Milan R. Amin, M.D.

532-nanometer potassium titanyl phosphate (KTP) laser-induced expression of selective matrix metalloproteinases (MMP) in the rat larynx
Mallur, Pavan S; Branski, Ryan C; Amin, Milan R
2011 Feb;121(2):320-324, Laryngoscope
OBJECTIVE/HYPOTHESIS: The 532-nm KTP laser is clinically useful to induce benign vocal fold lesion regression without a fibrotic response. Previously, we described an in vivo model for KTP-induced injury in the rat larynx. This study uses this model to correlate the KTP-induced histologic and biochemical changes with the absence of long-term vocal fold fibrosis seen in clinical scenarios. STUDY DESIGN: In vivo. METHODS: Unilateral vocal fold injury was induced via KTP laser at 10W (20mS pulse width) as described by our laboratory previously. Animals were subjected to serial endoscopic imaging from postoperative days 1 through 3. Animals were euthanized at 1 day, 4 weeks, and 12 weeks posttreatment and subjected to histologic analyses via hematoxylin and eosin and trichrome staining, as well as RT-PCR analyses for MMP-3, 9, transforming growth factor-beta (TGF-beta), and COX-2 mRNA expression. Uninjured vocal folds were used as controls. RESULTS: Our study revealed gross healing of the vocal fold mucosa by 3 days posttreatment, and an immediate, moderate inflammatory infiltrate with no subsequent ultrastructural changes on histology. MMP-3 and COX-2 expression increased transiently, although no changes were seen in expression of MMP-9, an MMP involved in extracellular matrix remodeling, or TGF-beta, a profibrotic cytokine. CONCLUSIONS: These data suggest that the KTP laser induces a modest inflammatory response, selective MMP expression, and no long-term fibrotic processes in a clinically relevant simulation. Laryngoscope, 2011
— id: 122538, year: 2011, vol: 121, page: 320, stat: Journal Article,

Quantification of benign lesion regression as a function of 532-nm pulsed potassium titanyl phosphate laser parameter selection
Mallur, Pavan S; Tajudeen, Bobby A; Aaronson, Nicole; Branski, Ryan C; Amin, Milan R
2011 Mar;121(3):590-595, Laryngoscope
OBJECTIVES/HYPOTHESIS: Although the potassium titanyl phosphate (KTP) laser is versatile, the variability in laser parameters for laryngeal pathologies and the lack of clinical efficacy data remain problematic. We provide preliminary data regarding these parameters for benign lesion regression. In addition, we describe a novel method for the quantification of the effects of the KTP laser on vocal fold (VF) lesions. STUDY DESIGN: Retrospective chart review. METHODS: Images were captured from examinations before and after in-office KTP treatment in patients with a range of benign lesions. Laser settings were noted for each patient. Imaging software was then used to calculate a ratio of lesion area to VF length. Ten percent of images were requantified to determine inter-rater reliability. RESULTS: Thirty-two patients underwent 47 procedures for lesions including hemorrhagic polyp, nonhemorrhagic polyp, vocal process granuloma, Reinke's edema, cyst/pseudocyst, leukoplakia, and squamous cell carcinoma in situ. No statistically significant differences were observed with regard to the laser parameters used as a function of lesion type. Regardless, by 1 month following treatment, all lesions had significantly decreased in size, except nonhemorrhagic polyps. Similar data were obtained at 2-month follow-up. We then compared the pre-KTP lesion size with the smallest lesion size quantified during the 1-year follow-up period. All lesions were significantly smaller, with the exception of Reinke's edema. Inter-rater reliability was quite good. CONCLUSIONS: KTP laser effectively reduced VF lesion size, irrespective of the laser parameters used. In addition, our quantification method for lesion size appeared to be both viable and reliable. Laryngoscope, 2011
— id: 124097, year: 2011, vol: 121, page: 590, stat: Journal Article,

Idiopathic ulcerative laryngitis
Simpson, C Blake; Sulica, Lucian; Postma, Gregory N; Rosen, Clark A; Amin, Milan R; Merati, Albert L; Courey, Mark S; Patel, Vatsal; Johns, Michael M 3rd
2011 May;121(5):1023-1026, Laryngoscope
OBJECTIVES/HYPOTHESIS: Idiopathic ulcerative laryngitis (IUL) is a distinct, clinical entity that presents after a prolonged upper respiratory infection with cough. It is characterized by the development of bilateral ulcerations of the mid-membranous vocal folds followed by a protracted course of healing. The purpose of this review was to characterize the typical patient presentation, clinical findings, and prognosis. STUDY DESIGN: Multi-institutional retrospective review METHODS: Retrospective review of charts and videostroboscopic exams from patients with IUL at eight institutions. RESULTS: Fifteen cases met the criteria for IUL and were included in the study. The mean age of the patients was 49 years, and 93% were female. All patients were nonsmokers. Multiple medical interventions were employed by the treating otolaryngologist during the course of the disease, none of which resulted in acute resolution of the ulcerations. The average time from initial presentation to resolution of the disease was 3.3 months. All of the patients reported that their voice was improved after resolution of the disease process. However, in the majority of the patients (60%) there were persistent vibratory abnormalities after resolution of the ulcerations. CONCLUSIONS: This is the first multi-institutional study to define the complete disease course of IUL and to establish diagnostic criteria. IUL is a rare yet well-recognized clinical entity; however, there is no established etiology for this condition and no definitive treatments have emerged. Further study is needed to establish the etiology/risk factors of this condition and to determine optimal medical management
— id: 133302, year: 2011, vol: 121, page: 1023, stat: Journal Article,

