Edward J. Damrose, MD, FACS

All Publications

• Autologous fibroblasts for vocal scars and age-related atrophy: A randomized clinical trial. The Laryngoscope Ma, Y., Long, J., Amin, M. R., Branski, R. C., Damrose, E. J., Sung, C., Achlatis, S., Kearney, A., Chhetri, D. K. 2019

  Abstract

  OBJECTIVES/HYPOTHESIS: To assess the safety and efficacy of autologous cultured fibroblasts (ACFs) to treat dysphonia related to vocal fold scar and age-related vocal atrophy (ARVA).STUDY DESIGN: Randomized, double-blinded, placebo-controlled, multi-institutional, phase II trial.METHODS: ACFs were expanded from punch biopsies of the postauricular skin in each subject; randomization was 2:1 (treatment vs. placebo). Three injections of 1-2*107 cells or placebo saline was performed at 4-week intervals for each vocal fold. Follow-up was performed at 4, 8, and 12 months. The primary outcome was improved mucosal waves. Secondary outcomes included Voice Handicap Index (VHI)-30, patient reported voice quality outcomes, and perceptual analysis of voice.RESULTS: Fifteen subjects received ACF and six received saline injections. At 4, 8, and 12 months after ACF treatments, a significant improvement in mucosal wave grade relative to baseline was observed in both vocal scar and ARVA groups. Relative to control group, mucosal waves were significantly improved in the ARVA group at 4 and 8 months. Perceptual analysis significantly improved in the vocal scar group 12 months after ACF treatments compared to controls. Vocal scar group reported significantly improved vocal quality from baseline. VHI and expert rater voice grade improved in both groups, but did not achieve significance. No adverse events related to fibroblast injections were observed.CONCLUSIONS: In this cohort, injection of ACFs into the vocal fold lamina propria (LP) was safe and significantly improved mucosal waves in patients with vocal scar and ARVA. ACF may hold promise to reconstruct the LP.LEVEL OF EVIDENCE: 1 Laryngoscope, 2019.

  View details for DOI 10.1002/lary.28453

  View details for PubMedID 31804729

• Increased expression of estrogen receptor beta in idiopathic progressive subglottic stenosis. The Laryngoscope Damrose, E. J., Campbell, R. D., Darwish, S., Erickson-DiRenzo, E. 2019

  Abstract

  BACKGROUND/OBJECTIVES: Idiopathic progressive subglottic stenosis (IPSS) predominantly affects females in perimenopause. It has, therefore, been hypothesized that estrogen is involved in its pathogenesis. There are two main types of estrogen receptors: ER-alpha and ER-beta. Abnormal variants of ER-beta have previously been shown to be associated with poor wound healing. Estrogen receptors have recently been identified in subglottic tissue samples, with elevated levels of ER-alpha and progesterone receptors, and no expression of ER-beta, in stenotic specimens reported in one study. The objective of this study was to confirm the presence of estrogen receptors in the subglottis and investigate levels of expression and types of estrogen receptors in normal and stenotic subglottic tissue.METHODS: Subglottic tissue was obtained from three female and one male cadaver without laryngotracheal pathology to serve as controls. Subglottic tissue specimens from five female patients with IPSS were also analysed. Immunofluorescence stains for ER-alpha and ER-SS were performed on specimens. Staining patterns were compared qualitatively and semi-qualitatively between control and IPSS specimens.RESULTS: Immunofluorescence stains demonstrated the presence of both ER-alpha and ER-beta in subglottic tissue. IPSS specimens demonstrated significantly greater staining intensity of ER-alpha in the epithelium and ER-SS in glands and ducts compared to controls.CONCLUSIONS: This study confirms the presence of estrogen receptors in the subglottis. Increased expression of ER-alpha in the epithelium and ER-SS in glands and ducts in IPSS compared to controls may help to explain the predisposition to stenosis in these individuals.LEVEL OF EVIDENCE: 3b Laryngoscope, 2019.

  View details for DOI 10.1002/lary.28364

  View details for PubMedID 31643093

• Hematologic malignancies of the larynx: A single institution review. American journal of otolaryngology Dewan, K., Campbell, R., Damrose, E. J. 2019: 102285

  Abstract

  BACKGROUND: Primary hematologic malignancies of the larynx are rare diagnoses, accounting for less than 1% of all laryngeal tumors. They most commonly present as submucosal masses of the supraglottis, with symptoms including hoarseness, dysphagia, dyspnea and rarely cervical lymphadenopathy.PURPOSE: METHODS: Retrospective case series of patients in a tertiary academic laryngeal practice with hematologic malignancy of the larynx presenting over a 10 year period; charts were reviewed for diagnosis, symptoms, treatment, and outcomes.RESULTS: 12 patients were found to have primary presentation of a hematologic malignancy within the larynx between 2009 and 2019. A submucosal mass was the most common finding, and hoarseness was the most common symptom. Local control of disease was high. Airway obstruction was managed with tracheostomy. Several patients required tube feeding prior to disease control. Most patients underwent radiation therapy and chemotherapy, although surgery alone was effective in patients with isolated disease.CONCLUSIONS: Hematologic malignancies of the larynx are rare but treatable. Biopsy is the mainstay of diagnosis, and imaging may be helpful to exclude diseases with a similar physical presentation (i.e., laryngocele). Prognosis depends on diagnosis but is generally favorable.

  View details for DOI 10.1016/j.amjoto.2019.102285

  View details for PubMedID 31515071

• Endoscopic Management of Postradiation Dysphagia in Head and Neck Cancer Patients: A Systematic Review ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Abu-Ghanem, S., Sung, C., Junlapan, A., Kearney, A., DiRenzo, E., Dewan, K., Damrose, E. J. 2019; 128 (8): 767–73

  View details for DOI 10.1177/0003489419837565

  View details for Web of Science ID 000481481400013

• Author's reply. The Journal of laryngology and otology Damrose, E. J., Manson, L., Nekhendzy, V., Collins, J., Campbell, R. 2019: 1–2

  View details for DOI 10.1017/S0022215119001464

  View details for PubMedID 31303193

• Type I thyroplasty: A safe outpatient procedure Junlapan, A., Sung, C., Damrose, E. J. WILEY. 2019: 1640–46

  View details for DOI 10.1002/lary.27686

  View details for Web of Science ID 000471915700032

• The Sternocleidomastoid Myocutaneous Flap: A Laryngeal Preservation Option for Total Hypopharyngoesophageal Stenosis Paknezhad, H., Borchard, N. A., Lee, G. K., Damrose, E. J. SAGE PUBLICATIONS LTD. 2019: 186–89

  View details for DOI 10.1177/0194599819835784

  View details for Web of Science ID 000473507100026

• Outcomes in modified transoral resection of diverticula for Zenker's diverticulum EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Junlapan, A., Abu-Ghanem, S., Sung, C., Damrose, E. J. 2019; 276 (5): 1423–29

  View details for DOI 10.1007/s00405-019-05374-z

  View details for Web of Science ID 000464861500022

• Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques JOURNAL OF LARYNGOLOGY AND OTOLOGY Damrose, E. J., Manson, L., Nekhendzy, Collins, J., Campbell, R. 2019; 133 (5): 399–403

  View details for DOI 10.1017/S0022215119000690

  View details for Web of Science ID 000484578500010

• Intralaryngeal Ectopic Thyroid Tissue. Ear, nose, & throat journal Paknezhad, H., Dholakia, S. S., Damrose, E. J. 2019: 145561319840186

  View details for PubMedID 30955373

• The Sternocleidomastoid Myocutaneous Flap: A Laryngeal Preservation Option for Total Hyopharyngoesophageal Stenosis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Paknezhad, H., Borchard, N. A., Lee, G. K., Damrose, E. J. 2019: 194599819835784

  Abstract

  Complete hypopharyngoesophageal (HPE) stenosis is rare and a challenging condition to treat. When endoscopic therapy fails, total laryngectomy with or without pharyngeal reconstruction is usually performed. We present a retrospective case series involving 3 patients with complete HPE stenosis who failed endoscopic repair and were gastrostomy dependent. All were managed successfully with the sternocleidomastoid myocutaneous (SCM) flap. A temporary fistula occurred in 1 patient. Hospitalization ranged from 5 to 15 days, patients resumed oral intake from 21 to 82 days postoperatively, and their gastrostomy tubes were removed from 28 to 165 days postoperatively. We suggest that the SCM flap is a laryngeal preservation option for reconstruction of complete HPE stenosis when endoscopic techniques fail. This flap allows HPE repair and reconstruction within the same surgical field, imposes no significant donor site morbidity, and affords good functional and cosmetic outcomes.

  View details for PubMedID 30909812

• Endoscopic Management of Postradiation Dysphagia in Head and Neck Cancer Patients: A Systematic Review. The Annals of otology, rhinology, and laryngology Abu-Ghanem, S., Sung, C., Junlapan, A., Kearney, A., DiRenzo, E., Dewan, K., Damrose, E. J. 2019: 3489419837565

  Abstract

  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.

