Browsing by Author "Rosen, Clark A."
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- ItemAssessment of Patients Receiving Short-Interval Botulinum Toxin Chemodenervation Treatment for Laryngeal Dystonia and Essential Tremor of the Vocal Tract(2023) Lagos Villaseca, Antonia Elisa; Bhatt, Neel K.; Abdolhosseini, Parirash; Quinonez, Leonel; Paoletti, Marcus F.; Gochman, Grant; Johns, Michael M.; Rosen, Clark A.; Kao,Tzu-Cheg; Meyer, Tanya K.ImportanceThe gold-standard treatment for laryngeal dystonia (LD) and essential tremor of the vocal tract (ETVT) is botulinum toxin (BoNT) chemodenervation. Although safe and effective, it is not curative, and periodic injections are required. Some medical insurance companies only cover injections at a 3-month interval, though some patients benefit from injections more frequently.ObjectiveTo determine the proportion and characteristics of patients who receive BoNT chemodenervation treatment in intervals shorter than 90 days.Design, Setting, and ParticipantsThis retrospective cohort study across 3 quaternary care neurolaryngology specialty practices in Washington and California recruited patients who underwent at least 4 consecutive laryngeal BoNT injections for LD and/or ETVT in the past 5 years. Data were collected from March through June 2022 and analyzed from June through December 2022.ExposureLaryngeal BoNT treatment.Main Outcomes and MeasuresBiodemographic and clinical variables, injection characteristics, evolution during the 3 interinjection intervals, and lifetime laryngeal BoNT treatment data were collected from patient medical records. Logistic regression was used to assess association to the short-interval outcome, defined as an average injection interval shorter than 90 days.ResultsOf 255 patients included from the 3 institutions, 189 (74.1%) were female, and the mean (SD) age was 62.7 (14.3) years. The predominant diagnosis was adductor LD (n = 199 [78.0%]), followed by adductor dystonic voice tremor (n = 26 [10.2%]) and ETVT (n = 13 [5.1%]). Seventy patients (27.5%) received short-interval injections (<90 days). The short-interval group was younger than the long-interval group (≥90 days), with a mean (SD) age of 58.6 (15.5) years and 64.2 (13.5) years, respectively, and a mean difference of −5.7 years (95% CI, −9.6 to −1.8 years). There were no patient-related differences between the short- and long-interval groups in terms of sex, employment status, or diagnosis.Conclusions and RelevanceThis cohort study demonstrated that while insurance companies often mandate a 3-month or greater interval for BoNT chemodenervation financial coverage, there is a considerable subset of patients with LD and ETVT who receive short-interval treatment to optimize their vocal function. Short-interval chemodenervation injections demonstrate a similar adverse effect profile and do not appear to predispose to resistance through antibody formation.
- ItemLaryngeal Mucous Membrane Pemphigoid as an Immune-related Adverse Effect of Pembrolizumab Treatment(Elsevier, 2023) Lagos Villaseca, Antonia Elisa; Koshkin, Vadim S.; Kinet, Maxime J.; Rosen, Clark A.Pembrolizumab is an immune checkpoint inhibitor (ICI) approved for multiple indications in a variety of malignancies. Although generally well tolerated, the potential for significant adverse effects, specifically immune related adverse effects (irAEs) needs to be taken into consideration. Several cases of bullous pemphigoid have been reported as a cutaneous adverse effect of ICIs since 2015, and there are recent reports of mucous membrane pemphigoid (MMP). We present the case of an 84-year-old male with metastatic urothelial carcinoma on treatment with pembrolizumab, who developed laryngeal mucous membrane pemphigoid as an irAE. The diagnosis was based on patient's clinical history and serologic testing, and supported by symptomatic improvement after ICI discontinuation and immunosuppression. Pembrolizumab-induced MMP is a newly described and infrequent irAE, requiring early suspicion and close monitoring for its diagnosis and management
- ItemPreoperative Acetaminophen For Microsuspension Laryngoscopy Reduces Postoperative Opioid Use(2024) Lagos Villaseca, Antonia Elisa; Lappin, James J.; Perrin, Claire E.; Ma, Yue; Young, VyVy N.; Pasvankas, George W.; Stockton, Steven D.; Rosen, Clark A.; Laohakittikul, ChantichaObjectives: The opioid crisis has prompted consideration of analgesic prescriptions. This study explored the value of pre-operative acetaminophen for pain control following microsuspension laryngoscopy (MSL) and compared the results with a pre-vious study of pain and opioid use following MSL (Tsang et al.). Methods: A prospective open-label clinical trial was conducted in patients undergoing MSL. All patients were adminis-tered preoperative acetaminophen. Short-form McGill Pain Questionnaire (SF-MPQ), pain visual analogue scale (VAS), and pre-sent pain intensity (PPI) scores were collected preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. Statisticalanalysis identified variables associated with opioid use or increased pain scores, and compared outcomes with Tsang et al. Results: Eighty-nine patients were included (mean age 52.8 17.3 years, 40 males). All patients received preoperative1 g acetaminophen (77 (86.5%) orally) with no adverse effects. On POD1, opioid usage was 10%. Median [IQR] pain scoreswere 5 [2–11], 21 [12.3–56.8], and 3 [2–3.3] on SF-MPQ, VAS, and PPI, respectively. Post-Anesthesia Care Unit (PACU) opioidr equirements significantly correlated with POD1 opioid consumption (τb = 0.214; p ≤ 0.05), and significant associations with PACU opioid administration were found for total anesthesia time (OR (95%CI) = 1.271 (1.043–1.548), p = 0.017) and totallaryngoscope suspension time (OR (95%CI) = 0.791 (0.651–0.962, p = 0.019)). This cohort demonstrated reduced opioidusage on POD1 compared with Tsang et al (23%). Conclusions: Preoperative acetaminophen is a safe intervention, resulting in decreased postoperative opioid use follow-ing MSL. Anesthesia time correlated with need for postoperative opioids