Bio

Bio


Dr. Sung is a laryngologist in the Department of Otolaryngology - Head & Neck Surgery who specializes in voice, swallowing and airway disorders, and is also the Residency Program Director.

Dr. Sung graduated from Harvey Mudd College in Claremont, CA with a bachelor?s of science degree in chemistry with a minor in music. He earned a master?s of science degree in organic chemistry from the University of Pennsylvania. He attended the State University of New York ? Downstate Medical Center and obtained his MD in 2004.

He completed his internship in general surgery at Mt. Sinai School of Medicine in New York City in 2005. He continued at Mt. Sinai to finish his residency in otolaryngology ? head & neck surgery in 2009. Following residency, he completed a fellowship in laryngology at Harvard Medical School ? Massachusetts Eye and Ear Infirmary with Ramon A. Franco, Jr., MD in 2010.

Dr. Sung joined the Stanford faculty in 2010 as Assistant Professor. He is also a staff physician at the Veteran?s Administration Palo Alto Health Care System.

In addition to his medical training, Dr. Sung worked extensively as a professional singer and actor for several years. He attended drama academy in New York City and performed in productions off-Broadway, in regional theaters, and in national and international tours. He has also performed with the Stanford University Symphonic Choir. He regularly lectures to voice and vocal pedagogy students in the Department of Music, in which he holds a courtesy appointment.

His clinical interests include the care of professional voice users; phonomicrosurgery; treatment of vocal fold paralysis with laryngeal framework surgery and injection techniques; diagnosis and Botox treatment of spasmodic dysphonia; office-based laser surgery; treatment of recurrent laryngeal papilloma; treatment of essential laryngeal tremor; and treatment of laryngeal cancer.

Clinical Focus


  • Otolaryngology
  • Laryngology
  • Voice Disorders
  • Hoarseness
  • Singers
  • Vocal Cord Paralysis
  • Spasmodic Dysphonia
  • Laryngeal Cancer
  • Laryngeal Laser Thearapy
  • Swallowing Disorders
  • Airway Disorders

Academic Appointments


  • Assistant Professor - Med Center Line, Otolaryngology - Head & Neck Surgery Divisions
  • Assistant Professor - Med Center Line (By courtesy), Music

Administrative Appointments


  • Residency Program Director, Stanford University School of Medicine, Dept. of Otolaryngology - Head & Neck Surgery (2019 - Present)
  • Director of Otolaryngology Medical Student Clerkship, Stanford University School of Medicine, Dept. of Otolaryngology - Head & Neck Surgery (2011 - 2017)
  • Medical Student Admissions Reviewer, Stanford University School of Medicine (2012 - 2013)
  • Laryngology & Bronchoesophagology Education Committee, American Academy of Otolaryngology ? Head and Neck Surgery (2011 - 2017)
  • Home Study Course Laryngology & Bronchoesophagology Working Group, American Academy of Otolaryngology ? Head and Neck Surgery (2011 - 2017)
  • Course Director of Otolaryngology - Head & Neck Surgery Grand Rounds, Stanford University School of Medicine, Dept. of Otolaryngology (2011 - 2015)

Honors & Awards


  • J. Arthur Campbell Award for Chemistry, Harvey Mudd College (1989)
  • Phi Lambda Upsilon, University of Pennsylvania (1989)
  • Outstanding Teaching Award, Department of Chemistry, University of Pennsylvania (1990)
  • Alpha Omega Alpha, SUNY Downstate Medical Center (2003)
  • Award for Outstanding Academic Achievement, Department of Otolaryngology, SUNY Downstate Medical Center (2004)
  • Magna Cum Laude, SUNY Downstate Medical Center (2004)
  • Third Prize, Metropolitan New York Resident Research Day Symposium (2007)
  • Travel Award, Triological Society (2007, 2009)
  • First Prize Proffered Paper Session, New York Head and Neck Society (2008)

Boards, Advisory Committees, Professional Organizations


  • Member, American Academy of Otolaryngology - Head & Neck Surgery (2005 - Present)
  • Diplomate, American Board of Otolaryngology (2010 - Present)
  • Member, American Broncho-Esophagological Association (ABEA) (2013 - Present)

