Medicine and Health Sciences Commons^™

Perioperative Opioids And Survival Outcomes In Resectable Head And Neck Cancer: A Systematic Review., Eric V Mastrolonardo, Derek S Mann, Harleen K. Sethi, Bo H Yun, Elliott M Sina, Maria Armache, Brooke Worster, Christopher E Fundakowski, Leila J Mady

Otolaryngology (ENT) Resident Research

BACKGROUND: Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC).

METHODS: A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included.

RESULTS: Three thousand three hundred seventy-eight studies met initial inclusion …

Bcor-Rearranged Sarcoma Of The Tonsil., Samuel Bosco, Tanner Lyons, Melanie Shpigel, Corrado Minimo, Rehka Bhat, Seth Zwillenberg, Amit Bhojwani

Otolaryngology (ENT) Resident Research

A tonsillar mass in a young patient with no medical issues routinely presents as an infectious process. Practitioners must maintain a broad differential if diagnostic testing does not support an infection. Neoplasm must be excluded. Otolaryngologists must consider malignancies other than squamous cell carcinoma, the most common oropharyngeal malignancy, and lymphoma. Rare tumors, such as sarcomas, must also be considered. Otolaryngologists must be familiar with the proper management of rare oropharyngeal malignancies.

Endolymphatic Sac Tumor, Tanner P. Lyons, Laura Barry, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Masses occupying the retrolabyrinthine space are uncommon and most often represent paragangliomas, choroid plexus papilloma, endolymphatic sac tumors (ELSTs) or distant metastasis. ELSTs are rare, locally invasive tumors of the inner ear, with less than 300 cases reported in the literature. ELSTs are associated with von-Hippel Lindau (VHL) disease. Patients diagnosed with an ELST should undergo genetic testing for VHL disease, and individuals with confirmed VHL disease should be screened for ELST(s).

Oncocytic Papillary Cystadenoma Of The Larynx: A Rare And Masquerading Entity., Samuel Bosco, James Ding, Christopher Fundakowski

Otolaryngology (ENT) Resident Research

We cared for a 59-year-old female smoker who presented with a supraglottic lesion mimicking a laryngeal saccular cyst. The lesion was found to be a oncocytic papillary cystadenoma. This is a rare, benign neoplasm that accounts for 2–4.7% of minor salivary gland neoplasms. Oncocytic papillary cystadenoma of the larynx is even more rare, compromising less than 1% of all benign laryngeal neoplasms. This case highlights the importance of comprehensive differential diagnosis for cystic laryngeal lesions.

Unresectable Primary Tracheal Synovial Sarcoma, Joann M. Butkus, Mackenzie Kramer, Daniel Eichorn, Ali Raza R. Shaikh, Rajesh R. Patel

Otolaryngology (ENT) Resident Research

Synovial sarcoma (SS) comprises less than 1% of head and neck cancers, and less than five cases of adult primary tracheal SS have been described. This case describes a patient encountered at a community-based academic hospital, and retrospective chart review was performed for data collection. A woman in her forties presented with shortness of breath due to a superior mediastinal mass found to be an unresectable primary tracheal SS. Primary treatment resorted to curative-intent radiation therapy. Subsequent metastasis required systemic chemotherapy with pazopanib. To the best of our knowledge, this is the first reported case of this nature and adds …

A Unique Case Of Metastatic Prostate Carcinoma To The Subglottis, Samuel Bosco, Kristen Prijs, Jordan Licata, Sandra A Schwartz, Raymond Lesser

Otolaryngology (ENT) Resident Research

An 85-year-old male presented to an otolaryngology office with hoarseness, stridor, and shortness of breath. He had been evaluated by 2 outside otolaryngologists for a 4-year history of hoarseness. He was referred for consideration for speech therapy regarding hoarseness, vocal fold edema, and a questionable right vocal fold polyp. The patient reported that his symptoms had worsened progressively over the prior 6-12 months. He had no history of head and neck cancer, recent intubation, autoimmune conditions, head and neck trauma, or smoking. The patient had a history of prostate carcinoma treated with radical prostatectomy, radiation therapy, and hormone therapy 18 …

