Medicine and Health Sciences Commons^™

Epithelial Cells Are Active Participants In Vocal Fold Wound Healing: An In Vivo Animal Model Of Injury, Ciara Leydon, Mitsuyoshi Imaizumi, Rebecca S. Bartlett, Sarah F. Wang, Susan L. Thibeault

Communication Disorders Faculty Publications

Vocal fold epithelial cells likely play an important, yet currently poorly defined, role in healing following injury, irritation and inflammation. In the present study, we sought to identify a possible role for growth factors, epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGFβ1), in epithelial regeneration during wound healing as a necessary first step for uncovering potential signaling mechanisms of vocal fold wound repair and remodeling. Using a rat model, we created unilateral vocal fold injuries and examined the timeline for epithelial healing and regeneration during early and late stages of wound healing using immunohistochemistry (IHC). We observed time-dependent …

Ent Educational Patient Bedside Tool, Alina M. Toma

Master's Projects and Capstones

Early educational and discharge preparations are an advantage to patients, the interdisciplinary team, and hospital. It was determined that lack in communication and coordination among staff members led to inadequate patient teaching, therefore an educational tool that is kept at the bedside may facilitate accountability and smoother transition to home.

The aim of the project is to improve the education of patients with tracheostomies and laryngectomies, and enhance staff communication and coordination by December 2014.

Analysis methods used included Failure Mode Effects Analysis (FMEA), fishbone diagram, process map, and SWOT analysis. The social learning theory is the framework chosen for …

Role Of Imaging In Rhinology, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

This E book discusses the role of imaging in rhinology. Since this book has been authored by an otolaryngologist it goes without saying that a surgeon's perspective will be evident throughout the book. It contains about 250 CT scan images with succinct description.

Comprehensive Management Of The Paranasal Sinuses In Patients Undergoing Endoscopic Endonasal Skull Base Surgery., Gurston G Nyquist, Md, Marc R Rosen, Md, Mark E. Friedel, Md, D David Beahm, Md, Christopher J Farrell, Md, James J. Evans, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: The endonasal route often provides the most direct and safe approach to skull base pathology. In this article we review the literature with regard to management of the paranasal sinuses in the setting of skull base surgery.

METHODS: We describe our institutional experience and review the literature of concurrent management of the sinusitis in patients undergoing endoscopic skull base surgery.

RESULTS: Patients should be optimized preoperatively to ensure the endonasal route is a safe corridor to enter the intracranial cavity. Often the paranasal sinuses can be surgically addressed at the same time as endoscopic skull base surgery. We describe …

Cavernous Hemangioma Uvula An Interesting Case Report And Review Of Literature, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Elongated uvula is mostly asymptomatic. In rare instances it may be come symptomatic. This article discusses a patient who presented with intractable cough due to cavernous hemangioma involving uvula. Uvula in this patient was found to be in contact with the posterior portion of the tongue. This case is being presented for its rarity.

Odontogenic Keratocyst Mandible An Interesting Case Report And Literature Review, Balasubramanian Thiagarajan, Geetha Ramamoorthy

Balasubramanian Thiagarajan

The term odontogenic keratocyst was first described by Philipsen in 1956. This cyst actually arises from the cell rests of dental lamina. It can occur anywhere in the jaw but is commonly seen in the posterior part of the mandible. Since the clinical features and radiological appearance are not characteristic this condition is commonly misdiagnosed. This is more so when the lesion is related to the nonvital tooth. Odontogenic keratocyst has been rechristened as keratocystic odontogenic tumor by WHO working group in 2005. This was necessitated to differentiate this lesion from its orthokeratinizing variant which is currently considered as odontogenic …

Inferior Meatus Maxillary Antrostomy: Time To Revisit A Previously Abandoned Surgical Technique?, Natalie Ziegler, Bs, Alfred Marc C. Lloreta, Md, Alexander Farag, Md, Ting Ting Zhan, Phd, Gurston G. Nyquist, Md, Marc Rosen, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Background: A small subset of patients have dysfunctional maxillary sinus mucosa. These patients require more aggressive surgical treatment to allow for gravity dependent mucous drainage, intra-operative and office debridements, and the delivery of irrigations and topical treatments. The aim of this study is to examine the use of inferior meatus maxillary antrostomy (IMMA) in combination with traditional maxillary antrostomy, in this challenging patient population.

