Otolaryngology Commons^™

Recurrent Laryngeal Nerve Variations And Strategies For Injury Prevention: A Systematic Review, Hana Abdelmeguid, Bamdad Tayyari, Yuvedha Senthil Velan, Michael J. Montalbano Md

Medical Student Research Symposium

Objective

Anatomical variations in the recurrent laryngeal nerve (RLN), namely extra-laryngeal terminal bifurcation and non-recurrent inferior laryngeal nerve, are known risk factors for RLN injury during surgery and represent a considerable jeopardy for iatrogenic damage like vocal cord paralysis. This systematic review aims to identify strategies for protecting RLN during thyroid surgery from nerve damage.

Methods

A search was conducted using EMBASE, MEDLINE, and PUBMED for articles published till February 2023 while strictly adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Subject headings and keywords related to anatomical variations, recurrent laryngeal nerve, and surgical prevention …

Reply To: S. N. Katkuri Et Al. And H. Liu Et Al. On Early And Sustained Improvements In Sense Of Smell With Tezepelumab Treatment In Patients With Chronic Rhinosinusitis With Nasal Polyps (Waypoint), Joaquim Mullol, Joseph K. Han, Tanya M. Laidlaw, Claire Hopkins, Anju T. Peters, Oliver Pfaar, Martin Desrosiers, Stella E. Lee, Andrew P. Lane, Claudia Chen, Yun Chon, Sandhia S. Ponnarambil, Andrew Foster, Andrew W. Lindsley, Christopher S. Ambrose

Department of Otolaryngology (ENT) Faculty Publications

[Introduction] We thank Dr. S. N. Katkuri, Dr. H. Liu, and their coauthors [1, 2] for their interest in our recent publication describing the improvements in loss of smell symptoms with tezepelumab versus placebo in patients with uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) in the WAYPOINT trial (NCT04851964) [3]. We are grateful for the authors' feedback on the clinical significance of the data presented and their appreciation of the consistency observed across a range of baseline clinical characteristic and demographic subgroups.

Indirect Treatment Comparison Of Tezepelumab Versus Other Biologics In Severe Chronic Rhinosinusitis With Nasal Polyps: A Systematic Literature Review And Network Meta-Analysis, Joseph K. Han, Joaquim Mullol, Claire Hopkins, Oliver Pfaar, Martin Desrosiers, Jason Steenkamp, Danny Gibson, Santiago Zuluaga Sanchez, Andrew Foster, Christopher S. Ambrose

Department of Otolaryngology (ENT) Faculty Publications

Introduction

This study compared the efficacy of tezepelumab with other approved biologics and endoscopic sinus surgery (ESS) using indirect treatment comparisons (ITCs) in adults with severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods

Randomized controlled trials (RCTs) identified via a systematic literature review (SLR) were synthesized in a network meta-analysis (NMA). Outcomes included change from baseline in nasal polyp score (NPS), nasal congestion/obstruction score (NCS/NOS), difficulty with sense of smell (DSS), Sino-Nasal Outcome Test-22 (SNOT-22) score, Lund Mackay score (LMS), time to nasal polyposis (NP) surgery decision, proportions requiring NP surgery or systemic corticosteroids (SCS), time to SCS use, …

Procedural-Based Contemporary Management Of Bell's Palsy Long-Term Sequelae: A Narrative Review, Robert M. Frederick, Rhorie Kerr, Eric Dobratz, William Dougherty

Department of Otolaryngology (ENT) Faculty Publications

Objective

To describe the long-term sequelae of Bell's palsy and summarize available treatment options, including recent advances, so that general otolaryngologists and other practitioners are aware of the clinical findings and available interventions.

Data Sources

PubMed.

