Otolaryngologist (ear, nose, throat)
20 years of experience
Video profile
Accepting new patients
Henry Ford Hospital
2799 W Grand Blvd
Central, Detroit, MI 48202
313-916-8103
Locations and availability (4)

Education ?

Medical School Score
Wright State University (1990)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Awards  
Hour Detroit Magazine's Top Docs (2011)
Hour Detroit Magazine's Top Docs (2010)
Hour Detroit Magazine's Top Docs (2010), Hour Detroit Magazine's Top Docs (2011)
Detroit Hour Magazine's Top Docs (2010)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
Member
American College of Surgeons
Member

Affiliations ?

Dr. Stachler is affiliated with 27 hospitals.

Hospital Affilations

Score

Rankings

  • Beaumont Hospital, Grosse Pointe
    Otolaryngology
    468 Cadieux Rd, Grosse Pointe, MI 48230
    • Currently 4 of 4 crosses
    Top 25%
  • Henry Ford Wyandotte Hospital
    Otolaryngology
    2333 Biddle Ave, Wyandotte, MI 48192
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital,Troy
    Otolaryngology
    44201 Dequindre Rd, Troy, MI 48085
    • Currently 4 of 4 crosses
    Top 25%
  • Harper University Hospital
    Otolaryngology
    3990 John R St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Henry Ford Hospital
    Otolaryngology
    2799 W Grand Blvd, Detroit, MI 48202
    • Currently 3 of 4 crosses
    Top 50%
  • Beaumont Hospital, Royal Oak
    Otolaryngology
    3601 W 13 Mile Rd, Royal Oak, MI 48073
    • Currently 3 of 4 crosses
    Top 50%
  • DMC - Sinai-Grace Hospital
    Otolaryngology
    6071 W Outer Dr, Detroit, MI 48235
    • Currently 3 of 4 crosses
    Top 50%
  • Rehabilitation Institute of Michigan
    Otolaryngology
    261 Mack Ave, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • POH Medical Center
    Otolaryngology
    50 N Perry St, Pontiac, MI 48342
    • Currently 3 of 4 crosses
    Top 50%
  • St. Joseph Mercy Oakland
    Otolaryngology
    44405 Woodward Ave, Pontiac, MI 48341
    • Currently 3 of 4 crosses
    Top 50%
  • Oakwood Hospital and Medical Center
    Otolaryngology
    18101 Oakwood Blvd, Dearborn, MI 48124
    • Currently 3 of 4 crosses
    Top 50%
  • Henry Ford Macomb Hospitals - Warren Campus
    Otolaryngology
    13355 E 10 Mile Rd, Warren, MI 48089
    • Currently 3 of 4 crosses
    Top 50%
  • Detroit Receiving Hospital & University Health Center
    Otolaryngology
    4201 Saint Antoine St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Henry Ford Macomb Hospitals
    Otolaryngology
    15855 19 Mile Rd, Clinton Township, MI 48038
    • Currently 2 of 4 crosses
  • Huron Valley-Sinai Hospital
    Otolaryngology
    1 William Carls Dr, Commerce Township, MI 48382
    • Currently 2 of 4 crosses
  • Poh Regional Medical Center
  • OAKWOOD HOSPITAL & MEDICAL CENTER DEARBORN
  • Royal Oak (4 Years
  • Royal Oak
  • HARPER UNIVERSITY HOSPITAL & HUTZEL WOMEN'S HOSPIT
  • Detroit Receiving Hospital
  • Beaumont Affiliation & Years on StaffRoyal Oak
  • Hutzel Women's Hospital
    3980 John R St, Detroit, MI 48201
  • Cottage Hospital
    159 Kercheval Ave, Grosse Pointe Farms, MI 48236
  • Grace Hospital
  • Children's Hospital of Michigan
    3901 Beaubien St, Detroit, MI 48201
  • Henry Ford Medical Center at Maplegrove
    6777 W Maple Rd, West Bloomfield, MI 48322
  • Publications & Research