Prostaglandin (PG)E(2) exhibits antifibrotic activity in vocal fold fibroblasts
Zhou, Hang; Felsen, Diane; Sandulache, Vlad C; Amin, Milan R; Kraus, Dennis H; Branski, Ryan C
2011 Jun;121(6):1261-1265, Laryngoscope
OBJECTIVES/HYPOTHESIS.: Prostaglandin (PG)E(2) has been implicated in a variety of disease processes. It has been described as antifibrotic in the lower airway, yet scar-inducing in the skin. We seek to describe the effects of PGE(2) on vocal fold fibroblasts and its interactions with transforming growth factor (TGF)-beta1. In addition, we describe a novel organotypic model, a critical step in the development of therapeutic trials. STUDY DESIGN.: In vitro, ex vivo. METHODS: Collagen secretion by human vocal fold fibroblasts (HVFF) was assayed in response to TGF-beta1, PGE(2) , and specific EP receptor agonists. Basal HVFF migratory rate was also quantified in response to PGE(2) . TGF-beta1 induced COX-2 mRNA expression/PGE(2) secretion was assayed. Excised vocal folds were subjected to exogenous IL-1beta; PGE(2) secretion into the supernatant was then assayed. RESULTS: TGF-beta1-induced collagen secretion was blunted in a dose-dependent manner in response to PGE(2) . This effect appears to be mediated primarily through the EP1 and EP2 receptors. TGF-beta1 induced COX-2 mRNA expression and PGE(2) secretion. In our organ culture model, IL-1beta stimulated PGE(2) secretion in a dose-dependent manner. CONCLUSIONS: PGE(2) is antifibrotic; this finding suggests that the upper airway response to this inflammatory mediator differs significantly from the lower airway. These data have important clinical implications for a variety of pathological processes. Furthermore, exogenous TGF-beta1 elicits induction of COX-2, suggesting inherent complexity regarding these processes and PGE(2) signaling, specifically. In addition, our organ culture model may prove useful as a means to quantify biological phenomena in the vocal folds
— id: 132882, year: 2011, vol: 121, page: 1261, stat: Journal Article,

Glucocorticoids regulate extracellular matrix metabolism in human vocal fold fibroblasts
Zhou, Hang; Sivasankar, Mahalakshmi; Kraus, Dennis H; Sandulache, Vlad C; Amin, Milan; Branski, Ryan C
2011 Sep;121(9):1915-1919, Laryngoscope
OBJECTIVES/HYPOTHESIS: Given the recent emergence of encouraging efficacy data regarding the utility of intralesional glucocorticoid (GC) injection for a variety of vocal fold pathologies, we sought to describe the location and expression pattern of the GC receptors within the vocal folds and quantify the effects of GCs on vocal fold fibroblasts. STUDY DESIGN: In vitro, in vivo. METHODS: Immunolocalization of the GC receptor was performed on normal rat vocal fold tissue. Receptor expression was also assayed in our human vocal fold fibroblast cell line. These cells were then treated with exogenous dexamethasone (DM) to quantify the effects of GCs on receptor expression, proliferation, transforming growth factor (TGF)-beta-induced collagen secretion, and matrix protease synthesis. RESULTS: Positive immunostaining for the GC receptor was found throughout the vocal fold with particularly strong staining in the epithelium and capillaries. Human vocal fold fibroblasts constitutively express the GC receptor, but this expression decreased in response to exogenous DM. DM also decreased fibroblast proliferation and TGF-beta-induced collagen synthesis. DM also abrogated TGF-beta-mediated effects on enzymes related extracellular matrix turnover. CONCLUSIONS: Our data are the first to provide mechanistic insight regarding the recently published favorable data regarding the utility of GCs in patients with vocal fold scar. Although further investigation is warranted, both the accessibility of this class of agents and the amenability to office-based procedures are likely to direct patient care models
— id: 140046, year: 2011, vol: 121, page: 1915, stat: Journal Article,

Cough and swallowing dysfunction
Amin, Milan R; Belafsky, Peter C
2010 Feb;43(1):35-42, viii, Otolaryngologic clinics of North America
The symptom of cough may result from a multitude of etiologies involving different parts of the aerodigestive tract. This article focuses on the association of cough and swallowing dysfunction in the sense that cough may be an indicator of swallow dysfunction and in the importance of cough in preventing aspiration and aspiration-related disorders. Whereas these associations have been known for a long time, research is starting to connect the dots, allowing targeting of strategies aimed at diagnosing and preventing illness in certain dysphagic patients
— id: 107779, year: 2010, vol: 43, page: 35, stat: Journal Article,

Collision Tumor of Primary Laryngeal Mucosal Melanoma and Invasive Squamous Cell Carcinoma with IL-17A and CD70 Gene Over-Expression
Sirikanjanapong, Sasis; Lanson, Biana; Amin, Milan; Martiniuk, Frank; Kamino, Hideko; Wang, Beverly Y
2010 Dec;4(4):295-299, Head & neck pathology
The most common primary malignancy of the larynx is the squamous cell carcinoma (SCC). The primary malignant melanoma is quite rare in this location. Less than 60 cases of laryngeal melanomas have been reported to date. To our knowledge, collision primary malignant melanoma and invasive squamous cell carcinoma in the vocal cords has not been reported. We report a 53-year-old male patient who was diagnosed with a collision tumor of laryngeal melanoma and invasive SCC. Multiple Th17 pathway related genes including CTLA-4, IL-17A-F, PLZF, FoxP3, RorgammaT, CD27, and CD70 were analyzed by reverse transcriptase-polymerase chain reaction (Rt-PCR) in this case. Both IL-17A and CD70 genes were detected in this case of collision tumor. The results may define useful biomarkers for early diagnosis of mucosal melanoma and open an immunotherapeutic field for clinical management with the potential benefit from the immunomodulators that enhance both genes
— id: 115268, year: 2010, vol: 4, page: 295, stat: Journal Article,

