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Baton Rouge, LA, United States

Virani A.,Louisiana State University | Kunduk M.,Louisiana State University | Fink D.S.,Louisiana State University | Fink D.S.,Our Lady of the Lake Voice Center | And 4 more authors.
Head and Neck | Year: 2015

Background. This study investigated the effects of 2 different swallowing exercise regimens performed during radiation therapy with/without chemotherapy on swallowing function. Methods. Fifty patients were recruited prospectively to 2 groups (the exercise group, n = 26 and the repetitive swallow group, n = 24). Functional Oral Intake Scale (FOIS) scores and percutaneous endoscopic gastrostomy (PEG) placements were compared at posttreatment and at 3 months. Results. The exercise group eliminated significantly more PEG tubes at 3 months posttreatment compared to the swallow group (16% vs 50%). Among patients who received both radiation and chemotherapy, the exercise group had significantly less PEG tubes immediately posttreat-ment as well as 3 months posttreatment (35% and 10%), compared to the swallow group (69% and 50%). Conclusion. Findings indicate significant benefits of the exercise group's exercise regimen in reducing PEG dependence and oral intake difficulties. © 2014 Wiley Periodicals, Inc.

Fink D.S.,Our Lady of the Lake Voice Center | Fink D.S.,Louisiana State University Health Sciences Center | Pena S.,Our Lady of the Lake Voice Center | Hanby D.,Our Lady of the Lake Voice Center | And 5 more authors.
Head and Neck | Year: 2015

Background Pharyngocutaneous fistula (PCF) is a common and challenging complication of laryngectomy. The purpose of this study was to evaluate the results of endoscopic repair of postlaryngectomy PCF. Methods Five patients who underwent salvage laryngectomy complicated by PCF underwent endoscopic repair at a regional medical center between 2006 and 2013. Data were compiled through a manual chart review and demographic data, adjuvant treatment, comorbidities, and clinical course were all recorded. Results Five patients underwent endoscopic repair of PCF. All patients had previously received radiation or chemoradiation therapy and underwent salvage total laryngectomy. The mean number of days to resumption of oral intake after endoscopic repair was 22 days. One patient required reoperation. No complications were noted. Conclusion Endoscopic suture repair can be an effective method for treating PCF with less morbidity than flap reconstruction or conservative wound management. © 2014 Wiley Periodicals, Inc.

Noel D.,Louisiana State University Health Sciences Center | Noel D.,Our Lady of the Lake Voice Center | Fink D.S.,Louisiana State University Health Sciences Center | Fink D.S.,Our Lady of the Lake Voice Center | And 8 more authors.
Head and Neck | Year: 2016

Background There is debate about the optimal voice restoration method and technique for patients who have undergone total laryngopharyngectomy, esophagectomy, and gastric pull-up. The purpose of this study was to report a series of patients who underwent awake, secondary tracheoesophageal puncture (TEP) after this procedure. Methods A retrospective chart review was performed at a tertiary referral center. All subjects who underwent TEP placement under transnasal esophagoscopy guidance between 2003 and 2013 were included. Results All patients underwent uncomplicated TEP in the clinic. At the time of last follow-up, all patients had functional TEP speech that they were using preferentially over an available electrolarynx. Conclusion In-office placement of secondary TEP using transnasal esophagoscopy is an efficient means of providing a conduit for voice prostheses in patients who have undergone laryngopharyngectomy with gastric pull up reconstruction. This procedure can be performed with minimal complications and with expectation of voice outcomes comparable to that seen with standard laryngectomy. © 2015 Wiley Periodicals, Inc.

Fink D.S.,Louisiana State University Health Sciences Center | Fink D.S.,Our Lady of the Lake Voice Center | Sibley H.,Louisiana State University Health Sciences Center | Kunduk M.,Louisiana State University Health Sciences Center | And 7 more authors.
Laryngoscope | Year: 2016

Objectives/Hypothesis Transoral laser microsurgery (TLM) continues to gain popularity as a treatment modality for early glottic cancer. Oncologic outcomes have been well-defined, but there are little data to date describing functional outcomes accounting for stage of resection. Study Design Retrospective review. Methods We retrospectively reviewed patient-rated voice handicap and observer-rated vocal quality of patients who underwent TLM for early glottic carcinoma. Patients were grouped by European Laryngological Society (ELS) resection type, and the data were combined for ELS type I-III and compared with advanced resections (ELS IV-VI). The Voice Handicap Index (VHI) was used for patient-rated voice outcomes, and voice recordings were graded by two senior speech-language pathologists. Voice recordings and VHI scores were taken preoperatively and at least 1 month postoperatively. Results No major complications were encountered. Six of 49 patients underwent repeat resection for suspicious findings with pathology, demonstrating moderate dysplasia in two cases, carcinoma in situ in two cases, and inflamed mucosa only in two cases. There was no significant difference in preoperative VHI scores or objective voice grades among patients who underwent limited (ELS I-III) and those who required more advanced (ELS IV-VI) resection. There was a significant improvement in VHI scores in patients after ELS type I to III resection, from 38.77 to 22.86 (P =.006). There was no significant difference between mean preoperative and postoperative perceptual evaluation scores in patients who underwent ELS type I, II, or III resections (62.25 and 64.32 respectively, P =.621). Conclusions Patients who undergo limited ELS resections can be assured of having a similar to improved voice after healing. Patients who undergo extended resections have poorer vocal outcomes. Level of Evidence 4 Laryngoscope, 126:405-407, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

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