Professional Education


  • Internship: Icahn School of Medicine at Mount Sinai (2005) NY
  • Fellowship: Massachusetts Eye and Ear Infirmary Ophthalmic Training (2010) MA
  • Medical Education: SUNY Downstate School of Medicine Registrar (2004) NY
  • Residency: Mt Sinai School of Medicine (2009) NY
  • Board Certification: Otolaryngology, American Board of Otolaryngology (2010)
  • Fellowship, Harvard Medical School - Massachusetts Eye & Ear Infirmary, Laryngology (2010)
  • Residency, Mt. Sinai School of Medicine, Otolaryngology (2009)
  • Internship, Mt. Sinai School of Medicine, General Surgery (2005)
  • MD, State University of New York - Downstate Medical Center, Medicine (2004)
  • MS, University of Pennsylvania, Organic Chemistry (1992)
  • BS, Harvey Mudd College, Chemistry (1989)

Research & Scholarship

Current Research and Scholarly Interests


- Development of office-based laryngeal surgical methods and instrumentation.
- Clinical outcomes after treatment of glottic insufficiency.
- Clinical outcomes after treatment of benign vocal fold pathology.
- Medical student and resident training curriculum development.

Teaching

2019-20 Courses


Publications

All Publications


  • The Clinical Course of Idiopathic Bilateral Vocal Fold Motion Impairment in Adults: Case Series and Review of the Literature JOURNAL OF VOICE Abu Ghanem, S., Junlapan, A., Tsai, S., Shih, L., Sung, C., Damrose, E. J. 2020; 34 (3): 465?70
  • A Preliminary Study of Vocal Health Among Collegiate A Cappella Singers JOURNAL OF VOICE Baird, B. J., Mokhtari, T. E., Sung, C., Erickson-DiRenzo, E. 2020; 34 (3)
  • Vocal Hygiene in Collegiate Singers-Does Formal Training Relate to Practices? Journal of voice : official journal of the Voice Foundation Santa Maria, C., Sung, C., Baird, B. J., Erickson-DiRenzo, E. 2020

    Abstract

    BACKGROUND: Vocal hygiene is vitally important for protecting vocal quality and promoting vocal longevity. It includes adequate hydration, avoidance of environmental irritants, and refraining from phonotraumatic behaviors such as screaming, excessive talking, and throat clearing. Formal singing training in addition to enhancing singing techniques, is also assumed to promote good vocal hygiene. Consequently, we investigated whether collegiate singers with formal training are more likely to practice good vocal hygiene habits than untrained collegiate singers.METHODS: We completed a prospective cohort study, where collegiate singers at Stanford University were voluntarily enrolled in an annual vocal health clinic. Full laryngeal exams were performed and demographic information, formal vocal training status, and information on vocal hygiene habits were obtained through questionnaires. The results were then analyzed by grouping singers as "untrained" if less than 1 year of formal training, and "trained" if greater than a year.RESULTS: A total of 82 singers were included for analysis, with 49 (59.8%) having greater than one year of formal training. Trained singers were more likely to employ a primary musical singing style of classical or operatic singing compared to untrained singers who were more likely to utilize "R&B" (P < 0.001). No significant differences were found between groups for hydration practices (P=0.20), caffeine consumption (P=0.73), warm up practices (P=0.08), and phonotraumatic behaviors. Alcohol consumption, smoking tobacco, marijuana, e-cigarette usage was similar between groups. Overall, 11% of our sample reported intermittent less than daily marijuana use, with one singer reporting daily consumption. None of the singers in this sample used e-cigarettes. These rates are noticeably lower than the agematched United States population. Perceptions of cigarettes, marijuana, electronic cigarettes, alcohol, and caffeine were also the same between groups, with the vast majority of singers perceiving these agents as harmful to the voice (64%-100% depending on the agent). No laryngeal pathology was identified during laryngeal examination of any singers.CONCLUSIONS: Vocal hygiene habits are similar between trained and untrained collegiate singers. This likely relates to a desire for vocal longevity irrespective of prior training. This may dispel the long-held assumption that formal training was necessary to develop good vocal habits. We do however, present a very homogenous, highly educated sample of collegiate singers from Stanford University, having significantly less at-risk behavior than their aged-matched counterparts in the general US population. A lack of laryngeal pathology despite extensive vocal demands may also be reflective of good vocal hygiene habits.