    Dr. Stachler has contributed to 24 publications.
    Title Effects of Sequential Dermatophagoides Pteronyssinus Antigen Stimulation on Anatomy and Physiology of the Larynx.
    Date August 2010
    Journal Ear, Nose, & Throat Journal
    Excerpt

    The goal of this investigation was to study the effects of sequential dust mite antigen stimulation on the appearance and function of the larynx. To that end, we designed a randomized, placebo-controlled, double-blind, prospective analysis of adults who had tested positive for perennial dust mite allergy. The larynx of patients who received the active antigen was challenged directly with a low (1:100) and a high (1:40) concentration of the dust mite allergen via an oral nebulizer. Voice laboratory assessment tools included voice and allergy questionnaires, videostroboscopic examination of the larynx, acoustic and speech aerodynamic analyses, and digital audio voice recordings. The study was prematurely terminated after 2 patients had been treated with the highest concentration of the antigenic suspension because of adverse effects, including chest tightness, coughing, and voice difficulties. Both of these patients had demonstrated viscous endolaryngeal secretions and vocal fold edema on videostroboscopy. No reactions were noted at the lower concentration of antigen exposure or in 1 control patient who completed the study. We believe that our findings, as preliminary as they are, may serve as an initial template for the differential diagnosis and treatment of other patients with inhalant allergies who present with chief complaints suggestive of allergic laryngitis.

    Title Preliminary Nsqip Results: a Tool for Quality Improvement.
    Date August 2010
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    To utilize National Surgical Quality Improvement Program (NSQIP) data to evaluate patient outcomes in otolaryngology-head and neck surgery.

    Title Clinical Practice Guideline: Hoarseness (dysphonia).
    Date February 2010
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness.

    Title Conservative Management of Iatrogenic Esophageal Perforation in Head and Neck Cancer Patients with Esophageal Stricture.
    Date May 2009
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Evaluate the efficacy of conservative management of iatrogenic esophageal perforation following dilatation of a stricture secondary to the treatment of head and neck cancer.

    Title Baseline Laryngeal Effects Among Individuals with Dust Mite Allergy.
    Date August 2008
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: To examine baseline effects of perennial allergy on laryngeal appearance, laryngeal function, and perceived vocal handicap among individuals without current allergy or voice symptoms. DATA SOURCES: This pilot study included 47 adults: 21 with positive and 26 with negative skin test responses for the dust mite, Dermatophagoides pteronyssinus. METHODS: Subjects were tested for sensitivity to dust mite antigen by prick testing. Laryngeal appearance and function were studied with laryngovideostroboscopy, acoustic and speech aerodynamic analysis, and voice sampling. These parameters were blindly analyzed by three trained examiners. Subjects also completed the Voice Handicap Index (VHI) as a measure of vocal handicap. RESULTS: Subjects allergic to dust mites perceived significantly greater vocal handicap on the VHI than did nonallergic subjects. No significant differences were noted between groups in laryngeal appearance or function. CONCLUSION: These pilot data suggest that, at baseline, allergic individuals perceive greater vocal handicap than their nonallergic counterparts (P = 0.04), even in the absence of current allergy symptoms or observable physical or functional abnormalities. These preliminary observations can serve as an impetus for further research into this important area, including the potential interrelationship between acid reflux disease and allergic laryngeal inflammation.

    Title Swallowing Function Outcomes Following Nonsurgical Therapy for Advanced-stage Laryngeal Carcinoma.
    Date January 2008
    Journal Dysphagia
    Excerpt

    The purposes of this study were to (1) evaluate swallowing function using both subjective and objective measures in patients treated nonsurgically for stages III and IV laryngeal squamous cell carcinoma, (2) assess the effect of time from treatment completion on swallowing function, and (3) assess sequelae associated with modality of treatment. To achieve these objectives, a retrospective study of 14 patients was conducted. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed and evaluated by three independent judges for seven functional criteria: standing secretions, valleculae spillage, valleculae residue, postcricoid residue, laryngeal penetration, aspiration, and cough. Patient interviews were performed to establish patient perception of swallowing and his/her current posttreatment diet. Results revealed that each patient exhibited swallowing abnormalities in at least one of the seven objective functional categories studied. Ten patients suffered from variable degrees of dysphagia, ranging from mild to severe, on all measures. No significant differences were noted between those patients with less than or greater than 12 months posttreatment. Common treatment sequelae included PEG tube placement for nutritional supplementation, tracheostomy placement for airway security and/or pulmonary toilet, repeated episodes of aspiration pneumonia requiring hospital admission, and radiation-induced oropharyngeal stricture. Further studies using subjective and objective swallowing function measures for patients treated with alternative chemoradiation regimens versus surgery (with or without adjuvant therapies) for advanced stage laryngeal cancer are needed.

