Conflicts of Interest
- Iotamotion: consultant, patent submission
- COOK Medical: consultant, licensing rights to patent developed through Univ of Iowa Research Foundation
- UpToDate: author
Note: “Iowa Head and Neck Protocols” is not a conflict – no compensation; it is designed to help fulfill education mission.
A. In-office counseling (applicable now)
1. Phlegm and its management
https://medicine.uiowa.edu/iowaprotocols/phlegm-and-its-management
2. Proton pump inhibitor weighing side effects vs efficacy
https://medicine.uiowa.edu/iowaprotocols/proton-pump-inhibitor-side-effects-ppi-considerations
3. Alkaline-water Mediterranean diet alternative to PPI’s
https://medicine.uiowa.edu/iowaprotocols/esophageal-reflux-precautions
B. In-office procedures (applicable now)
1. Transnasal laryngology preparation
a. Superior laryngeal nerve block technique
https://medicine.uiowa.edu/iowaprotocols/superior-laryngeal-nerve-blocks-instruction-video
b. Positioning
https://medicine.uiowa.edu/iowaprotocols/examination-subglottis-transnasal-laryngoscopy
2. Transnasal intubation (not in office)
https://medicine.uiowa.edu/iowaprotocols/content/positioning-awake-sitting-nasotracheal-intubation
3. Two nostril approach to transnasal laryngoscopy (partially applicable now)
a. https://medicine.uiowa.edu/iowaprotocols/laryngeal-papilloma-rrp-treatment-clinic-ktp-laser-video
b. https://medicine.uiowa.edu/iowaprotocols/two-nostril-technique-biopsy-laryngeal-leukoplakia-steering-sheath
c. https://medicine.uiowa.edu/iowaprotocols/transnasal-flexible-laryngoscopy-office-procedures-two-nostril-steerable-sheath-technique
d. https://medicine.uiowa.edu/iowaprotocols/two-nostril-approach-laryngeal-biopsies-and-ktp-lasing-instruction-video
KTP angiolytic effect (submitted: "Angiolytic Laser Effect on Laryngeal Papilloma")
4. Injection laryngoplasty in office (applicable now)
a. Positioning the wrong way: https://medicine.uiowa.edu/iowaprotocols/transcutaneous-percutaneous-transcricothyroid-membrane-injection-laryngoplasty-vocal-cord-paralysis
b. Positioning the right way: https://medicine.uiowa.edu/iowaprotocols/cymetra-injection-paralyzed-vocal-cord-clinic-technical-points-percutaneous-injection
c. Transoral injection to vocal cord with videostroboscopy assistance: https://medicine.uiowa.edu/iowaprotocols/vocal-cord-injection-prolaryn-gel-videostroboscopy-transoral
d. Injectables and durability: Injectable substances for injection laryngoplasty
e. Transoral injection to PCA with videostroboscopy assistance: https://medicine.uiowa.edu/iowaprotocols/case-example-transoral-videostrob-assisted-pca-injection
f. Transillumination to guide intra-laryngeal needle injection:
https://medicine.uiowa.edu/iowaprotocols/laryngeal-needle-localization-transillumination
https://medicine.uiowa.edu/iowaprotocols/laryngeal-emg-concurrent-transnasal-laryngoscopy
C. Airway concerns (applicable now)
1. Quantify degree of impairment with Peak Inspiratory Flow (PIF) and PImax (NIF = Negative Inspiratory Force)
a. https://medicine.uiowa.edu/iowaprotocols/case-example-1-subglottic-stenosis-due-wegeners-granulomatosis
b. https://medicine.uiowa.edu/iowaprotocols/spirometry-pif-peak-inspiratory-flow
c. https://medicine.uiowa.edu/iowaprotocols/nif-or-pimax-pfts
d. https://medicine.uiowa.edu/iowaprotocols/10-minute-primer-pfts-lecture-07-30-2016
2. Establish airway with elective cricothyrotomy
a. https://medicine.uiowa.edu/iowaprotocols/cricothyrotomy-elective-difficult-airway-management
3. Maintain airway during dilation of subglottic stenosis
a. https://medicine.uiowa.edu/iowaprotocols/subglottic-stenosis-example-cases
b. https://medicine.uiowa.edu/iowaprotocols/jet-ventilation-anesthesia-transoral-laryngeal-surgery
4. Consider use of Montgomery cannulas in selected patients
a. https://medicine.uiowa.edu/iowaprotocols/montgomery-cannula-canula-tracheotomy
b. https://medicine.uiowa.edu/iowaprotocols/montgomery-cannula-canula-insertion-clinic
c. Trach Lore Panel Hoffman slides April 19 2018
D. Vocal Fold Scarring and Sulcus (applicable now)
a. https://medicine.uiowa.edu/iowaprotocols/sulcus-vocalis
b. https://medicine.uiowa.edu/iowaprotocols/sulcus-vocalis-case-example-response-radiesse-voice-gel-injection
c. https://medicine.uiowa.edu/iowaprotocols/mers-march-2010-pig-experiment
E. Papilloma and Leukoplakia
1. KTP Laser (applicable now)
a. https://medicine.uiowa.edu/iowaprotocols/ktp-laser-larynx
b. https://medicine.uiowa.edu/iowaprotocols/ktp-laser-rrp-local-anesthesia-case-example
2. Microdirect laryngoscopy (applicable now)
a. https://medicine.uiowa.edu/iowaprotocols/ktp-laser-papilloma-microdirect-laryngoscopy
b. https://medicine.uiowa.edu/iowaprotocols/microdebrider-suction-modulator-rrp
F. Glottic insufficiency (partly applicable in the Saturday am lab)
1. Static repositioning of the vocal fold
a. https://medicine.uiowa.edu/iowaprotocols/complication-arytenoid-adduction-combined-medialization-laryngoplasty-gore-tex-thyroplasty
b. https://medicine.uiowa.edu/iowaprotocols/ard-arytenoid-repositioning-device
c. https://medicine.uiowa.edu/iowaprotocols/arytenoid-repositioning-device-video-2011-experiment
d. https://medicine.uiowa.edu/iowaprotocols/setup-thyroplasty-medialization-laryngoplasty
2. Dynamic repositioning of the vocal fold (under development)
Password protected: DCT Dynamically Controlled Thyroplasty