    View details for DOI 10.1016/j.jvoice.2020.03.014

    View details for PubMedID 32362576

  • Intraoperative Evaluation of Essential Vocal Tremor in Deep Brain Stimulation Surgery. American journal of speech-language pathology Erickson-DiRenzo, E., Sung, C. K., Ho, A. L., Halpern, C. H. 2020: 1?13

    Abstract

    Purpose Essential vocal tremor (EVT) is a prevalent and difficult-to-manage voice disorder. There is evidence that deep brain stimulation (DBS) of the ventral intermediate nucleus (Vim) of the thalamus may be beneficial for treating EVT. The objective of this preliminary investigation was to conduct intraoperative voice assessments during Vim-DBS implantation in order to evaluate immediate voice outcomes in medication-refractory essential tremor patients with co-occurring EVT. Method Seven adult subjects diagnosed with EVT undergoing Vim-DBS surgery participated in this investigation. Voice samples of sustained vowels were collected by a speech-language pathologist preoperatively and intraoperatively, immediately following Vim-DBS electrode placement. Voice evaluation included objective acoustic assessment of the rate and extent of EVT fundamental frequency and intensity modulation and subjective perceptual ratings of EVT severity. Results The rate of intensity modulation, extent of fundamental frequency modulation, and perceptual rating of EVT severity were significantly reduced intraoperatively as compared to preoperatively. Moderate, positive correlations were appreciated between a subset of acoustic measures and perceptual severity ratings. Conclusions The results of this study demonstrate a speech-language pathologist can conduct intra-operative evaluation of EVT during DBS surgery. Using a noninvasive, simple acoustic recording method, we were able to supplement perceptual subjective observation with objective assessment and demonstrate immediate, intraoperative improvements in EVT. The findings of this analysis inform the added value of intraoperative voice evaluation in Vim-DBS patients and contribute to the growing body of literature seeking to evaluate the efficacy of DBS as a treatment for EVT.

    View details for DOI 10.1044/2019_AJSLP-19-00079

    View details for PubMedID 32073285

  • Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol JOURNAL OF VOICE Abu-Ghanem, S., Rudy, S., Deane, S., Tsai, S., Shih, L., Damrose, E. J., Sung, C. 2020; 34 (1): 121?26
  • Autologous fibroblasts for vocal scars and age-related atrophy: A randomized clinical trial. The Laryngoscope Ma, Y., Long, J., Amin, M. R., Branski, R. C., Damrose, E. J., Sung, C., Achlatis, S., Kearney, A., Chhetri, D. K. 2019

    Abstract

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

    View details for DOI 10.1002/lary.28453

    View details for PubMedID 31804729

  • Operative and Conservative Management of Laryngeal Contact Granuloma: A Network Analysis and Systematic Review. Journal of voice : official journal of the Voice Foundation Tsai, S. W., Ma, Y. F., Shih, L. C., Tsou, Y. A., Sung, C. 2019

    Abstract

    OBJECTIVE: Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical management have reported effectiveness, yet optimal treatment has not been standardized. We compared primary and secondary outcomes of conservative and surgical treatment using endoscopic grading, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT), and recurrence rate.METHODS: We performed literature searches of MEDLINE, PubMed, and EMBASE from November 1985 to October 2017, with randomized controlled trials and case control studies of at least three months follow-up as the inclusion criteria. Outcomes included laryngoscopic findings, MPT, and VHI-10. Data regarding study design, outcome analysis, follow-up time, and disease remission were systematically collected.RESULTS: A total of 1069 patients were abstracted from 19 papers. With conservative treatment, 98% of patients' laryngeal granuloma resolved within three months, and 84% for the surgical group. There was a decrease in VHI-10 of 2.69 (95% credible interval (CI) -9.52 to 3.82) and 6.48 (95% CI -15.00 to 1.94) for conservative and surgical management, respectively. MPT improvement was 1.27 s (95% CI: 2.03-5.84) for conservative treatment and 5.02 s (95% CI: 0.78-8.07) for surgical. For all 19 studies, absolute recurrence risk for control, conservative, and surgical measures were respectively 4%, 16%, and 29%.CONCLUSIONS: Most patients treated conservatively or surgically alone responded to treatment, but conservative management was favored. VHI-10 and MPT improvement in surgical patients were noted, but only the latter was statistically significant. In regard to recurrence, conservative management had better outcome than surgical. Taken together, the results suggest that minimally symptomatic granulomas have higher response rate and lower recurrence risk when treated conservatively, while larger, symptomatic granulomas may favor surgical excision followed by medical management to reduce risk of recurrence.