Post-intubation tracheal stenosis in a rehabilitation setting: A case report
Traeger Z.T.; Amin M.; Gold J.
2010 ;2(9 SUPPL 1):S144-S144, PM&R
Patients or Programs: A 15-year-old boy with multiple injuries after a bicycle accident. Program Description: The patient was admitted to an acute care hospital after a bicycle accident resulting in diffuse axonal injury with callosal tear and T10 vertebral fracture. He self extubated and required reintubation and later for right lower lobe pneumonia (PNA). He presented to rehabilitation (rehab) with waxing and waning alertness and decreased short-term memory. He required maximum assistance (A) for activities of daily living (ADL). He ambulated with minimal A with a widened base of support. Soon after admission, he became tachypneic and hypoxemic, was transferred to acute care and treated for PNA. During his second rehab stay, he had 2 days of worsening stridor, thought to be related to upgrading his diet with possible aspiration. A 3-cm subglottic narrowing was seen on neck CT and was considered secondary to trauma from intubation. He had a balloon dilation of the trachea but had continued stridor. He required tracheal reconstruction with subsequent prolonged bedrest with his chin sewn to his chest. He was later readmitted to rehab. His rehab course was greatly prolonged by medical problems and extended bedrest. Setting: Acute pediatric rehabilitation unit. Results: Upon discharge, he was modified independent (I) to I in his ADLs and ambulated with modified I. His higher executive functioning appeared to be normal but he continued to have difficulties with problem solving and math skills. Discussion: As with all rehab patients, close physiatric care is required to monitor for medical issues that arise during therapy. If a patient presents with dyspnea or stridor during therapy, a broad differential diagnosis should be suspected, including aspiration PNA, asthma exacerbation and tracheal stenosis. Tracheal stenosis is a potential postintubation complication and may be fatal if not recognized. This typically does not manifest until 4-6 weeks post injury; thus it may not be seen in an acute care setting. It is likely to be seen in acute rehabilitation and needs to be acted upon in that setting. Conclusions: Many rehab patients are admitted post intubation. Postintubation tracheal stenosis should be suspected in those who present with dyspnea, stridor or wheezing
— id: 135622, year: 2010, vol: 2, page: S144, stat: Journal Article,

SWALLOWING PHYSIOLOGY AFTER SKULL BASE TUMOR RESECTION
Lazarus, C; Roland, J; Golfinos, J; DeLacure, M; Amin, M; Lalwani, A
2009 DEC ;24(4):465-465, Dysphagia
— id: 107740, year: 2009, vol: 24, page: 465, stat: Journal Article,

A model for 532-nanometer pulsed potassium titanyl phosphate (KTP) laser-induced injury in the rat larynx
Mallur, Pavan S; Amin, Milan R; Saltman, Benjamin E; Branski, Ryan C
2009 Oct;119(10):2008-2013, Laryngoscope
OBJECTIVES/HYPOTHESIS: The potassium titanyl phosphate (KTP) laser is emerging as a potentially effective treatment for various vocal fold pathologies. To date, the precise mechanism(s) of action of this wavelength on the layered microarchitecture of the vocal fold remains unknown. The purpose of this study is to develop an in vivo model for the use of the KTP laser in the rat vocal fold and to characterize the potential of this model for future studies. STUDY DESIGN: In vivo survival surgery. METHODS: A model for videoendoscopic visualization and injury to the rat vocal fold was established using a microlaryngoscope and rigid telescope. Unilateral vocal fold injury was induced with the KTP laser at 10 Watts (W) 20 milliseconds (ms) pulse width. Animals were euthanized at 1 day post-treatment. Larynges were subjected to gross visual analysis and histological analyses via hematoxylin and eosin and trichrome staining. RESULTS: Consistent endoscopic visualization and injury was obtained without significant operative morbidity or mortality. The KTP laser caused superficial blanching and minor edema in the vocal fold, which resolved grossly by 24 hours postinjury. A modest inflammatory cell infiltrate was observed 1 day following injury. However, no remarkable alterations to the vocal fold microarchitecture were observed in the acute period. CONCLUSIONS: We propose that this novel model simulates the clinical scenario of laser use for the vocal folds. Use of this model will allow us to further characterize effects, mechanisms, and therapeutic efficacy of this wavelength
— id: 102932, year: 2009, vol: 119, page: 2008, stat: Journal Article,

Advances in Office-Based Diagnosis and Treatment in Laryngology
Rosen, CA; Amin, MR; Sulica, L; Simpson, CB; Merati, AL; Courey, MS; Johns, MM; Postma, GN
2009 NOV ;119(11):S185-S212, Laryngoscope
— id: 105371, year: 2009, vol: 119, page: S185, stat: Journal Article,

Transnasal esophagoscopy: a position statement from the American Bronchoesophagological Association (ABEA)
Amin, Milan R; Postma, Gregory N; Setzen, Michael; Koufman, Jamie A
2008 Apr;138(4):411-414, Otolaryngology, head & neck surgery
OBJECTIVE: To review and summarize the current literature on transnasal esophagoscopy, and to compare information with conventional esophagoscopy. DATA SOURCES: Medline (Ovid), book chapters. REVIEW METHODS: A thorough review of the literature using the Medline database was performed with the following search terms: esophagoscopy, transnasal esophagoscopy, ultrathin endoscopy, and esophagoscope. RESULTS: The literature seems to support the equivalence of transnasal esophagoscopy and conventional esophagoscopy in image quality and diagnostic capability. It also points to some potential advantages of transnasal esophagoscopy. CONCLUSIONS: Transnasal esophagoscopy is a useful tool for accurate diagnosis and can be used in a variety of office procedures
— id: 79157, year: 2008, vol: 138, page: 411, stat: Journal Article,

