Otolaryngology Commons^™

A Narrative Review Of Scars After Surgery: What To Expect, Kathryn Landers, Michelle Hwang, Elizabeth Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background and Objective: For most surgical procedures, postoperative scars are inevitable. Scars that heal with poor cosmetic appearance or physical symptoms such as pain, pruritis, or tethering can have a negative impact on a patient’s quality of life. This review aims to identify current techniques for prevention of unfavorable scar formation and treatment of unfavorable scars.

Methods: A narrative review of the literature was conducted using our institution’s Primo search engine to search online databases including PubMed and EBSCO, among others. Included references were selected by the first author based on relevance to the subject matter and availability in English. …

Postoperative Radiotherapy And Facial Nerve Outcomes Following Nerve Repair: A Systematic Review, Hannah L. Kenny, Rachel H. Jonas, Samuel L. Oyer

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy (RT).

DATA SOURCES: PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov.

REVIEW METHODS: Databases were searched using terms including "facial nerve," "graft," "repair," and "radiotherapy." Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full-text review. Studies that utilized the House-Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis.

RESULTS: Twelve studies with 142 patients …

Improving Surgeon-Patient Communication In Thyroid Cancer Diagnosis And Treatment Discussions: A Narrative Review, Lauren Schlegel, Roberta S. Perry, Elizabeth Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background and Objective: Patient experience is greatly influenced by physician-patient communication. Yet, unmet communication needs continue to be well documented in patients with thyroid cancer. This review discusses factors that may impact this communication and presents communication interventions that are currently being used with thyroid cancer patients.

Methods: A narrative review of articles on the physician-patient relationship and communication in thyroid cancer published between 1985 and 2022 was conducted through PubMed and Google. An additional review of the articles referenced in the bibliography of the included articles was performed.

Key Content and Findings: This review discusses communication components impacting the …

Otologic Manifestations In The Setting Of Seronegative Small Vessel Vasculitis: A Case Report, Kathleen Gillmore, Samiat Awosanya, Ayan Kumar, Catherine Teskin, Rebecca Chiffer

Student Papers, Posters & Projects

Some patients with autoimmune disease will experience otologic symptoms, such as pain and hearing loss. We present a patient with ANCA-associated vasculitis who required surgery for a suspicious mastoid lesion associated with her disease.

Molecular Diagnostics In The Evaluation Of Thyroid Nodules: Current Use And Prospective Opportunities, Jena Patel, Joshua Klopper, Elizabeth E. Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Thyroid cancer is the most common endocrine malignancy with an estimated 43,800 new cases to be diagnosed in 2022 and representing the 7th most common cancer in women. While thyroid nodules are very common, being identified in over 60% of randomly selected adults, only 5-15% of thyroid nodules harbor thyroid malignancy. Therefore, it is incumbent upon physicians to detect and treat thyroid malignancies as is clinically appropriate and avoid unnecessary invasive procedures in patients with benign asymptomatic lesions. Over the last 15-20 years, rapid advances have been made in cytomolecular testing to aid in thyroid nodule management. Initially, indeterminate thyroid …

Rare Case Of Nasal Vault Oncocytic Cystadenoma, Aarti Agarwal, Kathleen Mcclain, Karen Banker, Kudakwashe Chikwava, Udayan K. Shah

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Oncocytic Cystadenomas are a rare benign pathology often found to arise from the salivary glands, reported more commonly in minor salivary glands, but even more rarely in major salivary glands and the larynx. This is the first known report of a nasal vault oncocytic cystadenoma in a pediatric patient.

Methods: Case Report and Literature Review.

Case presentation: A 10-year-old female presented with a mass involving the left nasal vestibule that caused nasal obstruction and a visible external abnormality. MRI imaging revealed a cystic lesion in the anterior nasal cavity that was rim enhancing with a bright T2 signal that …

A National Multi-Institutional Analysis Of Predictors Of Surgical Site Complications And Unplanned Reoperation After Paramedian Forehead Flap Reconstruction, Garrett Ni, Rohan Brebion, Pablo A. Baltodano, Michael C. Coronado, Nicholas Elmer, Theresa K. Webster, Huaqing Zhao, Xiaoning Lu, Sthefano Araya, Sameer Patel

Student Papers, Posters & Projects

Background: Although postoperative complications of paramedian forehead flap (PMFF) are generally low, surgical site complications and unplanned reoperation can still occur. Recent literature suggests infection to be the most common complication following PMFF reconstruction. This study sought to determine the patient and preoperative factors associated with surgical site complications and unplanned reoperations at a national level.

