The Laryngoscope (Laryngoscope)

Publications in this journal

• Article: Cochlear pharmacokinetics of cisplatin - an in vivo study in the guinea pig.

  Victoria Hellberg, Inger Wallin, Hans Ehrsson, Göran Laurell
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  ABSTRACT: Objective: Cisplatin produces toxic lesions to outer hair cells in the cochlear base but not in the apex. The objective of this study was to compare the pharmacokinetic profile of cisplatin in scala tympani perilymph in the cochlear base and apex respectively. Study Design: In vivo animal study. Methods: Forty-seven guinea pigs were given an intravenous bolus injection of an ototoxic dose of cisplatin. Ten to 240 min after cisplatin was given, blood, cerebrospinal fluid and scala tympani perilymph were aspirated within the same target time. Scala tympani perilymph was aspirated from the basal turn and from the apex of the cochlea by two different sampling techniques. Liquid chromatography with post-column derivatization was used for quantitative determination of the parent drug. Results: Ten min after administration, the concentration of cisplatin in scala tympani perilymph was 4-fold higher in the basal turn of the cochlea than in the apex. At 30 min, the drug concentrations did not differ. At 60 min, the level of cisplatin in scala tympani perilymph and blood ultrafiltrate was equivalent. The perilymph-blood ratio increased thereafter with time. Conclusion: The pharmacokinetic findings of an early high concentration of cisplatin in the base of the cochlea and delayed elimination of cisplatin from scala tympani perilymph compared to blood might correlate to the cisplatin-induced loss of outer hair cells in the base of the cochlea.
  The Laryngoscope 06/2013;
• Article: Demographic trends and disease-specific survival in acinic cell carcinoma: An analysis of 1,129 cases.

  Neal R Patel, Saurin Sanghvi, Mohemmed N Khan, Qasim Husain, Soly Baredes, Jean Anderson Eloy
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  ABSTRACT: Objective/Hypothesis: Acinic cell carcinoma (AciCC) is a rare salivary gland malignancy that most commonly arises in the parotid gland. Characteristics of AciCC are slow-growth and a long clinical course. As a rare tumor, population based studies are limited. We analyzed the incidence and survival for AciCC using a national population-based database. Study Design: Retrospective analysis. Methods: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to calculate incidence and disease-specific survival trends for AciCC between 1973 and 2009. Patient data were stratified according to age, gender, race, grade, and extent of disease. Incidence trends were studied across the last 30 years and long-term disease specific-survival outcomes were compared across the different demographic parameters. Results: 1,129 cases of AciCC were identified, comprising of 672 (59.52%) females. Incidence trend analysis revealed significant changes in yearly incidence rates from1973 to 2009 for male gender and white and "others" races. Overall 5-year survival was 97.15%, 10-year was 93.81%, and 20-year was 89.74%. Significant differences in survival outcomes were noted for extent of disease. Patients exhibiting distant metastasis displayed the worse long-term prognosis at 21.99% 20-year disease-specific survival. Hazard ratios demonstrated a significant increase in mortality in patients with poorly differentiated, undifferentiated, and metastatic disease. Conclusion: Trends in incidence of AciCC are influenced by gender, race and age. Long-term survival of this rare malignant tumor is influenced by gender, grade, race, and extent of disease. Future studies need to be conducted to investigate these dynamic trends related to AciCC.
  The Laryngoscope 06/2013;
• Article: Replacement of fractured reconstruction plate with customised mandible implant: A novel technique.

  Alberto Bedogni, Giordana Bettini, Giuseppe Ferronato, Stefano Fusetti, Giorgia Saia
  The Laryngoscope 06/2013;
• Article: A case report of intra-operative retroorbital fluid dissection after frontal minitrephine placement.

