Nancy Jiang, MD

All Publications

• In Response to Utilization of Artificial Intelligence in the Creation of Patient Information on Laryngology Topics. The Laryngoscope Tran, Q. L., Huynh, P. P., Le, B., Jiang, N. 2025

  View details for DOI 10.1002/lary.32035

  View details for PubMedID 39931950

• Differences in Patient Secure Message Volume Among Otolaryngologists: A Retrospective Cohort Study. The Annals of otology, rhinology, and laryngology Hoerter, J. E., Debbaneh, P. M., Jiang, N. 2024; 133 (10): 857-866

  Abstract

  To identify differences in inbox and secure message burden among otolaryngologists based on demographics and subspecialty over 4 years.Inbox data were queried from January 2019 until December 2022. Otolaryngologists were categorized into cohorts by area of practice and gender. All inbox tasks, secure messages, and clinical encounters were collected and compared by gender, practice type, and years in practice. Means were compared using t-tests and chi-squared tests.Of the 128 physicians, 45.7% were comprehensive otolaryngologists and 61.3% were male. The most common subspecialties were facial plastics (15.6%), oncology (8.6%), and otology (7.8%). Otolaryngologists had an average of 143.5 inbox tasks per month, with 97.2 (67.7%) of them being secure messages, resulting in an average of 1.14 inbox tasks and 0.80 secure messages per clinical encounter. The ratio of secure messages per clinical encounter was consistent across all specialties except oncology (1.10, P = .003). Otology (0.86, P = .032) and facial plastics (0.95, P = .028) had significantly lower ratios of inbox tasks to clinical encounters when compared to their colleagues, while oncology had a higher ratio (1.70, P < .001). No significant differences in inbox burden were observed between genders, years in practice, or languages spoken. Secure messages steadily increased over the study period.Inbox burden for otolaryngologists primarily stems from patient secure messages and varies across subspecialties. Considerations should be made to the inbox burden of head and neck oncologists. The implementation of support systems for inbox management could improve the imbalance between clinical and non-clinical responsibilities in otolaryngology.Level III, Retrospective Cohort Study.

  View details for DOI 10.1177/00034894241264114

  View details for PubMedID 39054802

• A Comparison of In-Person and Telemedicine Triage in Otolaryngology Hoerter , J., Debbaneh , P., Liu , K., Shah , S., Weintraub , M., Jiang , N. Perm J. . 2024 31-37
• Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. The Laryngoscope Saba, E. S., Kim, H., Huynh, P., Jiang, N. 2024; 134 (1): 480-495

  Abstract

  Orofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue placement and increase oropharyngeal tone. The objective of this systematic review and meta-analysis is to determine the efficacy of OMT in OSA patients.PubMed/Medline, EMBASE, Cochrane, Web of Science.Using PRISMA guidelines, a directed search strategy was performed for randomized control trials (RCTs) published prior to March 24, 2023, featuring 10+ patients with OSA undergoing mono-therapeutic OMT. The primary outcome of interest was apnea-hypopnea index (AHI). Secondary outcomes included subjective sleepiness, sleep-related quality-of-life, and snoring frequency.Of the 1244 abstracts that were identified, 7 RCTs involving 310 patients met inclusion criteria. Adult OMT patients had a statistically significant improvement in AHI (MD -10.2; 95% CI, -15.6, -4.8, p < 0.05), subjective sleepiness (Epworth Sleepiness Scale; MD -5.66; 95% CI, -6.82, -4.5, p < 0.05), sleep-related quality-of-life (Pittsburgh Sleep Quality Index; MD -3.00; 95% CI, -4.52, -1.49, p < 0.05), and minimum oxygen saturation (MD 2.71; 95% CI, 0.23, 5.18, p < 0.05) when compared with sham OMT or no therapy. Within the single RCT featuring pediatric OMT patients, patients had poor compliance (<50%) and did not show any improvements in AHI, minimum oxygen saturation, or snoring frequency.OMT may provide a reasonable alternative for OSA patients who cannot tolerate CPAP or other more established treatment options. OMT benefits appear limited in children due to poor compliance. More studies are required to evaluate compliance and the long-term effects of OMT on OSA outcomes.1 Laryngoscope, 134:480-495, 2024.