    View details for DOI 10.1016/j.jvoice.2019.08.019

    View details for PubMedID 31628044

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

    View details for DOI 10.1002/lary.27686

    View details for Web of Science ID 000471915700032

  • Outcomes in modified transoral resection of diverticula for Zenker's diverticulum EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Junlapan, A., Abu-Ghanem, S., Sung, C., Damrose, E. J. 2019; 276 (5): 1423?29
  • Treatment of early-stage laryngeal cancer: A comparison of treatment options ORAL ONCOLOGY Baird, B., Sung, C., Beadle, B. M., Divi, V. 2018; 87: 8?16
  • Surgical Management of Supraglottic Stenosis Using Intubationless Optiflow. The Annals of otology, rhinology, and laryngology Tam, K., Jeffery, C., Sung, C. K. 2017; 126 (9): 669?72

    Abstract

    Airway management during endoscopic surgical treatment of supraglottic and pharyngeal stenosis is often challenging and can be accomplished by various means, including tracheostomy, jet ventilation, or direct laryngoscopy. We describe CO2 laser excision of supraglottic-pharyngeal stenosis using intubationless Optiflow high-flow nasal cannula (HFNC).A 55-year-old male presented with dyspnea and dysphagia secondary to severe supraglottic-pharyngeal stenosis in the setting of previous chemoradiation for a T0N2aM0 squamous cell carcinoma. Laryngoscopy revealed severe supraglottic-pharyngeal stenosis with tethering of the epiglottis to the lateral pharyngeal walls. Optiflow HFNC was used to deliver 70 L/min of oxygen. After anesthetic induction, CO2 laser microlaryngoscopy was utilized to release scar tissue along the lateral epiglottic border, opening up the supraglottic airway sufficiently for endotracheal intubation and further laser resection.Airway management with Optiflow HFNC allowed initial endoscopic surgical access, partial stenotic release, and intubation. From anesthetic induction to intubation, the patient remained apneic for 26 minutes. The patient's stenosis was successfully addressed, and 10-month follow-up demonstrated stable patency of the airway.Optiflow is an important new tool in the management of severe supraglottic stenosis. It provides sufficient oxygenation to perform extended apneic surgery and improves endoscopic surgical access in a limited airway.

    View details for PubMedID 28766977

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

    Abstract

    Gastroesophageal reflux may contribute to the development of cricopharyngeal dysfunction and Zenker's diverticulum. Common dictum suggests that if upper esophageal sphincter tone is reduced through cricopharyngeal myotomy, symptoms of laryngopharyngeal reflux may worsen. We hypothesized that patients who undergo myotomy should show decreased dysphagia symptoms with concurrent worsening of reflux symptomatology and that these changes would be greater in those patients undergoing complete versus partial myotomy.A retrospective chart review was performed for patients who underwent endoscopic or open cricopharyngeal myotomy, with or without Zenker's diverticulectomy. Preoperative and postoperative reflux symptomatology was subjectively measured with the Reflux Symptom Index (RSI), and dysphagia symptomatology was measured with the Eating Assessment Tool 10 (EAT-10). Patients who underwent partial myotomy via endoscopic stapling of Zenker's diverticulum were compared with patients who underwent complete myotomy (either endoscopic laser-assisted or via an open transcervical approach). The patients were further subdivided into three groups for data analysis: endoscopic staple diverticulotomy, laser cricopharyngeal myotomy, and open approach.A total of 41 patient charts were reviewed. Of these 41 patients, 17 underwent endoscopic stapler-assisted diverticulotomy, 4 underwent endosopic laser-assisted cricopharyngeal myotomy, and 20 underwent open transcervical cricopharyngeal myotomy, with diverticulectomy as indicated. Mean pre- and postoperative RSIs were 21.8 and 8.9, respectively (P?