Pitch deviation analysis of pathological voice in connected speech
Laflen, J Brandon; Lazarus, Cathy L; Amin, Milan R
2008 Feb;117(2):90-97, Annals of otology rhinology & laryngology
OBJECTIVES: This study compares normal and pathologic voices using a novel voice analysis algorithm that examines pitch deviation during connected speech. The study evaluates the clinical potential of the algorithm as a mechanism to distinguish between normal and pathologic voices using connected speech. METHODS: Adult vocalizations from normal subjects and patients with known benign free-edge vocal fold lesions were analyzed. Recordings had been previously obtained in quiet under controlled conditions. Two phrases and sustained /a/ were recorded per subject. The subject populations consisted of 10 normal and 31 abnormal subjects. The voice analysis algorithm generated 2-dimensional patterns that represent pitch deviation in time and under variable window widths. Measures were collected from these patterns for window widths between 10 and 250 ms. For comparison, jitter and shimmer measures were collected from sustained /a/ by means of the Computerized Speech Lab (CSL). A t-test and tests of sensitivity and specificity assessed discrimination between normal and abnormal populations. RESULTS: More than 58% of the measures collected from connected speech outperformed the CSL jitter and shimmer measures in population discrimination. Twenty-five percent of the experimental measures (including /a/) indicated significantly different populations (p < .01%). CONCLUSIONS: The results demonstrate that the algorithm distinguishes between normal and abnormal populations by use of samples of connected speech
— id: 78366, year: 2008, vol: 117, page: 90, stat: Journal Article,

Physiology of swallowing
Amin, Milan R; Gupta, Reena
Textbook of laryngology San Diego CA: Plural Pub, 2007,
— id: 5184, year: 2007, vol: , page: ?, stat: Chapter,

Hands-on training methods for vocal fold injection education
Amin, Milan; Rosen, Clark A; Simpson, C Blake; Postma, Gregory N
2007 Jan;116(1):1-6, Annals of otology rhinology & laryngology
OBJECTIVES: Vocal fold injection (VFI) in the office setting and in the operating room is becoming increasingly popular. Most training programs fail to educate residents in performing these injections. In this report, we describe novel and effective teaching tools that provide real-life simulation of VFI for the education of residents and otolaryngologists in practice. METHODS: Equipment was developed to allow the use of excised fresh cadaver larynges to simulate peroral VFI in a life-sized model of the human head and neck. A separate setup was also developed for use of a laryngoscope holder and cadaver larynges to simulate microlaryngoscopy VFI. Each of these VFI training setups allows the student to perform and practice VFI in a simulated setting with physical and anatomic constraints and laryngeal anatomy similar to those of real-life VFI. The use of fresh cadaver larynges allows the user to have a realistic feel of actual injection. A visual analog scale was used to measure the participants' comfort levels with the peroral and microlaryngoscopic injection techniques before and after the workshop. RESULTS: Pre-workshop and post-workshop surveys were collected from 22 of the VFI course participants. The mean comfort levels for VFI prior to the workshop were 22 for peroral VFI and 69 for microlaryngoscopy VFI (0 = not comfortable at all and 100 = very comfortable). The post-workshop comfort levels were 52 for peroral VFI and 85 for microlaryngoscopy VFI. The differences in the pre- and post-workshop comfort level scores for each VFI technique were significant (microlaryngoscopy, p = .001; peroral, p < .0001). CONCLUSIONS: The use of VFI simulations appears to improve surgeon comfort level with injection techniques. The described training simulations may be useful for allowing residents and practicing otolaryngologists to learn VFI before attempting these techniques on actual patients
— id: 71150, year: 2007, vol: 116, page: 1, stat: Journal Article,

Unsedated flexible fiberoptic bronchoscopy in the resident clinic: technique and patient satisfaction
Morris, Luc G; Zeitler, Daniel M; Amin, Milan R
2007 Jul;117(7):1159-1162, Laryngoscope
— id: 73305, year: 2007, vol: 117, page: 1159, stat: Journal Article,

Monitoring tracheal tube cuff pressures in the intensive care unit: a comparison of digital palpation and manometry
Morris, Luc G; Zoumalan, Richard A; Roccaforte, J David; Amin, Milan R
2007 Sep;116(9):639-642, Annals of otology rhinology & laryngology
OBJECTIVES: Tracheal tube cuff overinflation is a recognized risk factor for tracheal injury and stenosis. International studies report a 55% to 62% incidence of cuff overinflation among intensive care unit (ICU) patients. However, there are no data on tracheotomy tubes, and no recent data from ICUs in the United States. It is unknown whether routine cuff pressure measurement is beneficial. We sought to determine the incidence of cuff overinflation in the contemporary American ICU. METHODS: We performed an Institutional Review Board-approved, prospective, observational study of endotracheal and tracheotomy tubes at 2 tertiary-care academic hospitals that monitor cuff pressure differently. At hospital A, cuff pressures are assessed by palpation; at hospital B, cuff pressures are measured via manometry. We audited cuff pressures in an unannounced fashion at these hospitals, using a handheld aneroid manometer. Cuffs were considered overinflated above 25 cm H2O. RESULTS: We enrolled 115 patients: 63 at hospital A and 52 at hospital B. Overall, 44 patients (38%) were found to have overinflated cuffs. The incidence of overinflation was identical at the 2 hospitals (38%; p = .99). Of the endotracheal tubes, 43% were overinflated, as were 32% of the tracheotomy tubes (p = .24). CONCLUSIONS: Despite increasing awareness among intensivists and respiratory therapists, the incidence of tracheal tube overinflation remains high, with both endotracheal and tracheotomy tubes. Our finding that the use of manometry to assess cuff pressures did not reduce the incidence of overinflation suggests that a more vigilant management protocol may be necessary
— id: 74467, year: 2007, vol: 116, page: 639, stat: Journal Article,