Examination Of Care Processes And Treatment Optimization For Head And Neck Cancer Patients In A Community Setting “Hub And Hub” Model, Harleen K. Sethi, Elijah Walker, Travis Weinsheim, Matthew J. Brennan, Christopher E. Fundakowski

Otolaryngology (ENT) Resident Research

Objective

To examine referral pattern, the timing of diagnostic/staging processes, and treatment initiation for new head and neck cancer patients in a community setting.

Methods

Patients with a newly diagnosed previously untreated diagnosis of head neck cancer managed at Asplundh Cancer Pavilion/Abington Memorial Hospital from October 2018 to March 2020. Source of referral and preceding workup were examined as well as intervals between initial head and neck consult and various timepoints of treatment initiation.

Results

One hundred and five patients were included in the study. The primary referral sources were external general otolaryngology (56.3%). Oral surgery and dermatology obtained tissue …

Exuberant Arytenoid Edema Following Gore-Tex Thyroplasty, Mopileola Tomi Adewumi, Eli Bress, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Arytenoid edema is not a well-described complication of thyroplasty. We report a case of exuberant arytenoid edema following thyroplasty in a 33-year-old female. The diagnosis was made post-operative day 1, the patient was immediately started on a 6-day course of methylprednisone with voice rest. The arytenoid edema completely resolved within 1 week.

Cartilaginous Choristoma Of The External Auditory Canal., Harleen K Sethi, Melanie Shpigel, Ghiath Alnouri, Jing Zhou, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Cartilaginous choristoma is a rare benign lesion of the external auditory canal, generally found incidentally on physical exam in an asymptomatic patient. Our patient had the largest cartilaginous choristomas described in the literature to date. Additionally, this reviews the nomenclature and differential diagnoses of masses within the external auditory canal.

Hereditary Angioedema., Helen Lesser, Jason E Cohn

Otolaryngology (ENT) Resident Research

A 14-year-old African American female presented to the emergency department with spontaneous, sudden-onset lip swelling for 1 h. On examination, there was significant water-bag edema of the upper lip extending to the philtrum and premaxilla. Nasopharyngeal laryngoscopy revealed a patent airway without edema. She was initiated on intravenous dexamethasone, famotidine, and diphenhydramine, after which her edema improved but did not resolve. She was subsequently transferred to a local pediatric hospital and upon further testing she was found to have a C1 esterase inhibitor de novo gene mutation. Angioedema causes localized, non-pitting edema of the dermis, subcutaneous and submucosal tissue, and …

Bilateral Sensorineural Hearing Loss In The Setting Of Acute Methamphetamine Overdose, Jeremy Reich, Harleen Sethi, Robert Sataloff

Otolaryngology (ENT) Resident Research

Substance abuse is a rare but known cause of sensorineural hearing loss (SNHL). We report a case of acute SNHL in a 28-year-old man following an overdose of methamphetamine and incidental ingestion of fentanyl. On initial encounter, he had moderate-to-severe hearing loss in the right ear and severe-to-profound hearing loss in the left ear in addition to acute kidney injury, liver failure, and lactic acidosis. The patient was treated with a two-week course of high-dose steroids and expressed a subjective improvement in hearing. This case highlights the importance of auditory testing following a drug overdose and is one of the …

Perichondritis: Inspect The Lobule, Eli Bress, Jason E Cohn

Otolaryngology (ENT) Resident Research

CASE PRESENTATION: This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

DIAGNOSIS: The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged …

Congenital Pulmonary Airway Malformation (Cpam): An Interesting Ent Consultation., James Ding, Lauren E Melley, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 13-month-old boy was referred to the emergency department from the pediatrician’s office for increased shortness of breath. A 2-view chest X-ray was ordered revealing right hemithorax hyperlucency, minimal lung markings, and leftward mediastinal shift.

Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants, Jason E. Cohn, Sammy Othman, Michael Toscano, Tom Shokri, Jason D Bloom, Seth Zwillenberg

Otolaryngology (ENT) Resident Research

BACKGROUND: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures.

METHODS: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing.

RESULTS: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this …

To Balloon Or Not To Balloon, The Current State Of Management Of Eustachian Tube Dysfunction., David J. Lafferty, Brian J Mckinnon

Otolaryngology (ENT) Resident Research

While otologic complaints are a common reason for patients to present to an otolaryngologist, Eustachian tube dysfunction (ETD) remains a poorly understood disease whose management is unclear. Among the general population in the United States, ETD has a prevalence of 4.6% among adults and 6.1% among children. Eustachian tube dysfunction is not just a common diagnosis for otolaryngologists, ETD accounted for 2 million visits for patients less than 20 years old to primary care providers and over 2 million visits for patients older than 20 years old between 2005 and 2012. Despite the commonality of ETD, opinions differ wildly among …

Eagle Syndrome Masquerading As A Chicken Bone, Jason E. Cohn, Sammy Othman, Karima Sajadi-Ernazarova

Otolaryngology (ENT) Resident Research

This is a brief report of a 17-year-old male who presented to the emergency department with odynophagia and a foreign body sensation in the throat after choking on a chicken wing. A soft tissue neck radiograph was performed which revealed a 4.6-cm linear object in the vallecula read by the radiology department as a chicken bone. The otolaryngology team was consulted and performed a nasopharyngeal laryngoscopy which did not reveal a foreign body in the upper aerodigestive tract. On physical examination, the right tonsillar fossa was tender to palpation. Upon further review of the radiograph, the right stylohyoid ligament was …

An Unusual Presentation Of Subglottic Stenosis Necessitating Urgent Tracheostomy, Jacob Burdett, Alexander Manteghi

Otolaryngology (ENT) Resident Research

By definition, the subglottis is the area of the larynx immediately below the vocal folds extending to the level of the inferior border of the cricoid cartilage. This area represents the narrowest portion of the pediatric airway and is the most common site of iatrogenic stenosis. This stenosis is generally secondary to increased rates of intubation in infants of prematurity. Evaluation and treatment for subglottic stenosis represents one of the most common airway consultations within pediatric otolaryngology. Goals of therapy include securing a safe airway and restoring subglottic patency. In this clinical case, we present a unique pattern and presentation …

An Interesting Secondary Airway Lesion In An Infant With Laryngomalacia, William L. Valentino, David Lafferty, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 2-month-old male with a prior diagnosis of laryngomalacia (LM) presented to the emergency department in respiratory distress with worsening inspiratory stridor, suprasternal retractions, and a dry cough. A chest X-ray and lateral neck radiograph were performed and demonstrated no abnormalities. Flexible laryngoscopy revealed the same, previously observed moderately prolapsed arytenoids and an omega-shaped epiglottis with shortened aryepiglottic (AE) folds. He also had a right lower neck mass. He was scheduled for a direct laryngoscopy and bronchoscopy (DLB) and supraglottoplasty. During the DLB, LM and anterior compression of the midtrachea was noted. Lysis of the AE folds was performed in …

Multilevel Sleep Surgery Including The Palate In Nonsyndromic, Neurologically Intact Children With Obstructive Sleep Apnea, Jason E. Cohn, George E. Relyea, Srihari Daggumati, Brian J. Mckinnon

Otolaryngology (ENT) Resident Research

OBJECTIVE:

To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population.

STUDY DESIGN:

A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017.

SETTING:

A tertiary care, university children's hospital.