    View details for DOI 10.1016/j.jvoice.2016.02.006

    View details for PubMedID 27049450

  • Phonomicrosurgery simulation: A low-cost teaching model using easily accessible materials. Laryngoscope Zambricki, E. A., Bergeron, J. L., DiRenzo, E. E., Sung, C. K. 2016; 126 (11): 2528-2533

    Abstract

    To introduce the use of a new phonomicrosurgical trainer using easily accessible materials, and to establish the effectiveness of the model.The model uses a grape imbedded in gelatin, a microscope, and microlaryngeal instruments. The study was designed to test baseline differences in training levels, as well as improvement in performance after training with the simulation model.Thirty subjects enrolled in the Stanford University School of Medicine otolaryngology training program performed microlaryngeal surgery tasks on a grape. Tasks were designed to model both excision of a vocal fold lesion and vocal fold injection. Anonymized video recordings comparing presimulation and postsimulation training were collected and graded by an expert laryngologist. Both objective comparison of skills and subjective participant surveys were analyzed.Objectively, trainees in all groups made statistically significant improvements across all tested variables, including microscope positioning, creation of a linear incision, elevation of epithelial flaps, excision of a crescent of tissue, vocal fold injection, preservation of remaining tissue, and time to complete all tasks. Subjectively, 100% of participants felt that they had increased comfort with microlaryngeal instruments and decreased intimidation of microlaryngeal surgery after completing the simulation training. This appreciation of skills was most notable and statistically significant in the intern trainees.Microlaryngeal surgical simulation is a tool that can be used to train residents to prepare them for phonomicrosurgical procedures at all levels of training. Our low-cost model with accessible materials can be easily duplicated and used to introduce trainees to microlaryngeal surgery or improve skills of more senior trainees.1B. Laryngoscope, 2016.

    View details for DOI 10.1002/lary.25940

    View details for PubMedID 27107403

  • Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Beswick, D. M., Vashi, A., Song, Y., Pham, R., Holsinger, F. C., Rayl, J. D., Walker, B., Chardos, J., Yuan, A., Benadam-Lenrow, E., Davis, D., Sung, C. K., Divi, V., Sirjani, D. B. 2016; 38 (6): 925-929

    Abstract

    The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit.Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference.Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17-36 days) and 72 (range, 31-108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs.A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. © 2016 Wiley Periodicals, Inc. Head Neck 38: 925-929, 2016.

    View details for DOI 10.1002/hed.24386

    View details for PubMedID 26899939

  • Tracheal Stenosis Because of Wegener Granulomatosis Misdiagnosed as Asthma. A & A case reports O'Hear, K. E., Ingrande, J., Brodsky, J. B., Morton, J. M., Sung, C. 2016; 6 (10): 311-312

    Abstract

    We describe a patient with Wegener granulomatosis whose complaint of wheezing was incorrectly attributed to asthma. Anesthesiologists must recognize that tracheal stenosis is extremely common in Wegener granulomatosis and can mimic other causes of wheezing.

    View details for DOI 10.1213/XAA.0000000000000307

    View details for PubMedID 27075424

  • Symptomatic Anterior Cervical Osteophyte Causing Dysphagia: Case Report, Imaging, and Review of the Literature. CureŻus Chen, Y., Sung, K., Tharin, S. 2016; 8 (2)

    Abstract

    Anterior cervical osteophytes are found in 20-30% of elderly patients. Rarely, severe osteophytes can cause dysphagia, dysphonia, and dyspnea. Here, we illustrate a case of severe dysphagia caused by a large post-traumatic osteophyte with oropharyngeal swallow study showing a significant mass effect on the pharynx and resolution following osteophytectomy. We also review the literature regarding the etiology, diagnosis, and treatment of symptomatic anterior cervical osteophytes.

    View details for DOI 10.7759/cureus.473

    View details for PubMedID 27004150

    View details for PubMedCentralID PMC4779080

  • Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology. Neurosurgical focus Ho, A. L., Erickson-DiRenzo, E., Pendharkar, A. V., Sung, C., Halpern, C. H. 2015; 38 (6): E6-?