  View details for PubMedID 30895823

• Association of Overlapping Surgery With Perioperative Outcomes JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Sun, E., Mello, M. M., Rishel, C. A., Vaughn, M. T., Kheterpal, S., Saager, L., Fleisher, L. A., Damrose, E. J., Kadry, B., Jena, A. B., Kooij, F., Wilczak, J., Soto, R., Berris, J., Price, Z., Urman, R. D., Lins, S., Harris, J. M., Cummings, K. C., Berman, M. F., Nanamori, M., Adelman, B. T., Wedeven, C., Bittner, E. A., LaGorio, J., McCormick, P. J., Tom, S., Aziz, M. F., Coffman, T., Ellis, T. A., Molina, S., Peterson, W., Mackey, S. C., van Klei, W. A., Mahajan, A., Geffen, D., Jameson, L. C., Biggs, D. A., Craft, R., Pace, N. L., Paganelli, W. C., Durieux, M. E., Nair, B. J., Wanderer, J. P., Miller, S. A., Helsten, D. L., Turnbull, Z. A., Schonberger, R. B., MPOG 2019; 321 (8): 762–72

  View details for DOI 10.1001/jama.2019.0711

  View details for Web of Science ID 000460191400017

• Association of Overlapping Surgery With Perioperative Outcomes. JAMA Sun, E., Mello, M. M., Rishel, C. A., Vaughn, M. T., Kheterpal, S., Saager, L., Fleisher, L. A., Damrose, E. J., Kadry, B., Jena, A. B. 2019; 321 (8): 762–72

  Abstract

  Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes.To determine the association between overlapping surgery and mortality, complications, and length of surgery.Retrospective cohort study of 66 430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge.Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed).Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration.The final sample consisted of 66 430 operations (mean patient age, 59 [SD, 15] years; 31 915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9% overlapping vs 1.6% nonoverlapping; difference, 0.3% [95% CI, -0.2% to 0.7%]; P = .21) or risk of complications (12.8% overlapping vs 11.8% nonoverlapping; difference, 0.9% [95% CI, -0.1% to 1.9%]; P = .08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95% CI, 24 to 37 minutes]; P < .001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8% vs 4.7%; difference, 1.2% [95% CI, 0.1% to 2.2%]; P = .03; complications: 29.2% vs 27.0%; difference, 2.3% [95% CI, 0.3% to 4.3%]; P = .03).Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

  View details for PubMedID 30806696

• What is the optimal timing for tracheostomy in intubated patients? The Laryngoscope Panuganti, B. A., Weissbrod, P., Damrose, E. 2019

  View details for DOI 10.1002/lary.28382

  View details for PubMedID 31714602

• Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques. The Journal of laryngology and otology Damrose, E. J., Manson, L., Nekhendzy, V., Collins, J., Campbell, R. 2019: 1–5

  Abstract

  To describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.The medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.Objective improvement of subglottic stenosis was seen in all four cases, with end-result Myer-Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.Laryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.

  View details for PubMedID 30975234

• Type I thyroplasty: A safe outpatient procedure. The Laryngoscope Junlapan, A., Sung, C. K., Damrose, E. J. 2018

  Abstract

  OBJECTIVES/HYPOTHESIS: Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.STUDY DESIGN: Retrospective chart review.METHODS: A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.RESULTS: Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.CONCLUSIONS: In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.LEVEL OF EVIDENCE: 4 Laryngoscope, 2018.

  View details for PubMedID 30582623

• The Clinical Course of Idiopathic Bilateral Vocal Fold Motion Impairment in Adults: Case Series and Review of the Literature. Journal of voice : official journal of the Voice Foundation Abu Ghanem, S., Junlapan, A., Tsai, S. W., Shih, L., Sung, C., Damrose, E. J. 2018

  Abstract

  AIM: Steps for assessment and successful management of bilateral vocal fold motion impairment (VFMI) are (1) recognition of its presence, (2) identifying the etiology and factors restricting vocal fold motion, (3) evaluation of airway patency, and (4) establishing a management plan. No large series documenting the course and outcome of adult idiopathic bilateral VFMI has been published within the past 15 years.METHODS: Retrospective chart review of adult patients with idiopathic bilateral VFMI at a tertiary academic center. A diagnosis was established if history, physical examination with laryngoscopy, and initial imaging excluded a cause. Records were reviewed for demographics, clinical characteristics, surgical intervention details, and length of follow-up.RESULTS: Nine adult patients with idiopathic bilateral VFMI were identified. There were five males and four females with a mean age of 59.6 years. The mean follow-up period was 54.4 months (range, 6-111 months). Upon presentation to our laryngology service, three patients were advised observation, three patients were advised to undergo urgent tracheostomy, and three patients were advised to undergo elective surgery for airway management. By the end of the follow-up period, only four patients (4/9, 44.4%) were tracheostomy dependent, one of them was lost to follow-up after tracheostomy tub downsizing for decannulation.CONCLUSIONS: To our best knowledge, this is the largest series so far of adult patients with idiopathic bilateral VFMI. Conservative treatment can be considered as an alternative to surgery in select cases.

  View details for PubMedID 30527967

• Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol. Journal of voice : official journal of the Voice Foundation Abu-Ghanem, S., Rudy, S., Deane, S., Tsai, S. W., Shih, L., Damrose, E. J., Sung, C. 2018

  Abstract

  Vocal fold movement impairment may significantly compromise postoperative recovery and quality of life of patients following thoracic or cardiothoracic surgery or prolonged intubation. The literature is limited and there is no standard screening protocol for the optimal postoperative swallowing and aspiration evaluations. We performed retrospective review of adult patients undergoing early vocal fold (VF) injection laryngoplasty for acute postoperative Vocal fold movement impairment (<30 days) that had both pre- and postinjection speech language pathologist (SLP) performed swallowing/aspiration evaluations. Records were reviewed for demographics, clinical characteristics, procedural details, and short-term outcome measures of oral intake. In total, 30 patients were included, and had data on swallowing/aspiration studies before and after the VF injection laryngoplasty. Most of the patients were injected within 5 days following the laryngologist evaluation and within 14 days following the iatrogenic recurrent laryngeal nerve injury (23/30, 76.7%). The majority of patients were injected at the bedside by awake transcutaneous injection (22/30, 73.3%), six patients were injected in the operating room under general anesthesia, and two at the outpatient clinic. Pre- and postinjection SLP evaluations included clinical bedside assessment or instrumental evaluation. Following VF injection laryngoplasty, oral diet advancement was noted in 81.8% of the patients that were nil per os before the injection (18/22). No complications were noted. In conclusions, acute VFMI following surgery requires immediate diagnosis and therapeutic strategy to minimize postoperative complications and to overcome impairments in the voice, swallow, and cough. Otolaryngology-SLP interdisciplinary aspiration and swallowing assessment protocol is proposed based on our experience and an extensive literature review.

  View details for PubMedID 30340927

• Overlapping Surgery: A Case Study in Operating Room Throughput and Efficiency. Anesthesiology clinics Morris, A. J., Sanford, J. A., Damrose, E. J., Wald, S. H., Kadry, B., Macario, A. 2018; 36 (2): 161–76

  Abstract

  A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. This article introduces a system to monitor overlapping surgery, providing a surgeon-specific Key Performance Indicator, and discusses overlapping surgery as an approach toward OR management goals of efficiency and throughput.

  View details for DOI 10.1016/j.anclin.2018.01.002

  View details for PubMedID 29759280

• Human Papillomavirus and students in Brazil: an assessment of knowledge of a common infection - preliminary report BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY Frizzo Burlamaqui, J. C., Cassanti, A. C., Borim, G. B., Damrose, E., Villa, L. L., Silva, L. 2017; 83 (2): 120-125

  Abstract

  Human Papillomavirus (HPV) infection is the most prevalent sexually transmitted disease worldwide. One of the barriers to the implementation of prevention programs against the disease is the limited knowledge possessed by most populations regarding the virus and its possible consequences.The purpose of this study was to evaluate the knowledge of Brazilian college students on transmission, clinical manifestations, and diseases correlated with HPV, highlighting the poor knowledge of a very common infection.A total of 194 students answered a questionnaire about transmission, clinical features and the possible consequences of persistent HPV infection. The questionnaire was self-applied under the supervision of the authors.The clinical manifestations of HPV infection were not clear to most students. Incorrect assumptions of the clinical manifestations of HPV infection included: bleeding (25%), pain (37%) and rashes (22%). Twelve per cent of respondents did not recognize warts as an HPV-related disease. Regarding potential consequences of persistent infection, students did not recognize a relationship between HPV and laryngeal carcinoma (80.9%), pharyngeal carcinoma (78.9%), anal carcinoma (73.2%), vulvar carcinoma (65.4%) and vaginal carcinoma (54.6%). Large portions of the population evaluated were unaware of modes of HPV transmission beyond genital contact.Knowledge of HPV by the population evaluated in this study is partial and fragmented. Lack of knowledge may contribute to the further spread of the disease. Public health policies for education and guidance of the population should be implemented in Brazil.

  View details for DOI 10.1016/j.bjorl.2016.02.006

  View details for Web of Science ID 000397985900002

• Improvement in the Reflux Symptom Index Following Surgery for Cricopharyngeal Dysfunction JOURNAL OF VOICE Jiang, N., Sung, C. K., Damrose, E. J. 2017; 31 (1): 86-89

  Abstract

  Gastroesophageal reflux may contribute to the development of cricopharyngeal dysfunction and Zenker's diverticulum. Common dictum suggests that if upper esophageal sphincter tone is reduced through cricopharyngeal myotomy, symptoms of laryngopharyngeal reflux may worsen. We hypothesized that patients who undergo myotomy should show decreased dysphagia symptoms with concurrent worsening of reflux symptomatology and that these changes would be greater in those patients undergoing complete versus partial myotomy.A retrospective chart review was performed for patients who underwent endoscopic or open cricopharyngeal myotomy, with or without Zenker's diverticulectomy. Preoperative and postoperative reflux symptomatology was subjectively measured with the Reflux Symptom Index (RSI), and dysphagia symptomatology was measured with the Eating Assessment Tool 10 (EAT-10). Patients who underwent partial myotomy via endoscopic stapling of Zenker's diverticulum were compared with patients who underwent complete myotomy (either endoscopic laser-assisted or via an open transcervical approach). The patients were further subdivided into three groups for data analysis: endoscopic staple diverticulotomy, laser cricopharyngeal myotomy, and open approach.A total of 41 patient charts were reviewed. Of these 41 patients, 17 underwent endoscopic stapler-assisted diverticulotomy, 4 underwent endosopic laser-assisted cricopharyngeal myotomy, and 20 underwent open transcervical cricopharyngeal myotomy, with diverticulectomy as indicated. Mean pre- and postoperative RSIs were 21.8 and 8.9, respectively (P < 0.001). Mean pre- and postoperative EAT-10 scores were 19.1 and 5.0, respectively (P < 0.001).Patients' reflux symptoms significantly improved after cricopharyngeal myotomy, with significant improvement in dysphagia symptoms. Concern for worsening of reflux symptoms following surgery does not appear to be clinically common.