Methods: We performed a retrospective study from February, 2008 until April, 2014 with a 118 patients undergoing a total of 128 IMMA procedures. Data was gathered regarding patient demographic, prior therapy, post-operative medical therapy, IMMA patency, …

Subperiosteal Hematoma Of Orbit An Interesting Case Report And Review Of Literature, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Subperiosteal Hematoma orbit is an uncommon disorder which may occur following injury to orbit. Of course there are other causes that cause this condition as well. This condition has been reported in young adults. This case report discusses a patient who developed subperiosteal hematoma following trivial injury to orbit. Since this condition had occurred following trivial injury to orbit diagnosis was not made pre operatively. It was discovered only on the table. A high index of suspicion and an accurate history is necessary to identify this condition. This case is being reported not only for its rarity but also to …

Endoscopic Orbital Decompression, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Orbital decompression surgery has been indicated in patients with compressive optic neuropathy, severe corneal exposure, cosmetic deformity due to proptosis. Traditional orbital decompression approaches were fraught with complications. With the advent of nasal endoscopes decompression is being carried out transnasally under endoscopic guidance. The entire medial wall of orbit can be taken down transnasally using nasal endoscope, and the inferior wall of orbit can be removed using the same approach. Currently endoscopic orbital decompression is being preformed commonly with very minimal complications. The aim of this paper is to review the current literature on the subject.

Orbital Complications Of Sinusitis A Review, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Introduction: Despite availability of excellent antibiotics, orbital complications’ following sinusitis is rather common. With the emergence of fungal sinusitis orbital involvement by the disease is getting frequent. Prevalence of life style disorders like diabetes mellitus has added to the woes. This article attempts to review the entire gamut of orbital complications following sinus infections. Aim: This study aims at analyzing orbital complications following sinusitis at Government Stanley Medical College Hospital during the period 2009 – 2013. Study design: Retrospective study Methodology: Cases with rhinosinusitis treated in our Institution during the period 2009-2013 were taken up for analysis. 112 patients were …

Patterns Of Orbital Disorders, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

This article discusses various patterns of presentations of orbital lesions. Since this article has been authored by an otolaryngologist, the entire concept has been viewed from otolaryngologist's angle. With the advent of nasal endoscope trans nasal access to orbit is becoming the order of the day. Major advantage being that external skin incision is avoided.

Laying The Tears Highway- A Drive Through Endo-Dcr, Balasubramanian Thiagarajan, Srikamakshi Kothandaraman

Balasubramanian Thiagarajan

This article is an attempt to review the technique of Dacryocystorhinostomy in the treatment of epiphora and bring to light the various modifications that have been developed in recent times to refine the procedure and optimize the outcome of surgery.

Orbital Fractures, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

This article attempts to review the role of Otolaryngologist in managing patients with orbital trauma. There is a high incidence of orbital injury in facio maxillary trauma. Trauma to orbit can be blunt / penetrating in nature. Commonest bony injury to orbit involves the floor and medial wall. Both these walls can be easily accessed by otolaryngologist. It is very important for otolaryngologist to be competent in handling these problems.

