Results from the present study suggest that for phototherapy of circadian rhythm sleep disorders in humans, a longer period of moderate intensity light may be more effective than a shorter exposure period of high intensity light.

The reported incidence of VFP following cardiac surgery via median sternotomy ranges between 1.7% and 67% depending on the type of surgery and the weight of the infant at the time of surgery. In our cohort, 19.7% had VFP. Surgery requiring aortic arch manipulation had a higher incidence of complications and required longer hospitalizations. These results may be used to improve informed consent and to manage postoperative expectations by identifying patients who are at higher risk for complications.

Objective Comparison of the Cincinnati criteria (midpoint >0.9 mm or operculum >1.9 mm) to the Valvassori criterion (midpoint ≥ 1.5 mm) for enlarged vestibular aqueduct (EVA) in pediatric cochlear implant patients. Study Design Cohort study Subjects 130 Pediatric cochlear implant recipients. Methods We reviewed temporal bone CT scans to measure the vestibular aqueduct midpoint and opercular width. Results The Cincinnati criteria identified 44% of patients with EVA versus 16% with the Valvassori criterion (P<0.01). Of those with EVA, 45% were unilateral and 55% were bilateral using Cincinnati criteria; 64% were unilateral and 36% bilateral using Valvassori criterion (P<0.01). The Cincinnati criteria diagnosed 70 ears with EVA classified as normal using the Valvassori criterion (P<0.01);59 lacked another medical explanation for their hearing loss. Conclusion The Cincinnati criteria identified a large percentage of pediatric cochlear implant patients with EVA who might otherwise have no known etiology for their deafness.

Objectives/Hypothesis Cigarette smoke (CS) is a primary risk factor for the development of numerous benign and malignant laryngeal diseases. The epithelium and mucus lining the vocal folds (VF) are the first barriers against CS. The primary objective of this study was to investigate epithelial and mucus barrier changes in the mouse laryngeal mucosa upon exposure to subacute CS. The secondary objective was to compare mucus barrier changes in mice and human smokers and nonsmokers. Study DesignAnimal model. Methods Mice were exposed to CS for 4 weeks for 4 hours (N = 12, high dose [HD]) or 1 hour (N = 12, low dose [LD]) per day. Air‐exposed mice were used as a control group (N = 10). Larynges were harvested and VF epithelial barrier integrity was evaluated including cellular proliferation and expression of cell junctions. We also investigated mucus production by examining mucus cell area and mucin expression in mice and human smokers and nonsmokers. Results HD CS increased VF epithelial cellular proliferation but did not alter the expression of cell junctions. HD CS also induced hypertrophy of the mucus‐producing submucosal glands. However, only LD CS increased MUC5AC gene expression. MUC5AC staining appeared elevated in laryngeal specimens from smokers, but this was not significant as compared to nonsmokers. Conclusions These findings help us identify potential adaptive mechanisms to CS exposure as well as set the foundation for further study of key aspects of epithelial and mucus barrier integrity that may be implicated in laryngeal disease development following prolonged smoking. Level of Evidence NA Laryngoscope, 131:2530–2539, 2021

Introduction Vocal fold paresis and paralysis are common conditions. Treatment options include augmentation laryngoplasty and voice therapy. The optimal management for this condition is unclear. The objective of this study was to assess possible neuromuscular compensation mechanisms that could potentially be used in the treatment of vocal fold paresis and paralysis. Methods In an in vivo canine model we examined three conditions: (1) unilateral right recurrent laryngeal nerve (RLN) paresis and paralysis, (2) unilateral superior laryngeal nerve paralysis (SLN), and (3) unilateral vagal nerve paresis and paralysis. Phonatory acoustics and aerodynamics were measured in each of these conditions. Effective compensation was defined as improved acoustic and aerodynamic profile. Results The most effective compensation for all conditions was increasing RLN activation and decreasing glottal gap. Increasing RLN activation increased the percentage of possible phonatory conditions that achieved phonation onset. SLN activation generally led to decreased number of total phonation onset conditions within each category. Differential effects of SLN (CT muscle) activation were seen: Ipsilateral SLN activation could compensate for RLN paralysis, normal CT compensated well in unilateral SLN paralysis, and in vagal paresis/paralysis contralateral SLN and RLN display antagonistic relationships. Conclusions Methods to improve glottal closure should be the primary treatment for large glottal gaps. Neuromuscular compensation is possible for paresis. This study provides insights into possible compensatory mechanisms in vocal fold paresis and paralysis.