  View details for DOI 10.1002/lary.30974

  View details for PubMedID 37606313

• In response to Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis Saba , E., Kim , H., Huynh , P., Jiang , N. Laryngoscope. 2024
• Evaluating Artificial Intelligence (AI)-Generated Patient Information on Laryngology Topics Tran , Q., Huynh , P., Le, B., Jiang , N. Laryngoscope. 2024
• Steroid Efficacy on Audiologic Recovery in Patients With Sudden Sensorineural Hearing Loss and Vestibular Schwannoma: A Retrospective Review. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Huynh, P. P., Saba, E. S., Hoerter, J. E., Jiang, N. 2023; 44 (8): 780-785

  Abstract

  The objectives of this study are to (i) estimate the incidence of vestibular schwannoma (VS) among patients in an integrated healthcare system who present for evaluation of sudden sensorineural hearing loss (SSNHL) and (ii) evaluate the efficacy of empiric steroid therapy on audiologic recovery among SSNHL patients ultimately diagnosed with VS.A retrospective chart review was performed on patients presenting with SSNHL in 2021 at a multicenter integrated healthcare system serving over 4 million members. Patient demographics, audiometric data, VS diagnosis, therapeutic steroid intervention, and data regarding treatment response were recorded. A clinically significant audiometric improvement was defined as (i) an increase of 15% in word recognition score, (ii) a decrease of 15 dB in four-frequency pure-tone average (PTA) using frequencies of 500, 1000, 2000, and 4000 Hz, or (iii) a PTA of <20 dB on follow-up audiogram.Six hundred fifty-eight patients were reviewed, of which 309 (56.0% male; mean, 57.5 years) met the inclusion criteria with audiometric data and magnetic resonance imaging data. Ten patients (70.0% male; mean, 51.3 years) were found to have VS. Of these, five patients received oral steroid therapy alone, and five had combination therapy (oral + intratympanic steroid injections). No patients received intratympanic steroid therapy alone. Median PTA improvement with steroid therapy was 3.1-dB hearing loss, and median word recognition score improvement was 16.5%. Six of 10 patients demonstrated clinically significant audiometric improvement with steroid therapy.This study represents the largest US-based study showcasing the prevalence of VS in patients originally presenting with SSNHL. It also reinforces previous findings that VS does not preclude trials of steroid therapy.

  View details for DOI 10.1097/MAO.0000000000003954

  View details for PubMedID 37464465

• Not Just for Kids: A Rare Case of Congenital Laryngeal Cleft in an Adult. Journal of voice : official journal of the Voice Foundation Xiao, C. C., Schloegel, L. S., Jiang, N. 2022; 36 (2): 293.e7-293.e9

  Abstract

  This case report aims to increase awareness of the diagnosis of laryngeal cleft in adult patients and discuss treatment options.Case report and review of the literature.We present a case of a 56-year-old male referred for hoarseness and chronic cough that was discovered to have a type 2 laryngeal cleft. He had chronic aspiration, recurrent pneumonia, and a hoarse voice for his entire life. In contrast to most described cases in adults, this patient was successfully treated with an endoscopic approach using absorbable suture.Laryngeal clefts are uncommon and almost always detected in childhood, making adult laryngeal clefts extremely rare. Endoscopic repair is a feasible and successful treatment option in these cases.

  View details for DOI 10.1016/j.jvoice.2020.05.017

  View details for PubMedID 32593610

• Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients. The Laryngoscope Huwyler, C., Merchant, M., Jiang, N. 2021; 131 (7): E2298-E2302

  Abstract

  To evaluate whether language of choice affects compliance with speech therapy for voice disorders.Retrospective chart review.A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance.Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P = .0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance.This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance.IV Laryngoscope, 131:E2298-E2302, 2021.

  View details for DOI 10.1002/lary.29429

  View details for PubMedID 33559902

• Academic and Gender Differences Among U.S. Otolaryngology Board Members. The Laryngoscope Hill, R. G., Boeckermann, L. M., Huwyler, C., Jiang, N. 2021; 131 (4): 731-736

  Abstract

  To determine the representation of women in leadership positions within otolaryngology societies and to compare their academic rank and research productivity to men.The leadership positions of all U.S. otolaryngology societies were compiled. The Medicare Physician Compare database was used to obtain gender and medical school graduation year for all otolaryngologists. An online search was used to determine board member's academic faculty rank. The Scopus database was used to determine an individual's number of publications, citations, and h-index. All websites were accessed from July 2019 to October 2019.Of the 200 leadership positions, there were 160 unique individuals available for analysis. Of those, 23% were female. In comparison, 18% of all otolaryngologists in the United States are female. The average medical school graduation year was significantly more recent for female leaders (1997 vs. 1990, P < .001) than males, which is similar to all otolaryngologists (2001 vs. 1993, P < .001). Stratifying by gender alone, women averaged significantly fewer publications, citations, and h-indices compared to men (P < .05), and were also less likely to be professors (P < .01). When considering both gender and graduation year, significant differences among academic productivity were only noted for those graduating between 1990 to 1999. Among all board members who graduated after 2000, women comprised a majority of those in leadership positions (52%).Leadership positions in otolaryngology societies reflect the changing demographic of otolaryngologists in the United States. There is proportionate representation, and the more recently graduated female physicians show the same research productivity as their male counterparts.4 Laryngoscope, 131:731-736, 2021.