    Title Facial Fracture Repair in the Traumatic Brain Injury Patient.
    Date October 2007
    Journal Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    Excerpt

    PURPOSE: To review the surgical complications of patients who had facial fractures repairs in the setting of a traumatic brain injury (TBI). PATIENTS AND METHODS: A review of all individuals admitted with the diagnosis of TBI based on an evaluation by the neurotrauma service who also underwent facial fracture repair was performed. More than 600 charts were reviewed and 99 patients met study criteria. Univariate and mulitvariate logistic regression model analysis were performed comparing the complication rate in the immediate postoperative period to the patients' age, gender, mechanism of injury, zone of facial injury, preoperative Glasgow Coma score, presence of multisystem injury, mechanism of TBI and treatment, length of time from injury to surgical repair and length of surgical procedure. RESULTS: Of the 99 individuals studied, there was an 11% complication rate (8 minor, 3 major) in the immediate postoperative period. After univariate analysis, the length of time from injury to surgical repair, zone 1 facial injury and low Glasgow Coma score were all factors associated with increased complications. Multivariate logistic regression model analysis revealed that the odds of a patient sustaining a postoperative complication was 1.298 as the hour of procedure increased by 1 hour (95% CI, 1.065-1.582) and was 1.152 as the days of repair increased by 1 day (95% CI, 1.030-1.288). CONCLUSIONS: The overall complication rate of facial fracture repair in the TBI patient was 11%. A prolonged surgical procedure and delay in surgical repair were associated with higher complication rates as identified by multivariate logistical regression analysis.

    Title Intradermal Positivity After Negative Prick Testing for Inhalants.
    Date September 2006
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: Examine the incidence of positive intradermal tests after a negative skin prick test for 24 inhalant antigens. STUDY DESIGN AND SETTING: Retrospective study. Charts from patients who underwent modified quantitative testing (MQT) over a 3-year period were reviewed. Patients were initially tested with Multi-Test II. Subjects with negative wheals to a specific allergen were then tested with a 1:500 weight:volume intradermal injection of that allergen. RESULTS: One hundred thirty-three patients underwent MQT for 24 antigens. Allergens with the highest incidence of positive intradermal wheals after negative prick testing were Dermatophagoides pteronyssinus and Dermatophagoides farinae at 26.67%. Allergens with elevated incidence of positive intradermals included fusarium, cockroach, cocklebur, rough marsh elder, and ragweed, all with incidences of 16% to 19%. CONCLUSION: Positive intradermal responses after negative prick testing occur commonly. Future study is needed to determine the generalizability and clinical significance of these findings. EBM rating: C-4.

