Bio

Clinical Focus


  • Laryngeal cancer
  • Tracheal stenosis
  • Hoarseness
  • Laryngology
  • Head and Neck Surgery
  • Vocal cord paralysis
  • Otolaryngology
  • Subglottic stenosis

Academic Appointments


Administrative Appointments


  • Member, Credentials and Privileges Committee (2013 - 2016)
  • Senator at Large, Stanford School of Medicine Faculty Senate (2012 - 2015)
  • Member, Quality, Patient Safety & Effectiveness Commitee (2010 - Present)
  • Member, Professional Practice Evaluation Committee (2009 - Present)
  • Clinic Chief, Otolaryngology/Head and Neck Surgery (2004 - Present)
  • Consultant, Stanford Sports Medicine Program (2003 - Present)
  • Chief, Division of Laryngology (2003 - Present)
  • Member, CMC Main Campus Operations Committee (2006 - Present)
  • Director, Fellowship in Laryngology and Bronchoesophagology (2006 - Present)
  • Co-Director, Managing the TEP Patient: A Practical Workshop (2005 - Present)
  • Director, Stanford Center for Voice and Swallowing Disorders (2003 - Present)
  • Chair, Quality Assurance Committee, Department of Otolaryngology/Head and Neck Surgery (2003 - Present)
  • Member, Stanford Collaborative on Clinical Excellence (2003 - Present)

Honors & Awards


  • Top Ten Doctors, Vitals.com (2012)
  • Compassionate Doctor Recognition, Vitals.com (2011-2013)
  • Patients' Choice 5th Anniversary Award, Vitals.com (2012)
  • Denise M. O'Leary Award for Excellence, Stanford Hospital and Clincs Board of Directors (September 10, 2012)
  • Best Doctors in America, Best Doctors, Inc. Boston, MA (2009)
  • Patients' Choice Award, Vitals.com (2008-2010)
  • Best Doctors in America, Best Doctors, Inc. Boston, MA (2008)
  • Stanford Biodesign Teaching Recognition Award, Stanford University (2004)
  • Physician of the Year - Nominee, UCLA (1996)
  • Medical Thesis Recognition Award, UCLA (1995)
  • Forest and Rachel Linden Scholarship, UCLA (1994)
  • Dale E. Wilson Scholarship, UCLA (1994)
  • Cum Laude, Yale University (1991)
  • Francis G. Fabian, Jr. Scholarship, Yale University (1987 - 1991)

Professional Education


  • Fellowship:UCLA Medical Center (2003) CA
  • Residency:UCLA Medical Center (2001) CA
  • BS, Yale University, Biology (1991)
  • MD, UCLA, Medicine (1995)
  • Board Certification: Otolaryngology, American Board of Otolaryngology (2002)
  • Residency:UCLA Medical Center (1997) CA
  • Medical Education:UCLA School Of Medicine (1995) CA

Community and International Work


  • US Navy Reserve

    Topic

    Commander, Battalion Surgeon, Medical Corps

    Populations Served

    Servicemen and women

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • International Association of Laryngectomees

    Topic

    Medical Director

    Populations Served

    Laryngeal Cancer Patients

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Foundation for Voice Restoration

    Topic

    Medical Advisor

    Populations Served

    Patients with Laryngeal Cancer

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Embrace the Children Camp, Guatemala

    Topic

    Board of Directors - Operations Director

    Populations Served

    Pediatric cancer patients

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


We are primarily interested in laryngeal physiology and function, with a particular interest in the application of advanced imaging techniques in studying vocal fold physiology. Currently, we are developing a method of high speed digital image analysis of normal and abnormal vocal fold vibration in a variety of states, including neurological disorders such as Parkinson's disease and spasmodic dysphonia. In addition, we are interested in the application of high resolution MRI imaging of the human larynx in detecting invasive laryngeal cancer at an earlier stage than can be currently detected. Finally, we are interested in the effects that hormones and exogenous factors such as anabolic steroids may exert on the voice and the subsequent changes to the vocal cords that these substances may incur.

