No abstract

Objective: Evaluate quality of life as well as quality of voice before and after endoscopic injection augmentation with Polydimethylsiloxane (VOX-Implants) for unilateral neurogenic vocal fold immobility.Method: Prospective study. Evaluation of 14 patients undergoing injection laryngoplasty (VOX-Implants) under general anesthesia. Evaluation of the following parameters concerning the patients voice (preoperatively, postoperatively): glottic closure (videostroboscopic and flexible-videoendoscopic), voice range profile, maximum phonation time, Dysphonia index (according to Friedrich) and Roughness-Breathiness-Hoarseness-Scale (RBH-Scale). Quality of life was assessed using Voice-Handicap-Index (VHI-12).

No abstract

Objectives We chose to review the outcomes of tracheotomies performed at San Jorge Children's Hospital, San Juan, Puerto Rico, over the last 15 years. Our objectives were: 1) Understand changing trends in the indications for tracheotomy and a perceived reduction in decanulation rates. 2) Be able to propose recommendations for the coordinated care of children with tracheotomy. Methods A retrospective chart review was performed of 189 patients undergoing tracheotomy from January 1991 to December 2006. The data were tabulated for age, diagnosis, complications, and outcome. Patients were divided in groups based on the indication for tracheotomy. Results 5 groups were identified based on the indication for tracheotomy: 1) True vocal cord paralysis: 11% of the study population with a 25% decanulation rate. 2) Airway obstruction: 21% of the study population with a 90% decanulation rate. 3) Craniofacial malformation: 8% of the study population with a 0% decanulation rate. 4) Neurological impairment: 46% of the study population with a 0% decanulation rate. 5) Prolonged intubation: 14% of the study population with a 25% decanulation rate. We report no intraoperative complications, an 18% overall complication rate, and a 10% mortality. Conclusions Over the last decades, the indications for tracheotomy have shifted toward children with underlying neurological impairment and need for prolonged mechanical ventilation. Decanulation rates for these children are significantly lower (approximately 10%) than for children with obstructive airway pathology (90%). Therefore, the care of these children and their tracheotomies will require coordinated multidisciplinary settings. We present several recommendations to achieve this goal.

POSTERSfurther studies with large numbers of cases and detection on premalignant lesions are needed to validate these findings. General Otolaryngology Percutaneous vs Open tracheostomy for Critical Care PatientsIman Naseri, MD (presenter) Objective: 1) Evaluate the indications for performing a tracheostomy across the spectrum of all trauma and pulmonary critical care patients. 2) Understand the existing contraindications used in the decision against performing a percutaneous dilatational tracheostomy. 3) Examine outcomes among the 2 modes of tracheotomy procedures.Method: A retrospective review identifying all patients who underwent open surgical or percutaneous dilatational tracheostomy procedure spanning 3 years (from 2008) within a tertiary hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related ER visits, and other complications.Results: A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open surgical versus 881 (66%) percutaneous dilatational techniques. There was no significant difference in age between the 2 groups (53 years). The average length of hospital stay was 21 days, indifferent among the 2 groups. The majority of the total tracheostomies were performed by the surgical services, in comparison to the pulmonary critical care service, 1080 (81%) versus 253 (19%), respectively. Approximately 26% of all discharged patients had a related ER visit (respiratory or tracheostomy-related) within a year. Conclusion:A majority of tracheostomies at our tertiary care trauma hospital are performed via the percutaneous technique. Both groups have similar short-term safety and complication rates. Our surprisingly high ER return rate suggests possible deficiency in pre-discharge teaching and care arrangements. Prospective studies are needed to determine long-term complications. General OtolaryngologyQuantitative assessment of aspiration: a Novel Porcine Model Sohit P. Kanotra, MD (presenter); Vito Forte, MD Objective: Develop a porcine model for quantitative assessment of pulmonary aspiration.Method: The porcine model consists of an endotracheally inserted pH probe with the distal end of the probe at the carina. The pH probe is sutured to the posterior tracheal wall, and the position is verified by a flexible endoscope. An acidic solution of known pH (2.5) is delivered through a catheter attached to the endotracheal tube, with the distal end on the cuff of the tube. The pH probe is connected to a multifunctional data acquisition device (NI USB 6009. National Instruments, USA) with an analogue output signal measuring the voltage generated, which is analyzed on software (Lab View 2011, National Instruments). This continuously provides a quantitative assessment of aspiration by detecting any voltage changes over a period of time indicating leakage of fluid around the endotracheal cuff. Results:The mean voltage measured with the cuff fully inflated and a column of 10 mL of a solution of known pH on t...