  Jamie N Andrews, Manuel A Lopez, Erik K Weitzel
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  ABSTRACT: We report a case of a 24-year-old male with a history of allergic fungal sinusitis, who experienced an intraoperative retroorbital fluid dissection after frontal minitrephine placement. Although minitrephination of the frontal sinus is a useful technique that is frequently employed during endoscopic sinus surgery it has potential complications. The purpose of this report is to discuss a previously unreported complication of frontal minitrephination and its management.
  The Laryngoscope 06/2013;
• Article: Delayed mobilization after microsurgical reconstruction: An independent risk factor for pneumonia.

  Justin K Yeung, Robertson Harrop, Olivia McCreary, Leslie T Leung, Naushad Hirani, David McKenzie, Vim de Haas, T Wayne Matthews, Steve Nakoneshny, Joseph C Dort, Chistiaan Schrag
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  ABSTRACT: OBJECTIVE: Large defects secondary to oral cancer resection are reconstructed with microsurgical free flaps. Pulmonary complications in these patients are common. Post-operative mobilization is recommended to decrease respiratory complications however many microsurgeons are reluctant to adopt early mobilization protocols due to the perceived risk of flap compromise. The purpose of this study was to determine the incidence of pneumonia among patients undergoing oral cancer resection and immediate free flap reconstruction and to compare the incidence of this complication between patients mobilized early (<4 days post-op) versus later. A secondary goal was to determine whether early postoperative mobilization affected microvascular flap outcome. STUDY DESIGN: Retrospective cohort study. METHODS: Sixty-two consecutive patients treated between 2005-2009 with oral carcinoma resection and free flap reconstruction were studied. Information pertaining to comorbidities, postoperative care, and complications were collected. Risk factors for development of pulmonary and flap complications were analysed. RESULTS: The incidence of pneumonia was 30.6%. Longer ICU stay (p=0.01), tracheostomy decannulation later than 10 days (p=0.04) and longer operative times (p=0.04) were significantly associated with pneumonia. Delayed mobilization (after day 4 postop) was an independent risk factor for pneumonia (OR=4.2, 95% CI: 1.1, 17.1). Early mobilization (before day 4 postop) was not associated with an increased incidence of secondary flap procedures or flap failure. CONCLUSION: Late mobilization of free flap patients is an independent risk factor for developing post-operative pneumonia. Earlier mobilization does not increase flap failure rates, is safe, and should be strongly considered in all free flap patients to reduce pulmonary complications.
  The Laryngoscope 06/2013;
• Article: Merkel cell carcinoma of the head and neck (HNMCC): Potential histopathologic predictors.

  Stephan K Haerle, Carolyn Shiau, David P Goldstein, Xin Qiu, Boban M Erovic, Danny Ghazarian, Wei Xu, Jonathan C Irish
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  ABSTRACT: Objective: To identify or confirm any new or suggested independent histopathological predictors in Merkel cell carcinoma (MCC) of the head and neck (HN) correlated with outcome. Study design: Retrospective chart and pathology review. Methods: Between 1990-2010, 58 patients with HNMCC were identified for study. Pathologic specimens were reviewed and evaluated for independent prognostic factors and correlated with locoregional recurrence and disease specific survival. Results: The 2- and 5-year disease-specific survival (DSS) rates were 72.7%, and 63.6%, respectively. The local and regional recurrence rates were 12.0% and 24.1%, respectively. 25.9% of the patients developed distant metastases during follow-up. Tumor size (<1cm vs. >1cm) and the presence of a positive deep resection margin were independently found to be significantly associated with regional recurrence (p=0.01, and p=0.04, respectively). No other prognostic factors could be identified. Conclusion: Adjuvant radiotherapy cannot remediate a positive resection margin. Given these results consideration for revision surgery should be considered for a positive deep margin. Frozen section analysis may help to define the margins in this invasive and aggressive disease.
  The Laryngoscope 06/2013;
• Article: Helmet modification for soft-band bone-anchored hearing aid use during cranial orthosis.

  Michael F Bonnar, Mauricio Ventura, Audrey Winans, Andrew R Scott
  The Laryngoscope 06/2013;
• Article: Extra-esophageal reflux (EER), NOSE score, and sleep quality in a adult clinic population.