  View details for DOI 10.1002/lary.28958

  View details for PubMedID 32730668

• Reducing opioid use in post-operative otolaryngology patients: A quality improvement project. American journal of otolaryngology Kshirsagar, R. S., Xiao, C., Luetzenberg, F. S., Luu, L., Jiang, N. 2021; 42 (4): 102991

  Abstract

  In opioid-naive patients, many low-risk surgical procedures are associated with an increased risk of chronic opioid use. The goal of this quality improvement project was to reduce the amount of opioid prescriptions after commonly performed surgeries in otolaryngology.Pre-intervention opioid prescribing state was measured using anonymous provider and patient surveys, as well as pharmacy provider prescription data. Next, this information was used to develop an opioid prescription protocol that both standardized opioid prescribing practices and encouraged multimodal analgesia following routine surgery. Finally, post-intervention data were gathered and compared to pre-intervention data to assess changes in prescribing patterns.By patient survey, the worst pain and average pain after surgery (scale of 1-10) were unchanged after the intervention (5.1 to 4.8, p = 0.52; 4.1 to 3.6, p = 0.35, respectively). Post-intervention, 41% of patients reported receiving no opiates, whereas pre-intervention 100% of patients surveyed received opiates. The amount of ibuprofen and acetaminophen prescribed post-intervention increased 113% and 71%, respectively. By survey, the average number of opioid doses decreased from 24.0 ± 7.0 to 18.4 ± 6.6 (p = 0.018).The implementation of a standardized physician opioid prescription protocol did not affect patient pain perceptions, resulted in an increase in multimodal analgesia prescription, and increased provider awareness of opioid over prescription.

  View details for DOI 10.1016/j.amjoto.2021.102991

  View details for PubMedID 33640800

• Does Nasal Surgery Affect Voice Outcomes? A Systematic Review with Meta-Analyses. The Annals of otology, rhinology, and laryngology Xiao, C. C., Luetzenberg, F. S., Jiang, N., Liang, J. 2020; 129 (12): 1174-1185

  Abstract

  Changes in airflow dynamics after nasal surgery may have implications on voice quality. Multiple studies have evaluated the impact of nasal surgery on voice using heterogeneous outcome measures. We aim to systematically review the impact of nasal surgery on voice quality.Our study design was a systematic review with meta-analyses. A literature search of PubMed, Ovid, Cochrane from 1997 to 2017 was performed. Inclusion criteria included English language studies containing original data on nasal surgery and voice. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Meta-analysis was completed on quantitative voice measurements.Of 463 identified, 19 studies with 692 patients fulfilled eligibility. Nasal surgeries performed included endoscopic sinus surgery (11/20), septoplasty (11/20), rhinoplasty (2/20), and turbinate reduction (2/20). Voice outcomes measured included nasalance (8/20), fundamental frequency (11/20), jitter (10/20), shimmer (10/20), harmonic to noise ratio (HRN) (8/20), formants (5/20), and voice handicap index (VHI) (4/20). Voice examinations were assessed preoperatively and 1 to 30 months postoperatively. Meta-analysis revealed statistically significant changes in nasalance, (P < .01) 1 month postoperatively; there was no significant difference in nasalance at 6 months postoperatively. All other variables analyzed revealed no statistically significant differences. Five of nine studies showed majority of patients did not notice subjective change in voice after surgery, but with high heterogeneity of measurements.There may be a short-term increase in nasalance that resolves at longer follow-up, but there seem to be no other objective changes in voice. There may be subjective changes after surgery, but require further study to evaluate.

  View details for DOI 10.1177/0003489420933290

  View details for PubMedID 32525399

• Outcomes of Intubation-induced Vocal Fold Motion Impairment. Journal of voice : official journal of the Voice Foundation Pan, D. R., Jiang, N. 2020; 34 (2): 250-258

  Abstract

  Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-intubation.Retrospective chart review.Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features.With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077).Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology.

