Medications and the larynx Purpose of review The larynx is a complex organ that houses some of the most intricate structures of the human body. Owing to its delicate nature, the larynx is affected by different medications to varying degrees. Many of these effects manifest in subjective complaints in one's voice or swallow. This review article invokes the present available literature to describe the effects different medical agents have on the functionality of the laryngeal structures. Recent findings Multiple available studies explore the effects of inhaled corticosteroids on the larynx. While laryngeal candidiasis is a well known complication of chronic steroid use, other rarer fungal infections have also demonstrated themselves as risks. Among anesthetics, the literature suggests that sevoflurane in standard and high doses does not appear to significantly reduce the risk of laryngospasm. The use of topical and intravenous lidocaine appear to have conflicting evidence regarding their use in laryngospasm prevention, whereas postoperative sore throat, hoarseness, and cough may be prevented with preinduction nebulization of ketamine and magnesium sulfate or budesonide. Summary Further study is warranted to explore the effects that these and other classes of agents, such as antibiotics, have on the structure and function of the larynx. Correspondence to Nausheen Jamal, MD, Associate Dean of Graduate Medical Education/DIO, Chief, Division of Otolaryngology – Head & Neck Surgery, Associate Professor of Surgery, 1210 West Schunior Street, EMEBL 3.145, Edinburg, TX 78541, USA. Tel: +1 956 296 1423; e-mail: Nausheen.Jamal@utrgv.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Gastric inlet patches: symptomatic or silent? Purpose of review The purpose of this review is to assess recent literature on the clinical relevance of the gastric inlet patch with particular focus on endoscopic diagnosis and treatment, the relationship of the inlet patch to laryngopharyngeal reflux disease and the association of proximal esophageal adenocarcinoma with inlet patch. Recent findings Recent studies suggest endoscopic diagnosis of inlet patch increases with endoscopist awareness (up to 10-fold) and when using enhanced imaging techniques such as narrow band imaging (up to three-fold). The literature remains mixed on the association of inlet patch with laryngopharyngeal symptoms or globus sensation. Studies of endoscopic ablation, using argon plasma coagulation or radiofrequency ablation have shown improved laryngopharyngeal reflux symptom scores posttreatment. Proximal esophageal adenocarcinomas are rare but often associated with inlet patch when they occur. Case studies have described endoscopic resection of malignant lesions related to inlet patch, using endoscopic mucosal resection or submucosal dissection. Summary Prospective, multicenter studies of symptom association with inlet patch using validated symptom questionnaires and blinded sham-controlled treatments are needed to further clarify the role of such treatments, which to date are limited to a small numbers of centers with a special interest. Correspondence to Charles Cock, FRACP, Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University of South Australia, 1 Flinders Drive, Adelaide 5042, SA, Australia. Tel: +61 8 8204 4964; fax: +61 8 8204 4964; e-mail: charles.cock@flinders.edu.au Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Safety of in-office laryngology procedures Purpose of review A wide range of diagnostic and therapeutic laryngology procedures are currently performed in an office setting. In-office laryngology procedures (IOLP) are increasingly seen as standard-of-care, and while generally considered safe, high-quality evidence supporting the latter statement is lacking. This review aims to summarize recent literature regarding the safety of IOLP. Recent findings There is a paucity of guidelines and standardized protocols for IOLP. To date, there is one available safety protocol specific to in-office laser procedures. Haemodynamic changes during IOLP have been documented and the significance of these changes continues to be unclear. Therefore, monitoring of vital signs is recommended. Continuing antithrombotic therapy during IOLP also appears safe, and this decision may be left to surgeon discretion. A protocol for management of antithrombotic therapy prior to in-office laser procedures is available. Actual serum lidocaine levels following topical application of mixed lidocaine preparations falls well below reported toxic levels but persists for longer than previously reported. Summary IOLP are safer that suspension laryngoscopy under general anaesthetic. Although complication rates of IOLP are low, patient characteristics and potential complications of both the procedure and of topical anaesthetic use must be considered. One must be prepared and equipped to deal with these potential complications. Correspondence to Silvia G. Marinone Lares, Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Tel: +64 21 0824 3506; e-mail: smar685@aucklanduni.ac.nz Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.