  Supawan Laohasiriwong, Nikki Johnston, B Tucker Woodson
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  ABSTRACT: OBJECTIVES: Gastroesophageal reflux disease and heartburn negatively impact sleep; the impact of extra-esophageal reflux (EER) symptoms on sleep is unknown. This study's goal was to evaluate the association of EER and measures of nasal obstruction, mood, insomnia, hypersomnia, and obstructive sleep apnea (OSA) risk. Study Design: Cross-sectional study Setting: Tertiary care hospital SUBJECTS AND METHODS: A prospective cohort of adult patients were evaluated using validated questionnaires for insomnia (PSQI), hypersomnia (ESS), OSA risk (STOP-Bang), sleep quality of life (FOSQ-10), EER reflux symptoms (RSI), nasal symptoms (NOSE), and measures of mood (HADA). Pharyngeal saliva samples underwent western blot immunoassay for pepsin. RESULTS: Ninety three adults (mean age 50.2±15.2 years, 43 % female) were evaluated. Reflux Symptom Index (RSI) was elevated in 32%, significant heartburn symptoms were reported in only 12%. Prevalence of pepsin (+) was 27%. Both RSI and NOSE were significantly associated with sleep measures related to insomnia (r=0.48 and r=0.50, p< 0.001 respectively), QOL (r=0.30 and r=0.34, p< 0.001, respectively), and hypersomnolance (r=0.18, p < 0.04 and r=0.29, p<0.01, respectively), but not apnea risk (all p< 0.05). Nasal symptoms and mood were associated with all non-OSA sleep metrics (r=0.24). In multivariate analysis, both NOSE and RSI remained significantly associated with sleep measures. CONCLUSIONS: Insomnia, hypersomnia, and sleep QOL are associated with measures of EER, nasal symptoms, and mood but not OSA risk supporting that disrupted sleep may be a associated with EER and nasal symptoms independent of sleep apnea.
  The Laryngoscope 06/2013;
• Article: Prospective clinical trial of gelatin-thrombin matrix as first line treatment of posterior epistaxis.

  Shaun J Kilty, Mohammad Al-Hajry, Dakheelallah Al-Mutairi, James P Bonaparte, Melanie Duval, Euna Hwang, Darren Tse
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  ABSTRACT: Objective: To evaluate the effectiveness of gelatin-thrombin matrix for first line treatment of posterior epistaxis. Secondarily, we evaluated discomfort during treatment and the cost savings of treatment with gelatin-thrombin matrix compared to posterior packing, endoscopic or endovascular treatment at our institution. Study Design: Prospective pilot, non-blinded, non-controlled registered clinical trial (NCT01098578). Methods: 20 patients with posterior epistaxis were enrolled into this study. Gelatin-thrombin matrix was used for posterior epistaxis treatment with simultaneous ipsilateral choanal occlusion. Patients were discharged within two hours of being successfully treated. A visual analog scale (range 0-10) was used to assess treatment discomfort. Patients were evaluated in clinic 5 and 30 days after treatment to assess for intranasal complications and recurrent epistaxis. Results: Gelatin-thrombin matrix successfully treated epistaxis in 80% of the patients. The procedure was associated with a mean discomfort of 3.6 (range 0-9.7). The institutional per case cost of treatment of patients with posterior epistaxis with gelatin-thrombin matrix is 80.3%, 87.4%, and 89.4% less than with endoscopic surgery, posterior packing, or embolization, respectively. There were no complications. Conclusion: This pilot study demonstrated that gelatin-thrombin matrix is a safe and both a clinically effective and cost saving means of treating posterior epistaxis. In this study, its use is associated with a low level of discomfort. This treatment method may improve the quality of care for patients with posterior epistaxis.
  The Laryngoscope 06/2013;
• Article: Trends of human papillomavirus-related head and neck cancers in Korea: National cancer registry data.