    Title Visual Risks of Facial Fracture Repair in the Setting of Traumatic Optic Neuropathy.
    Date April 2006
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To identify whether facial fracture repair in patients with traumatic optic neuropathy results in visual deterioration. DESIGN: A retrospective analysis was performed of all patients admitted from 1992 through 1997 with the diagnosis of facial fracture and traumatic optic neuropathy. Vision was recorded before and after fracture repair using logarithm of the minimum angle of resolution measurements. Visual outcome was compared with a nonsurgically treated group of patients with a similar diagnosis. SETTING: University trauma hospital. PATIENTS: A total of 700 medical charts were reviewed, and 54 patients met study criteria. All patients received megadose corticosteroid treatment and were divided into 3 groups: (1) facial fracture repair alone, (2) optic nerve decompression (OND) + facial fracture repair, or (3) nonsurgical treatment. RESULTS: For the 16 patients in the fracture repair alone group, 12 (75%) had improved vision and 4 (25%) had no change postoperatively. For the 10 patients in the OND + fracture repair group, 3 (30%) had improved vision, 5 (50%) had no change, and 2 (20%) had worsened vision postoperatively. For the 28 patients in the nonsurgical group, 18 (64%) had improved vision, 9 (32%) had no change, and 1 (4%) had worsened vision by discharge. Facial fracture repair alone and the nonsurgical groups both demonstrated significant visual improvement by discharge. The amount of improvement was not significantly different between all 3 groups (facial fracture repair, 0.38 +/- 0.40; OND + facial fracture repair; 0.32 +/- 1.38; and nonsurgical, 0.69 +/- 1.07). CONCLUSIONS: Facial fracture repair in the setting of traumatic optic neuropathy had no adverse effect on vision. Patients requiring OND + fracture repair had a significantly worse visual prognosis.

    Title Endoscopic Ligation of the Sphenopalatine Artery As a Primary Management of Severe Posterior Epistaxis in Patients with Coagulopathy.
    Date September 2005
    Journal Ear, Nose, & Throat Journal
    Excerpt

    We describe our experience with endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis in 2 patients with coagulopathy. Conservative treatment had failed in both cases. The key elements of this procedure are the identification of the branches of the sphenopalatine artery via an endoscopic endonasal approach and the application of two titanium clips under direct vision. This procedure was successful in both patients, and we recommend it in selected cases.

    Title Is Voice Amplification for Teachers with Dysphonia Really Beneficial?
    Date August 2004
    Journal Journal of Speech, Language, and Hearing Research : Jslhr
    Title Current in Vivo and in Vitro Screens for Inhalant Allergy.
    Date February 2004
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Screening for inhalant allergy requires the use of a rapid, accurate, cost-effective methodology for the detection of the presence or absence of allergic responsiveness. In vivo and in vitro methods have been demonstrated to be sensitive and specific in the diagnosis of inhalant allergy, even with panels as small as seven or eight antigens. There is good concurrence between skin testing techniques and various serum measures of specific IgE, and both methods can be used effectively for screening inhalant allergy, although per-test costs for in vitro methods remain higher than comparable costs for skin testing [28]. Although the rapidity of both methods is acceptable, skin testing allows immediate observation and interpretation of test results, whereas all in vitro methods involve serum processing that delays results for hours to days. In general, both in vitro methods and epicutaneous testing with a device such as the Multi-Test II offer the clinician effective techniques in screening for inhalant allergy. Each technique has benefit and can be used in both primary care practices and in specialists' offices. The choice of the primary technique to be used for screening depends on the type of practice, the practice's familiarity with skin testing, the geographic region, and the relevant payer mix. A review of the relevant research on allergy screening suggests that the number of antigens used should be in the range of 8 to 12 and should include representative allergens from all the significant classes for the specific geographic [table: see text] region. This screen would probably contain one or two grasses, weeds, and trees, two or three molds, cat allergen, and one dust mite allergen. A sample panel is demonstrated in Box 6. It is important to recognize that the diagnosis and treatment of inhalant allergy is a fluid process. In patients who have negative allergy screens but for whom suspicion of inhalant allergy remains high, additional testing with ID techniques is sometimes indicated. This procedure might be suggested in patients for whom there is a high suspicion of mold allergy or who have unusual inhalant exposures. These individuals may represent a failure of the screening process and require additional testing. In these unusual cases, the judgment of the otolaryngic allergist is critical in guiding this further diagnostic work-up. The use of screening procedures for the diagnosis of inhalant allergy provides a rapid, accurate, and cost-effective method for evaluating patients with a history suggestive of allergic disease. Research suggests that a screening panel has strong clinometric properties and has both sensitivity and specificity in excess of 95%. It is statistically unlikely that a patient with negative findings to an allergy screen will demonstrate clinically significant inhalant allergy.