Cervical Spine Osteomyelitis After Esophageal Dilation In Patients With A History Of Laryngectomy Or Pharyngectomy And Pharyngeal Irradiation, Richard A. Goldman, Md, Jill N. D'Souza, Md, Adam J. Luginbuhl, Md, Joshua E. Heller, Md, Joseph M. Curry, Md, David M. Cognetti, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Dysphagia is a common sequela of the treatment of head and neck cancer and is frequently managed with esophageal dilation in patients with dysphagia secondary to hypopharyngeal stenosis. Reported complications of esophageal dilation include bleeding, esophageal perforation, and mediastinitis. We examine four cases of cervical spine osteomyelitis presenting as a delayed complication of esophageal dilation for hypopharyngeal stenosis in patients with a history of laryngectomy or pharyngectomy and radiation with or without chemotherapy. The history of head and neck surgery and radiation in these patients further complicates the management of the cervical spine osteomyelitis.

Nut Midline Carcinoma In A Pregnant Woman, Jill N. D'Souza, Md, David M. Cognetti, Md, Ryan N. Heffelfinger, Md, James J. Evans, Md, Madalina Tuluc, Md, Jurij R. Bilyk, Marc R. Rosen, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

NUT midline carcinoma is a rare, highly aggressive tumor that involves midline structures, particularly in the head, neck and mediastinum. It is characterized by NUT gene translocations on chromosome 15. It typically impacts teenagers or young adults, and has a fulminant course leading to death in less than a year in most cases despite aggressive chemoradiotherapy. Due to its location, this tumor is frequently considered inoperable. We present a case of a sinonasal NUT midline carcinoma with orbital invasion discovered during the workup of sinusitis in a young, pregnant woman. The tumor was managed with definitive excision to negative margins …

Postoperative Non-Steroidal Anti-Inflammatory Drugs And Risk Of Bleeding In Pediatric Intracapsular Tonsillectomy, Jill N. D'Souza, Md, Julie P. Adelman, Bs, Richard J. Schmidt, Md, Heather C. Nardone, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Tonsillectomy with or without adenoidectomy is one of the most frequently performed surgeries in the United States, with over 500,000 performed annually. Post-tonsillectomy hemorrhage is one of the most feared complications; thus, medications that could increase the risk of postoperative bleeding traditionally have been avoided. With recent FDA guidelines encouraging a departure from codeine-based medications in pediatric patients undergoing tonsillectomy, we examined the use of ibuprofen for post-tonsillectomy pain control. The records of 449 children who underwent tonsillectomy and received ibuprofen for postoperative pain control were reviewed and compared to a cohort of 1731 children who received codeine for pain …

Physiology And Advancements In Wound Healing, Adam Baker, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Outline of presentation:

Fundamentals

Advances

• -Growth Factors
• -Platelet Rich Plasma
• -Engineered skin
• -Hyperbaric Oxygen Therapy

Research

Presbyacusis A Review, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Life expectancy of Humans is on the rise. World’s human population is aging rapidly. According to a report of US census Bureau nearly 24% of current world population is above the age of 50. This is a phenomenal number. Hearing loss due to degenerative process is rather common in old age. Presbyacusis is defined as a progressive bilateral symmetrical age related sensorineural hearing loss. The hearing loss is confined to higher frequencies. This causes a greater burden on them considering the fact that they already have failing eyesight. This article attempts to review the current scenario pertaining to Presbyacusis with …

Nasal T Cell Lymphoma: A Rare Entity, Maliha Kazi, Mubasher Ikram, Montasir Junaid

Section of Otolaryngology, Head & Neck Surgery

Nasal type of Natural Killer (NK)/T cell lymphoma manifests in the nasal cavity. Approximately 95% of them are associated with EBV(Ebstein Barr Virus) with a strong predilection for the Asian population. It has certain systemic and localized symptoms which aid in diagnosis of the condition. However, the histological criteria is pivotal in confirming the diagnosis as well as aiding in confirming the association of EBV. Nasal type of NK/T cell lymphoma has a guarded prognosis. Treatment plan include radiotherapy with concurrent chemotherapy. Despite all this, the 5-year survival rate ranges from 15-75%. A 35 years old male presented with an …

A Novel In Vivo Model For Evaluating Functional Restoration Of A Tissue-Engineered Salivary Gland., Swati Pradhan-Bhatt, Daniel A Harrington, Randall L Duncan, Mary C Farach-Carson, Xinqiao Jia, Robert L Witt

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: To create a novel model for development of a tissue-engineered salivary gland from human salivary gland cells that retains progenitor cell markers useful for treatment of radiation-induced xerostomia.