  Aesun Shin, Yuh-S Jung, Kyu-Won Jung, Kyeezu Kim, Junsun Ryu, Young-Joo Won
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  ABSTRACT: Objective: The incidence of human papillomavirus (HPV)-positive head and neck cancers (HNCs) is increasing sharply worldwide, whilst their HPV-negative counterparts are showing a decreased frequency. However, epidemiologic data related to these changes are sparse in Korea, which is rapidly adopting more westernized lifestyles. Study design: Data from the Korea Central Cancer Registry, a nationwide population-based cancer registry from 1999 to 2009 were retrieved. Methods: Age-standardized rates (ASRs), their annual percent changes (APC) and male-to-female incidence rate ratios (IRRs) were analyzed and compared between HPV-related and HPV-unrelated primary sites. Results: HPV-related sites (oropharynx) had increased significantly over the period 1999-2009 (APC=2.35%, P=0.017), particularly in young men (30-59 years, APC=2.65%, P=0.031), whereas HPV-unrelated sites such as larynx and hypopharynx, decreased markedly in both sexes. Interestingly, tongue cancer was found to have increased gradually (APC=2.35%, P=0.003) in both sexes. The male-to-female IRRs and the median age of occurrence remained stable. Conclusions: Although the cultural and ethnic background differs from the United States, cancers of HPV-related sites are increasing in Korea, whereas cancers of HPV-unrelated sites are decreasing, which is similar to the trends observed in the United States. Greater public awareness in Korea of HPV-related HNCs is therefore warranted.
  The Laryngoscope 06/2013;
• Article: Long-term results of surgical treatment of vocal fold nodules.

  Emilie Béquignon, Christine Bach, Claude Fugain, Lia Guilleré, Marc Blumen, Frédéric Chabolle, Isabelle Wagner
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  ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the long-term outcome of patients with vocal fold nodules treated by surgery alone, or by a combination of surgery and voice therapy and to identify factors associated with long-term recurrent dysphonia. STUDY DESIGN: Retrospective study. METHODS: All patients who had undergone surgery for vocal fold nodules in a tertiary care hospital between 1996 and 2006 were contacted. After giving their consent, they were evaluated by videostroboscopic examination of vocal fold nodules and by a subjective questionnaire including the Voice Handicap Index (VHI). RESULTS: Sixty-two out of 90 patients (69%) (60 women, 2 men with a mean age of 33 years) answered the questionnaire at a mean interval of 9.5 years after surgery. Recurrent dysphonia was observed in 19 patients (30%) at a mean interval of 5.2 years after surgery and new benign vocal fold lesions (nodules or Reinke's edema) were observed in 11 patients (18%). Absence of postoperative voice therapy was significantly associated with a higher recurrence rate (P = 0.02) (56% of recurrent dysphonia without voice therapy versus 22% with voice therapy). CONCLUSIONS: Postoperative voice therapy decreases the risk of recurrence. Vocal fold nodules can recur over a period of 5 years, consequently requiring follow-up for at least 5 years in clinical practice and in future prospective studies. LEVEL OF EVIDENCE: 2b (Individual retrospective cohort study). Laryngoscope, 2013.
  The Laryngoscope 06/2013;
• Article: Vocal fold hemorrhage: Factors predicting recurrence.

  Christen J Lennon, Thomas Murry, Lucian Sulica
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  ABSTRACT: Objective: Vocal fold hemorrhage is an acute phonotraumatic injury treated with voice rest; recurrence is a generally accepted indication for surgical intervention. This study aims to identify factors predictive of recurrence based on outcomes of a large clinical series. Study Design: Retrospective cohort Methods: Retrospective review of cases of vocal fold hemorrhage presenting to a university laryngology service. Demographic information was compiled. Videostroboscopic exams were evaluated for hemorrhage extent, presence of varix, mucosal lesion, and/or vocal fold paresis. Vocal fold hemorrhage recurrence was the main outcome measure. Follow-up telephone survey was used to complement clinical data. Results: Forty-seven instances of vocal fold hemorrhage were evaluated (25M:22F; 32 professional voice users). 12 of the 47 (26%) patients experienced recurrence. Only the presence of varix demonstrated significant association with recurrence (p=0.0089) on multivariate logistic regression. Conclusion: Vocal fold hemorrhage recurred in approximately 25% of patients. Varix was a predictor of recurrence. Monitoring, behavioral mamanagement and/or surgical intervention may be indicated to treat patients with such characteristics.
  The Laryngoscope 06/2013;
• Article: Comparison of nasal sprays and irrigations in the delivery of topical agents to the olfactory mucosa.