  View details for DOI 10.1016/j.jvoice.2016.02.006

  View details for PubMedID 27049450

• Transoral endoscopic head and neck surgery for minor saliary gland tumors of the oropharynx. Cancers Head Neck Schoppy, D. W., Kupferman, M. E., Hessel, A. C., Bell, D. M., Garland, E. M., Damrose, E. J., Holsinger, F. C. 2017; 2 (5): 1-7
• Epidural abscess and paraplegia: delayed sequela of tracheoesophageal puncture. Otolaryngol Case Rep Song, Y., Kiyosaki, C., Damrose, E. J. 2017; 5: 21-23
• Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx. Cancers of the head & neck Schoppy, D. W., Kupferman, M. E., Hessel, A. C., Bell, D. M., Garland, E. M., Damrose, E. J., Holsinger, F. C. 2017; 2: 5

  Abstract

  Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy.A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included.The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.In this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies.None/not applicable.

  View details for DOI 10.1186/s41199-017-0024-2

  View details for PubMedID 31093352

  View details for PubMedCentralID PMC6460795

• Clinical characteristics of laryngeal versus nonlaryngeal amyloidosis. The Laryngoscope Rudy, S. F., Jeffery, C. C., Damrose, E. J. 2017

  Abstract

  Amyloidosis represents a heterogeneous group of disorders marked by abnormal protein formation and deposition. Laryngeal amyloidosis is rare and classically thought to remain isolated with little risk of systemic involvement or associated malignancy. This study sought to further characterize differences in clinical characteristics between patients with laryngeal and nonlaryngeal amyloidosis.Retrospective case-control study.The Stanford Translational Research Integrated Database Environment was searched to identify patients with biopsy-confirmed laryngeal amyloidosis and patients with amyloidosis without laryngeal involvement on endoscopy. Mann-Whitney U and χ(2) tests were used for statistical analysis.Of 865 patients treated for amyloidosis between 1996 and 2016, 22 (2.5%) patients with biopsy-proven laryngeal amyloidosis were identified. An additional 22 patients with amyloidosis of a different organ and negative laryngoscopy-and therefore without laryngeal amyloidosis-were identified as controls. Compared to these controls with nonlaryngeal amyloidosis, patients with laryngeal amyloidosis were younger (mean age 52.8 years vs. 68.4 years, P < .0006), and 18% had additional organ involvement. Immunoglobulin light-chain amyloidosis was the most common subtype in both groups of patients. Eighty-six percent of patients with laryngeal amyloidosis required surgical excision, and of these patients, over 30% required multiple excisions.There is a significant rate (18%) of multiorgan involvement in patients with laryngeal amyloidosis, which contradicts conventional concepts that this is an isolated disorder. This finding could have a significant impact on the evaluation and management of patients with laryngeal amyloidosis.3b Laryngoscope, 2017.

  View details for PubMedID 28868800

• A Tracheal Mass. JAMA otolaryngology-- head & neck surgery Chen, M. M., Jeffery, C., Damrose, E. J. 2017; 143 (1): 87-88

  View details for DOI 10.1001/jamaoto.2016.1544

  View details for PubMedID 27356210

• Laryngeal leishmaniasis, a rare manifestation of an emerging disease. European annals of otorhinolaryngology, head and neck diseases Silva, L., Damrose, E., Fernandes, A. M. 2017

  View details for PubMedID 28344078

• Repeat Imaging in Idiopathic Unilateral Vocal Fold Paralysis: Is It Necessary? The Annals of otology, rhinology, and laryngology Noel, J. E., Jeffery, C. C., Damrose, E. 2016; 125 (12): 1010-1014

  Abstract

  Imaging plays a critical role in the evaluation of patients presenting with unilateral vocal fold paresis or paralysis of unknown etiology. In those with idiopathic unilateral vocal fold paralysis (iUVFP), there is no consensus regarding the need or timing of repeat imaging. This study seeks to establish the rate of delayed detection of alternate etiologies for these patients to determine if and when imaging should be repeated.Retrospective chart review was conducted identifying patients at our institution with vocal fold movement impairment between 1998 and 2014. Idiopathic paralysis was diagnosed if physical examination, laryngoscopy, and initial imaging excluded a cause. Demographic data, length of follow-up, and the presence of late lesions were noted. Time to detection was plotted using the Kaplan-Meier method.Of 3210 patients reviewed, 207 had a diagnosis of iUVFP. Of these patients, 8 went on to develop alternate diagnoses, including pulmonary disease, skull-base and laryngeal neoplasms, and thyroid malignancy. In Kaplan-Meir analysis, 90% remained "idiopathic" at 5 years of follow-up. The mean time to detection was 27 months.Patients initially diagnosed with iUVFP may have an occult cause that later becomes evident. We recommend repeat imaging within 2 years after diagnosis, but this is likely unnecessary beyond 5 years.

  View details for PubMedID 27670956

• Tracheoesophageal fistula length decreases over time EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Jiang, N., Kearney, A., Damrose, E. J. 2016; 273 (7): 1819-1824

  Abstract

  The objectives of this study were to demonstrate that the length of the tracheoesophageal voice prosthesis changes over time and to determine whether the prosthesis length over time increased, decreased, or showed no predictable change in size. A retrospective chart review was performed at a tertiary care referral center. Patients who underwent either primary or secondary tracheoesophageal puncture between January 2006 and August 2014 were evaluated. Patients were excluded if the tracheoesophageal prosthesis size was not consistently recorded or if they required re-puncturing for an extruded prosthesis. Data analyzed included patient demographics and the length of the tracheoesophageal voice prosthesis at each change. A total of 37 patients were identified. The mean age was 64 years. Seventy-six percent were male. 24 % underwent primary tracheoesophageal puncture and 76 % underwent secondary tracheoesophageal puncture. The length of the prosthesis decreased over time (median Kendall correlation coefficient = -0.60; mean = -0.44) and this correlation between length and time was significant (p = 0.00085). Therefore, in conclusion, tracheoesophageal prosthesis length is not constant over time. The tracheoesophageal wall thins, necessitating placement of shorter prostheses over time. Patients with a tracheoesophageal voice prosthesis will require long-term follow-up and repeat sizing of their prosthesis. Successful tracheoesophageal voicing will require periodic reevaluation of these devices, and insurers must, therefore, understand that long-term professional care will be required to manage these patients and their prostheses.

  View details for DOI 10.1007/s00405-016-3949-x

  View details for Web of Science ID 000377413500023

  View details for PubMedID 26951219

• Primary tracheoesophageal puncture and cricopharyngeal myotomy in stapler-assisted total laryngectomy. journal of laryngology and otology BESWICK, D. M., Damrose, E. J. 2016; 130 (7): 686-690

  Abstract

  To evaluate the utility of the hybrid tracheoesophageal puncture procedure in stapler-assisted laryngectomy.Patients who underwent total laryngectomy at a single institution from 2009 to 2015 were reviewed. The interventions assessed were surgical creation of a tracheoesophageal puncture and placement of a voice prosthesis. The outcomes measured included voicing ability and valve failure.Thirty-nine patients underwent total laryngectomy or pharyngolaryngectomy. Of these, nine underwent stapler-assisted laryngectomy; seven of the nine patients underwent concurrent stapler-assisted laryngectomy, cricopharyngeal myotomy and a hybrid tracheoesophageal puncture procedure. These seven patients were the focus of this review. Successful voicing and oral alimentation was achieved in all patients. Mean time to phonation was 30 days (range, 7-77 days) and mean time to first valve change was 90 days (range, 35-117 days).Primary tracheoesophageal puncture with concurrent voice prosthesis placement and cricopharyngeal myotomy is easily performed with stapler-assisted laryngectomy. The hybrid tracheoesophageal puncture procedure is a simple method that enables a single operator to achieve primary tracheoesophageal puncture and valve placement; in addition, it facilitates concurrent cricopharyngeal myotomy.

  View details for DOI 10.1017/S0022215116008070

  View details for PubMedID 27225511

• Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Damrose, E. J., Beswick, D. M. 2016; 154 (3): 568-571

  Abstract

  Posterior glottic stenosis is a difficult clinical problem that frequently results in bilateral vocal fold immobility, dyspnea, and tracheostomy dependence. Charts were reviewed of all patients undergoing a modified endoscopic postcricoid advancement flap procedure for posterior glottic stenosis between October 1, 2003, and June 30, 2015. Age, sex, operative findings, complications, and outcomes were noted. Follow-up was available in 10 of 11 patients, 10 of whom were successfully decannulated. There were no complications. Regular diet was maintained in all patients. In patients with bilateral vocal fold immobility secondary to posterior glottis stenosis, endoscopic repair via endoscopic postcricoid advancement flap can restore full vocal fold motion and allow decannulation. In select patients with posterior glottic stenosis, repair via endoscopic postcricoid advancement flap should be considered in lieu of ablative methods, such as cordotomy, cordectomy, or arytenoidectomy.

  View details for DOI 10.1177/0194599815622626

  View details for PubMedID 26861233

• Oncologic Outcomes After Transoral Robotic Surgery A Multi-institutional Study JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY de Almeida, J. R., Li, R., Magnuson, J. S., Smith, R. V., Moore, E., Lawson, G., Remacle, M., Ganly, I., Kraus, D. H., Teng, M. S., Miles, B. A., White, H., Duvvuri, U., Ferris, R. L., Mehta, V., Kiyosaki, K., Damrose, E. J., Wang, S. J., Kupferman, M. E., Koh, Y., Genden, E. M., Holsinger, F. C. 2015; 141 (12): 1043-1051

  Abstract

  Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer.To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality.A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions.Select patients received radiation therapy and/or chemotherapy before or after TORS.Locoregional control, disease-specific survival, and overall survival were calculated. We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors.Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2- year locoregional control rate was 91.8% (95% CI, 87.6%-94.7%), disease-specific survival 94.5% (95% CI, 90.6%-96.8%), and overall survival 91% (95% CI, 86.5-94.0%). Multivariate analysis identified improved survival among women (P = .05) and for patients with tumors arising in tonsil (P = .01). Smoking was associated with worse overall all-cause mortality (P = .01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis.This large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.

