HSC Section 6 Nov2016 Green Book

Otolaryngology–Head and Neck Surgery 151(2)

Table 3. Presentation Time for 92 Patients Referred to the WUSM. a

Fraction of Original Total (%)

Outside ENT Presentation, Median, mo

WUSM ENT Presentation, Median, mo Difference

Range in Difference

Etiology

n

Carotid surgery

4 5 5 3 5 4 4 4

4/22 (18.2) 5/48 (10.4) 5/61 (8.2) 3/18 (16.7) 5/73 (6.8) 4/58 (6.9) 4/20 (20.0) 4/14 (28.6) 17/140 (12.1) 21/124 (16.9)

1.8 3.0 4.0 3.0 1.5 2.0 2.5 1.5 2.1 3.0 2.0 2.5

8.5 7.0

6.7 4.0

2-178

Cervical spine surgery Lateral neck surgery Parathyroid surgery

0.5-43

15.0

11.0

2-116

8.0

5.0

5-49

Thyroid surgery

17

12.0 92.0

10.5 90.0

0.5-111

Lung surgery

1-104

Cardiac surgery Laryngeal cancer Thyroid cancer

6.5 4.5 6.0

4.0 3.0 3.9 9.0 1.8

2-5 3-7

1.75-19 0.5-51

Idiopathic Intubation

21

12.0

4 4

4/58 (6.9) 4/18 (22.2)

3.8

1-3

CVA

14.0

11.5

3-150

Total b

92

92/938 (9.8)

2.1

9.5

7.4

0.5-563

Abbreviations: ENT, ear, nose, and throat; WUSM, Washington University School of Medicine. a Excludes etiologies with less than 3 patients. b Includes 12 outside referral patients not listed above.

Figure 3. Histogram and cumulative plot from Figure 2 , focusing on the first 4 months after symptom onset. WUSM, Washington University School of Medicine.

Figure 2. Histogram and cumulative plot of time from unilateral vocal fold paralysis symptom onset to presentation to the Washington University School of Medicine (WUSM; open bars) or to outside otolaryngologist prior to referral to the WUSM (solid bars; 9.8% of cases). Data shown for first 3 years following onset.

sided carotid endarterectomies more technically diffi- cult for right-handed surgeons. 25 Intubation . More people in general are right-handed; there may be some greater tendency for right- handed anesthetists to traumatize the left hemilarynx more than the right during intubation. The mechan- ism of UVFP with intubation is not known but may relate to an acute event (at the time of intubation) or a longer-term event (while the tube is in place) that may be related to the cuff pressure or tube position- ing. Some postintubation vocal fold immobility may

Carotid endarterectomy . Stroke and death rates in caro- tid endarterectomy have been shown to be higher for left-sided vs right-sided surgeries. Explanations for this observation include that due to the dominance of the left cerebral hemisphere, left-sided events are more symptomatic than right-sided events, and there- fore more surgeries occur on the left side. There also may be a role in surgeon handedness, making left-

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