Clinical Trials


  • A Phase 2 Clinical Trial of the Safety and Effects of IRX-2 in Treating Patients With Operable Head and Neck Cancer Not Recruiting

    IRX-2 is designed to activate your own body's immune system so that it can better fight the invasion of head and neck cancer. In pre-clinical studies, IRX-2 has been shown to activate a number of different cells of the immune system. IRX-2 was previously tested in a study of 13 patients with advanced head and neck cancer who had been previously treated and failed chemotherapy and/or radiation therapy. The trials were specifically designed to test the safety of IRX-2. Researchers found that IRX-2 did not appear to have major side effects. Also, the researchers believed that further study in less advanced head and neck cancer patients could be useful in obtaining more data on the safety of IRX-2 as well as data on possible effects on tumors and on patient survival.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ruth Lira, (650) 723 - 1367.

    View full details

  • Imaging and Biomarkers of Hypoxia in Solid Tumors Recruiting

    To establish PET imaging with the tracer FMISO as an accurate and reliable method for measuring the oxygen content of a tumor and to establish the measurement of secreted markers in blood as an accurate and reliable method for measuring the oxygen content of a tumor.

    View full details

Teaching

2013-14 Courses


Graduate and Fellowship Programs


Publications

Journal Articles


  • 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
  • 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 Web of Science ID 000305415100012

    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

  • 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

  • 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 EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Damrose, E. J. 2009; 266 (5): 759-761

    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 AURIS NASUS LARYNX Damrose, E. J. 2009; 36 (1): 110-112

    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

  • 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 JOURNAL OF LARYNGOLOGY AND OTOLOGY Damrose, E. J., Damrose, J. F. 2008; 122 (8): 824-828

    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 ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Chhetri, D. K., Merati, A. L., Blumin, J. H., Sulica, L., Damrose, E. J., Tsai, V. W. 2008; 117 (3): 159-165

    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 JOURNAL OF VOICE Yan, Y., Damrose, E., Bless, D. 2007; 21 (5): 604-616

    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 OTOLARYNGOLOGY-HEAD AND NECK SURGERY Cohen, A. N., Damrose, E. J., Huang, R. Y., Nelson, S. D., Blackwell, K. E., Calcaterra, T. C. 2004; 131 (6): 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

  • 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

  • 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

Conference Proceedings


  • The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment Morzaria, S., Damrose, E. J. CAMBRIDGE UNIV PRESS. 2011: 714-718

    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

  • Complications of esophagoscopy in an academic training program 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

  • Lack of evoked laryngeal electromyography response in patients with a clinical diagnosis of vocal cord paralysis Damrose, E. J., Huang, R. Y., Blumin, J. H., Blackwell, K. E., Sercarz, J. A., Berke, G. S. ANNALS PUBL CO. 2001: 815-819

    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

  • Extranasopharyngeal angiofibroma 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 Damrose, E. J., Hoh, C., Calcaterra, T. C. W B SAUNDERS CO-ELSEVIER INC. 2000: 394-397

    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 Huang, R. Y., Damrose, E. J., Alavi, S., Maceri, D. R., Shapiro, N. L. ELSEVIER IRELAND LTD. 2000: 167-172

    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 Damrose, E. J., Huang, R. Y., Abemayor, E. OCEAN SIDE PUBLICATIONS INC. 2000: 241-244

    Abstract

    Sarcoidosis is a chronic granulomatous disease of unknown etiology. Otolaryngologic and ophthalmologic manifestations occur in 15 to 55% of afflicted individuals, respectively. Neck masses, parotid enlargement, and facial nerve palsy are the most common presenting otolaryngologic complaints, while lacrimal gland enlargement, uveitis, and upper eyelid masses often call the attention of the ophthalmologist. Biopsy reveals non-caseating granulomas, while the angiotensin converting enzyme (ACE) level may be elevated. We report an unusual case of a patient who presented with severe bilateral exophthalmos as the sole initial complaint. A prior workup included a negative conjunctival biopsy. On magnetic resonance imaging (MRI) and computed tomography (CT), the patient had pansinusitis. Endoscopic ethmoidectomies with tissue analysis revealed sarcoidosis. Further evaluation revealed no evidence of systemic disease, and all symptoms resolved with a course of oral steroids. Thus, nasal endoscopy and biopsy of affected paranasal sinus mucosa may prove a useful adjunct to the diagnosis of sarcoidosis, particularly in atypical cases.

    View details for Web of Science ID 000088949400006

    View details for PubMedID 10979497

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