  View details for DOI 10.1001/jamaoto.2015.1508

  View details for PubMedID 26402479

• Bronchoscopy in panendoscopy: review and assessment JOURNAL OF LARYNGOLOGY AND OTOLOGY Shahangian, A., Damrose, E. J. 2015; 129 (12): 1220-1223

  Abstract

  To determine the utility of bronchoscopy to identify synchronous primaries in head and neck cancer patients.Case series with chart review.The charts of all patients undergoing bronchoscopy between January 2008 and December 2013 were reviewed. Only those undergoing bronchoscopy as part of panendoscopy for head and neck cancer were included. Operative reports, pathology reports and discharge summaries were reviewed for operative findings, complications and length of hospital stay.A total of 404 charts were reviewed and 168 were included in the study. No synchronous primaries were identified. Bronchoscopy changed clinical management in one patient. There were no complications from bronchoscopy.Bronchoscopy is a safe and well-tolerated procedure commonly performed in the investigation of head and neck cancer patients, but it adds little additional useful clinical information. Routine performance of bronchoscopy in this setting should be weighed against its added costs, and tailored to the individual patient.

  View details for DOI 10.1017/S0022215115002856

  View details for Web of Science ID 000367250200012

  View details for PubMedID 26522182

• Laryngeal papillomatosis in children: The impact of late recognition over evolution JOURNAL OF MEDICAL VIROLOGY Silva, L., Goncalves, C. P., Fernandes, A. M., Damrose, E. J., Costa, H. O. 2015; 87 (8): 1413-1417

  Abstract

  To assess the impact of the delay in recognition of the initial symptoms of laryngeal papillomatosis in children over the evolution of the disease. Retrospective study of patients with respiratory papillomatosis referred from general pediatric practices to a tertiary hospital with pediatric laryngology specialization. Gender, age at time of diagnosis, symptom duration, sites affected at the time of diagnosis, treatment, and evolution of the disease over time were evaluated. From January 2003 to December 2013, 21 patients (15 females and 6 males) were identified and followed for at least 3 years. The average age at which symptoms first appeared was 40.2 months, and the average age at the time of initial treatment was 76 months. The most frequent clinical manifestation was hoarseness. The most common site of involvement was the glottis followed by the supraglottis and subglottis, respectively. Three of the 21 patients required tracheostomy. The average time from symptom onset to diagnosis was 52.3 months. There were no fatalities. On average 3.7 procedures were performed per patient. Patients presenting more than 1 year from the symptom onset to the time of first treatment required a greater number of procedures to control disease. Delay in diagnosis can have negative clinical consequences due to disease progression. The later the diagnosis the more surgeries are needed to control the disease. Involvement of the subglottic larynx is a risk factor for emergent tracheostomy.

  View details for DOI 10.1002/jmv.24181

  View details for Web of Science ID 000355748400022

  View details for PubMedID 25879415

• Safety of Outpatient Airway Dilation for Adult Laryngotracheal Stenosis ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Hsu, Y., Damrose, E. J. 2015; 124 (6): 452-457

  Abstract

  To evaluate the safety of outpatient airway dilation for adult patients with subglottic or tracheal stenosis.The records of patients treated with airway dilation between October 2003 and September 2013 were reviewed. Outcomes of patients who underwent dilation as inpatients versus outpatients were compared. Emergency room visits, readmissions, and 3 or more primary care physician visits within 30 days postoperatively were specifically evaluated. Postoperative hemorrhage, airway edema, recurrent laryngeal nerve paralysis, reintubation, tracheostomy, tracheal rupture, pneumomediastinum, pneumothorax, acute respiratory distress, or death were also reviewed.One hundred fourteen dilations performed in 53 patients with airway stenosis were included. Outpatient dilation was performed in 93 (82%); 21 (18%) underwent the procedure in the inpatient setting. Complications were low among both inpatient and outpatient groups (10% vs 1%, P = .09). No complications occurred during the overnight stay of the inpatient group.Outpatient airway dilation is a safe and feasible procedure. It can be routinely performed on an ambulatory basis.

  View details for DOI 10.1177/0003489414564999

  View details for Web of Science ID 000354135100005

  View details for PubMedID 25533507

• Chondronecrosis of the Larynx Following Use of the Laryngeal Mask Airway LARYNGOSCOPE Beswick, D. M., Collins, J., Nekhendzy, V., Damrose, E. J. 2015; 125 (4): 946-949

  Abstract

  This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69-year-old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation. Laryngoscope, 2014.

  View details for DOI 10.1002/lary.24967

  View details for PubMedID 25345975

• The Hybrid Tracheoesophageal Puncture Procedure: Indications and Outcomes ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Damrose, E. J., Cho, D., Goode, R. L. 2014; 123 (8): 584-590

  Abstract

  This report aimed to describe a novel and efficient method of tracheoesophageal puncture using a hybrid device assembled from 2 commercially available puncture kits; to demonstrate the utility of this technique in the performance of primary and secondary procedures, under general and local anesthesia, with and without flap reconstruction; and to evaluate the efficacy of concurrent puncture and valve placement.Thirty-four patients who underwent either primary or secondary tracheoesophageal puncture for voice restoration. Charts were reviewed retrospectively for complications, time to first valve change, operative time, and blood loss.Using this novel hybrid device, simultaneous puncture and valve placement was achieved in 34 consecutive patients. There was 1 major complication; blood loss was negligible; and the procedure could be accomplished in all cases. There were no cases of prosthesis failure as a result of the insertion technique.Concurrent tracheoesophageal puncture and voice prosthesis placement is a simple and efficient method of voice restoration in the laryngectomized patient and can be more easily accomplished with a hybrid device assembled from the components of 2 commercially available puncture kits. It can be performed under local as well as general anesthesia. The procedure is adaptable to a variety of clinical situations.

  View details for DOI 10.1177/0003489414525591

  View details for Web of Science ID 000339538000010

• Does exposure to laser plume place the surgeon at high risk for acquiring clinical human papillomavirus infection? Laryngoscope Manson, L. T., Damrose, E. J. 2013; 123 (6): 1319-1320

  View details for DOI 10.1002/lary.23642

  View details for PubMedID 23703382

• A meta-analysis of voice outcome comparing calcium hydroxylapatite injection laryngoplasty to silicone thyroplasty. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Shen, T., Damrose, E. J., Morzaria, S. 2013; 148 (2): 197-208

  Abstract

  To compare the voice outcome of calcium hydroxylapatite (CaHA) injection laryngoplasty (IL) vs silicone medialization thyroplasty (MT) in the treatment of unilateral vocal fold paralysis (UVFP).Systematic review of English literature from MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane library from January 1, 1980, to December 31, 2010.Included studies reporting voice-related quality of life (Voice Handicap Inventory [VHI]) following IL with CaHA or MT with silicone. The primary outcome measure was the improvement in VHI. The secondary outcome was improvement in maximum phonatory time (MPT).Of the 742 abstracts screened for relevancy, 24 studies qualified for analysis. The mean (SD) VHI scores were 72.22 (11.06) before MT and 34.02 (6.48) after MT. The mean (SD) VHI scores were 68.36 (6.88) before IL and 32.24 (7.33) after IL. The paired difference mean of VHI improvement was 38.20 (95% confidence interval [CI], 17.05-59.32; P = .007) for MT and 36.11 (95% CI, 29.65-42.57; P = .001) for IL. The mean (SD) MPT scores were 7.40 (3.14) before IL and 13.00 (1.75) after IL. The mean (SD) MPT scores were 6.16 (1.90) before MT and 12.40 (2.72) after MT. The paired difference mean of MPT improvement was 6.23 (95% CI, 4.74-7.73; P < .001) for MT and 5.60 (95% CI, 2.95-8.25; P = .006) for IL.Injection laryngoplasty with CaHA and MT with silicone appear to achieve comparable voice improvement within 1 year, but a definitive conclusion is limited by a lack of standardized outcome measures.

  View details for DOI 10.1177/0194599812464193

  View details for PubMedID 23077153

• A Comparison of the VHI, VHI-10, and V-RQOL for Measuring the Effect of Botox Therapy in Adductor Spasmodic Dysphonia JOURNAL OF VOICE Morzaria, S., Damrose, E. J. 2012; 26 (3): 378-380

  Abstract

  Although disease-specific quality-of-life (QOL) instruments are an invaluable outcome measure in spasmodic dysphonia, there is no consensus on which QOL instrument should be used.To determine the responsiveness of the Voice Handicap Index (VHI), Voice Handicap Index-10 (VHI-10), and Voice-Related Quality of Life (V-RQOL) to the treatment effect of botulinum toxin (Botox) in adductor spasmodic dysphonia (ADSD).Stanford University Voice and Swallowing Center.Prospective case series (level of evidence=4).Consecutive ADSD patients with a stable Botox dose-response relationship were recruited prospectively. VHI, VHI-10, and V-RQOL scores were obtained pretreatment and during the middle third of the posttreatment injection cycle.Thrity-seven patients completed the follow-up. The average total Botox dose was 0.88 units. The average follow-up time after injection was 7.84 weeks. The pretreatment QOL scores reflected the burden of the disease. All the three instruments were highly correlated in subscale and total scores. After treatment, all three instruments showed significant improvement.The VHI, VHI-10, and V-RQOL all reflected the morbidity associated with ADSD and were significantly responsive to the effect of Botox therapy. The choice of instrument should be based on physician preference.

  View details for DOI 10.1016/j.jvoice.2010.07.011

  View details for Web of Science ID 000303519600023

  View details for PubMedID 20951552

• A method of securing the Xomed endotracheal tube for accurate monitoring of the recurrent laryngeal nerve JOURNAL OF CLINICAL ANESTHESIA Nekhendzy, V., Lopez, J. R., Damrose, E. J. 2012; 24 (3): 259-260

  View details for DOI 10.1016/j.jclinane.2011.05.009

  View details for Web of Science ID 000303790200022

  View details for PubMedID 22495085

• More Than a Frog in the Throat A Case Series and Review of Localized Laryngeal Amyloidosis ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Stevenson, R., Witteles, R., Damrose, E., Arai, S., Lafayette, R. A., Schrier, S., Afghahi, A., Liedtke, M. 2012; 138 (5): 509-511

  View details for PubMedID 22652951

• Suture laterofixation of the vocal fold for bilateral vocal fold immobility CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY Damrose, E. J. 2011; 19 (6): 416-421

  Abstract

  To review the recent published literature on the subject of suture laterofixation for bilateral vocal fold immobility, to evaluate outcomes, and to assess advances and modifications of the procedure during the review period.Suture laterofixation offers potential benefits over other surgical procedures employed in the treatment of bilateral vocal fold immobility. The procedure is potentially reversible, avoids long-term consequences of ablative procedures such as arytenoidectomy, and can be accomplished under jet ventilation without the need for tracheostomy. Modifications to the technique such as increasing suture size and utilizing a dual suture technique may decrease the risk of injury to the vocal fold mucosa. The advantages of suture laterofixation have argued for closer scrutiny as a potential treatment for pediatric patients.Suture laterofixation is an important option in the treatment of bilateral vocal fold immobility. Laryngologists should be aware of the potential advantages over other procedures, particularly those that necessitate surgical ablation of the arytenoid or vocal fold.