The thyrohyoid approach to in-office injection augmentation of the vocal fold
Zeitler, Daniel M; Amin, Milan R
2007 Dec;15(6):412-416, Current opinion in otolaryngology & head & neck surgery
PURPOSE OF REVIEW: The purpose of this article is to review the history of vocal fold injection augmentation and provide a thorough description of the percutaneous thyrohyoid approach to office-based vocal fold injection augmentation for the management of glottic incompetence. RECENT FINDINGS: A number of techniques for vocal fold injection augmentation have been developed since the first procedure was performed. Since vocal fold injection augmentation is performed without an open surgical approach, morbidity is reduced and the technique can be done in the outpatient setting. Accordingly, over the past decade there has been an effort to perfect techniques and to develop new materials and methods to make the procedure more effective and comfortable for the patient. SUMMARY: Recently, office-based vocal fold injection augmentation has gained significant popularity among laryngologists. While there are a variety of in-office injection techniques, the thyrohyoid approach, in the authors' opinion, is the simplest and best tolerated. This technique is effective and eliminates many of the shortcomings of the other approaches. This approach continues to be the 'workhorse' for in-office vocal fold injection augmentation in the senior author's practice. It is important, however, for any practitioner to be familiar with the other approaches, as this technique is not universally effective for all patients
— id: 93862, year: 2007, vol: 15, page: 412, stat: Journal Article,

Adult with dysphagia volume 35, number 6
Amin MR
2006 ;35(6):1-16, AAO-HNSF Patient of the Month Program
— id: 74439, year: 2006, vol: 35, page: 1, stat: Journal Article,

Thyrohyoid approach for vocal fold augmentation
Amin, Milan R
2006 Sep;115(9):699-702, Annals of otology rhinology & laryngology
OBJECTIVES: I performed a retrospective chart review to evaluate the patient tolerance and clinical results of a new technique for office-based vocal fold augmentation. METHODS: Ten patients undergoing the thyrohyoid approach for vocal fold augmentation were asked to rate their tolerance of the procedure using a 10-point rating scale (1 = 'no problem' and 10 = 'very uncomfortable'). The patients also filled out a quality-of-life survey (Voice Handicap Index-10) immediately before and 1 month after the procedure. I reviewed the preprocedure and postprocedure stroboscopic findings. The findings analyzed included changes in wave symmetry and glottal closure, and evidence of implant migration. RESULTS: All patients successfully underwent the procedure. The mean patient tolerance score was found to be 2.1. The average score on the Voice Handicap Index-10 improved from 21.3 before the procedure (SD, 9.23) to 7.5 after the procedure (SD, 5.77). These values were compared by use of a paired t-test, and the difference was found to be significant, with a p value of .01. The analysis of stroboscopic results revealed 'improvement' or 'no change' in the wave symmetry, 'improvement' in glottal closure, and 'no evidence of migration' after the procedure in all cases. CONCLUSIONS: The study findings demonstrate that the thyrohyoid approach can be used successfully in patients who need vocal fold augmentation, and that it is generally well tolerated
— id: 69086, year: 2006, vol: 115, page: 699, stat: Journal Article,

Sensory testing in the assessment of laryngeal sensation in patients with amyotrophic lateral sclerosis
Amin, Milan R; Harris, Donna; Cassel, Stacy Gallese; Grimes, Eric; Heiman-Patterson, Terry
2006 Jul;115(7):528-534, Annals of otology rhinology & laryngology
OBJECTIVES: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease of unknown cause. Mortality in the population is frequently due to aspiration pneumonia. Although typically considered to be a disorder limited to motor neuron involvement, some investigators have indicated that decreased sensory function in ALS patients additionally contributes to the disease process. The objective of this study was to evaluate laryngopharyngeal sensation in the ALS population in order to quantify the range of sensory deficits and correlate any abnormalities with demographic data to determine which patients are at risk of having sensory deficits. METHODS: We examined the sensation of the larynx in 22 patients with ALS to determine whether a sensory deficit was present. After completion of a dysphagia questionnaire and medical history, patients underwent flexible endoscopic evaluation of swallowing with sensory testing (FEESST) to evaluate sensory function. Threshold values were determined and recorded for initiation of the adductor reflex. RESULTS: The results of the sensory and swallowing function assessments performed on 22 patients demonstrate abnormal sensation in 54.5% of the tested population. Asymmetric findings were noted in 75% of these patients. There was no correlation noted between the presence of sensory deficits and the severity or duration of the disease. CONCLUSIONS: Progressive dysphagia in the ALS population has typically been attributed to muscle weakness. This study points to the presence of sensory deficits in the larynx, which can further affect proper swallowing function
— id: 93864, year: 2006, vol: 115, page: 528, stat: Journal Article,

Using windowed relative deviation to detect possible voice pathology
Laflen, J Brandon; Lazarus, Cathy L; Amin, Milan R
2006 ;1:3755-3758, Conference Proceedings (IEEE Engineering in Medicine & Biology Society)
A diagnostic method is presented that provides for analyzing pitch 'jitter' in running speech. 'Jitter' is typically measured with explicit voice tasks, namely sustained vowel phonation. However, some voice pathologies cannot be detected with sustained phonation. Further, it is not possible to ensure explicit voice productions from certain patients, including pediatric populations. In contrast, windowed relative deviation reports instantaneous pitch 'jitter' as well as the overall 'jitter' statistic commonly reported. Also, the width of the analysis window is related to the rate of pitch deviation, which provides a unique form of selectivity. Voice productions from a normal adult speaker and from an adult speaker with a known voice pathology were analyzed with this method. Voice productions from the normal speaker exhibited less than 1% pitch deviation during phonetic portions of the signal that were akin to sustained phonation. On the other hand, the speaker with a known pathology exhibited greater than 10% pitch deviation at quasi-periodic intervals within sustained phonation
— id: 93863, year: 2006, vol: 1, page: 3755, stat: Journal Article,