  Kent Lam, Bruce K Tan, Jennifer M Lavin, Eric Meen, David Conley
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  ABSTRACT: Objective: Sinonasal diseases are often treated with topical agents administered through various application techniques, but few prior studies have examined their distribution to the olfactory mucosa. The purpose of this study was to compare the distribution of nasal irrigations to sprays within the olfactory cleft. Study Design: Human cadaveric study. Methods: Eight cadaveric heads, providing a total of 15 nasal sides, underwent treatment with methylene blue solution. Application utilized a pressurized spray device followed by an irrigation squeeze bottle, both used according to manufacturer instructions. Videos and images from six standardized anatomical positions were recorded by rigid nasal endoscopy prior to and following each method of agent delivery. Using the acquired images, three reviewers blinded to the means of application scored the approximate surface area stained. An image analysis program was additionally calibrated and used to measure pixel intensity in order to quantify surface delivery of methylene blue. Results: Based on both blinded reviewer ratings and image pixel intensity measurements, irrigations demonstrated a greater extent and intensity of staining than sprays within the sphenoethmoid recess, superior turbinate, and superior olfactory cleft (all p<0.05). Sprays and irrigations, however, were comparable in the extent of staining at the nasal vestibule (p>0.05), inferior turbinate (p=0.04), and middle turbinate (p>0.05). Conclusions: Compared to sprays, irrigations provide a more effective method of delivering topical agents to the posterior and superior aspects of the nasal cavity. The thorough distribution of irrigations has important clinical implications for improving the delivery of therapeutic agents to the olfactory mucosa.
  The Laryngoscope 06/2013;
• Article: Obesity is associated with sensorineural hearing loss in adolescents.

  Anil K Lalwani, Karin Katz, Ying-Hua Liu, Sarah Kim, Michael Weitzman
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  ABSTRACT: Objective: Childhood obesity, defined as body mass index (BMI) ≥ 95%, is a significant health problem associated with a variety of disorders and in adults has been found to be a risk factor for hearing loss. We investigated the hypothesis that obese children are at increased risk of sensorineural hearing loss(SNHL). Study Design: A complex, multistage, stratified geographic area design for collecting representative data from noninstitutionalized US population. Methods: Relevant cross-sectional data from the National Health and Nutrition Examination Survey, 2005-2006, for 1488 participants 12 to 19 years of age was examined. Subjects were classified as obese if their BMI ≥ 95(th) percentile. SNHL was defined as average pure-tone level greater than 15 dB for 0.5, 1, and 2 kHz(low frequency) and 3, 4, 6, and 8 kHz(high frequency). Results: Compared to normal weight participants (BMI 5-85%), obesity in adolescents was associated with elevated pure tone hearing thresholds and greater prevalence of unilateral low frequency SNHL (15.2 vs 8.3%, P=0.01). In multivariate analyses, obesity was associated with a 1.85 fold increase in the odds of unilateral low frequency SNHL (95% CI: 1.10-3.13) after controlling for multiple hearing related covariates. Conclusions: We demonstrate, for the first time, that obesity in childhood is associated with higher hearing thresholds across all frequencies and an almost 2 fold increase in the odds of unilateral low frequency hearing loss. These results add to the growing literature on obesity related health disturbances and add to the urgency in instituting public health measures to reduce it.
  The Laryngoscope 06/2013;
• Article: Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: Clinicopathologic correlates of outcome.