    Abstract

    Tremulous voice is a characteristic feature of a multitude of movement disorders, but when it occurs in individuals diagnosed with essential tremor, it is referred to as essential vocal tremor (EVT). For individuals with EVT, their tremulous voice is associated with significant social embarrassment and in severe cases may result in the discontinuation of employment and hobbies. Management of EVT is extremely difficult, and current behavioral and medical interventions for vocal tremor result in suboptimal outcomes. Deep brain stimulation (DBS) has been proposed as a potential therapeutic avenue for EVT, but few studies can be identified that have systematically examined improvements in EVT following DBS. The authors describe a case of awake bilateral DBS targeting the ventral intermediate nucleus for a patient suffering from severe voice and arm tremor. They also present their comprehensive, multidisciplinary methodology for definitive treatment of EVT via DBS. To the authors' knowledge, this is the first time comprehensive intraoperative voice evaluation has been used to guide microelectrode/stimulator placement, as well as the first time that standard pre- and post-DBS assessments have been conducted, demonstrating the efficacy of this tailored DBS approach.

    View details for DOI 10.3171/2015.3.FOCUS1537

    View details for PubMedID 26030706

  • Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology NEUROSURGICAL FOCUS Ho, A. L., Erickson-DiRenzo, E., Pendharkar, A. V., Sung, C., Halpern, C. H. 2015; 38 (6)

    Abstract

    Tremulous voice is a characteristic feature of a multitude of movement disorders, but when it occurs in individuals diagnosed with essential tremor, it is referred to as essential vocal tremor (EVT). For individuals with EVT, their tremulous voice is associated with significant social embarrassment and in severe cases may result in the discontinuation of employment and hobbies. Management of EVT is extremely difficult, and current behavioral and medical interventions for vocal tremor result in suboptimal outcomes. Deep brain stimulation (DBS) has been proposed as a potential therapeutic avenue for EVT, but few studies can be identified that have systematically examined improvements in EVT following DBS. The authors describe a case of awake bilateral DBS targeting the ventral intermediate nucleus for a patient suffering from severe voice and arm tremor. They also present their comprehensive, multidisciplinary methodology for definitive treatment of EVT via DBS. To the authors' knowledge, this is the first time comprehensive intraoperative voice evaluation has been used to guide microelectrode/stimulator placement, as well as the first time that standard pre- and post-DBS assessments have been conducted, demonstrating the efficacy of this tailored DBS approach.

    View details for DOI 10.3171/2015.3.FOCUS1537

    View details for Web of Science ID 000355539900006

    View details for PubMedID 26030706

  • Deep Brain Stimulation for Essential Vocal Tremor: A Technical Report. Cureus Ho, A. L., Choudhri, O., Sung, C. K., DiRenzo, E. E., Halpern, C. H. 2015; 7 (3)

    Abstract

    Essential vocal tremor (EVT) is the presence of a tremulous voice that is commonly associated with essential tremor. Patients with EVT often report a necessary increase in vocal effort that significantly worsens with stress and anxiety and can significantly impact quality of life despite optimal medical and behavioral treatment options. Deep brain stimulation (DBS) has been proposed as an effective therapy for vocal tremor, but very few studies exist in the literature that comprehensively evaluate the efficacy of DBS for specifically addressing EVT. We present a technical report on our multidisciplinary, comprehensive operative methodology for treatment of EVT with frameless, awake deep brain stimulation (DBS).

    View details for DOI 10.7759/cureus.256

    View details for PubMedID 26180680

  • Endoscopic suture retriever for endolaryngeal keel placement in treatment of anterior glottic webs. The Annals of otology, rhinology, and laryngology Beswick, D. M., Clark, A. K., Bergeron, J., Sung, C. K. 2015; 124 (3): 240-243

    Abstract

    Endoscopic placement of a laryngeal keel has traditionally required the use of a Lichtenberger endo-extralaryngeal needle passer, which is not universally available. We discuss a safe and technically simple alternate technique using an endoscopic suture retriever through a percutaneously placed angiocatheter that obviates the need for the Lichtenberger instrument.Case series.Two 14-gauge angiocatheters were passed through the anterior neck under telescopic visualization of the larynx. The suture retriever was inserted through the catheter and deployed within the larynx to withdraw a Prolene suture that was threaded through a Silastic keel. The keel was then tied in position over a sterile button on the anterior neck.This procedure was performed on 2 patients with excellent outcomes in both cases.Endoscopic keel placement is a widely used procedure for treating anterior glottic webs and requires suture passage from within the larynx to the anterior neck to secure the keel into position. This is the first report of an exo-endolaryngeal suture retriever for placement of a laryngeal keel. This technique provides a safe, reliable, and efficient alternative to endo-extralaryngeal needle puncture and uses materials that are available in many operating room settings.