    Title Cymetra Injection for Unilateral Vocal Fold Paralysis.
    Date December 2003
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Cymetra has shown excellent tissue biocompatibility, a low rate of resorption, and no tissue reactivity when injected for treatment of facial wrinkling. On the basis of these findings, we hypothesize that injection of Cymetra into the thyroarytenoid muscle for treatment of glottal incompetence may demonstrate similar findings and lead to long-term improvement in voice quality and glottal gap closure. Ten patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent transoral injection of Cymetra into the thyroarytenoid muscle. Each subject underwent preoperative and postoperative acoustic analysis, aerodynamic measures, taped voice sampling, and videostroboscopy. Significant improvements were identified in maximum phonation time, relative glottal area, and subjective judgment of glottal competency. These results were not maintained at the 3-month study interval. No significant change in quantitative or subjective voice quality was noted for the study group during the investigation. Resorption of Cymetra may play a significant role in contributing to these findings.

    Title More on the Role of the Mandible in Speech Production: Clinical Correlates of Green, Moore, and Reilly's (2002) Findings.
    Date December 2003
    Journal Journal of Speech, Language, and Hearing Research : Jslhr
    Title Voice and Deglutition Functions After the Supracricoid and Total Laryngectomy Procedures for Advanced Stage Laryngeal Carcinoma.
    Date November 2003
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVES: This investigation compared speech and deglutition functions after alternative surgical treatments for advanced stage laryngeal carcinoma: the supracricoid laryngectomy (SCL) versus the total laryngectomy (TL).Study design and setting Cohort investigation at Wayne State University School of Medicine. METHODS: Quantitative studies of laryngeal biomechanics, acoustic and speech aerodynamic features, and deglutition skills of these individuals were coupled to listener and patient self-impressions of speech and voice characteristics for group comparative analyses. RESULTS: Results revealed that patients from each subgroup performed comparably relative to speech intelligibility and voice quality disturbances. Videostroboscopy of the neoglottal mechanisms in these two populations helped to explain these outcomes. Acoustic and speech aerodynamic testing demonstrated variably abnormal features in both surgical subgroups. Whereas the SCL patients eventually achieved full oral diets, they required many sessions of swallowing therapy to obtain this objective and eliminate tube feeding supplementation. The TL patients did not evidence protracted swallowing difficulties or the need for specific exercises in order to remove their feeding tubes postoperatively. References to organ preservation strategies in lieu of surgical management are included for completeness purposes. CONCLUSIONS: The SCL and TL surgical procedures for advanced stage laryngeal carcinoma resulted in equivalent speech and swallowing functional outcomes.

    Title Functional Outcomes Following Nonsurgical Treatment for Advanced-stage Laryngeal Carcinoma.
    Date May 2003
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES: Objectives were 1) to provide comprehensive evaluations of functional outcomes using perceptual and objective measures of patients treated nonsurgically for stages III and IV laryngeal squamous cell carcinoma and 2) to propose a standard battery of tests that can be used for appraising functional outcomes in this patient population. STUDY DESIGN: Retrospective study of 14 patients. METHODS: Perceptual measures of voice were obtained using blinded expert listener impression ratings and a validated quality of life questionnaire (Voice Handicap Index). Objective data included acoustic, speech aerodynamic, and videostroboscopic evaluations. Patients were also assessed relative to stability of the airway, secretion control, and ability to tolerate oral diet without aspiration symptoms. RESULTS: Patients demonstrated functional but abnormal voice, speech, and swallowing abilities after treatment. More specifically, patients were judged to have moderately deviant biomechanical findings on videostroboscopy that did not improve with longer time intervals after treatment. These findings helped to explain the moderately abnormal acoustic and aerodynamic measurements revealing high values for jitter, shimmer, noise, airflow, glottal resistance, and subglottal pressures and substantially lower than normal maximum phonation times. Expert listeners were in agreement with the objective findings. However, patients rated themselves as only mildly impaired with regard to the emotional, physical, and functional handicapping effects of treatment, difficulties that were judged to improve with longer time intervals after treatment. Swallowing function showed a trend toward improvement for patients with time intervals of more than 12 months since completion of therapy. CONCLUSIONS: Patients demonstrated variable degrees of laryngeal dysfunction as evidenced by perceptual and objective measures. Patients rated themselves to be only mildly handicapped with regard to voice quality. A methodology and battery of tests are proposed to help standardize outcome data collection for this patient population.