  View details for DOI 10.1016/j.jvoice.2018.09.015

  View details for PubMedID 30309770

• Practice patterns of reflux medication prescriptions in otolaryngology compared to other specialties. The Laryngoscope Luetzenberg, F. S., Jiang, N. 2020; 130 (2): 321-327

  Abstract

  To describe the trends in proton pump inhibitor (PPI) prescription rates and durations and compare them to those of H2-receptor antagonists (H2RAs) between 2013 and 2016 in otolaryngology, gastroenterology, and family practice, following the increasing publications on PPI adverse effects and inappropriate prescribing.Retrospective review of publicly available Medicare Part D prescribing data.PPI and H2RA prescription and beneficiary data were obtained through the Centers for Medicare and Medicaid Services website. For prescription rates, 30-day fill counts were analyzed nationally and regionally per 10,000 Medicare members. Days supply per beneficiary was examined to show average prescription durations. Results were compared between otolaryngology, gastroenterology, and family practice. Medication-related economic burden per year was calculated based on reported drug cost.From 2013 to 2016, PPI 30-day fill counts remained stable, whereas H2RA prescription rates increased by up to 62% per 10,000 Medicare beneficiaries. The South consistently prescribed two to three times as much antireflux medication as the lowest prescribing region over time and across all three specialties. The days supply per beneficiary remained stable and ranged from an average of 128 to 203 days depending on the specialty. Antireflux medication-related healthcare cost decreased steadily.Despite numerous publications describing a multitude of adverse events and inappropriate prescribing patterns of PPIs in the past decade, prescription rates and durations per beneficiary have remained stable in the fields of otolaryngology, gastroenterology, and family practice. Additionally, H2RA prescriptions have increased from 2013 to 2016.NA Laryngoscope, 130:321-327, 2020.

  View details for DOI 10.1002/lary.27916

  View details for PubMedID 30861137

• The incidence and recovery rate of idiopathic vocal fold paralysis: a population-based study. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Masroor, F., Pan, D. R., Wei, J. C., Ritterman Weintraub, M. L., Jiang, N. 2019; 276 (1): 153-158

  Abstract

  To determine the incidence and spontaneous recovery rate of idiopathic vocal fold paralysis (IVFP) and paresis (IVFp), and the impact of steroid treatment on rates of recovery.This retrospective cohort study included all patients with IVFP or IVFp within a large integrated health-care system between January 1, 2008 and December 31, 2014. Patient demographics and clinical characteristics, including time to diagnosis, spontaneous recovery status, time to recovery, and treatment, were examined.A total of 264 patients were identified, 183 (69.3%) with IVFP and 81 (30.7%) with IVFp. Nearly all cases (96.6%) were unilateral and 89.8% of patients were over the age of 45. The combined (IVFP and IVFp) 7-year mean incidence was 1.04 cases per 100,000 persons each year with the highest 7-year mean annual incidence in white patients (1.60 per 100,000). The total rate of spontaneous recovery was 29.5%, where 21.2% had endoscopic evidence of resolution and 8.3% had clinical improvement in their voice without endoscopic confirmation. The median time to symptom resolution was 4.0 months. Use of steroids was not linked with spontaneous recovery in multivariable analyses.The annual incidence of VFP (IVFP and IVFp) was 1.04 cases per 100,000 persons, with spontaneous recovery occurring in nearly a third of patients, regardless of steroid use.

  View details for DOI 10.1007/s00405-018-5207-x

  View details for PubMedID 30443781

• Factors Impacting Online Ratings for Otolaryngologists. The Annals of otology, rhinology, and laryngology Calixto, N. E., Chiao, W., Durr, M. L., Jiang, N. 2018; 127 (8): 521-526

  Abstract

  To identify factors associated with online patient ratings and comments for a nationwide sample of otolaryngologists.Ratings, demographic information, and written comments were obtained for a random sample of otolaryngologists from HealthGrades.com and Vitals.com . Online Presence Score (OPS) was based on 10 criteria, including professional website and social media profiles. Regression analyses identified factors associated with increased rating. We evaluated for correlations between OPS and other attributes with star rating and used chi-square tests to evaluate content differences between positive and negative comments.On linear regression, increased OPS was associated with higher ratings on HealthGrades and Vitals; higher ratings were also associated with younger age on Vitals and less experience on HealthGrades. However, detailed correlation studies showed weak correlation between OPS and rating; age and graduation year also showed low correlation with ratings. Negative comments more likely focused on surgeon-independent factors or poor bedside manner.Though younger otolaryngologists with greater online presence tend to have higher ratings, weak correlations suggest that age and online presence have only a small impact on the content found on ratings websites. While most written comments are positive, deficiencies in bedside manner or other physician-independent factors tend to elicit negative comments.