    View details for DOI 10.1177/0003489414549577

    View details for PubMedID 25204710

  • Office-Based Laser Laryngeal Surgery Op Tech in Otolaryngol Sung CK 2012; 23 (2): 102-105
  • Management of Recurrent Laryngeal Nerve Paralysis Surgery of the Thyroid and Parathyroid Glands Sung CK, Franco RA Jr. 2011
  • Airway and respiratory complications: Tracheal Stenosis Spinal Cord Injury: Rehabilitation Medicine Quick Reference Altman KW, Sung CK 2010
  • Airway and respiratory interventions: Tracheostomies. Spinal Cord Injury: Rehabilitation Medicine Quick Reference Altman KW, Sung CK 2010
  • TRANSORAL ROBOTIC SURGERY FOR THE MANAGEMENT OF HEAD AND NECK CANCER: A PRELIMINARY EXPERIENCE HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Genden, E. M., Desai, S., Sung, C. 2009; 31 (3): 283-289

    Abstract

    The aim of this prospective study was to determine the technical feasibility, safety, and efficacy of transoral robotic surgery (TORS) for a variety of malignant head and neck lesions.From April 2007 to November 2007, 20 patients were enrolled in an institutional review board-approved prospective trial using the daVinci surgical robot. Inclusion criteria for the study consisted of adults with early head and neck cancer involving the oral cavity, oropharynx, hypopharynx, and larynx.Twenty patients were included in this study. In 2 cases, access to the tumor was inadequate and the procedure was terminated. In all 18 cases, negative resection margins were achieved. Intraoral reconstruction was performed in 8 patients. Fifteen of 18 patients underwent concomitant unilateral (n = 10) or bilateral (n = 5) selective neck dissections. None of the patients required tracheotomy and there were no intraoperative or postoperative complications. The average setup time was 54.6 minutes (range, 140-20 minutes), with a precipitous decrease in the setup time as the study progressed.TORS is a safe, feasible, and minimally invasive alternative to classic open surgery or endoscopic transoral laser surgery in patients with early cancer of the head and neck. With increasing experience, surgical setup as well as operative time will continue to decrease.

    View details for DOI 10.1002/hed.20972

    View details for Web of Science ID 000264011500001

    View details for PubMedID 18972413

  • Transoral robotic assisted free flap reconstruction OTOLARYNGOLOGY-HEAD AND NECK SURGERY Mukhija, V. K., Sung, C., Desai, S. C., Wanna, G., Genden, E. M. 2009; 140 (1): 124-125

    View details for DOI 10.1016/j.otohns.2008.09.024

    View details for Web of Science ID 000262458100025

    View details for PubMedID 19130975

  • Transoral Robotic Surgery Using a Carbon Dioxide Flexible Laser for Tumors of the Upper Aerodigestive Tract LARYNGOSCOPE Desai, S. C., Sung, C., Jang, D. W., Genden, E. M. 2008; 118 (12): 2187-2189

    Abstract

    To determine the safety, feasibility, and efficacy of coupling transoral robotic technology with the flexible carbon dioxide (CO2) laser for various tumors of the oropharynx and supraglottic larynx.Prospective, pilot trial.Eight patients were enrolled in an IRB-approved prospective trial for transoral robotic surgery with the aid of the flexible CO2 laser.Seven male patients with early carcinoma of the oropharynx or larynx successfully underwent tumor extirpation with the transoral robot and the flexible CO2 laser. We were unable to gain access to the supraglottic larynx in one female patient. The final pathology revealed seven patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma. The flexible CO2 laser provided fine incisions with excellent hemostasis and minimal peripheral tissue injury. Additionally, the laser provided an excellent tool for raising pharyngeal flaps for reconstruction of the oropharynx.The flexible CO2 laser offers a unique advantage of precise incisions and may provide a valuable tool for both tumor extirpation and the creation of flaps for transoral robotic reconstruction.