    Title The Utility of Chest Radiography Following Percutaneous Dilational Tracheotomy.
    Date December 2002
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To determine the need for routine chest radiography following percutaneous dilational tracheotomy (PDT). DESIGN: Retrospective chart review. SETTING: Tertiary care academic medical center. PATIENTS: The records of 119 patients undergoing PDT between 1993 and 2000 for indications of prolonged intubation or need for pulmonary toilet. All patients received a portable chest radiograph immediately following the procedure. OUTCOME MEASURE: Incidence of postoperative pneumothorax or pneumomediastinum. RESULTS: One patient (0.8%) undergoing PDT experienced a postoperative pnuemothorax. This patient was noted to have respiratory distress within 10 minutes following the procedure, suggesting a pneumothorax. A postoperative chest radiograph confirmed the clinical impression. No asymptomatic patients were diagnosed as having a pnuemothorax or pneumomediastinum using postoperative chest radiography. CONCLUSIONS: Chest radiography following PDT is indicated when there are clinical findings suggesting pneumothorax or pneumomediastinum. Without clinical signs or symptoms, routine use of postoperative chest radiographs are unnecessary and not cost-effective.

    Title Craniocervical Necrotizing Fasciitis: an 11-year Experience.
    Date October 2001
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF). STUDY DESIGN: All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes. RESULTS: A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required. CONCLUSION: Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension. SIGNIFICANCE: This is the largest single institution report of CCNF with thoracic extension identified to date.

    Title Functional Outcomes After Supracricoid Laryngectomy.
    Date October 2001
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES: Local control and 5-year survival rates are similar for patients undergoing total laryngectomy and supracricoid laryngectomy for the treatment of advanced-stage laryngeal carcinoma. However, comprehensive studies of functional outcomes after supracricoid laryngectomy are lacking. STUDY DESIGN: Cohort study. METHODS: This investigation provides objective voice laboratory data, skilled listener impressions of voice samples, swallowing evaluations, and patient self-perceptions of speech ability obtained from 10 supracricoid laryngectomees. RESULTS: Results demonstrated variable acoustic and speech aerodynamic disturbances, hoarse-breathy vocal quality, and speech dysfluency. Patients' self-perceptions of voice revealed severe dysphonia that induced certain emotional, physical, and functional setbacks. However, blinded judges rated these individuals as possessing intelligible speech and communication skills. All patients demonstrated premature spillage of the bolus and varying degrees of laryngeal penetration, aspiration, and retention during swallowing studies. However, each patient used a compensatory strategy to protect the airway. Voice and swallowing abilities appeared to depend on the mobility of the arytenoid cartilages, base of tongue action, and residual supraglottic tissue for the creation of a competent neoglottal sphincter complex that vibrated during phonation efforts and protected the airway during deglutition. CONCLUSIONS: Supracricoid laryngectomy avoids the potential complications, limitations, and emotional problems associated with a permanent tracheostoma. All patients demonstrated intelligible voice and effective swallowing function postoperatively, supporting supracricoid laryngectomy as a suitable alternative surgical approach to the total laryngectomy in select patients.

    Title Scintigraphic Quantification of Aspiration Reduction with the Passy-muir Valve.
    Date March 1996
    Journal The Laryngoscope
    Excerpt

    The Passy-Muir "speaking" tracheostomy valve has been noted to aid in swallowing, based on videofluoroscopy to assess aspiration. In this study scintigraphy was used to quantify the amount of material aspirated. Eleven patients were studied who currently had a tracheostomy in place and were either known to aspirate or were suspected of aspirating. Most were post-treatment head and neck cancer patients who were tumor free at the time of testing. Swallowing was evaluated using videofluoroscopy and scintigraphy. Videofluoroscopy was performed to assess anatomy and determine whether aspiration had occurred. Scintigraphic testing was then performed when the patient had the one-way valve on, and again with it off and tracheostomy open. Following a swallow, the amount (%) of aspirate with the valve in place was found to be significantly less than with the tracheostomy open. A one-way valve can be helpful in reducing aspiration in patients who are at risk for aspiration and who require that their tracheostomy be open.