Endoscopic evaluation of the upper aerodigestive tract
Postma, Gregory N; Belafsky, Peter C; Amin, Milan R; Halum, Stacey L; Koufman, Jamie A
Head & neck surgery -- otolaryngology Philadelphia PA : Lippincott Williams & Wilkins, 2006,
— id: 5181, year: 2006, vol: , page: ?, stat: Chapter,

Chronic cough: state-of-the-art review
Simpson, C Blake; Amin, Milan R
2006 Apr;134(4):693-700, Otolaryngology, head & neck surgery
Cough is the most common presenting complaint in adults seeking medical treatment in an ambulatory setting. Chronic cough (persisting greater than 3 weeks) can be associated with myriad diseases that may overlap multiple medical specialties. For this reason, a thorough assessment of the patient with chronic cough relies on a multidisciplinary approach and close cooperation between pulmonary medicine, gastroenterology, and otolaryngology. Despite this daunting task, success can be achieved in up to 90% of patients with chronic cough if a systematic and thorough approach is used. The purpose of this review is to summarize the state-of-the-art in the diagnosis and treatment of chronic cough for the practicing otolaryngologist
— id: 93865, year: 2006, vol: 134, page: 693, stat: Journal Article,

Evaluation of middle and distal esophageal diverticuli with transnasal esophagoscopy
Kumar, Veena V; Amin, Milan R
2005 Apr;114(4):276-278, Annals of otology rhinology & laryngology
To emphasize the utility of office-based transnasal esophagoscopy (TNE) in the evaluation of patients with swallowing complaints, we present 2 case reports and a review of the literature. The 2 patients both presented with complaints of chronic dysphagia, globus sensation, and a sensation of 'food sticking' with swallowing. The patients were counseled to undergo esophagoscopy. Informed consent was obtained. The nasal cavities and pharynx were anesthetized with topical 4% lidocaine hydrochloride solution. Transnasal esophagoscopy was performed. The procedure was well tolerated by the patients. Esophagoscopy revealed diverticuli in various segments of the esophagus, including the midesophageal and distal areas. The cause of the patients' complaints could be well attributed to the endoscopic findings. No morbidity was associated with the TNE examination. A review of the literature concerning office-based TNE was performed. We found no published reports of middle or distal esophageal diverticuli detected on routine office TNE. We conclude that transnasal esophagoscopy is a relatively safe and efficient tool that can be used in the office setting for evaluation of swallowing complaints
— id: 56261, year: 2005, vol: 114, page: 276, stat: Journal Article,

Office evaluation of swallowing
Amin, Milan R; Postma, Gregory N
2004 Jul;83(7 Suppl 2):13-16, Ear, nose & throat journal
— id: 56263, year: 2004, vol: 83, page: 13, stat: Journal Article,

Office evaluation of the tracheobronchial tree
Amin, Milan R; Simpson, C Blake
2004 Jul;83(7 Suppl 2):10-12, Ear, nose & throat journal
— id: 56264, year: 2004, vol: 83, page: 10, stat: Journal Article,

Office procedures for the esophagus
Postma, Gregory N; Amin, Milan R; Simpson, C Blake; Belafsky, Peter C
2004 Jul;83(7 Suppl 2):17-21, Ear, nose & throat journal
— id: 56262, year: 2004, vol: 83, page: 17, stat: Journal Article,

Office-based procedures for the voice
Simpson, C Blake; Amin, Milan R
2004 Jul;83(7 Suppl 2):6-9, Ear, nose & throat journal
— id: 56265, year: 2004, vol: 83, page: 6, stat: Journal Article,

Topical anesthesia of the airway and esophagus
Simpson, C Blake; Amin, Milan R; Postma, Gregory N
2004 Jul;83(7 Suppl 2):2-5, Ear, nose & throat journal
— id: 56266, year: 2004, vol: 83, page: 2, stat: Journal Article,

Cough and paradoxical vocal fold motion
Altman, Kenneth W; Simpson, C Blake; Amin, Milan R; Abaza, Mona; Balkissoon, Ron; Casiano, Roy R
2002 Dec;127(6):501-511, Otolaryngology, head & neck surgery
OBJECTIVES: The differential diagnosis and treatment of patients with chronic cough, paradoxical vocal fold motion, and disordered breathing can be a challenge to most practicing otolaryngologists. Tracheobronchial (ie, asthma, bronchitis, and tracheal stenosis), laryngeal (ie, vocal fold paralysis and neoplasms), and rhinologic (ie, allergies and rhinosinusitis) etiologies are commonly diagnosed and treated effectively. However, occasionally one is faced with patients who are refractory to medical treatment and have no obvious rhinologic, laryngeal or pulmonary cause. STUDY DESIGN AND SETTING: We conducted a review of the literature. METHODS: We present a thorough review of the current medical literature exploring the complex neurologic mechanisms involved in the production of cough and the relationship between gastroesophageal reflux disease, vagal neurapathy, and paradoxical vocal fold motion. RESULTS: The diagnosis and successful treatment of chronic cough can be complex. It requires a thorough understanding of the neurologic mechanisms behind cough excitation and suppression. Successful treatment strategies include aggressive management of the patient's reactive airway disease, gastroesophageal reflux disease, and, in select cases, paradoxical vocal fold motion. This may involve a well-coordinated effort among pulmonologists, otolaryngologists, gastroenterologists, and speech pathologists. CONCLUSION: Gastroesophageal reflux disease, vagal neuropathy, and paradoxical vocal fold motion are additional causes of chronic cough and disordered breathing that need to be considered, in the absence of obvious laryngotracheal and/or rhinologic pathology. A high index of suspicion is essential in making the diagnosis and formulating an effective multidisciplinary treatment plan for these patients
— id: 56267, year: 2002, vol: 127, page: 501, stat: Journal Article,