  Allen M Chen, Valerie H Lau, D Gregory Farwell, Quang Luu, Paul J Donald
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  ABSTRACT: Objective: To determine clinical and pathological correlates of outcome among patients treated by surgery and postoperative radiation therapy for mucoepidermoid carcinoma of the parotid gland. Study Design: Retrospective review Methods: The medical records of 64 patients treated by surgery and postoperative radiation therapy for localized mucoepidermoid carcinoma of the parotid gland were retrospectively reviewed in an attempt to identify clincopathologic correlates of overall survival. Secondary endpoints included local-regional control, distant metastasis-free survival, and complications. Results: The 3- and 5-year estimates of overall survival were 85% and 79%, respectively. Multivariate analysis identified high tumor grade (hazard ratio [HR]=7.92) and T4 disease (HR=3.35) as independent predictors of decreased survival, with the former also predicting for distant metastasis and the latter predicting for local-regional recurrence. The 5-year estimate of overall survival was 83% for patients with non-high-grade tumors compared to 52% for those with high-grade histology (p=0.001). Late complications included trismus (2 patients), osteoradionecrosis (1 patient), and hearing loss (1 patient). Conclusion: Patients with high-grade tumors and T4 disease are at increased risk for treatment failure after surgery and postoperative radiation therapy for mucoepidermoid carcinoma of the parotid gland. Investigative strategies to improve outcome should be considered for these particular patients in the future.
  The Laryngoscope 06/2013;
• Article: Modalities of treatment for laryngotracheal stenosis: The EVMS experience.

  John T Sinacori, Sal J Taliercio, Elizabeth Duong, Chris Benson
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  ABSTRACT: Objectives: The aims of the study were to identify trends in surgical management of laryngotracheal stenosis (LTS) based on lesion location, as well as to recognize factors associated with recurrence and repeat surgical intervention. Design: The study is a retrospective review of all adult patients cared for at a tertiary care Laryngology practice with a diagnosis of laryngotracheal stenosis between October 2001 and July 2010, following IRB approval. Methods: This study collectively measured demographics, co-morbidities, etiologies, sites of stenoses, treatment modalities, and recurrences. Results: Incisions made with the CO2 laser were the most common modality of treatment; patients with multi-level tracheal stenosis were most likely to have undergone at least one operation in which the CO2 laser was used to make incisions (78.7%). Balloon dilation was most commonly employed in patients with multi-level tracheal stenosis (66.0%). Lowest rates of decannulation were identified in patients with a pure tracheal stenosis (23.1%). Patients presenting with multi-level tracheal stenosis underwent the most procedures (6.7). Supraglottic, glottic, and multi-level laryngeal stenosis recurred at the lowest rates. Patients suffering from diabetes mellitus recurred in an average period of 3.9 months, a shorter time frame than those without diabetes, who recurred every 10.5 months. Conclusions: Laser incision and/or balloon dilation, are most effective in treatment of pure glottic, subglottic and tracheal stenosis. ultilevel tracheal stenosis warrant closer follow up, and are more likely to require multiple procedures. Worsening stenosis despite endoscopic management warrants an open procedure. Diabetes is associated with an earlier recurrence of stenosis.
  The Laryngoscope 06/2013;
• Article: What is the perioperative antibiotic prophylaxis in adult oncologic head and neck surgery?

  Yekaterina A Koshkareva, Jonas T Johnson
  The Laryngoscope 06/2013;
• Article: Development and validation of the cough severity index: A severity index for chronic cough related to the upper-airway.