  View details for DOI 10.1177/0003489418778062

  View details for PubMedID 29882425

• Sinus procedures in the Medicare population from 2000 to 2014: A recent balloon sinuplasty explosion. The Laryngoscope Calixto, N. E., Gregg-Jaymes, T., Liang, J., Jiang, N. 2017; 127 (9): 1976-1982

  Abstract

  To describe sinus procedure trends from 2000 to 2014, particularly following the introduction of balloon sinuplasty Common Procedural Technology (CPT) codes in 2011.Retrospective review of Medicare billing data available to the public.Procedure and beneficiary data from 2000 to 2014 and provider data from 2012 to 2014 were obtained online from the Centers for Medicare and Medicaid Services. Sinus CPT codes were classified as balloon sinus procedure (BSP) or nonballoon sinus procedure (nBSP). Providers billing for sinus procedures were categorized as BSP only, nBSP only, or both. For comparison, data on septoplasty procedures from 2000 to 2014 were obtained.From 2000 to 2014, the total number of sinus procedures per 10 thousand beneficiaries (PP10K) nationwide increased by 3.7% annually. From 2011 to 2014, nBSP PP10K decreased by 3.1% annually, and BSP PP10K increased by 59% annually. Septoplasty PP10K changed by < 1% annually between 2000 and 2014. States with the highest BSP PP10K from 2012 to 2014 were Kansas, Texas, and Louisiana. Providers performing sinus procedures increased by 30.9% from 2012 to 2014. There was a 244% increase in BSP-only providers, a 0.7% increase in nBSP-only providers, and an 83.3% increase in providers using both. Septoplasty providers increased by 4.1%.Although the total number of sinus procedures increased from 2000 to 2014, the number of BSP increased at a substantially greater rate since the introduction of CPT codes for these procedures in 2011. Nationwide increases in sinus providers were driven by new providers performing balloon-guided procedures.4. Laryngoscope, 127:1976-1982, 2017.

  View details for DOI 10.1002/lary.26597

  View details for PubMedID 28397270

• Herpes Simplex Virus Laryngitis Presenting as Airway Obstruction: A Case Report and Literature Review. The Annals of otology, rhinology, and laryngology Harless, L., Jiang, N., Schneider, F., Durr, M. 2017; 126 (5): 424-428

  Abstract

  Herpes simplex virus (HSV) laryngitis is rare in adults. We add a case report to the literature and perform a literature review to further delineate the clinical presentation, course, and treatment of HSV laryngitis in adults.Case report and literature review using PubMed and Ovid databases.Ten cases of diagnosed HSV laryngitis in adults were reported in the literature. It is more common in immunocompromised patients. The mean patient age was 51 years with a male to female ratio of 1:1. The clinical presentation and course of HSV laryngitis is variable. Patients may have mild chronic symptoms, such as dysphonia, or a fulminant course with rapid airway compromise. On laryngoscopic exam, the most common findings are a white exudate or ulceration. The most common treatment is with antiviral medication, such as acyclovir, which tends to be highly effective.Herpes simplex virus laryngitis is rare. Clinical presentation of HSV laryngitis is variable, and its course may be indolent or fulminant. Treatment with antiviral medication tends to be highly effective.

  View details for DOI 10.1177/0003489417699421

  View details for PubMedID 28397560

• Transgender Phonosurgery: A Systematic Review and Meta-analysis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Song, T. E., Jiang, N. 2017; 156 (5): 803-808

  Abstract

  Objectives Different surgical techniques have been described in the literature to increase vocal pitch. The purpose of this study is to systematically review these surgeries and perform a meta-analysis to determine which technique increases pitch the most. Data Sources CINAHL, Cochrane, Embase, Medline, PubMed, and Science Direct. Review Methods A systematic review and meta-analysis of the literature was performed using the CINAHL, Cochrane, Embase, Medline, PubMed, and Science Direct databases. Studies were eligible for inclusion if they evaluated pitch-elevating phonosurgical techniques in live humans and performed pre- and postoperative acoustic analysis. Data were gathered regarding surgical technique, pre- and postoperative fundamental frequencies, perioperative care measures, and complications. Results Twenty-nine studies were identified. After applying inclusion and exclusion criteria, a total of 13 studies were included in the meta-analysis. Mechanisms of pitch elevation included increasing vocal cord tension (cricothyroid approximation), shortening the vocal cord length (cold knife glottoplasty, laser-shortening glottoplasty), and decreasing mass (laser reduction glottoplasty). The most common interventions were shortening techniques and cricothyroid approximation (6 studies each). The largest increase in fundamental frequency was seen with techniques that shortened the vocal cords. Preoperative speech therapy, postoperative voice rest, and reporting of patient satisfaction were inconsistent. Many of the studies were limited by low power and short length of follow-up. Conclusions Multiple techniques for elevation of vocal pitch exist, but vocal cord shortening procedures appear to result in the largest increase in fundamental frequency.