Laryngopharyngeal reflux
Amin, Milan R; Koufman, James A
Alexandria VA : American Academy of Otolaryngology-Head and Neck Surgery, 2002,
— id: 1915, year: 2002, vol: , page: , stat: ,

Symptoms and findings of laryngopharyngeal reflux
Belafsky, Peter C; Postma, Gregory N; Amin, Milan R; Koufman, James A
2002 Sep;81(9 Suppl 2):10-13, Ear, nose & throat journal
Even though the symptoms and findings of laryngopharyngeal reflux (LPR) have been described, the clinical diagnosis is sometimes elusive. Symptoms can occur in the absence of conclusive laryngeal physical findings, and they can be nonspecific. For example, dysphonia can be caused not only by LPR, but also by neoplasia and by geriatric, neurologic, and behavioral disorders. The clinician must realize that the diagnosis of LPR is based on a combination of factors, including symptoms, laryngeal findings, and diagnostic test results
— id: 56268, year: 2002, vol: 81, page: 10, stat: Journal Article,

Predicting outcome in pediatric coin ingestion
Amin MR; Buchinsky FJ; Gaughan JP; Szeremeta W
2001 Jul 2;59(3):201-206, International journal of pediatric otorhinolaryngology
OBJECTIVE: To determine the relationship between coin size, coin location, patient age, and patient weight and likelihood of coin passage through the esophagus following pediatric coin ingestion. A secondary objective is to test the hypothesis that coin denomination can be determined based on radiographic appearance. METHODS: A retrospective review was performed of all children seen and evaluated for coin ingestion at a single institution over a 25-month period. Outcome measures included the number of coins that were retained in the esophagus, and the number that passed. Various factors were assessed for their predictive value in judging outcome in coin ingestion cases. RESULTS: Nineteen percent of patients (15/79) in the study passed their ingested coins. Coin denomination could be accurately determined on every patient that had a standard AP or lateral X-ray film. These findings were marked when compared with the lack of reliability of history in determining coin denomination. Patients who passed coins were as a group older (4.6 vs. 3.2 year, P=0.04), but did not differ significantly by weight (19.5 vs. 15.4 kg, P=0.07) from those that retained the coins. Coins located at the gastroesophageal junction had a significantly higher passage rate than coins located elsewhere in the esophagus (89 vs. 8.2%, P<0.01). Coin size was not predictive of coin passage (P=0.7 by chi(2)). CONCLUSIONS: Radiographic assessment of coin denomination is reliable, but in this study could not be used to predict coin passage. Patient age and coin location at the gastroesophageal junction, however, do correlate with this event
— id: 56272, year: 2001, vol: 59, page: 201, stat: Journal Article,

Endoscopic arytenoid repositioning for unilateral arytenoid fixation
Amin MR; Koufman JA
2001 Jan;111(1):44-47, Laryngoscope
OBJECTIVES: To describe a new endoscopic technique for medialization of the laterally fixed arytenoid. The surgical technique, endoscopic arytenoid repositioning, is described, and the results of a series of cases are discussed. STUDY DESIGN: Retrospective chart review. METHODS: Eight patients underwent the procedure. Six patients were available for long-term follow-up. Preoperative and postoperative voice ratings were compared to evaluate the success of the procedure. Follow-up ranged from 3 to 64 months (mean follow-up, 31.5 mo). RESULTS: Long-term follow-up in six cases revealed that 67% (4 of 6) patients had normal or near-normal postoperative voices and one patient experienced moderate improvement. The mean preoperative voice score was 4.24, and the mean postoperative voice score was 1.83 (range, 1-5). The difference was statistically significant (P < 0.001). CONCLUSIONS: Endoscopic arytenoid repositioning is a newly described procedure with a very specific indication: a unilateral, laterally fixed arytenoid complex resulting in a severely dysphonic voice. Though technically demanding, this procedure provides a promising option for medialization of the posterior glottis in a scarred larynx
— id: 56274, year: 2001, vol: 111, page: 44, stat: Journal Article,

Hemicricoidectomy for voice rehabilitation following hemilaryngectomy with ipsilateral arytenoid removal
Amin MR; Koufman JA
2001 Jun;110(6):514-518, Annals of otology rhinology & laryngology
The purpose of this article is to describe an approach to reconstruction of the larynx after vertical partial laryngectomy with removal of the ipsilateral arytenoid cartilage. This method addresses the problem of postoperative posterior glottal incompetence (aphonia with or without aspiration). The technique involves resection of the ipsilateral half of the cricoid cartilage, use of an inferiorly based strap muscle flap for vocal fold reconstruction, and placement of a customized stent. This technique may be used at the time of the primary cancer extirpation or as a secondary rehabilitative procedure. Generally, patients who have undergone this procedure have had minimal postoperative breathiness with good phonatory and airway function. We recommend this reconstructive technique for patients with large posterior defects following hemilaryngectomy
— id: 56271, year: 2001, vol: 110, page: 514, stat: Journal Article,

Vagal neuropathy after upper respiratory infection: a viral etiology?
Amin MR; Koufman JA
2001 Jul-Aug;22(4):251-256, American journal of otolaryngology
PURPOSE: To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. Patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction. This so-called postviral vagal neuropathy (PVVN) appears to have similarities with other postviral neuropathic disorders, such as glossopharyngeal neuralgia and Bell's palsy. MATERIALS AND METHODS: Five patients were identified with PVVN. Each patient's chart was reviewed, and elements of the history were recorded. RESULTS: Each of the 5 patients showed different features of PVVN. CONCLUSIONS: Respiratory infection can trigger or cause vocal fold paresis, laryngopharyngeal reflux, and neuropathic pain
— id: 56270, year: 2001, vol: 22, page: 251, stat: Journal Article,