STUDY DESIGN: A three-dimensional (3D) hyaluronic acid (HA)-based hydrogel scaffold was used to encapsulate primary human salivary gland cells and to obtain organized acini-like spheroids. Hydrogels were implanted into rat models, and cell viability and receptor expression were evaluated.

METHODS: A parotid gland surgical resection model for xenografting was developed. Salivary cells loaded in HA hydrogels formed spheroids and in vitro were implanted in the three-fourths resected parotid bed of athymic …

Mutational Falsetto: A Panoramic Consideration, Balasubramanian Thiagarajan, Srikamakshi Kothandaraman

Balasubramanian Thiagarajan

This article is intended to present everything that is known about puberphonia in a comprehensive yet concise manner. The evolution of the approach and attitude to its treatment from ancient concepts to recent trends is highlighted.

In Reference To "The Value Of Resident Presentations At Scientific Meetings", J. A. Eloy, P. F. Svider, A. J. Folbe, M. Setzen, S. Baredes

Journal Articles

No abstract provided.

Malignancy Rate In Thyroid Nodules Classified As Bethesda Category Iii (Aus/Flus), A. S. Ho, E. E. Sarti, K. S. Jain, H. J. Wang, I. J. Nixon, A. R. Shaha, J. P. Shah, D. Kraus, R. Ghossein, L. G. T. Morris, +3 Addiltional Authors

Journal Articles

Background: The Bethesda System for Reporting Thyroid Cytopathology is the standard for interpreting fine needle aspiration (FNA) specimens. The atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category, known as Bethesda Category III, has been ascribed a malignancy risk of 5-15%, but the probability of malignancy in AUS/FLUS specimens remains unclear. Our objective was to determine the risk of malignancy in thyroid FNAs categorized as AUS/FLUS at a comprehensive cancer center. Methods: The management of 541 AUS/FLUS thyroid nodule patients treated at Memorial Sloan-Kettering Cancer Center between 2008 and 2011 was analyzed. Clinical and radiologic features were examined as …

Internal Maxillary Artery-Middle Cerebral Artery Bypass: Infratemporal Approach For Subcranial-Intracranial (Sc-Ic) Bypass, E. Nossek, P. Costantino, M. Eisenberg, A. R. Dehdashti, A. Setton, D. J. Chalif, R. A. Ortiz, D. J. Langer

Journal Articles

BACKGROUND:Internal maxillary artery (IMax)-middle cerebral artery (MCA) bypass has been recently described as an alternative to cervical extracranial-intracranial bypass. This technique uses a keyhole craniectomy in the temporal fossa that requires a technically challenging end-to-side anastomosis.OBJECTIVE:To describe a lateral subtemporal craniectomy of the middle cranial fossa floor to facilitate wide exposure of the IMax to facilitate bypass.METHODS:Orbitozygomatic osteotomy is used followed by frontotemporal craniotomy and subsequently laterotemporal fossa craniectomy, reaching its medial border at a virtual line connecting the foramen rotundum and foramen ovale. The IMax was identified by using established anatomic landmarks, neuronavigation, and micro Doppler probe (Mizuho Inc. …

Laryngeal Myxoma: A Case Report And Review Of The Literature, A. Ritchie, J. Youngerman, J. E. Fantasia, L. B. Kahn, R. S. Cocker

Journal Articles

Myxomas are a rare benign neoplasm of uncertain mesenchymal cell origin, typically involving the heart. Laryngeal myxomas are uncommon, and are usually misdiagnosed as laryngeal polyp. To the best of our knowledge, there are only nine reported cases in the English literature. We report a case of a laryngeal myxoma presenting clinically as a left vocal cord polyp in a 77 year old male, and review the literature related to this rare entity.