  View details for DOI 10.1177/0194599817697050

  View details for PubMedID 28349733

• 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 < 0.001). Mean pre- and postoperative EAT-10 scores were 19.1 and 5.0, respectively (P < 0.001).Patients' reflux symptoms significantly improved after cricopharyngeal myotomy, with significant improvement in dysphagia symptoms. Concern for worsening of reflux symptoms following surgery does not appear to be clinically common.

  View details for DOI 10.1016/j.jvoice.2016.02.006

  View details for PubMedID 27049450

• Use of Lean and CAHPS Surgical Care Survey to Improve Patients' Experiences with Surgical Care. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Jiang, N., Malkin, B. D. 2016; 155 (5): 743-747

  Abstract

  (1) Measure patients' experiences with surgical care using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surgical Care Survey. (2) Use lean thinking to analyze and improve quality of patient care.A prospective quality improvement study.Hospital-based otolaryngology clinic.The CAHPS Surgical Care Survey was distributed to 17 surgical patients to determine their perception of the current state of care. Survey results were analyzed with lean thinking, and changes were made to improve critical areas. A second set of surveys was distributed to 10 patients to assess the success of the interventions immediately and 2 months later. The data were analyzed with the Mann-Whitney U test.Seventeen patients completed the CAHPS Surgical Care Survey to determine the initial state. A3 Thinking was used to analyze the results and design an improvement. Overall positive patient experience was 57% at the postoperative visit with 3 key aspects of care: time spent during visit, encouragement to ask questions, show of respect to the patient. Two causes were postulated; then, solution approaches were developed and tested in a series of rapid experiments. Two groups of 10 patients completed the CAHPS Surgical Care Survey to determine the postintervention state. Overall positive patient experience significantly improved to 93% (U = 474, P < .001) and 83% (U = 546, P = .009) immediately and 2 months later, respectively.Lean thinking helps to eliminate defects by breaking down complex problem solving into a scientific process. When combined with the CAHPS Surgical Care Survey, it can be successfully used to improve patients' surgical experiences.

  View details for DOI 10.1177/0194599816657051

  View details for PubMedID 27329420

• Tracheoesophageal fistula length decreases over time EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY Jiang, N., Kearney, A., Damrose, E. J. 2016; 273 (7): 1819-1824

  Abstract

  The objectives of this study were to demonstrate that the length of the tracheoesophageal voice prosthesis changes over time and to determine whether the prosthesis length over time increased, decreased, or showed no predictable change in size. A retrospective chart review was performed at a tertiary care referral center. Patients who underwent either primary or secondary tracheoesophageal puncture between January 2006 and August 2014 were evaluated. Patients were excluded if the tracheoesophageal prosthesis size was not consistently recorded or if they required re-puncturing for an extruded prosthesis. Data analyzed included patient demographics and the length of the tracheoesophageal voice prosthesis at each change. A total of 37 patients were identified. The mean age was 64 years. Seventy-six percent were male. 24 % underwent primary tracheoesophageal puncture and 76 % underwent secondary tracheoesophageal puncture. The length of the prosthesis decreased over time (median Kendall correlation coefficient = -0.60; mean = -0.44) and this correlation between length and time was significant (p = 0.00085). Therefore, in conclusion, tracheoesophageal prosthesis length is not constant over time. The tracheoesophageal wall thins, necessitating placement of shorter prostheses over time. Patients with a tracheoesophageal voice prosthesis will require long-term follow-up and repeat sizing of their prosthesis. Successful tracheoesophageal voicing will require periodic reevaluation of these devices, and insurers must, therefore, understand that long-term professional care will be required to manage these patients and their prostheses.

  View details for DOI 10.1007/s00405-016-3949-x

  View details for Web of Science ID 000377413500023

  View details for PubMedID 26951219

• Sinonasal sarcoidosis: A new system of classification acting as a guide to diagnosis and treatment. American journal of rhinology & allergy Lawson, W., Jiang, N., Cheng, J. 2014; 28 (4): 317-22