  View details for DOI 10.1097/MOO.0b013e32834c7d15

  View details for Web of Science ID 000296792900002

  View details for PubMedID 21986803

• Management of intraoral needle migration into the posterior cervical space AURIS NASUS LARYNX Ho, A. S., Morzaria, S., Damrose, E. J. 2011; 38 (6): 747-749

  Abstract

  Foreign bodies within the deep spaces of the neck pose infrequent but substantial risks involving migration, including infection, pseudoaneurysm formation, pneumothorax, hemopericardium, and embolization to the central circulation. A rare case of foreign body migration through the parapharyngeal space into the posterior cervical space is described from an intraoral needle shard. A 48-year-old male presented with a right neck tenderness, referred otalgia, and intermittent neck twitching after a needle fragment was lost during an inferior alveolar nerve block. A CT scan six months after the incident revealed migration of the 2.5 cm needle posterolateral to the great vessels into the posterior cervical space. A transcervical approach led to identification and extraction of the foreign body, with resolution of symptoms. Sharp foreign bodies in the head and neck introduce an uncommon but high-impact risk of complications. Migration is often unpredictable in trajectory and time course. Early surgical removal is recommended for persistent symptoms, sustained migration, and localization to sites with critical structures.

  View details for DOI 10.1016/j.anl.2011.01.003

  View details for Web of Science ID 000293263900016

  View details for PubMedID 21324618

• Real-Time Motion Correction for High-Resolution Larynx Imaging MAGNETIC RESONANCE IN MEDICINE Barral, J. K., Santos, J. M., Damrose, E. J., Fischbein, N. J., Nishimura, D. G. 2011; 66 (1): 174-179

  Abstract

  Motion--both rigid-body and nonrigid--is the main limitation to in vivo, high-resolution larynx imaging. In this work, a new real-time motion compensation algorithm is introduced. Navigator data are processed in real time to compute the displacement information, and projections are corrected using phase modulation in k-space. Upon automatic feedback, the system immediately reacquires the data most heavily corrupted by nonrigid motion, i.e., the data whose corresponding projections could not be properly corrected. This algorithm overcomes the shortcomings of the so-called diminishing variance algorithm by combining it with navigator-based rigid-body motion correction. Because rigid-body motion correction is performed first, continual bulk motion no longer impedes nor prevents the convergence of the algorithm. Phantom experiments show that the algorithm properly corrects for translations and reacquires data corrupted by nonrigid motion. Larynx imaging was performed on healthy volunteers, and substantial reduction of motion artifacts caused by bulk shift, swallowing, and coughing was achieved.

  View details for DOI 10.1002/mrm.22773

  View details for Web of Science ID 000292425100019

  View details for PubMedID 21695722

  View details for PubMedCentralID PMC3383318

• The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment 64th Annual Meeting of the Canadian-Society-of-Otolaryngology-Head-and-Neck-Surgery/Poliquin Residents Competition Morzaria, S., Damrose, E. J. CAMBRIDGE UNIV PRESS. 2011: 714–18

  Abstract

  Botulinum toxin injection under electromyographic guidance is the 'gold standard' for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction.To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients.Stanford University Voice and Swallowing Center.Prospective case series (evidence level four).Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose-response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively.Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total).The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

  View details for DOI 10.1017/S0022215111000739

  View details for Web of Science ID 000292102600009

  View details for PubMedID 21524329

• Primary cervical tracheal monophasic synovial sarcoma confirmed by SYT-SSX gene rearrangement JOURNAL OF LARYNGOLOGY AND OTOLOGY Corrales, C. E., Berry, G., Damrose, E. J. 2011; 125 (6): 651-654

  Abstract

  To review the existing diagnostic modalities and treatment for primary tracheal synovial sarcoma, and to report a case of primary cervical synovial sarcoma arising in the trachea.Retrospective.Head and neck surgery unit at a tertiary university centre.One case of primary cervical tracheal monophasic synovial sarcoma diagnosed by SYT-SSX gene rearrangement.This patient underwent surgical resection of the synovial sarcoma, together with tracheal resection and primary anastomosis assisted by laryngeal-releasing manoeuvres, without complication.Clinical, radiographical, pathological and surgical information were collected.One year post-operatively, there was no evidence of recurrence.Synovial sarcoma arising in the trachea is very rare. Diagnosis is confirmed by demonstrating the SYT-SSX gene rearrangement. The first-line treatment is surgery.

  View details for DOI 10.1017/S0022215110002975

  View details for Web of Science ID 000292101800023

  View details for PubMedID 21281530

• Carbon Dioxide Laser-Assisted Endoscopic Cricopharyngeal Myotomy With Primary Mucosal Closure ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Ho, A. S., Morzaria, S., Damrose, E. J. 2011; 120 (1): 33-39

  Abstract

  Carbon dioxide laser-assisted endoscopic cricopharyngeal myotomy (ECPM) has emerged as a viable therapy for dysphagia. The risks of the procedure include pharyngoesophageal perforation and mediastinitis, which may discourage adoption of this technique. To address these complications, we examined outcomes of ECPM with primary mucosal closure.A case series of 7 patients who underwent ECPM between 2006 and 2008 were reviewed for length of operation, length of hospitalization, postoperative complications, and outcomes by use of the M. D. Anderson Dysphagia Index (MDADI) and the Functional Outcome Swallowing Scale (FOSS). The results were compared to those of a control group of 7 patients treated during the same period via open cricopharyngeal myotomy.All patients who had ECPM were treated successfully without complications. The operative times averaged 128 minutes. The hospitalization averaged 2.1 days. Statistically significant improvements in swallowing were seen (MDADI score from 51.3 to 77.7, p < 0.0006; FOSS score from 3.7 to 1.3, p < 0.0005), and were similar to those in the patients who had the open procedure (FOSS score from 3.0 to 1.0, p <0.006). Trends toward decreased blood loss, a shorter hospital stay, and a lower complication rate were observed in the patients who had ECPM.ECPM is beneficial as a primary treatment for cricopharyngeal dysfunction. Closure of the mucosal defect may help reduce the incidence of postoperative cervical emphysema and mediastinitis, and does not appear to compromise functional outcome.

  View details for Web of Science ID 000286645500005

  View details for PubMedID 21370678

• Suture laterofixation of the vocal fold for bilateral vocal fold immobility Curr Opinion Otol Head Neck Surg Damrose EJ 2011; 19 (6): 416-421
• Transoral Robotic Surgery (TORS): The Natural Evolution of Endoscopic Head and Neck Surgery KAPLAN ARTICLE REVIEWED ONCOLOGY-NEW YORK Kaplan, M. J., Damrose, E. J. 2010; 24 (11): 1022-1030

  View details for Web of Science ID 000293341200008

  View details for PubMedID 21155452

• Percutaneous Injection Laryngoplasty in the Management of Acute Vocal Fold Paralysis LARYNGOSCOPE Damrose, E. J. 2010; 120 (8): 1582-1590

  Abstract

  To evaluate the clinical outcome of patients with acute vocal fold paralysis treated with bovine collagen via percutaneous injection laryngoplasty under simple topical anesthesia.Retrospective case series.The charts of 38 consecutive patients with acute unilateral vocal fold paralysis who underwent percutaneous injection laryngoplasty under simple topical anesthesia were reviewed. Symptoms and laryngeal function were assessed pre- and postinjection using the Glottal Function Index (GFI), GRBAS Dysphonia Scale, Functional Outcome Swallowing Scale (FOSS), and maximum phonation time (MPT).Mean GFI, GRBAS, FOSS, and MPT improved from 13.71 to 7.68, 7.24 to 3.95, 3.70 to 2.20, and 12.87 to 16.45, respectively (P < or = .0001). There were no complications related to the procedure. In seven patients requiring tube feeding secondary to dysphagia and aspiration, injection was successful in restoring oral alimentation in only three patients, with the four failures occurring in patients with multiple cranial neuropathies.Percutaneous injection laryngoplasty is a viable option for immediate rehabilitation of acute vocal fold paralysis, and can be performed in the inpatient setting. With dysphagia and aspiration secondary to multiple cranial nerve palsies, medialization of the paralyzed cord alone may be insufficient to restore safe oral alimentation.

  View details for DOI 10.1002/lary.21028

  View details for Web of Science ID 000280695000016

  View details for PubMedID 20641072

• Complications of esophagoscopy in an academic training program 113th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation-and-OTO-EXPO Tsao, G. J., Damrose, E. J. SAGE PUBLICATIONS LTD. 2010: 500–504

  Abstract

  To assess the efficacy and safety of flexible versus rigid esophagoscopy in an academic training setting.Case series with chart review.Tertiary academic training center.A retrospective medical record review was performed on all adult patients undergoing esophagoscopy from 2002 to 2007.A total of 546 procedures were performed with flexible (n = 276) or rigid (n = 270) endoscopes. Seven esophageal perforations (2.6%) occurred, all in association with rigid endoscopy and all in patients with a history of head and neck cancer. Esophageal perforation rates were associated with attending level of experience. There were no deaths. No synchronous esophageal cancers were found in any patient undergoing panendoscopy for the evaluation of a head and neck cancer.The 2.6 percent esophageal perforation rate observed in this study is higher than that typically reported for rigid esophagoscopy. When performed as part of routine panendoscopy, no synchronous esophageal tumors were found, questioning the value of esophagoscopy in this setting. All perforations occurred in patients with a history of head and neck cancer and were associated with the level of the surgeon's experience in performing rigid endoscopy.