Review Methods

A literature search was performed on December 18, 2024, via PubMed using keywords such as "synkinesis," "selective myectomy," "selective neurectomy," "botulinum toxin," "intervention" in the context of "Bell's palsy" with preference for articles published within the last 5 to 10 years but inclusion of select older articles that provided necessary context for the current topic. Articles included in the review were written …

Reply To: Malik Mmud On Early And Sustained Improvements In Sense Of Smell With Tezepelumab Treatment In Patients With Chronic Rhinosinusitis With Nasal Polyps (Waypoint), Joaquim Mullol, Joseph K. Han, Tanya M. Laidlaw, Claire Hopkins, Anju T. Peters, Oliver Pfaar, Martin Desrosiers, Stella E. Lee, Andrew P. Lane, Claudia Chen, Yun Chon

Department of Otolaryngology (ENT) Faculty Publications

[Introduction] To the Editor:

We thank Professor MMUD Malik [1] for his interest in our recent publication describing the improvements in loss of smell symptoms with tezepelumab versus placebo in patients with uncontrolled chronic rhinosinusitis with nasal polyps in the WAYPOINT trial (NCT04851964) [2]. We appreciate Professor Malik's comments on the language used to describe the findings and the specific analyses presented as well as his note regarding the consistent improvements in sense of smell observed with tezepelumab treatment versus placebo, demonstrated by large effect sizes across three instruments.

Vestibular Migraine And Ssri Withdrawal: A Case Report, Grace Fairchild, Sarah Redding, Ashley G. Flagge

Ashley Flagge Publications

Vestibular migraine (VM) has been described as a diagnosis of exclusion, with no one singular definitive assessment for diagnosis. It has been suggested that possible pharmaceutical intervention for VM can include antidepressant drugs, but this is potentially complicated by the fact that dizziness is a common side effect of both use and withdrawal for certain types of antidepressant medications. This article describes the case of a 56-year old with probable VM, who was previously diagnosed with depression and treated with the selective serotonin reuptake inhibitor (SSRI) Citalopram. Following discontinuation with no taper, the patient experienced a series of withdrawal side …

Categorizing Clinical Response To Mepolizumab For Patients With Chronic Rhinosinusitis With Nasal Polyps: Synapse Trial, Claire Hopkins, Larry Borish, Jared Silver, Peter Howarth, Robert Chan, Priya Dsilva, Joseph K. Han

Department of Otolaryngology (ENT) Faculty Publications

[Introduction] Chronic rhinosinusitis with nasal polyps (CRSwNP) can substantially affect quality of life (QoL), and is often challenging to manage.¹ First-line treatment for the management of CRSwNP involves intranasal corticosteroids, with short courses of systemic corticosteroids (SCS) for exacerbations, and sinus surgery for uncontrolled disease.² Biologics targeting type 2 inflammation (eg, dupilumab, omalizumab, and mepolizumab) have become a treatment option for refractory CRSwNP. With the advent of disease-modifying treatments such as biologics, control, defined as patients reporting no/low-symptom levels, has increasingly become the treatment goal for CRSwNP.³ However, the optimal use of biologics for symptom control in individual patients remains …

Head And Neck Metastasis Of Colorectal Adenocarcinoma: A Case Report And Literature Review, Taha Al Hassan, Jessica Flores, Adam Bender-Heine, Rachel A. Giese

Research Colloquium

Introduction/Background: Colorectal Adenocarcinoma (CRC) metastasis is found in approximately 1 in 5 patients diagnosed with CRC and frequently spreads to the liver, lungs, peritoneum, bone, and nervous system. There are several subtypes of adenocarcinoma but the single most associated with distant metastasis, multiple sites of metastasis, and poorer survival is the signet-ring cell carcinoma variant. We present an unusual case of a head and neck mass demonstrating immunohistochemical staining specific for colorectal origin in a patient with a history of mucinous adenocarcinoma of the colon.

Case Presentation: A 53-year-old female was referred for a left cervical neck mass associated with …

An Atypical Mechanism Of Thyroid Cartilage Fracture, Jack Grossweiler, Andrew Friedman, Michael Scharf, Matthew K. Nguyen, Jory P. Parson, Alexander Axelrad

Tower Health Research Day

No abstract provided.