Proton pump inhibitor resistance in the treatment of laryngopharyngeal reflux
Amin MR; Postma GN; Johnson P; Digges N; Koufman JA
2001 Oct;125(4):374-378, Otolaryngology, head & neck surgery
OBJECTIVE: To describe the occurrence of relative proton pump inhibitor (PPI) drug resistance in the treatment of laryngopharyngeal reflux (LPR). STUDY DESIGN AND SETTING: A retrospective review was performed for 1053 consecutive adults undergoing double-probe (simultaneous esophageal and pharyngeal) pH testing in our laboratory. Two hundred five patients who had pH studies performed while taking at least a daily dose of PPI therapy were identified; 167 qualified for further analysis. The pH data was reviewed for the presence of abnormalities in either esophageal or pharyngeal acid exposure to evaluate drug efficacy. RESULTS: Forty-four percent (74/167) of the study patients demonstrated abnormal levels of acid exposure. Results were further analyzed to compare failure rates based on different dosage regimens. Patients on once daily doses of PPI failed at a rate of 56%, with lower failure rates for higher-dose regimens. CONCLUSIONS: A significant number of LPR patients on PPI therapy demonstrate relative drug resistance
— id: 56269, year: 2001, vol: 125, page: 374, stat: Journal Article,

Diagnostic laryngeal electromyography: The Wake Forest experience 1995-1999
Koufman JA; Postma GN; Whang CS; Rees CJ; Amin MR; Belafsky PC; Johnson PE; Connolly KM; Walker FO
2001 Jun;124(6):603-606, Otolaryngology, head & neck surgery
BACKGROUND: Laryngeal electromyography (LEMG) is a valuable diagnostic/prognostic test for patients with suspected laryngeal neuromuscular disorders. OBJECTIVE: To report our experience with diagnostic LEMG at the Center for Voice Disorders of Wake Forest University and to evaluate the impact of LEMG on clinical management. METHODS: Retrospective chart review of 415 patients who underwent diagnostic LEMG over a 5-year period (1995-1999). RESULTS: Of 415 studies, 83% (346 of 415) were abnormal, indicating a neuropathic process. LEMG results altered the diagnostic evaluation (eg, the type of radiographic imaging) in 11% (46 of 415) of the patients. Unexpected LEMG findings (eg, contralateral neuropathy) were found in 26% (107 of 415) of the patients, and LEMG results differentiated vocal fold paralysis from fixation in 12% (49 of 415). Finally, LEMG results altered the clinical management (eg, changed the timing and/or type of surgical procedure) in 40% (166 of 415) of the patients. CONCLUSIONS: LEMG is a valuable diagnostic test that aids the clinician in the diagnosis and management of laryngeal neuromuscular disorders
— id: 56273, year: 2001, vol: 124, page: 603, stat: Journal Article,

Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders
Koufman JA; Amin MR; Panetti M
2000 Oct;123(4):385-388, Otolaryngology, head & neck surgery
OBJECTIVES: The goal was to estimate the prevalence of laryngopharyngeal reflux (LPR) in patients with laryngeal and voice disorders. STUDY DESIGN AND SETTING: This was a prospective study of 113 unselected, new patients with laryngeal and voice disorders. Patients completed an extensive medical history form including a reflux symptom profile. A comprehensive otolaryngologic examination was performed with photographic transnasal fiberoptic laryngoscopy. Patients with both symptoms and findings of LPR (78/133, 69%) underwent ambulatory 24-hour double-probe pH monitoring. RESULTS: Seventy-three percent (57/78) of patients undergoing pH testing had abnormal studies. Thus 50% (57/113) of the entire the study population had pH-documented reflux. Of the diagnostic sub-groups studied, the highest incidence of reflux was found in patients with vocal cord neoplastic lesions (88%) and patients with muscle tension dysphonias (70%). LPR was infrequently found in patients with neuromuscular disorders. CONCLUSION: LPR occurs in at least 50% of all patients at our center with laryngeal and voice disorders at presentation
— id: 56275, year: 2000, vol: 123, page: 385, stat: Journal Article,

Straight midline mandibulotomy revisited
Amin MR; Deschler DG; Hayden RE
1999 Sep;109(9):1402-1405, Laryngoscope
OBJECTIVE: Describe recent experience with a simplified modification of the traditional mandibulotomy approach. STUDY DESIGN: Retrospective chart review. METHODS: Charts were reviewed retrospectively for 17 consecutive patients who underwent this approach over a 3-year period as a part of treatment for oral and oropharyngeal malignancies. RESULTS: No cases of bony nonunion, plate exposure, or other complications related to the mandibulotomy occurred in the postoperative phase. CONCLUSIONS: The modified straight midline mandibulotomy approach is simple and provides safe access for the treatment of oral and oropharyngeal tumors while minimizing postoperative morbidity
— id: 56276, year: 1999, vol: 109, page: 1402, stat: Journal Article,

State-dependent laryngomalacia
Amin MR; Isaacson G
1997 Nov;106(11):887-890, Annals of otology rhinology & laryngology
We have observed 5 infants who demonstrate normal breathing when awake, but develop stridor while asleep. Flexible laryngoscopy in the awake state reveals either a normal larynx or redundancy of the aryepiglottic folds or arytenoid soft tissue without prolapse into the laryngeal inlet. When these children are sedated, however, the classic signs of laryngomalacia appear. Wet inspiratory stridor with concomitant supraglottic prolapse can be demonstrated by flexible videolaryngoscopy in this state. As these findings vary with level of consciousness, we have dubbed this condition 'state-dependent' laryngomalacia. We believe the appearance and disappearance of classic laryngomalacia with changes in level of consciousness adds credence to the neurogenic theory of laryngomalacia
— id: 56277, year: 1997, vol: 106, page: 887, stat: Journal Article,