  View details for DOI 10.1016/j.otohns.2010.01.008

  View details for Web of Science ID 000276071400005

  View details for PubMedID 20304267

• Surgical Rehabilitation of Voice and Swallowing After Jugular Foramen Surgery ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Oestreicher-Kedem, Y., Agrawal, S., Jackler, R. K., Damrose, E. J. 2010; 119 (3): 192-198

  Abstract

  We sought to determine the patient population that will benefit from surgical rehabilitation of voice and swallowing after jugular foramen tumor (JFT) resection.We performed a retrospective case study of patients with a history of JFT resection. The patients' files were reviewed for data on preoperative and postoperative function of cranial nerves VII and IX through XII, voice and swallowing function, and surgical procedures for voice and swallowing rehabilitation and their timing.Twenty-one patients underwent JFT resection. Thirty-eight percent presented with deficits of cranial nerves VII and IX through XII, and 61% developed new postoperative deficits. Three patients recovered glossopharyngeal nerve function, 2 recovered vagus nerve function, and 1 recovered facial nerve function. Surgical rehabilitation procedures were undertaken in 8 patients. Patients who eventually underwent surgical rehabilitation procedures for voice and swallowing tended to have larger tumors, tumors within the nerve bundle in the jugular foramen, and multiple nerve deficits.Most patients with multiple deficits of cranial nerves VII and IX through XII after JFT resection are unlikely to regain spontaneous nerve function, will experience long-term dysphonia and dysphagia, and will elect to undergo corrective surgery to improve voice and swallowing. Preoperative evaluation and close postoperative follow-up can identify patients who would benefit from early surgical rehabilitation.

  View details for Web of Science ID 000276421300008

  View details for PubMedID 20392033

• Type 2 sulcus vocalis: sulcus vergeture. Ear, nose, & throat journal Damrose, E. J. 2010; 89 (1): E27-?

  View details for PubMedID 20155686

• Endoscopic resection of low grade, subglottic chondrosarcoma JOURNAL OF LARYNGOLOGY AND OTOLOGY Oestreicher-Kedem, Y., Dray, T. G., Damrose, E. J. 2009; 123 (12): 1364-1366

  Abstract

  This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

  View details for DOI 10.1017/S0022215109990284

  View details for Web of Science ID 000273081100014

  View details for PubMedID 19566974

• A simple method to alleviate aspiration in the near-total laryngectomy patient Annual Meeting of the American-Bronchoesophagological-Association Damrose, E. J. SPRINGER. 2009: 759–61

  Abstract

  Near-total laryngectomy is a surgical technique which grants the potential for postoperative speech without the need for prostheses or secondary surgical procedures. Aspiration can be a problem, however, that can require completion laryngectomy to resolve. A 60-year-old male underwent a near-total laryngectomy for recurrent laryngeal cancer. The patient developed chronic aspiration secondary to a leaking shunt. Work up was negative for recurrent cancer. Calcium hydroxylapatite was injected transorally at the opening into the shunt and transtomally into the exit of the shunt to seal it. Postoperative barium swallow showed resolution of aspiration. At approximately 17 months, the patient developed recurrent intermittent aspiration of thin liquids and required reinjection of the shunt, with resolution of the aspiration. Calcium hydroxylapatite allows simple and effective alleviation of aspiration following near-total laryngectomy but requires repeated injection to maintain efficacy. Injection of calcium hydroxylapatite can be an effective alternative to completion laryngectomy in patients who aspirate following near-total laryngectomy.

  View details for DOI 10.1007/s00405-008-0713-x

  View details for Web of Science ID 000264519600022

  View details for PubMedID 18506465

• Quantifying the impact of androgen therapy on the female larynx 87th Annual Meeting of the American-Broncho-Esophagological-Association Damrose, E. J. ELSEVIER SCI LTD. 2009: 110–12

  Abstract

  To describe the timing of changes in fundamental frequency of the female voice following androgen therapy during female to male gender reassignment.A 33-year-old female semi-professional singer undergoing gender reassignment and intramuscular androgen injections was examined at monthly intervals to monitor the impact of therapy on the voice. Laryngostroboscopy and acoustic analysis were performed simultaneously to monitor for potential laryngeal pathology.Pretreatment mean fundamental frequency (MF(0)) was 228.45 Hz and ranged from 140.26 Hz to 430.64 Hz. Between month 3 and month 4 of treatment, MF(0) declined to 116.52 Hz and ranged from 90.75 Hz to 201.07 Hz. Shimmer increased from 3.4% to 7.8%. Noise to harmonics ratio (NHR) also increased from 0.12 to 0.17. The patient has continued to sing semi-professionally despite these changes in laryngeal function.Androgen therapy exerted a profound change on mean fundamental frequency between the third and fourth months of treatment. In addition, pitch range was reduced in a commensurate fashion. Patients undergoing androgen therapy may undergo a significant change in speaking voice between the third and fourth months of therapy. Moreover, though these changes may exert a profound impact on the singing voice, patients undergoing gender reassignment may still be able to achieve personal and professional success in their singing careers.

  View details for DOI 10.1016/j.anl.2008.03.002

  View details for Web of Science ID 000262818800024

  View details for PubMedID 18456442

• Delayed tracheal rupture following thyroidectomy AURIS NASUS LARYNX Damrose, E. J., Damrose, J. F. 2009; 36 (1): 113-115

  Abstract

  Thyroidectomy is a commonly performed, low-risk procedure. Tracheal perforation during thyroidectomy is rare, and delayed rupture of the trachea rarer still. We present the case of a patient who underwent total thyroidectomy secondary to Grave's disease who, on postoperative day 7, developed massive subcutaneous emphysema and respiratory distress. Surgical exploration revealed a rupture of the anterolateral tracheal wall at the level of the first tracheal ring. The defect was repaired primarily and the patient recovered uneventfully. The risk factors for and the management of this rare complication are discussed.

  View details for DOI 10.1016/j.anl.2008.03.007

  View details for Web of Science ID 000262818800025

  View details for PubMedID 18487029

• Quantitative analysis of diplophonic vocal fold vibratary pattern fron high-speed digital imaging of glottis Models and analysis of vocal emissions for biomedical applications : 6th international workshop Yan, Y., Izdebksi, K., Damrose, E., Bless, D. Firenze University Press. 2009: 145–147
• Radiographic properties of injected calcium hydroxylapatite: potential false positive findings on positron emission tomography JOURNAL OF LARYNGOLOGY AND OTOLOGY Damrose, E. J. 2008; 122 (12): 1394-1396

  Abstract

  To describe the positron emission tomography and computed tomography features of injected calcium hydroxylapatite, and to discuss how these may be mistaken for malignancy.Positron emission tomography is now readily employed in the staging and monitoring of patients with head and neck carcinoma. Concomitant with the growing use of this modality has been the increasing popularity of injected calcium hydroxylapatite to treat glottic incompetence secondary to vocal fold paralysis or following partial laryngectomy. A patient developed aspiration following near-total laryngectomy and subsequently underwent injection of calcium hydroxylapatite, with effective resolution of the aspiration. The patient underwent positron emission tomography scanning as part of routine tumour surveillance; this showed intense tracer uptake at the site of injection, and this pattern persisted for one year following injection.As injectable calcium hydroxylapatite becomes more widely used, especially in the treatment of patients with a history of head and neck cancer, physicians should be aware it may cause a potentially misleading, false positive positron emission tomography finding.

  View details for DOI 10.1017/S0022215108002065

  View details for Web of Science ID 000261964600028

  View details for PubMedID 18346300

• Botulinum toxin as adjunctive therapy in refractory laryngeal granuloma 85th Annual Meeting of the American-Broncho-Esophagological-Association Damrose, E. J., Damrose, J. F. CAMBRIDGE UNIV PRESS. 2008: 824–28

  Abstract

  This study evaluated the role of botulinum toxin type A in the treatment of refractory laryngeal granulomas.Retrospective clinical review at a tertiary care hospital. Seven patients with vocal process granulomas underwent percutaneous injection of botulinum toxin into both vocal folds, performed in an office setting. Total doses ranged from 10 to 25 U, divided between both vocal folds.All patients experienced resolution of their granulomas over two to seven weeks. No patient developed aspiration pneumonia. All patients experienced hoarseness secondary to the injections, but voice quality returned to baseline in all patients as the toxin was degraded.Botulinum toxin is safe and effective therapy in resolving vocal process granulomas in patients refractory to traditional therapy. The optimal treatment dose remains to be determined.Percutaneous botulinum toxin injection is helpful in resolving laryngeal granulomas.

  View details for DOI 10.1017/S0022215107000710

  View details for Web of Science ID 000258380000011

  View details for PubMedID 17908354

• Infectious granulomatous laryngitis: a retrospective study of 24 cases EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Silva, L., Damrose, E., Bairao, F., Nina, M. L., Junior, J. C., Costa, H. O. 2008; 265 (6): 675-680

  Abstract

  The diagnostic and treatment of verrucous lesions of the larynx involves a high level of suspicion by the physician attending the patient. The causes may go from unspecific laryngitis to neoplasia and granulomatous diseases. This kind of lesion is uncommon and the presentation aspects may vary broadly. The lesions in larynx are significant source of morbidity. The onset of symptoms is insidious and the diagnosis is usually delayed. Symptoms include dysphonia, dyspnea, dysphagia and odynophagia. Proper treatment depends upon tissue biopsy, identification of the causative organism, and the appropriate pharmacotherapy. As there are few papers presenting the clinical features of infectious granulomatous laryngitis (IGL) as leishmaniasis, tuberculosis and paracoccidiodomycosis affecting the larynx, we considered important to show the experience of a big Brazilian Laryngology Service in dealing with this potential worldwide problem. We present a retrospective chart review showing our institution's experience with IGL focusing in the diagnostic, treatment and prognosis aspects. Twenty-four patients were identified. Mycobacterium tuberculosis and Paracoccidiodis brasiliensis accounted for ten cases each, and Leishmania braziliensis the remaining four. Hoarseness was the most common symptom of infection. Up to one-third of patients with laryngeal involvement lacked laryngeal symptoms. The average delay from onset of symptoms to diagnosis was 7 months. All patients underwent direct laryngoscopy and biopsies. Caseating granulomas was the key histopathologic finding. Identification of the causative organism was uncommon. No evidence of concomitant malignancy was seen on biopsy. Despite treatment, almost 40% of patients had permanent sequelae of infection, including hoarseness, dyspnea, and dysphagia. Mycobacterium tuberculosis, P. brasiliensis, and L. braziliensis accounted for all cases of IGL. Patients may have laryngeal infection but lack laryngeal symptoms. Prompt diagnosis relies upon a high index of suspicion, especially when evaluating patients from endemic areas. Given the degree of tissue destruction, which accompanies infection, timely intervention may be important in the prevention of late sequelae. Despite appropriate therapy, a significant number of patients may have permanent sequelae of infection.