    Title Clinical Accuracy of Capillary Blood Glucose Monitoring in Hospitalized Patients with Diabetes.
    Date March 1995
    Journal The Diabetes Educator
    Excerpt

    This study evaluated the clinical accuracy of capillary blood glucose monitoring (CBGM) performed by nursing personnel on hospitalized patients with diabetes. We compared the results of 80 serum glucose samples obtained in a blinded fashion within 5 minutes of routine capillary glucose measurements performed during the course of clinical care. The CBGM results obtained by a diabetes nurse specialist during endocrine testing procedures were correlated with the serum results. Correlation of CBGM to serum glucose ranged from .74 to .99 depending on the method used. Visual and manual interpretation yielded the lowest correlation and variable accuracy results, per error grid analysis, with 1 in 4 patients having errors of sufficient magnitude that could lead to inappropriate therapy. Monitoring with the AccuChek II blood glucose meter produced the highest correlation and most accurate clinical readings. Bedside blood glucose monitoring of inpatients has a wide range of reliability depending on the method used.

    Title Swallowing of Bolus Types by Postsurgical Head and Neck Cancer Patients.
    Date December 1994
    Journal Head & Neck
    Excerpt

    BACKGROUND. Clinically, head and neck cancer patients with anterior resections have better postoperative outcomes than do patients with posterior resections. METHODS. Videofluoroscopy was used to study the swallowing characteristics in postsurgery head and neck cancer patients and normal controls. Most patients received post-operative radiotherapy and chemotherapy, and no cancer recurrence was noted at the time of study, 4-8 months posttreatment. Bolus types included: 3 mL and 10 mL liquid barium, barium paste, and barium-coated cookie. Temporal measurements and a count of the number of swallows required to ingest each material were made from the videotaped data. Statistical analysis using an unbalanced univariate repeated measures ANOVA was performed. RESULTS. The major differences were found between bolus types, with few differences noted between surgical groups (anterior vs posterior resections) and normal controls. Patients took longer to ingest viscous material, accomplishing this by multiple piecemeal and clearing swallows. Coordination of mastication and swallowing of the cookie was different between normal and patient groups. CONCLUSIONS. Patients who are able to swallow reasonably well postoperatively maintain normal coordination and timing of swallowing activity and do not vary these parameters to compensate for structural inadequacy. Instead, repeated swallows are used.

    Title Scintigraphic Assessment of Swallow Efficiency Postlaryngectomy.
    Date September 1994
    Journal The Laryngoscope
    Excerpt

    There have been reports of a high incidence of hypopharyngeal stenosis in total laryngectomy patients when the surgery requires a partial pharyngectomy for pyriform sinus involvement. In this study, three groups were compared: total laryngectomy patients without partial pharyngectomy, total laryngectomy patients with partial pharyngectomy, and normal controls. All patients had received radiation therapy following surgery. All were maintaining oral nutrition, and none complained of dysphagia. Patients were tested between 1 and 7 months postradiation therapy, with a mean of 3 months. Measures of swallowing efficiency were based on scintigraphic data for a liquid swallow. Patients with partial pharyngectomy had abnormally long oropharyngeal transit times and low efficiency scores. For a subgroup of patients with partial pharyngectomy, swallowing data were available postsurgery and postradiation therapy. Postsurgery this patient group did not differ significantly from normal patients in swallowing efficiency, and swallowing efficiency deteriorated in postradiation therapy. This scintigraphic methodology is shown to be a sensitive method of assessing swallowing function in this patient population.

    Title Craniocervical Necrotizing Fasciitis with and Without Thoracic Extension: Management Strategies and Outcome.
    Date
    Journal American Journal of Otolaryngology
    Excerpt

    OBJECTIVE: First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors. METHODS: Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension. RESULTS: Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived. CONCLUSION: This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.

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