  Abstract

  The signs and symptoms of sinonasal sarcoidosis are diverse and nonspecific. It easily mimics more common sinonasal disorders such as allergic rhinitis, bacterial sinusitis, and atrophic rhinitis. The purpose of this study was to develop a classification system of sinonasal sarcoidosis that will help serve as a guide for both diagnosis and treatment.A retrospective chart review was performed of all patients diagnosed with sinonasal sarcoidosis from 1974 to 2013. A PubMed literature review of all published case series of sinonasal sarcoidosis was also reviewed.The charts of 14 patients with biopsy-proven sinonasal sarcoidosis were reviewed. Follow-up time ranged from 6 months to 28 years. Presenting signs included hypertrophic mucosa, nasal polyps, crusting, nasal enlargement, and destructive processes. Eight patients underwent medical management alone and six patients underwent endoscopic sinus surgery. Five of the six patients were successfully treated with surgery. On review of the literature, 256 cases of sinonasal sarcoidosis were found, of which 43 patients underwent surgery. Clinical outcomes of the patients who underwent surgery were not consistently reported.Based on critical analysis of the clinical presentation of sinonasal sarcoidosis in our case series and on review of the literature, sinonasal sarcoidosis can be classified into four subgroups: atrophic, hypertrophic, destructive, and nasal enlargement. Each subgroup responds differently to treatment and has its own differential diagnosis. Surgery is only indicated for a select group of patients and the vast majority of patients benefit from medical management alone.

  View details for DOI 10.2500/ajra.2014.28.4061

  View details for PubMedID 25197919

• Prevalence of severe obstructive sleep apnea in pediatric adenotonsillectomy patients. The Laryngoscope Jiang, N., Muhammad, C., Ho, Y., Del Signore, A. G., Sikora, A. G., Malkin, B. D. 2014; 124 (8): 1975-8

  Abstract

  To determine the prevalence of severe obstructive sleep apnea (OSA) in a pediatric population who underwent indicated surgery for sleep disordered breathing (SDB).Retrospective chart review.We reviewed the charts of patients aged 2 to 18 years who underwent tonsillectomy or adenotonsillectomy over a 4-year period. Indications for preoperative polysomnography (PSG), PSG results, and perioperative complications were recorded.Two hundred and thirty-five patients were included in the final analysis. Of these, 160 patients had preoperative PSG performed. The overall prevalence of severe OSA was 38%. The prevalence in patients for whom preoperative PSG was indicated or for which it should have been advocated according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guideline was 45% and 40%, respectively, whereas the prevalence in patients with no indication for preoperative PSG was 34%. There was no significant difference between groups (P = 0.39). The overall complication rate was 11%, with the rate being significantly lower (P = 0.0022) in patients who did not have preoperative PSG performed (0%) when compared to those who did (16%).The prevalence of severe OSA in this pediatric population was high. Specifically, a significant percentage of children who would not have received preoperative PSG under the AAO-HNS recommendations had severe OSA and were consequently admitted for overnight observation. Our results suggest that preoperative PSG should be obtained for all pediatric patients with sleep disordered breathing.

  View details for DOI 10.1002/lary.24692

  View details for PubMedID 24668559

• High-resolution microendoscope images of middle ear cholesteatoma and surrounding tissue: evaluation of interobserver concordance. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Bradley, J., Jiang, N., Levy, L., Richards-Kortum, R., Sikora, A., Smouha, E. 2014; 150 (4): 654-8

  Abstract

  Investigate how accurately otolaryngologists could differentiate between images obtained with high-resolution microendoscopy (HRME) of ex vivo cholesteatoma specimens and surrounding middle ear epithelium.HRME images of surgically resected cholesteatoma and middle ear epithelium were obtained and otolaryngologists classified these images.Tertiary medical center.Resected cholesteatoma and middle ear epithelium were stained with a contrast agent, proflavine, and HRME images were captured. Specimens were sent for standard histopathology and compared with HRME images. Quality-controlled images were used to assemble a training set. After viewing training images, otolaryngologists without prior cholesteatoma HRME experience reviewed and classified test images.Ten cholesteatoma and 9 middle ear specimens were collected, of which 17 representative cholesteatoma and 19 middle ear epithelium images were extracted for a testing set. Qualitative analysis for concordance between HRME images and histological images yielded a strong correlation between modalities. The mean accuracy of all reviewers in correctly identifying images was 95% (95% confidence interval [CI], 92%-98%). The sensitivity to correctly detect cholesteatoma images was 98% (95% CI, 93%-100%), and the specificity was 92% (95% CI, 87%-97%). The Fleiss kappa interrater reliability score was 0.83, (95% CI, 0.77-0.89).Medical professionals can quickly be trained to accurately distinguish between HRME images of cholesteatoma and normal middle ear epithelium, both of which have distinct imaging characteristics. Real-time HRME optical imaging can potentially improve the results of otologic surgery by allowing for extirpation of cholesteatomas while eliminating residual disease.

