Karuna Dewan

All Publications

• Validation of ultrasound as a diagnostic tool to assess vocal cord motion in an animal feasibility study GLAND SURGERY Dewan, K., Sebelik, M. E., Boughter, J. D., Shires, C. B. 2018; 7 (5): 433–39

  View details for DOI 10.21037/gs.2018.07.09

  View details for Web of Science ID 000447693100004

• A Clinical Trial of Proton Pump Inhibitors to Treat Children with Chronic Otitis Media with Effusion. The journal of international advanced otology Dewan, K., Lieu, J. 2018; 14 (2): 245–49

  Abstract

  OBJECTIVE: Gastroesophageal reflux (GER) is considered a cause of otitis media with effusion (OME). This study aimed to investigate whether OME can be effectively treated with a proton pump inhibitor (PPI), therefore implicating GER as a causative factor of OME.MATERIALS AND METHODS: A PPI or placebo was randomly administered to enrolled subjects for 4-8 weeks. To monitor effusion status, subjects underwent monthly pneumatic otoscopy and acoustic reflectometry. At enrollment and at completion of treatment, subjects underwent an audiogram and tympanogram for assessing changes in hearing due to altered fluid levels in the middle ear. After the treatment period, tympanostomy tube placement was recommended for subjects with unresolved effusion.RESULTS: This study enrolled 16 patients with an average age of 5.17 years. Between the treatment and placebo groups, there was no significant difference in the need for tympanostomy tubes. At completion of this study, patients receiving Lansoprazole demonstrated a significant improvement in pure tone average (p<0.01) and speech recognition thresholds (p=0.04). Four patients (25%) from the cohort dropped out of the study. Eight patients (50%) from the cohort required tympanostomy tube placement.CONCLUSION: Owing to difficulties with recruitment and small sample size, this study was unable to demonstrate the use of PPI in treating OME. A larger study is needed for further evaluation of this process.

  View details for DOI 10.5152/iao.2018.4286

  View details for PubMedID 30256198

• Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting CASE REPORTS IN OTOLARYNGOLOGY Dewan, K., Erman, A., Long, J. L., Chhetri, D. K. 2018: 9369602

  Abstract

  Tracheoesophageal prosthesis (TEP) is the most common voice restoration method following total laryngectomy. Prosthesis extrusion and aspiration occurs in 3.9% to 6.7% and causes dyspnea. Emergency centers are unfamiliar with management of the aspirated TEP. Prior studies report removal of aspirated TEP prostheses under general anesthesia. Laryngectomees commonly have poor pulmonary function, posing increased risks for complications of general anesthesia. We present a straightforward approach to three cases of aspirated TEP prosthesis removed in the ambulatory setting. In each case, aspirated TEP was diagnosed with flexible bronchoscopy under local anesthesia at the time of consultation, and all prostheses were retrieved atraumatically using a biopsy grasper forceps inserted via the side channel of the bronchoscope. The aspirated TEP prosthesis can be safely and efficiently removed via bedside bronchoscopy.

  View details for DOI 10.1155/2018/9369602

  View details for Web of Science ID 000445570900001

  View details for PubMedID 30302298

  View details for PubMedCentralID PMC6158927

• Neuromuscular compensation mechanisms in vocal fold paralysis and paresis. Laryngoscope Dewan, K., Vahabzadeh-Hagh, A., Soofer, D., Chhetri, D. K. 2017

  Abstract

  Vocal fold paresis and paralysis are common conditions. Treatment options include augmentation laryngoplasty and voice therapy. The optimal management for this condition is unclear. The objective of this study was to assess possible neuromuscular compensation mechanisms that could potentially be used in the treatment of vocal fold paresis and paralysis.In vivo canine model.In an in vivo canine model, we examined three conditions: 1) unilateral right recurrent laryngeal nerve (RLN) paresis and paralysis, 2) unilateral superior laryngeal nerve (SLN) paralysis, and 3) unilateral vagal nerve paresis and paralysis. Phonatory acoustics and aerodynamics were measured in each of these conditions. Effective compensation was defined as improved acoustic and aerodynamic profile.The most effective compensation for all conditions was increasing RLN activation and decreasing glottal gap. Increasing RLN activation increased the percentage of possible phonatory conditions that achieved phonation onset. SLN activation generally led to decreased number of total phonation onset conditions within each category. Differential effects of SLN (cricothyroid [CT] muscle) activation were seen. Ipsilateral SLN activation could compensate for RLN paralysis; normal CT compensated well in unilateral SLN paralysis; and in vagal paresis/paralysis, contralateral SLN and RLN displayed antagonistic relationships.Methods to improve glottal closure should be the primary treatment for large glottal gaps. Neuromuscular compensation is possible for paresis. This study provides insights into possible compensatory mechanisms in vocal fold paresis and paralysis.NA Laryngoscope, 127:1633-1638, 2017.

