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Now that the initial shock of Joan Rivers’ passing is fading, questions have started to arise as to how such a routine procedure ended in tragedy. Particularly now that it has been revealed that a mystery ear, nose and throat specialist (ENT) was present in the operating room and may or may not have performed a procedure on Ms. Rivers at that time.
Joan Rivers entered the Yorkville Endoscopy Clinic on August 28 for an endoscopy to examine her upper digestive system. During the procedure an ear, nose and throat specialist (ENT) was brought into the operating room by Ms. Rivers’s gastroenterologist, Dr. Lawrence Cohen, sources confirm. The ENT specialist was asked to examined to examine Ms. Rivers’s vocal cords for any abnormalities while Dr. Cohen, performed the endoscopy. Some sources have reported that the ENT specialist performed a biopsy on Ms. Rivers after an anomaly was noticed. The clinic has denied these reports.
While the ENT specialist has not been identified, it has been confirmed that this physician did not have authorization as an attending physician at the Yorkville Clinic in Manhattan. Federal and state law require that any physician performing procedures at a clinic must have their credentials examined and approved.
After hearing the news, we asked Dr. CT Nguyen a leading ENT specialist from Houston Sinus and Allergy to provide some expert insight into what may have happened.
What does biopsy of the vocal cords test for?
Biopsy of the vocal cords is a procedure performed to collect tissue samples of one’s voice box specifically the vocal cords to find the causes of a hoarse voice, breathing problems ,throat pain confirm cancer or other conditions concerning the vocal cords. The procedure is performed by an otolaryngologist also known as ear nose and throat specialist (ENT), under general anesthesia in a licensed and accredited facility.
What should happen before having a biopsy of vocal cords?
A thorough medical and surgical history should be obtained followed by physical exam and review of prior tests such blood, radiological, and/or other tests for ENT specialist thinks is pertinent. Once a vocal cord biopsy is deemed necessary and before performing the procedure, a proper medical consent should be obtained. The consent explains the procedure, risks and complications. This consent is discussed with the patient. Once proper consent has been obtained the biopsy can be performed.
What might have led to Ms . Rivers cardiac arrest?
Assuming that a vocal cord biopsy of the vocal cords was indeed performed, Ms. Rivers may have suffered a vocal cord contraction (laryngospasm) during the procedure thus closing her airway. Unable to breath or the stress of the laryngospasm, could have lend to Ms. Rivers suffering cardiorespiratory arrest.
What needs to be done when a laryngospasm occurs?
If a laryngospasm occurs causing airway loss, the anesthesiologist needs to attempt forced high pressure mask ventilation. If that doesn’t work, a muscle paralytic agent can be used to relax the vocal cord muscles with a breathing tube. An emergency tracheostomy or cricothyroidotomy are the last options if the other procedures have not been successful . These procedures involve cutting a hole directly in the neck, into the breathing pipe which bypasses the vocal cords completely. Timing is extremely crucial . After only 5 or 10 minutes without oxygen, a patient can suffer irreparable brain damage.
It has not been established if any wrongdoing occurred in that operating room. There are some questions as to whether Ms. Rivers’ ultimate cardiac event was due to a complication of an unplanned vocal cord biopsy or from the GI endoscopy. Others speculate the cardiac event was due to the use of Propofol, an anesthetic that has come under fire before due to its very delicate margin of error between sedation and respiratory distress.It is known that Ms. Rivers’ oxygen levels crashed rapidly during the procedure. She was transferred to Mount Sinai Hospital, she never regained consciousness and died on Sept. 4 after being taken off life support.
Joan Rivers is perhaps best remembered for her acerbic red carpet interviews at events. The sometimes controversial, but always funny, comedienne was known for her particularly witty and sharp sense of humor. She was often self-deprecating but also ready with quick zingers at her fellow comedians, actors, and stars, particularly on her show Fashion Police.
She was an entertainer, from her early days as a witty guest on The Tonight Show, to her time as the first female host on The Late Show with Joan Rivers. She continued to entertain audiences throughout her life which included a reality show collaboration with her daughter Melissa Rivers , numerous books, tv appearances such as The Apprentice, documentaries, and comedy albums.