SUBJECTS AND METHODS:

Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN …

Speech And Language Outcomes In Patients With Ankyloglossia Undergoing Frenulectomy: A Retrospective Pilot Study, Srihari Daggumati, Jason E. Cohn, Matthew J. Brennan, Marissa Evarts, Brian J. Mckinnon, Alyssa R. Terk

Otolaryngology (ENT) Resident Research

Ankyloglossia is a controversial topic with no standardized treatment guidelines. A retrospective chart review was conducted to identify children who underwent lingual frenulectomy for speech and language impairment. Impairment severity was recorded pre- and postoperatively as mild, mild to moderate, moderate, moderate to severe, or severe. Variables were tested with chi-square analysis for their statistical relationship to improvements in speech and language. Children with preoperative moderate and moderate-to-severe speech and language impairment attained better speech and language outcomes after frenulectomy as compared with children with mild and mild-to-moderate impairment (100% vs 82%, P = .015). Sutured closure after frenulectomy was …

Is Lifitegrast 5.0% Ophthalmic Solution Effective In Improving Eye Dryness And Safe, In Terms Of Ocular Adverse Effects, In Adults 18 Years Or Older With Dry Eye Disease?, Aubrey E. Cole

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not lifitegrast 5.0% ophthalmic solution is effective in improving eye dryness and safe, in terms of ocular adverse effects, in adults 18 years or older with dry eye disease (DED).

Study Design: Systematic review of three primary double-blinded, randomized placebocontrolled trials that were published in peer-reviewed journals between 2014-2017.

Data Sources: Studies were obtained through the PubMed database based on relevance to the clinical question and evaluation of patient-oriented outcomes.

Outcomes Measured: Efficacy of lifitegrast treatment was measured based on the eye dryness …

Management Of Enophthalmos From Silent Sinus Syndrome With A Customized Orbital Implant, Jason E. Cohn, Mofiyinfolu Sokoya, Mohammad Hararah, Sameep Kadakia, Yadranko Ducic

Otolaryngology (ENT) Resident Research

Background We describe the surgical treatment of silent sinus syndrome, a disease characterized by progressive enophthalmos and hypoglobus due to orbital floor collapse with opacification of the maxillary sinus, in the presence of chronic maxillary sinusitis.

Methods Case study of a 55-year-old male with persistent diplopia secondary to left-sided esotropia and enophthalmos from chronic maxillary sinusitis.

Results Two stage procedure to treat the sinonasal and orbital symptoms, which include endoscopic sinus surgery to treat the underlying the ostial obstruction along with decompression of maxillary sinus. Then, reconstruction of the orbital floor with a customized implant.

Conclusions Though the treatment of …

Holmium Laser For Endoscopic Treatment Of Benign Tracheal Stenosis, D J. Verret, Arneya Jategaonkar, Samuel Helman, Sameep Kadakia, Arash Bahrami, Eli Gordin, Yadranko Ducic

Otolaryngology (ENT) Resident Research

Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis.

Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy.

Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998–2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety.

Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis …

Orbital Skull Base Reconstruction With Temporalis Muscle: The Sphenoid Keyhole Technique, Mofiyinfolu Sokoya, Arash Bahrami, Jason Cohn, Sameep Kadakia, Moustafa Mourad, Yadranko Ducic

Otolaryngology (ENT) Resident Research

The temporalis flap is a common flap used in head and neck reconstruction. In this article, the authors present a new modification of the use of the temporalis muscle flap for orbital skull base reconstruction with the use of a sphenoid keyhole. This technique confers multiple advantages in reducing the arc of rotation and providing a tension-free reconstruction of the orbital skull base.

Is The Use Of Intestinal Helminths Safe And Effective In The Treatment Of Allergic Rhinitis?, Tanner Mccalley

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this EBM review is to determine whether the use of intestinal helminths is safe and effective in the treatment of allergic rhinitis.

STUDY DESIGN: Review of three English language, blinded randomized controlled trials from 2009, 2010, and 2010.

DATA SOURCE: Randomized, controlled, blinded trials comparing the use of intestinal helminths versus visually matched placebo as a treatment for allergic rhinitis found using PubMed and Ovid databases.

OUTCOMES MEASURED: Several different systems were used to evaluate the symptoms or occurrence of AR. Bager et al.2010 uses symptom scores of AR scale of 0 …