  View details for DOI 10.1177/0194599813519051

  View details for PubMedID 24415492

• Salmonella thyroid abscess in human immunodeficiency virus-positive man: A diagnostic pitfall in fine-needle aspiration biopsy of thyroid lesions Kazi , S., Liu , H., Jiang , N., Glick , J., Teng , M., Labombardi , V., Szporn , A., Chen, H. Diagn Cytopathol . 2014
• Histopathological evaluation of chronic rhinosinusitis: a critical review. American journal of rhinology & allergy Jiang, N., Kern, R. C., Altman, K. W. 2013; 27 (5): 396-402

  Abstract

  Chronic rhinosinusitis (CRS) consists of a constellation of symptoms, including facial pressure/pain, hyposmia, rhinorrhea, and nasal congestion. On histopathological evaluation, the disease can be divided into pathophysiologically distinct subgroups. This study systematically reviews the literature regarding the unique histopathological findings of the various subtypes of CRS to determine the potential diagnostic value of performing tissue analysis of CRS specimens beyond routine hematoxylin and eosin (H&E) staining.A PubMed search was untaken to identify articles that evaluated the histopathological features of CRS. Six hundred fifty-four relevant articles were identified and after application of specific exclusion criteria, 71 articles were further reviewed in detail.All articles included analysis of tissue samples from in-office biopsies or intraoperative specimens of patients who underwent sinus surgery. CRS was often further divided into subgroups and compared with each other and with a control group. The subgroups included CRS with and without nasal polyps, asthmatic and nonasthmatic patients, and with and without eosinophilia. Distinct inflammatory mediators were found for the different subgroups. Twenty-eight articles evaluated these inflammatory markers for their potential value as prognostic indicators.CRS is a heterogeneous disease based on its histopathological findings. Information that is obtainable from light microscopy, but typically goes unreported, can serve as valuable prognostic indictors. However, routine H&E staining is suboptimal in distinguishing among the various subgroups of CRS. Assessment of specific inflammatory mediators in sinus mucosa specimens may help provide prognostic information and guide more tailored treatment for the individual patient.

  View details for DOI 10.2500/ajra.2013.27.3916

  View details for PubMedID 24119603

• Evaluation of a teaching tool to increase the accuracy of pilot balloon palpation for measuring tracheostomy tube cuff pressure. The Laryngoscope Jiang, N., Del Signore, A. G., Iloreta, A. M., Malkin, B. D. 2013; 123 (8): 1884-8

  Abstract

  The purpose of this study was to evaluate the efficacy of a novel teaching tool to improve health care providers' ability to inflate tracheostomy tube cuffs to the appropriate pressure.Single-blinded, randomized, controlled trial.Subjects were randomized to a control and study group. The control group viewed a video about inflating tracheostomy tube cuffs to safe pressure levels. The study group viewed the same video and also got to palpate the pilot balloons of tracheostomy tube cuffs inflated to three different pressures. All subjects inflated tracheostomy tube cuffs to pressures they believed to be appropriate based on palpation of the pilot balloon preintervention, and immediately, 2 weeks, and 3 months postintervention.Forty-nine health care providers participated in the study. There was no significant difference in the mean preintervention cuff inflation pressures between the two groups (36 cm H2 O vs. 38 cm H2 O, P = 0.4888), with both initially overinflating. Postintervention, the study group inflated the cuffs to significantly lower pressures than the control group, closer to the ideal of 25 cm H2 O (26 cm H2 O vs. 35 cm H2 O, P = 0.0001). This difference was also observed 2 weeks (28 cm H2 O vs. 37 cm H2 O P <0.0001) and 3 months (28 cm H2 O vs. 36 cm H2 O, P = 0.0002) postintervention.The novel teaching tool evaluated in this study is simple, easily reproducible, and low-cost. Its use leads to long-lasting improvement in health care providers' ability to more accurately inflate tracheostomy tube cuffs to safe pressures.

  View details for DOI 10.1002/lary.24062

  View details for PubMedID 23553449

• Optical Imaging with a HighResolution Microendoscope to Identify Cholesteatoma of the Middle Ear Levy , L., Jiang , N., Smouha , E., Richards-Kortum , R., Sikora , A. Laryngoscope . 2013 1016-20
• Chapter 2: Gross and Radiographic Anatomy Anesthesiology and Otolaryngology Pawha , P., Jiang , N., Luttrell , M., Govindaraj , S. 2013: 3-33
• Radiology quiz case 2. Intramuscular capillary hemangioma (small-vessel subtype). Archives of otolaryngology--head & neck surgery Jiang, N., Pramanik, B., Darvishian, F., Jethanamest, D., Myssiorek, D. 2010; 136 (1): 96

  View details for DOI 10.1001/archoto.2009.183-a

  View details for PubMedID 20083788