  View details for DOI 10.1007/s00405-007-0533-4

  View details for Web of Science ID 000256261200009

  View details for PubMedID 18060554

• Reliability of the perceptual evaluation of adductor spasmodic dysphonia 128th Annual Meeting of the American-Laryngological-Association Chhetri, D. K., Merati, A. L., Blumin, J. H., Sulica, L., Damrose, E. J., Tsai, V. W. ANNALS PUBL CO. 2008: 159–65

  Abstract

  Although perceptual assessment by experienced voice clinicians remains the gold standard for the diagnosis and assessment of severity of adductor spasmodic dysphonia (ADSD), the interrater reliability of voice experts for this task has not been assessed. In addition, it is unknown whether telephone-recorded or -transmitted voice samples could be used for this task. The aims of this study were (1) to assess the reliability of perceptual analysis of ADSD severity by voice experts and (2) to compare the results between digitally recorded voice samples and those recorded over the telephone.Five laryngologists randomly selected voice samples from 46 ADSD patients and rated the severity of ADSD on a 5-point rating scale. A set of digital voice recordings and a set of telephone voice recordings made from filtering the digital set via the telephone were rated, and each voice set was rated twice. Measures of intrarater and interrater reliability, as well as a measure of the probability of agreement among the raters, were calculated.There was a high level of agreement on ADSD severity, with excellent interrater and intrarater reliability (Cronbach's alpha, .93 to .96). The probabilities of rater agreement on the digitally recorded and telephone-filtered voice samples were similar (chi2, p = .07). The ratings of digital versus telephone voice samples were highly correlated (Pearson r, 0.99; p < .001).These results demonstrate that voice experts are reliably able to judge and agree on the severity of ADSD. Telephone-filtered voices appear to convey adequate ADSD perceptual cues for expert listeners to judge the severity of spasmodic dysphonia.

  View details for Web of Science ID 000254104700001

  View details for PubMedID 18444474

• On the development of idiopathic subglottic stenosis MEDICAL HYPOTHESES Damrose, E. J. 2008; 71 (1): 122-125

  Abstract

  Idiopathic subglottic stenosis is a fibrotic narrowing of the airway at the level of the cricoid cartilage, which can result in severe dyspnea. There is an overwhelming female preponderance, and treatment usually involves dilation, tracheostomy or resection with reconstruction of the involved portion of the airway. The exact mechanism of action is unknown. Estrogen has been thought to play a role in the pathogenesis of this disease, but estrogen receptors have not been found in tissue specimens taken from afflicted individuals. A careful history taken from the patient often reveals a severe episode of coughing prior to the development of symptoms, and intraoperative examination can reveal impaction of the first tracheal ring within the lumen of the cricoid cartilage. Based on these observations, we surmise that an intermittent telescoping effect of the first tracheal ring within the lumen of the cricoid cartilage can lead to disruption of the local blood supply and trauma to the cricoid mucosa, with consequent mucosal edema, ischemia, and ultimately fibrosis. While estrogen has been shown to play a beneficial role in wound healing, abnormal wound healing may be potentiated by variations in estrogen receptor expression, and could also explain the female preponderance seen in this disease.

  View details for DOI 10.1016/j.mehy.2007.12.017

  View details for Web of Science ID 000256982800024

  View details for PubMedID 18295979

• Techniques in Laryngeal Imaging - The State of the Art and Beyond US Radiology Damrose EJ 2008; 1 (1): 18 - 21
• Functional analysis of voice using simultaneous high-speed imaging and acoustic recordings 34th Annual Symposium of the Voice-Foundation Yan, Y., Damrose, E., Bless, D. MOSBY-ELSEVIER. 2007: 604–16

  Abstract

  We present a comprehensive, functional analysis of clinical voice data derived from both high-speed digital imaging (HSDI) of the larynx and simultaneously acquired acoustic recordings. The goals of this study are to: (1) correlate dynamic characteristics of the vocal folds derived from direct laryngeal imaging with indirectly acquired acoustic measurements; (2) define the advantages of using a combined imaging/acoustic approach for the analysis of voice condition; and (3) identify new quantitative measures to evaluate the regularity of the vocal fold vibration and the complexity of the vocal output -- these measures will be key to successful diagnosis of vocal abnormalities. Image- and acoustic-based analyses are performed using an analytic phase plot approach previously introduced by our group (referred to as 'Nyquist' plot). Fast Fourier Transform (FFT) spectral analyses are performed on the same data for a comparison. Clinical HSDI and acoustic recordings from subjects having normal and specific voice pathologies, including muscular tension dysphonia (MTD) and recurrent respiratory papillomatosis (RRP) were analyzed using the Nyquist plot approach. The results of these analyses show that a combined imaging/acoustic analysis approach provides better characterization of the vibratory behavior of the vocal folds as it correlates with vocal output and pathology.

  View details for DOI 10.1016/j.jvoice.2006.05.011

  View details for Web of Science ID 000249413100010

  View details for PubMedID 16968665

• Endocrine Disorders of the Larynx. The Larynx. 3rd Edition. San Diego: Plural Publishing. Edward J. Damrose, Mai Thy Truong 2007
• Distribution of class I and II human leukocyte antigens in the larynx OTOLARYNGOLOGY-HEAD AND NECK SURGERY Wang, E. C., Damrose, E. J., Mendelsohn, A. H., Nelson, S. D., Shintaku, I. P., Ye, M., Berke, G. S., Blackwell, K. E. 2006; 134 (2): 280-287

  Abstract

  To examine the antigenic distribution of human leukocyte antigens (HLA) of the human larynx.Twelve human larynges were examined for Class I (HLA-A, -B, -C) and Class II (HLA-DR) histocompatibility antigens using mouse monoclonal antibodies in an indirect immunoperoxidase assay. Structures of the larynx and surrounding tissues were examined and given a semiquantitative score based on HLA Class I and II expression.The mucosal surface epithelium of the larynx stains 2+ or stronger for HLA Class I antigens and 1+ for Class II antigens. The deeper submucosal glands stain 1+ for Class I antigens and 2+ or stronger for Class II antigens. Thyroid cartilage showed 2+ or stronger staining of the chondrocytes for Class I antigens only. Thyroid follicular cells also stain only for Class I antigens. Perichondrium and Schwann cells of nerves stain stronger for Class I antigens than Class II antigens. Cartilage matrix, muscle cells, and axons of nerves do not stain for either class of antigens. Endothelium stains 3+ for both classes of antigens.The detailed distribution of major transplantation antigens in the human larynx is elucidated. Class II antigens implicated as initiators of organ transplant rejection were primarily found in 6 areas: mucosal surface epithelium, submucosal glands, ducts, vascular endothelium, perichondrium, and Schwann cells of nerves. The relevance of these findings to the initiation and detection of laryngeal allograft graft rejection is discussed.

  View details for Web of Science ID 000235293600017

  View details for PubMedID 16455378

• Endocrine Disorders of the Larynx. Textbook of Laryngology. San Diego: Plural Publishing. Edward J. Damrose, Mai Thy Truong 2006
• Reinnervation of the paralyzed vocal fold. Ear, nose, & throat journal Damrose, E. J., Berke, G. S. 2005; 84 (7): 400-?

  View details for PubMedID 16813023

• Reinnervation of the paralyzed vocal fold Ear Nose Throat Journal Damrose EJ, Berke GS 2005; 84 (7): 400
• Rehabilitation of lower cranial nerve palsies Neurotology (Jackler RK, Brackman DE, Eds.). 2nd Edition. Damrose EJ, Clumeck HV, Kaplan MJ 2005: 1350-1362
• Adenoid cystic carcinoma of the submandibular gland: A 35-year review Meeting of the Western-Section of the Triologic-Society Cohen, A. N., Damrose, E. J., Huang, R. Y., Nelson, S. D., Blackwell, K. E., Calcaterra, T. C. MOSBY-ELSEVIER. 2004: 994–1000

  Abstract

  To evaluate the treatment results of adenoid cystic carcinoma (ACC) of the submandibular gland at a single institution during a 35-year period.A retrospective review was performed by examining the records and reviewing the pathology of 22 patients with ACC of the submandibular gland treated at UCLA Medical Center from June 1963 to December 1997.Seven men and 15 women with an age range of 23 to 85 years (median, 48 years) were treated. Surgical intervention was performed in 21 patients. All patients with advanced tumor size, perineural invasion, microscopically positive surgical margins, or regional neck metastases received postoperative adjunctive therapy, primarily radiotherapy. Follow-up varied from 6 months to 181 months (median, 67 months). Disease-free survival at 3, 5, and 10 years was 66%, 57%, and 41% respectively, whereas overall survival was 76%, 70%, and 37%, respectively (note: 5- and 10-year survival rates are not statistically conclusive due to the small sample size).We report fairly high disease-free survival rates in this patient population and a number of prognostic trends are evident. Early diagnosis, wide surgical intervention, and postoperative radiation are associated with a favorable prognosis. Advanced tumor size, positive surgical margins, perineural invasion, and local recurrence of the tumor are associated with an unfavorable prognosis.C.

