Otolaryngologists should offer injection laryngoplasty to patients with a diagnosis of UVFP within 6 months of diagnosis (recommendation based on grade C evidence with a preponderance of benefit over harm). Laryngoscope, 128:935-940, 2018.

Introduction Following acute injury to the recurrent laryngeal nerve (RLN), laryngeal electromyography (LEMG) is increasingly being used to determine prognosis for recovery. The LEMG findings change during the recovery process, but the timing of these changes is not well described. In this canine study, LEMGs were obtained serially following model RLN injuries. Methods 36 canine RLNs underwent crush (n=6), complete transection with reanastomosis (n=6), half-transection-half-crush (n=5), cautery (n=5), stretch (n=5), inferior crush (n=4), or inferior transection with reanastomosis (n=5) injuries. Injuries were performed 5cm from cricoid, or were 5cm further inferior. Under light sedation, LEMG of thyroarytenoid muscles was performed monthly for 6 months following injury. At 6 months, spontaneous and induced vocal fold motion was assessed. Results Except for the stretch injury, the remaining groups showed very similar recovery patterns. Fibrillation potentials (FPs) and/or positive sharp waves (PSWs) (signs of “bad prognosis”) were seen in all cases at one month and lasted on average for 2.26 months (range 1–4). Motor unit potentials of at least 2+ (scale 0–4+) (signs of “good prognosis”) were seen beginning at 3.61 months (range 2–6). The stretch injury was less severe, with 3/5 showing no FPs/PSWs at one month; all recovered full mobility. Ten of the 36 TA muscles (27.8%) had one EMG showing both bad prognosis and good prognosis signs simultaneously, at 2–4 months post-injury. Conclusion LEMG can be used to predict RNL recovery, but timing is important and LEMG results earlier than 3 months may overestimate a negative prognosis.

IMPORTANCEZenker diverticulum (ZD) can cause significant dysphagia, and symptoms can return or persist after surgery. This systematic review and network meta-analysis is the first to our knowledge to compare 3 common surgical techniques for ZD. OBJECTIVE To compare the 3 most common surgical techniques-endoscopic laser-assisted diverticulotomy, endoscopic stapler-assisted diverticulotomy, and transcervical diverticulectomy with cricopharyngeal myotomy-in adult patients with ZD.DATA SOURCES The published literature was searched using strategies designed by a medical librarian (search performed September 21, 2018). Strategies were established using a combination of controlled vocabulary terms and keywords and were executed in Ovid MEDLINE (1946 to September 21, 2018), Embase (1947 to September 21, 2018, Scopus (1823 to September 21, 2018), Cochrane Library, and ClinicalTrials.gov. Results were limited to English using database-supplied filters, which generated studies from 1997 to 2017.STUDY SELECTION Inclusion criteria were cohort studies or randomized clinical trials. Studies that included patients needing revision surgery or undergoing an alternative technique were excluded. DATA EXTRACTION AND SYNTHESISThe Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analyses (PRISMA-NMA) checklist was used to report the study findings. Two authors independently reviewed the studies. MAIN OUTCOME AND MEASUREThe primary outcome measure was the incidence of persistent or recurrent symptoms following surgery. The primary study outcome was planned before data collection began. RESULTSThe search generated 529 studies. After applying inclusion and exclusion criteria, 9 cohort studies remained, consisting of 903 patients treated with either laser-assisted diverticulotomy (n = 283), transcervical diverticulectomy (n = 150), or stapler-assisted diverticulotomy (n = 470). A network meta-analysis was performed. Between endoscopic laser-assisted diverticulotomy and open diverticulectomy, the open approach showed a statistically lower likelihood of persistent/recurrent symptoms following treatment (odds ratio [OR], 0.20; 95% CI, 0.04-0.91). Comparing laser-assisted diverticulotomy with the stapler-assisted technique, there was not a significant difference between the 2 techniques (OR, 0.83; 95% CI, 0.43-1.60). The consistency model for the network meta-analysis was supported (χ 2 1 = 0.12; P = .73).CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis compared 3 common techniques for treating ZD. The open approach showed a decreased likelihood of persistent or recurrent symptoms following surgery compared with the 2 other techniques.

NA Laryngoscope, 127:1525-1530, 2017.

NA. Laryngoscope, 2017.

4. Laryngoscope, 127:2033-2037, 2017.

The CMAP is a measure of vocal fold innervation. The technique could be further developed for clinical and experimental applications.

This study suggests that symptoms of upper respiratory infection frequently occur with the presentation of IUVFP. The onset of symptoms tended to occur between December and February. The mechanism of viral-mediated UVFP has not been established. Future studies to explore this pathophysiology are needed.