Overexpressed Beta-Catenin Localizes To Plasma Membrane In Respiratory Papillomas, A. V. Lucs, A. L. Abramson, B. M. Steinberg

Journal Articles

No abstract provided.

Early Efficacy Trial Of Anakinra In Corticosteroid-Resistant Autoimmune Inner Ear Disease, A. Vambutas, M. Lesser, V. Mullooly, S. Pathak, G. Zahtz, L. M. Rosen, E. Goldofsky

Journal Articles

BACKGROUND. Autoimmune inner ear disease (AIED) is a rare disease that results in progressive sensorineural hearing loss. Patients with AIED initially respond to corticosteroids; however, many patients become unresponsive to this treatment over time, and there is no effective alternative therapy for these individuals. METHODS. We performed a phase I/II open-label, single-arm clinical trial of the IL-1 receptor antagonist anakinra in corticosteroid-resistant AIED patients. Given that the etiology of corticosteroid resistance is likely heterogeneous, we used a Simon 2-stage design to distinguish between an unacceptable (= 30%) response rate to anakinra therapy. Subjects received 100 mg anakinra by subcutaneous injection …

Cochlear Development And Auditory Function In The Absence Of Thyroid Hormone Transporters Mct8 And Oatp1c1, Richard Sinn

All Graduate Theses, Dissertations, and Other Capstone Projects

Thyroid hormone (TH) is essential for the development and maturation of the nervous system. The thyroid gland secretes an active form of TH, triiodothyronine, and a prohormone, thyroxine, into the blood. TH is charged, which prevents it from passively diffusing across cell membranes and thus requires cell membrane transporters to facilitate its movement into and out of cells. However, whether TH transporters are required for TH-mediated developmental events, including the auditory system, is largely unknown.

The purpose of the present study was to investigate two specific TH transporters, monocarboxylate transporter 8 (Mct8) and organic anion transporting polypeptide 1c1 (Oatp1c1), and …

Decreased Langerhans Cell Responses To Il-36 Gamma: Altered Innate Immunity In Patients With Recurrent Respiratory Papillomatosis, J. Devoti, L. Hatam, A. Lucs, A. Afzal, A. Abramson, B. M. Steinberg, V. Bonagura

Journal Articles

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomaviruses (HPVs) types 6 and 11 that is characterized by the polarization of adaptive immune responses that support persistent HPV infection. Respiratory papillomas express elevated mRNA levels of IL-36 gamma, a proinflammatory cytokine in comparison to autologous clinically normal laryngeal tissues; however there is no evidence of inflammation in these lesions. Consistent with this, respiratory papillomas do not contain T(H)1-like CD4(+) T-cells or cytotoxic CD8(+) T-cells, but instead contain a predominance of T(H)2-like and T regulatory cells (Tregs). In addition, papillomas also are infiltrated with immature Langerhans cells …

Squamous Cell Carcinoma Of The Tonsil Managed By Conventional Surgery And Postoperative Radiation, R. Rahmati, S. Dogan, O. Pyke, F. Palmer, M. Awad, N. Lee, D. Kraus, J. P. Shah, S. G. Patel, I. Ganly

Journal Articles

BACKGROUND: The purpose of this study was to report the long-term outcome of patients with squamous cell cancer (SCC) of the tonsil managed by surgery followed by postoperative radiotherapy (PORT). METHODS: Eighty-eight patients treated between 1985 and 2005 were analyzed. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome were determined by univariate and multivariate analysis. RESULTS: Forty-eight percent of patients had T3 to T4 disease and 75% had a positive neck. Five-year OS, DSS, and RFS were 66%, 82%, and 80%, respectively. The status of the neck was …