  View details for DOI 10.1002/lary.26409

  View details for PubMedID 28059441

• Bilateral Vocal Fold Medialization: A Treatment for Abductor Spasmodic Dysphonia. Journal of voice : official journal of the Voice Foundation Dewan, K., Berke, G. S. 2017

  Abstract

  Abductor spasmodic dysphonia, a difficult-to-treat laryngologic condition, is characterized by spasms causing the vocal folds to remain abducted despite efforts to adduct them during phonation. Traditional treatment for abductor spasmodic dysphonia-botulinum toxin injection into the posterior cricoarytenoid muscle-can be both technically challenging and uncomfortable. Due to the difficulty of needle placement, it is often unsuccessful. The purpose of this investigation is to present a previously undescribed treatment for abductor spasmodic dysphonia-bilateral vocal fold medialization.A retrospective case review of all cases of abductor spasmodic dysphonia treated in a tertiary care laryngology practice with bilateral vocal fold medialization over a 10-year period was performed. The Voice Handicap Index and the Voice-Related Quality of Life surveys were utilized to assess patient satisfaction with voice outcome.Six patients with abductor spasmodic dysphonia treated with bilateral vocal fold medialization were identified. Disease severity ranged from mild to severe. All six patients reported statistically significant improvement in nearly all Voice Handicap Index and Voice-Related Quality of Life parameters. They reported fewer voice breaks and greater ease of communication. Results were noted immediately and symptoms continue to be well controlled for many years following medialization.Bilateral vocal fold medialization is a safe and effective treatment for abductor spasmodic dysphonia. It is performed under local anesthesia and provides phonation improvement in the short and long term.

  View details for DOI 10.1016/j.jvoice.2017.09.027

  View details for PubMedID 29132808

• Pulsed dye laser treatment of primary cryptococcal laryngitis: A novel approach to an uncommon disease AMERICAN JOURNAL OF OTOLARYNGOLOGY Ihenachor, E. J., Dewan, K., Chhetri, D. 2016; 37 (6): 572-574

  Abstract

  An 82-year-old supplemental oxygen dependent woman with severe COPD presented with an eight month history of worsening hoarseness and stridor. Office laryngoscopy revealed laryngeal edema and ulcerative masses throughout the larynx. In-office biopsies were positive for Cryptococcus neoformans. This report details a novel approach to the treatment of cryptococcal laryngitis, a combination of in-office pulsed-dye laser (PDL) ablation and medical therapy. Despite treatment with oral fluconazole, the recommended treatment for cryptococcal laryngitis the patient continued to be symptomatic with dysphonia and throat discomfort. Repeated laryngeal exam demonstrated persistent cryptococcal nodules. The patient was subsequently effectively treated with an in-office PDL laser. This case demonstrates the efficacy of in-office laser treatment for residual laryngeal Cryptococcus. For patients like this one, who have failed medical therapy and are unfit for general anesthetic, the in-office laser provides an excellent alternative treatment approach.

  View details for DOI 10.1016/j.amjoto.2016.08.007

  View details for Web of Science ID 000387736600019

  View details for PubMedID 27654751

• Incidence and implication of vocal fold paresis following neonatal cardiac surgery LARYNGOSCOPE Dewan, K., Cephus, C., Owczarzak, V., Ocampo, E. 2012; 122 (12): 2781-2785

  Abstract

  To study the incidence and implications of vocal fold paresis (VFP) following congenital neonatal cardiac surgery.Retrospective chart review.All neonates who underwent median sternotomy for cardiac surgery from May 2007 to May 2008 were evaluated. Flexible laryngoscopy was performed to evaluate vocal fold function after extubation. Swallow evaluation and a modified barium swallow study were performed prior to initiating oral feeding if the initial screening was abnormal.A total of 101 neonates underwent cardiac surgery during the study period. Ninety-four patients underwent a median sternotomy, and 76 of these were included in the study. Fifteen (19.7%) had vocal fold paresis (VFP) postoperatively. Almost 27% of the patients with aortic arch surgery had VFP while only 4.1% of the patients with nonaortic arch surgery developed VFP (P=0.02) Those patients who underwent aortic arch surgery weighed significantly less (P<0.01). All the patients with VFP had significant morbidity related to swallowing and nutrition (P=0.01) and required longer postsurgical hospitalization (P=0.02).The reported incidence of VFP following cardiac surgery via median sternotomy ranges between 1.7% and 67% depending on the type of surgery and the weight of the infant at the time of surgery. In our cohort, 19.7% had VFP. Surgery requiring aortic arch manipulation had a higher incidence of complications and required longer hospitalizations. These results may be used to improve informed consent and to manage postoperative expectations by identifying patients who are at higher risk for complications.

