Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P219

Poster Presentations

An Unusual Laryngeal Mass in a Young
Female With Acute Myeloid Leukemia
Akash N. Naik, MD (Presenter); Sarah Nyirjesy;
Brandon J. Kim, MD
Objectives: A 31-year-old woman presented with a 3-month
history of dysphonia and relapsed acute myeloid leukemia having previously undergone chemotherapy and stem cell transplant approximately 3 years before. Of note, the patient noted
similar symptoms at the time of initial diagnosis that resolved
with treatment. Flexible fiber-optic laryngoscopy demonstrated a right submucosal mass filling the laryngeal ventricle
without overlying mucosal changes. Computed tomography of
the neck with contrast showed a hyperdense submucosal mass
involving the right aryepiglottic fold and right false vocal cord
with involvement of the paraglottic fat. The patient underwent
direct microlaryngoscopy with biopsy of the mass and potassium titanyl phosphate laser application to the biopsy site.
Final pathology was consistent with myeloid sarcoma (MS).
Methods: Institutional review board exempt status was
confirmed.
Results: The patient was started on chemotherapy. At the
time of writing, the patient noted significant improvement to
her voice without any airway or bleeding complications.
Conclusions: MS is an extramedullary manifestation of acute
and, occasionally, chronic myeloid leukemia. Most commonly, it manifests in the skin, bone, and gastrointestinal tract.
Rarely, it involves the larynx and may present with voice
changes, dysphagia, or stridor. MS is associated with worse

overall prognosis, and aggressive and early systemic treatment of the underlying leukemia is the standard of care.
However, it is unclear whether there may additionally be a
role for adjuvant radiation to the MS site. Otolaryngologists
should maintain a high suspicion for extramedullary manifestations of hematologic malignancies.
Validation of Computation Fluid Dynamic
Modeling of Glottic Airflow
Shanik J. Fernando, MD (Presenter); Haoxiang Luo, PhD;
Yi Song; Alexander Gelbard, MD
Objectives: Bilateral vocal fold immobility (BVFI) is a rare
and life-threatening condition in which both vocal cords are
fixed, resulting in airway obstruction associated with lifethreatening compromise. Treatment of BVFI is largely surgical and a compromise between voice, breathing, and swallowing in which improving one domain of laryngeal function
results in sacrifices in another. Our group sought to use computational fluid dynamic (CFD) modeling to assess surgical
techniques and now seeks to validate these data using 3-dimensional (3D) printing.
Methods: Computed tomography scans of patients with
BVFI were used to generate 3D surface representations of the
surface of the trachea and glottis, which are modified to represent incremental decreases in size of the glottic aperture.
COMSOL Multiphysics 5.2a was used to run flow dynamic
modeling in computer simulation. The same 3D surface representations are used to create 3D-printed models, which are
then subjected to the airflow modeling.
Results: Incremental changes in glottic aperture size resulted
in changes in inspiratory airflow pressures in both the CFD
model and 3D-printed models when each was subjected to
flow modeling. These changes in inspiratory airflow pressure
were comparable in terms of magnitude of change when computational and 3D-printed models were compared.
Conclusions: The findings from this study will help provide
insight into the ability of CFD to model the dynamics of the
airway and elucidate the potential of CFD in providing the
airway surgeon with predictive modeling regarding surgical
interventions in BVFI and potentially subglottic stenosis and
unilateral vocal fold paralysis. By validating CFD through use
of 3D-printed models, we hope to move forward ultimately
with in vivo modeling.
White Coat Dysphonia: A Time Series
Analysis of Office Versus Ambulatory VHI-10
Questionnaires
Eliezer C. Kinberg (Presenter); Mingyang L. Gray, MD;
Peter Filip, MD; Amir Taree; Mark S. Courey, MD
Objectives: The Voice Handicap Index-10 (VHI-10) is a
commonly used self-reported measure of vocal disability. We
hypothesize that patients' perception of their voice may vary
depending on the location and situation in which they complete the VHI-10 form.

Laryngology

Methods: Patients were prospectively recruited from an
academic laryngology clinic to complete the VHI. The cohort
included patients with voice disorders (determined by provider) and without voice disorders (controls). Median VHI
across groups was compared using the Kruskal-Wallis test and
the post hoc Dunn test with Bonferroni correction.
Results: A total of 158 patients were enrolled, of whom 18%
were controls (median VHI 2). From highest to lowest median
VHI, the voice disorders included were glottic stenosis (VHI
26.5), scar (VHI 22), spasmodic dysphonia (SD; VHI 22),
masses (VHI 18), paresis (VHI 16.5), muscle tension dysphonia (MTD; VHI 11), bowing (VHI 9), and inflammatory disorders (laryngopharyngeal reflux, laryngitis, edema; VHI 7).
Mass, paresis, SD/tremor, and glottic stenosis had a significantly higher median VHI compared with controls (P < .001).
Interestingly, the median VHI of patients with inflammatory
disorders, MTD, scar, and bowing were not significantly different from controls.
Conclusions: Disorders that affect structure (glottic stenosis,
mass) or movement (SD, paresis) tended to have higher VHIs.
Interestingly, other groups of voice disorders (eg, inflammation, MTD, bowing) reported voice-related disability that was
not different from patients without pathology. This study highlights the variability of a patient-perceived vocal disability
and can help guide clinicians toward choosing patientcentered treatment approaches.

P219

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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