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

The Effect Of Genetic Taste Status On Swallowing: A Literature Review, Theresa S. Lee, Angela M. Dietsch, Rana H. Damra, Rachel W. Mulheren

Department of Special Education and Communication Disorders: Faculty Publications

Purpose

Swallowing and taste share innervation pathways and are crucial to nutritive intake. Individuals vary in their perception of taste due to factors such as genetics; however, it is unclear to what extent genetic taste status influences swallowing physiology and function. The purpose of this review article is to provide background on genetic taste status, review the evidence on the association between genetic taste status and swallowing, and discuss research and clinical implications.

Method

A comprehensive literature review was conducted using search terms related to swallowing and genetic taste status. Studies were included if they investigated the main effect of …

Factors Affecting Variability In Vestibulo-Ocular Reflex Gain In The Video Head Impulse Test In Individuals Without Vestibulopathy: A Systematic Review Of Literature, Laurel Elise Money-Nolan, Ashley G. Flagge

Ashley Flagge Publications

The purpose of this systematic review was to summarize and synthesize published evidence examining variations in vestibulo-ocular reflex (VOR) gain outcomes for the Video Head Impulse Test (vHIT) in healthy individuals without vestibulopathy in order to describe factors that may influence test outcomes. Computerized literature searches were performed from four search engines. The studies were selected based on relevant inclusion and exclusion criteria, and were required to examine VOR gain in healthy adults without vestibulopathy. The studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2020). A total of …

Complications Of Pediatric Cochlear Implant Surgery, Andrew Stefan, Sabrina Bernardo, William Azkoul Ii, Bianca Siegel

Medical Student Research Symposium

Background:

Cochlear implantation (CI) surgery is the standard of care treatment for pediatric patients diagnosed with severe to profound sensorineural hearing loss. While considered a relatively safe operation, any invasive procedure involving the cranium has risks. However, there are few recent studies in the United States that have analyzed complication rates among children who have received CI. Furthermore, existing studies fail to discuss specific risk factors that led to post-operative complications, nor offer solutions to reduce their incidence. This study aims to 1) determine the incidence of specific complications in pediatric CI patients and 2) identify evidence-based risk factors for …

Case Report: How A Vallecular Cyst Could Have Become An Airway Emergency, Adam Kandil, Robin Lahr, Andrew Caravello

Rowan-Virtua Research Day

Vallecular cysts, also known as epiglottic mucous retention cysts are known to be generally self-limiting laryngeal lesion. They can however also be associated with airway obstruction, and dysphagia in infants. In adults, they are usually asymptomatic, and usually incidentally diagnosed. At times they are diagnosed during rapid sequence intubation, as they may contribute to endotracheal intubation difficulty. Moreover, there is question as to the correlation between vallecular cysts and the incidence of acute epiglottitis, as a vallecular cyst may become infected and cause a localized expansion of inflammation and infection. This expansion from the vallecula progresses to epiglottis.

The Utility Of An Inpatient Consult For Paradoxical Vocal Fold Motion, Pankti P. Acharya, Jason Cohn

Rowan-Virtua Research Day

Paradoxical vocal fold motion (PVFM) is vocal fold adduction during inspiration

Patients often present with dyspnea, throat tightness, and cough

Common risk factors that predispose patients to PVFM include gastroesophageal reflux disease, psychiatric disease, chronic cough, airway irritation, and female gender

This study was conducted to identify possible risk factors and associated conditions for PVFM; additionally, a novel scoring system was developed to aid in diagnosis of PVFM

Cpap And Epistaxis: Is There A Connection In Osa Patients?, Aesha Patel

Rowan-Virtua Research Day

Nasal continuous positive airway pressure (CPAP) has become a standard form of therapy for patients with obstructive sleep apnea (OSA). There are reports of patients suffering from episodes of epistaxis within the initial few weeks of starting CPAP therapy, believed to be due to the high flow rate of air during use, nasal CPAP purportedly dries the nasal mucosa, leading to an increased risk of scabbing, ulceration, and ultimately epistaxis. This study seeks to analyze whether epistaxis is common in patients following CPAP initiation and then compare this rate of epistaxis amongst OSA patients that received upper airway stimulation (UAS) …

