HSC Section 6 Nov2016 Green Book

T ABLE OF C ONTENTS Selected Recent Materials - Reproduced in this Study Guide

NOVEMBER 2016 SECTION 6: LARYNGOLOGY, VOICE DISORDERS, AND BRONCHOESOPHAGOLOGY

ADDITIONAL REFERENCE MATERIAL…………………………………………................ i-ii

I.

LARYNGOLOGY A. Neurolaryngology: Injection and Diagnostics

Domer AS, Leonard R, Belafsky PC. Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility. Laryngoscope . 2014; 124(10):2371-2374. EBM level 4....................................................................................1-4 Summary: Individuals with unilateral vocal fold immobility of iatrogenic and idiopathic etiologies with subjective dysphagia demonstrate objective evidence of pharyngeal weakness. The increased prevalence of aspiration in this population may not solely be the result of impaired airway protection. Li M, Chen S, Wang W, et al. Effect of duration of denervation on outcomes of ansa- recurrent laryngeal nerve reinnervation. Laryngoscope . 2014; 124(8):1900-1905. EBM level 4.............................................................................................................................5-10 Summary: Although delayed laryngeal reinnervation is proved valid for unilateral vocal fold paralysis, surgical outcome is better if the procedure is performed within 2 years after nerve injury than after 2 years. Paddle PM, Mansor MB, Song PC, Franco RA Jr. Diagnostic yield of computed tomography in the evaluation of idiopathic vocal fold paresis. Otolaryngol Head Neck Surg . 2015; 153(3):414-419. EBM level 4.................................................................11-16 Summary: This study reviewed charts of 174 patients with a diagnosis of idiopathic unilateral vocal fold paresis (IUVFP) who underwent CT scan from skull base to mediastinum in a tertiary laryngology practice over a 10-year period. Of the 174 patients, 5 patients had a cause for their paresis identified on CT. This equated to a diagnostic yield of 2.9% (95% confidence interval, 0.94% to 6.6%). In addition, 48 patients had other incidental lesions identified that required further follow-up, investigation, or treatment. This equated to an incidental yield of 27.6% (95% confidence interval, 21.1% to 34.9%). This review demonstrates a low diagnostic yield and a high incidental yield. These findings suggest that the routine use of CT in the evaluation of idiopathic vocal fold paresis should be given careful consideration and that a tailored approach to investigation with good otolaryngologic follow-up is warranted.