  View details for DOI 10.1002/lary.23575

  View details for Web of Science ID 000312540000029

  View details for PubMedID 22952115

• Radiology Quiz Case 2 Nontraumatic atlantoaxial subluxation (also known as Grisel syndrome) ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Dewan, K., Giannoni, C. 2012; 138 (2): 199-201

  View details for Web of Science ID 000300525900016

  View details for PubMedID 22351870

• Light-Induced Changes of the Circadian Clock of Humans: Increasing Duration is More Effective than Increasing Light Intensity SLEEP Dewan, K., Benloucif, S., Reid, K., Wolfe, L. F., Zee, P. C. 2011; 34 (5): 593-599

  Abstract

  To evaluate the effect of increasing the intensity and/or duration of exposure on light-induced changes in the timing of the circadian clock of humans.Multifactorial randomized controlled trial, between and within subject designGeneral Clinical Research Center (GCRC) of an academic medical center56 healthy young subjects (20-40 years of age)Research subjects were admitted for 2 independent stays of 4 nights/3 days for treatment with bright or dim-light (randomized order) at a time known to induce phase delays in circadian timing. The intensity and duration of the bright light were determined by random assignment to one of 9 treatment conditions (duration of 1, 2, or 3 hours at 2000, 4000, or 8000 lux).Treatment-induced changes in the dim light melatonin onset (DLMO) and dim light melatonin offset (DLMOff) were measured from blood samples collected every 20-30 min throughout baseline and post-treatment nights. Comparison by multi-factor analysis of variance (ANOVA) of light-induced changes in the time of the circadian melatonin rhythm for the 9 conditions revealed that changing the duration of the light exposure from 1 to 3 h increased the magnitude of light-induced delays. In contrast, increasing from moderate (2,000 lux) to high (8,000 lux) intensity light did not alter the magnitude of phase delays of the circadian melatonin rhythm.Results from the present study suggest that for phototherapy of circadian rhythm sleep disorders in humans, a longer period of moderate intensity light may be more effective than a shorter exposure period of high intensity light.

  View details for Web of Science ID 000291145800009

  View details for PubMedID 21532952

  View details for PubMedCentralID PMC3079938

• Assessment of self-selection bias in a pediatric unilateral hearing loss study OTOLARYNGOLOGY-HEAD AND NECK SURGERY Lieu, J. E., Dewan, K. 2010; 142 (3): 427-433

  Abstract

  To examine the differences between participants and nonparticipants in a study of children with unilateral hearing loss that might contribute to selection bias.Case-control study.Academic pediatric otolaryngology practice.Comparison of clinical and sociodemographic characteristics between the 81 participants and 78 nonparticipants with unilateral hearing loss in a case-control study.Compared with nonparticipants, the study participants were younger but were diagnosed at an older age. Participants were more likely to have been diagnosed through a primary care screen and have normal ear anatomy, and less likely to have an attributed etiology for their unilateral hearing loss or tried assistive hearing devices. No other significant demographic, socioeconomic, or clinical differences were identified.Self-selection bias may jeopardize both internal and external validity of study results and should be evaluated whenever possible. Methods to minimize self-selection bias should be considered and implemented during the planning stages of clinical studies.

  View details for DOI 10.1016/j.otohns.2009.11.035

  View details for Web of Science ID 000276574600024

  View details for PubMedID 20172393

  View details for PubMedCentralID PMC2975441

• Enlarged vestibular aqueduct in pediatric sensorineural hearing loss OTOLARYNGOLOGY-HEAD AND NECK SURGERY Dewan, K., Wippold, F. J., Lieu, J. E. 2009; 140 (4): 552-558

  Abstract

  Comparison of the Cincinnati criteria (midpoint >0.9 mm or operculum >1.9 mm) to the Valvassori criterion (midpoint > or =1.5 mm) for enlarged vestibular aqueduct (EVA) in pediatric cochlear implant patients.Cohort study.One hundred thirty pediatric cochlear implant recipients.We reviewed temporal bone CT scans to measure the vestibular aqueduct midpoint and opercular width.The Cincinnati criteria identified 44 percent of patients with EVA versus 16 percent with the Valvassori criterion (P < 0.01). Of those with EVA, 45 percent were unilateral and 55 percent were bilateral using Cincinnati criteria; 64 percent were unilateral and 36 percent bilateral using Valvassori criterion (P < 0.01). The Cincinnati criteria diagnosed 70 ears with EVA classified as normal using the Valvassori criterion (P < 0.01); 59 lacked another medical explanation for their hearing loss.The Cincinnati criteria identified a large percentage of pediatric cochlear implant patients with EVA who might otherwise have no known etiology for their deafness.

  View details for DOI 10.1016/j.otohns.2008.12.035

  View details for Web of Science ID 000264622700019

  View details for PubMedID 19328346

  View details for PubMedCentralID PMC2846828