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

Capstone Showcase

Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

Age Based Evaluation Of Nut Aspiration Risk., Jill N D'Souza, Taher S Valika, Bharat Bhushan, Jonathan B Ida

School of Medicine Faculty Publications

Objective: To identify an age at which initiation of whole nut into the pediatric diet could be considered safe, by evaluating the age distribution of children undergoing bronchoscopy with removal of nut or seed material from the airway. Method: A retrospective chart review over a ten-year period identifying children age 0–18 that have undergone bronchoscopy with retrieval of airway foreign bodies. A statistical analysis of demographic data was carried out to identify age distribution of aspiration events. Results: Sixty-four cases of foreign body aspiration were identified, of which 43 (67%) were of organic origin, specifically nuts. A Fisher's exact test …

Endoscopic Removal Of Fractured 3d-Printed Nasopharyngeal Swabs From The Olfactory Cleft During Covid-19, Matthew Miller, Kristy Carlson, Jayme Dowdall, Christie Barnes, Sam Pate

Graduate Medical Education Research Journal

The severe acute respiratory syndrome SARS-CoV-2 pandemic has posed significant challenges to hospital and public health systems in the United States. In response to a shortage in nasopharyngeal swabs, our institution developed, tested, and deployed 3D-printed swabs to obtain a specimen for testing. A patient was tested in preparation for a scheduled Esophagogastrodeuodenoscopy. During the procedure the swab broke and a portion remained in the superior meatus and olfactory cleft. This case study describes the process of locating and removing the broken sections of the 3D-printed swab. In response to this incident, 3D-printing teams test swabs for sample collection and …

A Developmental Study Of Apoptotic Markers And Histamine In Cephalopod Statocysts, Samantha Nicole Leef

Honors Theses and Capstones

Cephalopods can participate in complex navigation using landmarks that show context due to their statocysts. Statocysts are analogous to the vertebrate vestibular and auditory system encased in cartilage rather than bone making them more easily accessible. Age and anatomical dysfunctions are the reasons for many human vestibular malfunctions. Two of these sources are endolymph hydrops and aging. In the past, endolymph pressure changes were attributed to the ineffectual ion transport. Recent studies have illuminated the possibility of histamine receptors in the semicircular canal could be responsible for patients’ endolymph pressure changes rather than the previous belief that the pressure changes …

Olfactory Thresholds Of The U.S. Population Of Home-Dwelling Older Adults: Development And Validation Of A Short, Reliable Measure, David W. Kern, L Phillip Schumm, Kristen E. Wroblewski, Jayant M. Pinto, Thomas Hummel

Psychology & Gerontology Faculty Publications

Current methods of olfactory sensitivity testing are logistically challenging and therefore infeasible for use in in-home surveys and other field settings. We developed a fast, easy and reliable method of assessing olfactory thresholds, and used it in the first study of olfactory sensitivity in a nationally representative sample of U.S. home-dwelling older adults. We validated our method via computer simulation together with a model estimated from 590 normosmics. Simulated subjects were assigned n-butanol thresholds drawn from the estimated normosmic distribution and based on these and the model, we simulated administration of both the staircase and constant stimuli methods. Our …

Insulinlike Growth Factor 1- And 2-Augmented Collagen Gel Repair Of Facial Osseous Defects, James S. Toung, Roy C. Ogle, Raymond F. Morgan, William H. Lindsey

School of Medical Diagnostics & Translational Sciences Publications

BACKGROUND: Defects of the facial bone structure are common problems for the facial plastic surgeon. Native type 1 collagen gels (T1CGs) have been shown to mediate repair of facial critical-size defects in rat models.

OBJECTIVE: To evaluate the efficacy of T1CG augmented with insulinlike growth factor (IGF) 1, IGF-2, and a combination of IGF-1 and IGF-2 on the repair of facial critical-size defects in a rodent model.

METHODS: Twenty-four retired male breeder Sprague-Dawley rats were divided into 4 groups of 6 animals. Facial critical-size defects were created by removing the nasalis bones with a bone-cutting drill. Defects were treated with …