Objectives: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an intraoperative ventilatory technique that allows avoidance of tracheal intubation (TI) or jet ventilation (JV) in selected laryngologic surgical cases. Unimpeded access to all parts of the glottis may improve surgical precision, decrease operative time, and potentially improve patient outcomes. The objective of this prospective, randomized, patient-blinded, 2-arm parallel pilot trial was to investigate the safety and efficacy of THRIVE use for adult patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. Methods: Twenty adult, American society of anesthesiology class 1-3 patients with body mass index (BMI) < 35 kg/m 2 were randomly assigned to either an experimental THRIVE group or active comparator conventional ventilation group (TI or supraglottic high-frequency JV [SHFJV]). Primary outcomes included intraoperative oxygenation, anesthesia awakening/ extubation time, time to laryngoscopic suspension, number of intraoperative suspension adjustments, and operative time. Secondary patient outcomes including postanesthesia and functional patient recovery were investigated. Results: Compared to TI/SHFJV, THRIVE use was associated with significantly lower intraoperative oxygenation (SpO 2 93.0 AE 5.6% vs. 98.7 AE 1.6%), shorter time to suspension (1.8 AE 1.1 minutes vs. 4.3 AE 2.1 minutes), fewer suspension adjustments (0.4 AE 0.5 vs. 1.7 AE 0.9), and lower postoperative pain scores on recovery room admission (1.3 AE 1.9 vs. 3.7 AE 2.9) and discharge (0.9 AE 1.3 vs. 2.7 AE 1.8). The study was underpowered to detect other possible outcome differences. Conclusion: We confirm the safe intraoperative oxygenation profile of THRIVE for selected patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. THRIVE facilitated surgical exposure and improved early patient recovery, suggesting a potential economic benefit for outpatient laryngologic procedures. The results of this exploratory study provide a framework for designing future adequately powered THRIVE trials. Trial Register: ClinicalTrials.gov (NCT03091179).

Objectives: To systematically review the success rate and safety profile of the available endoscopic surgical options for radiation-induced dysphagia in head and neck cancer patients following organ preservation treatment, including upper esophageal sphincter (UES) dilation, cricopharyngeus (CP) myotomy (CPM), and CP intramuscular botulinum toxin (Botox) injection. Methods: A search of MEDLINE, Scopus, Google Scholar, and Cochrane databases was done to identify articles published between January 1980 and December 2017. Pediatric series, foreign language articles, series with Zenker’s diverticulum or following primary surgical treatment including laryngectomy, open UES/CP surgery, or samples with fewer than 5 patients were excluded. Results: An initial search identified 539 articles. All titles and abstracts were reviewed. One hundred and sixteen potentially relevant articles were inspected in more detail, and 14 retrospective studies met eligibility criteria. Dilation group included 10 studies on anterograde and/or retrograde dilation, with an overall 208 patients. Success rate ranged from 42% to 100%. The endoscopic CPM group included 3 studies with a total of 36 patients, and the success rate ranged from 27% to 90%. In the Botox group, 1 one study with 20 patients met our inclusion criteria, with an overall 65% success rate (13/20). Major complications were only reported in the dilation group, which included esophageal perforation and death. Conclusions: The lack of consistency across trials indicates insufficient evidence for guiding clinical practice. This systematic review suggests the need for greater standardization of outcomes and instruments. Future prospective evaluation should use validated patient-rated and clinician-rated assessment tools to optimally measure postoperative swallowing outcomes of head and neck cancer dysphagic patients following organ preservation therapy.

Background: Lymphedema after treatment for head and neck cancer negatively impacts the quality of life and can produce neck tissue stiffness, dysphagia, pain, and swelling. One form of treatment for lymphedema is machine-delivered sequential lymphedema massage, which is home based and self administered. This study was undertaken to determine economic and system access to home-based lymphedema therapy and to measure patient-reported outcomes among those able to access therapy.Methods: This study is a retrospective cohort study of 84 head and neck cancer patients who met the criteria for referral for home-based lymphedema treatment.Patients who were able to access lymphedema therapy were surveyed prior to initiation of therapy and again after therapy.Results: Thirty-five out of 84 patients were approved for home-based therapy and received the equipment. Medicare denial of coverage (21/84) was the most common cause of the inability to access therapy. Of the 35 patients who accessed therapy, presenting complaints included: stiffness (31), pain (29), dysphagia (20), and swelling (19). The average time from completion of cancer treatment to initiation of lymphedema therapy was 9 months. Thirty-four (97%) reported compliance with prescribed therapy, 33 (94%) reported reduced fibrosis, and 30 (89%) reported improvement in activities of daily living. All reported symptoms improved with therapy in 30 (86%) patients. Thirty-two (91%) reported overall satisfaction with home-based lymphedema treatment.Conclusions: Stiffness and pain were the most common complaints of our patients with head and neck lymphedema. Forty-two percent of patients who were recommended home lymphedema machine use were able to obtain this with cost coverage by their insurance company or by donation from the company. We found a high compliance rate and a highly reported improvement in symptoms with the machine.The only identifiable factor for the patients with less improvement in symptoms was