRACT FROM AUTHOR]

Objective: The objective of this work was to assess the effect of a single intralesional subglottic steroid injection on fasting blood glucose over 7 days in a cohort of patients with subglottic stenosis. Methods: A prospective cohort study of patients undergoing intralesional steroid injections at a tertiary academic center. Patients had baseline bloodwork performed, including fasting blood glucose (FBG), and hemoglobin A1C levels. Demographic data and risk factors were collected. Fasting capillary glucose (FCG) was measured using a capillary glucometer and performed by patients daily from days 0 to 7 after a single injection of Triamcinolone into the subglottic airway. Data were analyzed using descriptive and comparative statistics. Results: Eleven patients were enrolled, and 10 completed data collection over 7 days. All were female, with a mean age of 52.6 years (SD 17.5). Two patients were diabetic (non‐insulin dependent). There was a statistically significant increase in FCG on day 1 post‐injection (mean = 122.4 mg/dl compared to 100.7 mg/dl) that normalized for all patients within 24–72 h. The mean increase in FCG was 21.5% (SD 22.5%) of the initial value for the cohort. The diabetic group had statistically significant higher glucose values on day 1 compared to the non‐diabetic group (146.5 mg/dl compared to 117.0 mg/dl). Conclusion: A single subglottic steroid injection appears to cause a transient increase in FCG 1 day post injection, which resolves after 24–72 h and can be more pronounced in diabetic patients. Level of Evidence: 4 Laryngoscope, 133:1590–1594, 2023 [ABSTRACT FROM AUTHOR]

Objective: Currently, no classification system exists to grade the severity of supraglottic stenosis. The aim of this investigation was to (1) develop a novel grading system for supraglottic stenosis that can both enhance communication between providers and relay information about patient functional status and (2) determine the reliability of the grading system. Methods: A retrospective analysis of patients with supraglottic stenosis at three institutions from 2010–2021 was conducted. After demographic data were collected, two focus group meetings of five laryngologists were held to develop a grading system based on functional status and morphology of stenosis seen on laryngoscopy. Three laryngologists then used the grading system to rate 20 case examples of supraglottic stenosis. Quadratic‐weighted kappa coefficients were calculated to assess inter‐rater and intra‐rater reliabilities of the novel grading system. Results: Twenty‐eight patients were included. Epiglottic and arytenoid fixation were morphological features associated with worse functional outcomes such as requiring a G‐tube or a tracheostomy, respectively. Inter‐rater reliability was substantial to almost perfect (Kw = 0.79–0.81) and intra‐rater reliability was almost perfect for all raters (0.88–1.0) when using the novel grading system. Conclusion: A grading system for supraglottic stenosis has been proposed with strong inter‐rater and intra‐rater reliabilities. The proposed system has the advantage of being descriptive of both patient functionality and morphology of the stenosis. Level of Evidence: 3—According to the Oxford Center for Evidence‐Based Medicine 2011 level of evidence guidelines, this non‐randomized retrospective cohort study is classified as level 3 evidence Laryngoscope, 133:1442–1447, 2023 [ABSTRACT FROM AUTHOR]

Background: Vocal fold injection augmentation (VFI) is a common procedure for the treatment of glottic insufficiency. Material options for VFI and decisions regarding material selection are not standardized and often based on clinician preference. Objective: This study aims to understand the variations in provider preference and utilization of injectable materials for VFI. Methods: A 40‐question survey was sent to 158 academic laryngologists. Questions pertained to the type of injectable materials used including brand preferences and rationale for preferences. Results: Ninety‐seven of the 158 laryngologists contacted participated in the survey (61.4%). The most frequently used injectable materials were Hyaluronic Acid (HA)‐based products. Carboxymethylcellulose (CMC)‐based products were preferred for trial augmentation (57.2%), HA‐based products were preferred for acute/subacute vocal fold paralysis, presbyphonia, and sulcus/scar (54.2%, 61.5%, 44.7%, 41.7% respectively), and Calcium Hydroxyapatite (CaHA)‐based products were preferred for long‐term paralysis (28.1%). CMC‐based products were discontinued by 21.8% of participants, largely due to quick material resorption. 17.8% of participants discontinued HA‐based products largely due to adverse events and 26.0% abandoned CaHA‐based products mostly due to inflammatory properties causing vocal fold stiffness and material unpredictability. Over 30% of respondents reported wanting to reinitiate micronized alloderm Cymetra® as an available injectable. Conclusion: Our survey demonstrated that there are significant variations in practice and preferences in regard to injectable material selection for VFI. As there is limited data on the direct material comparison, understanding the rationale behind these variations is crucial to guide new providers in material selection and provide information to patients undergoing these procedures. Level of Evidence: 5 Laryngoscope, 133:1176–1183, 2023 [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the safety profile of platelet‐rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. Methods: Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post‐injection at each session. Patient‐reported outcomes were collected at every visit using the Voice Handicap Index‐10 (VHI‐10) and Vocal Fatigue Index (VFI) questionnaires. Results: Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty‐three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6–2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri‐procedural complications. The average duration of follow‐up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient‐reported outcomes at the 3 month follow up (n = 9) follow‐up (mean ΔVHI‐10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two‐tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. Conclusion: This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri‐procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. Level of Evidence: 4 Laryngoscope, 133:647–653, 2023 This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri‐procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 predominately affects safety net hospitals. Tracheostomies improve outcomes and decrease length of stay for COVID-19 patients. Our objectives are to determine if (1) COVID-19 tracheostomies have similar complication and mortality rates as non-COVID-19 tracheostomies and (2) to determine the effectiveness of our tracheostomy protocol at a safety net hospital. Methods: Patients who underwent tracheostomy at Los Angeles County Hospital between August 2009 and August 2020 were included. Demographics, SARS-CoV-2 status, body mass index (BMI), Charlson Co-morbidity Index (CCI), length of intubation, complication rates, decannulation rates, and 30-day all-cause mortality versus tracheostomy related mortality rates were all collected. Results: Thirty-eight patients with COVID-19 and 130 non-COVID-19 patients underwent tracheostomies. Both groups were predominately male with similar BMI and CCI, though the COVID-19 patients were more likely to be Hispanic and intubated for a longer time (P =.034 and P <.0001, respectively). Both groups also had similar, low intraoperative complications at 2% to 3% and comparable long-term post-operative complications. However, COVID-19 patients had more perioperative complications within 7 days of surgery (P <.01). Specifically, they were more likely to have perioperative bleeding at their tracheostomy sites (P =.03) and long-term post-operative mucus plugging (P <.01). However, both groups had similar 30-day mortality rates. There were no incidences of COVID-19 transmission to healthcare workers. Conclusions: COVID-19 tracheostomies are safe for patients and healthcare workers. Careful attention should be paid to suctioning to prevent mucus plugging. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]