  View details for DOI 10.1016/j.otohns.2004.06.705

  View details for Web of Science ID 000225725200035

  View details for PubMedID 15577803

• Nasal and Sinus Pathology Handbook of Plastic Surgery (Greer SE, et al. Eds. Damrose EJ, Shapiro NL 2004: 663-668
• Advances in the management of glottic insufficiency. Current opinion in otolaryngology & head and neck surgery Damrose, E. J., Berke, G. S. 2003; 11 (6): 480-484

  Abstract

  Glottic insufficiency secondary to vocal fold scarring, atrophy, or paresis remains a clinically challenging problem for the laryngologist. Numerous methods have been described in the treatment of glottic insufficiency, belying the complexity of the problem. Type I thyroplasty and injection of fat, fascia, and gelatin powder have been the mainstay of treatment to date, but the ability to restore a normal mucosal waveform to a damaged vocal fold remains an elusive goal.Advances in the material and biomedical sciences have allowed the introduction of newer substances and techniques not only to medialize the vocal fold but also to help restore its viscoelastic properties as well. These substances include expanded polytetrafluoroethylene (ePTFE), collagen, cross-linked hyaluronic acid, micronized acellular human dermis calcium hydroxyapatite, and polydimethylsiloxane. ePTFE can be introduced through a window in the thyroid ala or placed intracordally, and the others can be injected either transorally or transcutaneously, allowing in-office placement under simple topical anesthesia.Although the ideal augmentation material and technique have yet to be devised, the laryngologist now has several options with which to address the problem of glottic insuffiency. Since the problem is complex and since it is possible that a customized solution may need to be devised on an individual basis, future laryngologists will need to be comfortable with the indications and applications that each material and technique will afford.

  View details for PubMedID 14631183

• Surgical anatomy of the recurrent laryngeal nerve: Implications for laryngeal reinnervation ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Damrose, E. J., Huang, R. Y., Ye, M., Berke, G. S., Sercarz, J. A. 2003; 112 (5): 434-438

  Abstract

  Functional laryngeal reinnervation depends upon the precise reinnervation of the laryngeal abductor and adductor muscle groups. While simple end-to-end anastomosis of the recurrent laryngeal nerve (RLN) main trunk results in synkinesis, functional reinnervation can be achieved by selective anastomosis of the abductor and adductor RLN divisions. Few previous studies have examined the intralaryngeal anatomy of the RLN to ascertain the characteristics that may lend themselves to laryngeal reinnervation. Ten human larynges without known laryngeal disorders were obtained from human cadavers for RLN microdissection. The bilateral intralaryngeal RLN branching patterns were determined, and the diameters and lengths of the abductor and adductor divisions were measured. The mean diameters of the abductor and adductor divisions were 0.8 and 0.7 mm, while their mean lengths were 5.7 and 6.1 mm, respectively. The abductor division usually consisted of one branch to the posterior cricoarytenoid muscle; however, in cases in which multiple branches were seen, at least one dominant branch could usually be identified. We conclude that the abductor and adductor divisions of the human RLN can be readily identified by an extralaryngeal approach. Several key landmarks aid in the identification of the branches to individual muscles. These data also indicate the feasibility of selective laryngeal reinnervation in patients who might be candidates for laryngeal transplantation after total laryngectomy.

  View details for Web of Science ID 000182760800009

  View details for PubMedID 12784983

• Kuttner tumor (chronic sclerosing sialadenitis) AMERICAN JOURNAL OF OTOLARYNGOLOGY Huang, C., Damrose, E., Bhuta, S., Abemayor, E. 2002; 23 (6): 394-397

  Abstract

  Kuttner tumor (KT), known descriptively as chronic sclerosing sialadenitis, is a chronic inflammatory disease of the salivary gland. Clinically, it produces a firm swelling of the glands and may be difficult to distinguish from neoplasia. The diagnosis can only be made histologically and should not be difficult if the pathologist is aware of the condition's existence. Errors in diagnosis arise because KT is underrecognized and few cases have been reported in the English literature. We present a case of KT initially diagnosed as a primary salivary gland neoplasm that intraoperative frozen section revealed to be chronic sclerosing sialadenitis. Excision of the mass, usually carried out diagnostically, is adequate treatment.

  View details for Web of Science ID 000179474200015

  View details for PubMedID 12430136

• Response to the comments made by Yin et al. The Annals of otology, rhinology, and laryngology Damrose, E. J., Berke, G. S. 2002; 111 (10): 956-?

  View details for PubMedID 12389867

• Lack of evoked laryngeal electromyography response in patients with a clinical diagnosis of vocal cord paralysis Meeting of the American-Laryngological-Association Damrose, E. J., Huang, R. Y., Blumin, J. H., Blackwell, K. E., Sercarz, J. A., Berke, G. S. ANNALS PUBL CO. 2001: 815–19

  Abstract

  There has been recent debate about whether patients with vocal cord immobility have a neurologic paralysis or whether synkinesis, the misdirection of axons to competing laryngeal muscles, is responsible for the lack of voluntary vocal cord motion. This issue was studied in 15 patients with vocal cord paralysis who underwent laryngeal reinnervation. Evoked electromyography was performed with a surface electrode endotracheal tube. The recurrent laryngeal nerve (RLN) was identified and stimulated with constant current. Of the 15 patients, only 1 produced a compound muscle action potential upon nerve stimulation. The remaining 14 patients had no evoked response during RLN stimulation. A control group of 8 patients with normal vocal cord mobility was studied, and each had a normal evoked electromyography response after RLN stimulation. These results support the assertion that patients who require treatment for vocal cord paralysis do not have synkinesis produced by RLN reinnervation.

  View details for Web of Science ID 000171097200003

  View details for PubMedID 11558756

• Radiology forum: quiz case 2. Diagnosis: petrous apicitis with secondary abducens nerve palsy. Archives of otolaryngology--head & neck surgery Damrose, E. J., Petrus, L. V., Ishiyama, A. 2001; 127 (6): 715-717

  View details for PubMedID 11405876

• Extranasopharyngeal angiofibroma 45th Annual Fall Scientific Meeting of the American-Rhinologic-Society Huang, R. Y., Damrose, E. J., Blackwell, K. E., Cohen, A. N., Calcaterra, T. C. ELSEVIER IRELAND LTD. 2000: 59–64

  Abstract

  Juvenile nasopharyngeal angiofibromas are vascular neoplasms, which originate characteristically in the posterior lateral wall of the nasopharynx. Although angiofibromas extend beyond the nasopharynx commonly, they rarely originate outside the nasopharynx. Reports of primary extranasopharyngeal angiofibromas have appeared sporadically in the literature. We present an unusual case of an angiofibroma arising from the middle turbinate. The clinical characteristics of extranasopharyngeal angiofibromas do not conform to that of nasopharyngeal angiofibromas. Therefore, they can present diagnostic challenges. A methodic evaluation and a high index of suspicion are essential in establishing the proper diagnosis and treatment.

  View details for Web of Science ID 000165350000008

  View details for PubMedID 11074117

• Gamma-probe localization of a parathyroid adenoma in the reoperative neck Annual Meeting of the American-Head-and-Neck-Society Damrose, E. J., Hoh, C., Calcaterra, T. C. W B SAUNDERS CO-ELSEVIER INC. 2000: 394–97

  Abstract

  Preoperative localization of parathyroid adenomas in patients with hyperparathyroidism currently relies on a combination of computed tomography, magnetic resonance imaging, ultrasound, (99m)Tc-sestamibi scintigraphy, and venous sampling of parathyroid hormone. No procedure is universally reliable, however, and in reoperation for missed parathyroid adenomas, development of an optimal preoperative localization strategy becomes especially problematic. We report the case of a patient with hyperparathyroidism who required reoperation for a missed parathyroid adenoma despite preoperative localization with (99m)Tc-sestamibi scintigraphy. (99m)Tc-sestamibi scintigraphy was done 2.5 hours before reoperation. On reoperation, a gamma-detecting probe (C-Track; Care Wise Medical Corporation, Morgan Hill, CA) introduced through a right neck incision was used to localize a 4-cm adenoma within 45 minutes. No significant radiation hazard existed, and no special handling of the specimen was required. The patient's hyperparathyroidism resolved within 24 hours postoperatively. Therefore, this intraoperative technique may prove to be a useful adjunct to preoperative localization studies of parathyroid adenomas, particularly in patients requiring reoperation for persistent postsurgical hyperparathyroidism.

  View details for Web of Science ID 000165880100006

  View details for PubMedID 11115524

• Third branchial cleft anomaly presenting as a retropharyngeal abscess 81st Annual Meeting of the Pacific-Coast-Oto-Ophthalmological-Society Huang, R. Y., Damrose, E. J., Alavi, S., Maceri, D. R., Shapiro, N. L. ELSEVIER IRELAND LTD. 2000: 167–72

  Abstract

  Branchial cleft anomalies are congenital developmental defects that typically present as a soft fluctuant mass or fistulous tract along the anterior border of the sternocleidomastoid muscle. However, branchial anomalies can manifest atypically, presenting diagnostic and therapeutic challenges. Error or delay in diagnosis can lead to complications, recurrences, and even life-threatening emergencies. We describe a case of an infected branchial cleft cyst that progressed to a retropharyngeal abscess in a 5-week-old female patient. The clinical, radiographic, and histologic findings of this rare presentation of branchial cleft cyst are discussed.

  View details for Web of Science ID 000089211000017

  View details for PubMedID 10967390

• Endoscopic diagnosis of sarcoidosis in a patient presenting with bilateral exophthalmos and pansinusitis. Am J Rhinol Damrose, E. J. 2000; 14 (4): 241-4
• RELATION OF RECURRENT LARYNGEAL NERVE COMPOUND ACTION-POTENTIAL TO LARYNGEAL BIOMECHANICS LARYNGOSCOPE Nasri, S., Dulguerov, P., Damrose, E. J., Ye, M., Kreiman, J., Berke, G. S. 1995; 105 (6): 639-643

  Abstract

  This study was designed to investigate the compound action potential (CAP) of the recurrent laryngeal nerve (RLN) and to correlate this electrophysiologic signal to laryngeal biomechanics and phonatory function. Four adult mongrel canines were anesthetized. The RLN was isolated and stimulated, and recording electrodes were applied. The electromyographic (EMG) electrode was placed in the thyroarytenoid (TA) muscle. The RLN CAP and the EMG of the TA muscle were recorded and compared to the stimulation intensity, subglottic pressure (Psub), and each other. The CAP peak-to-peak and EMG peak-to-peak amplitudes demonstrated a sigmoidal relation to stimulus intensity and a linear relation to Psub and to each other. On the basis of these findings, the RLN CAP appears to be a reliable physiologic measure of laryngeal function.

  View details for Web of Science ID A1995RB26600015

  View details for PubMedID 7769950