  Adrianna C Shembel, Clark A Rosen, Thomas G Zullo, Jackie L Gartner-Schmidt
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  ABSTRACT: OBJECTIVES/HYPOTHESIS: To develop and validate a cough severity index (CSI) which quantifies patients' symptoms associated with upper airway chronic cough and to provide a tool for treatment outcome measures. METHODS: Two hundred patients who had a complaint of chronic cough and/or dyspnea were given a 49- item questionnaire developed through a clinical consensus of the most common symptoms of chronic cough of upper airway origin. The instrument was reduced to 10 questions using statistical methodology. Fifty subsequent patients were given the CSI to measure test-retest reliability at two different moments in time. Twenty healthy controls (HC) were given the instrument to obtain validity. An additional 95 participants provided pre- and posttreatment outcomes using the CSI. RESULTS: Principle Component Analysis (PCA) revealed a single factor with the original 49 questions. A combination of PCA, rank-ordering item-total correlation and communality, as well as clinical consensus further reduced the questionnaire to 10 items. Internal consistency of the CSI was 0.97. Test-retest reliability was r = 0.83. An r = 0.60 for divergent validity between the CSI and the Cough-Specific Quality-of-Life Questionnaire (CQLQ) demonstrated two fairly separate instruments, although both measured cough. Mann-Whitney test was significant between symptomatic patients and healthy controls (P < 0.0004). The results of 20 HC showed a mean of 0.45 (standard deviation = 1.39). Results for treatment outcomes revealed significance with the Wilcoxon test (P < 0.0001) and paired samples t test showed significantly different correlations between pre- and postmeasures. CONCLUSION: The CSI is a short, simple instrument that can be used in the clinical setting to quantify a patient's symptoms of chronic cough of upper airway origin. It represents a statistically reliable, valid, and clinically relevant instrument that can be used to measure treatment outcomes for chronic cough. LEVEL OF EVIDENCE: 2c. Laryngoscope, 2013.
  The Laryngoscope 06/2013;
• Article: Is speech language pathologist evaluation necessary in the nonoperative treatment of head and neck cancer?

  Heather M Starmer, Christine G Gourin
  The Laryngoscope 06/2013;
• Article: National trends in thyroid surgery and the effect of volume on short-term outcomes.

  Myriam Loyo, Ralph P Tufano, Christine G Gourin
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  ABSTRACT: OBJECTIVES/HYPOTHESIS: To characterize contemporary patterns of thyroid surgical care and the effect of volume status on surgical care and short-term outcomes. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Discharge data from the Nationwide Inpatient Sample for 871,644 patients who underwent surgery for thyroid disease in 1993 through 2008 were analyzed using cross-tabulations and multivariate regression modeling. RESULTS: Surgical cases increased from 364,288 in 1993 through 2000 to 507,356 in 2001 through 2008, with an increase in thyroid cancer surgical cases from 28% to 34%. Cases performed by high-volume surgeons increased from 12% in 1993 through 2000 to 25% in 2001 through 2008, whereas cases performed by very-low volume surgeons decreased from 51% to 34% (P < .001). Cases performed at high-volume hospitals increased from 14% in 1993 through 2000 to 29% in 2001 through 2008, whereas cases performed at very-low volume hospitals decreased from 46% to 33% (P < .001). High-volume surgeons were significantly more likely to perform total thyroidectomy (odds ratio [OR] = 1.4, P < .001) and had a lower incidence of recurrent laryngeal nerve injury (OR = 0.7, P = .024), hypocalcemia (OR = 0.7, P = .002), and in-hospital death (OR = 0.3, P = .004). High-volume hospital care was not associated with extent of surgery, postoperative morbidity, or mortality after adjusting for surgeon volume. After controlling for other variables, thyroid surgery in 2001 through 2008 was associated with an increase in cases performed by low-volume (relative risk ratio [RRR] = 1.5, P < .001), intermediate-volume (RRR = 1.7, P < .001), and high-volume surgeons (RRR = 2.1, P < .001), high-volume hospitals (RRR = 2.0, P = .008), total thyroidectomy (RRR = 2.1, P < .001), and neck dissection (RRR = 1.3, P = .016). CONCLUSIONS: These data reflect changing trends in the surgical management of thyroid disease, with meaningful differences in the type of surgical care provided by high-volume surgeons. LEVEL OF EVIDENCE: 2c. Laryngoscope, 2012.
  The Laryngoscope 06/2013;