    View details for DOI 10.1097/MLG.0b013e31818379e4

    View details for Web of Science ID 000263200900019

    View details for PubMedID 19029867

  • Transoral Robotic Surgery Using an Image Guidance System LARYNGOSCOPE Desai, S. C., Sung, C., Genden, E. M. 2008; 118 (11): 2003-2005

    Abstract

    To describe a novel technique using the image guidance system for transoral robotic surgery of the pharyngeal and parapharyngeal spaces.Case series presentation.Three cases of oropharyngeal and pharyngeal space lesions are reviewed for presentation, workup, and original management.Final pathology of a vascular malformation, an acinic cell adenocarcinoma, and a squamous cell carcinoma were located and minimally invasively removed by a transoral robotic approach with the aid of image guidance. No complications or recurrences were observed on an average of 7 month follow-up.Transoral robotic surgery using an image guidance system seems safe and effective in assisting dissection.

    View details for DOI 10.1097/MLG.0b013e3181818784

    View details for Web of Science ID 000260874700017

    View details for PubMedID 18849862

  • The administration of IL-12/GM-CSF and Ig-4-1BB ligand markedly decreases murine floor of mouth squamous cell cancer OTOLARYNGOLOGY-HEAD AND NECK SURGERY Adappa, N. D., Sung, C., Choi, B., Huang, T., Genden, E. M., Shin, E. J. 2008; 139 (3): 442-448

    Abstract

    To assess immune-based gene therapy in a murine floor of mouth (FOM) squamous cell carcinoma (SCC) model.In vitro and in vivo testing of immune therapy for SCC.Multiple SCC lines were infected by using advRSV-interleukin-12 (IL-12) and advCMV-interleukin-12/granulocyte macrophage colony-stimulating factor (IL-12/GM-CSF) and monitored for production of IL-12 and GM-CSF. Intratumoral injections of viral vectors were administered with systemic Ig-4-1BB ligand in an orthotopic murine FOM SCC model and followed for tumor size and survival.In vitro, all cell lines produced substantial levels of IL-12 and GM-CSF. In vivo, tumors treated with advCMV-IL-12/GM-CSF and Ig-4-1BBL showed a striking reduction in tumor volume (vs control P<0.0001) and improved median survival (38 days vs 19 days for control, P<0.0001).Combination immune-based therapies effectively improve survival in mice bearing FOM SCC over single-modality therapy.

    View details for DOI 10.1016/j.otohns.2008.05.001

    View details for Web of Science ID 000258858400020

    View details for PubMedID 18722228

  • Combined VSV Oncolytic Virus and Chemotherapy for Squamous Cell Carcinoma 110th Annual Meeting of the Triological-Society Sung, C., Choi, B., Wanna, G., Genden, E. M., Woo, S. L., Shin, E. J. WILEY-BLACKWELL. 2008: 237?42

    Abstract

    Vesicular stomatitis virus (VSV) is a negative-strand ribonucleic acid (RNA) virus that replicates specifically in tumor cells and has oncolytic effects in a variety of malignant tumors. We previously demonstrated recombinant VSV vectors incorporating viral fusion protein (rVSV-F) and interleukin 12 (rVSV-IL12) to have significant antitumor effects against squamous cell carcinoma (SCC) in a murine model. Here we evaluate the potential to combine a potent chemotherapeutic agent for SCC (cisplatin) with rVSV-F and rVSV-IL12 to improve efficacy.In vitro, three SCC cell lines were tested using rVSV-F and rVSV-IL12 with cisplatin, monitoring viral replication and cell survival. In an orthotopic floor of mouth murine SCC model, intratumoral injections of virus combined with systemic cisplatin were tested for tumor control and animal survival.In vitro, virus and cisplatin combination demonstrated rapid replication and enhanced tumor cell kill. Human keratinocytes were unaffected by virus and cisplatin. In vivo, combined rVSV-F with cisplatin reduced tumor burden and improved survival (P = .2 for both), while rVSV-IL12 monotherapy had better tumor control (P = .06) and survival (P = .024) than combination therapy.Addition of cisplatin did not affect the ability of either virus to replicate in or kill murine SCC cells in vitro. In vivo, combination therapy enhancedrVSV-F antitumor activity, but diminished rVSV-IL12 antitumor activity. Combination therapy may provide useful treatment for SCC with the development of more efficient viral vectors in combination with different chemotherapy agents or immunostimulatory agents.

    View details for DOI 10.1097/MLG.0b013e3181581977

    View details for Web of Science ID 000260661500008

    View details for PubMedID 18043494

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