Methods: Patients who underwent PMFF reconstruction from the ACS-NSQIP 2007 - 2019 database were analyzed to determine composite surgical site morbidity and unplanned return to the operating room. Patient and operative factors were also analyzed to assess independent risk factors for surgical site morbidity …

Metformin Increases Natural Killer Cell Functions In Head And Neck Squamous Cell Carcinoma Through Cxcl1 Inhibition, Mckenzie Crist, Benyamin Yaniv, Sarah Palackdharry, Maria A. Lehn, Mario Medvedovic, Timothy Stone, Shuchi Gulati, Vidhya Karivedu, Michael Borchers, Bethany Fuhrman, Audrey Crago, Joseph Curry, Ubaldo Martinez-Outschoorn, Vinita Takiar, Trisha M. Wise-Draper

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Metformin slows tumor growth and progression in vitro, and in combination with chemoradiotherapy, resulted in high overall survival in patients with head and neck cancer squamous cell carcinoma (HNSCC) in our phase 1 clinical trial (NCT02325401). Metformin is also postulated to activate an antitumor immune response. Here, we investigate immunologic effects of metformin on natural killer (NK) and natural killer T cells, including results from two phase I open-label studies in patients with HNSCC treated with metformin (NCT02325401, NCT02083692).

METHODS: Peripheral blood was collected before and after metformin treatment or from newly diagnosed patients with HNSCC. Peripheral immune cell …

Impact Of Adjuvant Radiation Therapy After Definitive Surgery In Senior Adults >80 Years Old With Advanced Head And Neck Squamous Cell Carcinoma On Overall Survival., Joann M Butkus, Meghan Crippen, Voichita Bar-Ad, Adam Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Adjuvant radiotherapy (RT) following surgical resection confers a survival benefit for adult patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We aim to investigate if adjuvant RT provides a similar survival advantage to patients ages 80+ through a national curated database.

Methods: This retrospective cohort study queried the National Cancer Database (NCDB) for all cases of HNSCC between 2004-2016. Patients treated with surgical resection alone were compared to those treated with surgery plus adjuvant RT. Overall survival (OS) was compared within adult (age <80 >years) and senior adult (age ≥80 years) cohorts using Kaplan-Meier analysis. Hazard ratios …

Libretto-531: A Phase Iii Study Of Selpercatinib In Multikinase Inhibitor-Naïve, Lori J Wirth, Marcia S Brose, Rossella Elisei, Jaume Capdevila, Ana O Hoff, Mimi I Hu, Makoto Tahara, Bruce Robinson, Ming Gao, Meng Xia, Patricia Maeda, Eric Sherman

Department of Medicine Faculty Papers

Selpercatinib is a first-in-class, highly selective and potent, central nervous system-active RET kinase inhibitor. In the phase I/II trial, selpercatinib demonstrated clinically meaningful antitumor activity with manageable toxicity in heavily pre-treated and treatment-naive patients with RET-mutant medullary thyroid cancer (MTC). LIBRETTO-531 (NCT04211337) is a multicenter, open-label, randomized, controlled, phase III trial comparing selpercatinib to cabozantinib or vandetanib in patients with advanced/metastatic RET-mutant MTC. The primary objective is to compare progression-free survival (per RECIST 1.1) by blinded independent central review of patients with progressive, advanced, multikinase inhibitor-naive, RET-mutant MTC treated with selpercatinib versus cabozantinib or vandetanib. …

Coronavirus Disease-19 Infection And Angioedema In African Americans: A Case Series, Jose Manuel Martinez Manzano, Otoniel Ysea-Hill, Brenda Chiang, Simone A Jarrett, Kevin Bryan Lo, Zurab Azmaiparashvili

Department of Medicine Faculty Papers

Rationale: Few case series have described the simultaneous development of angioedema in patients with coronavirus 19 disease (COVID-19). Most of these reports were described in at-risk patients for developing bradykinin angioedema. Therefore, we aim to describe 5 African American patients who developed simultaneous COVID-19 and angioedema.

Methods: This was a case series of hospitalized patients with simultaneous angioedema and COVID-19 infection in a single center from May 2020 to February 2022. We used descriptive statistics. The study was approved by the institutional review board.

Results: Their median age was 55 years (range 28-66); all patients were African American, and 3/5 …

Accrual-Monitoring Practices For Various Disease Trials Among Aaci Member Cancer Centers, Zachary T Elliott, Zachary N. Goldberg, Ramez Philips, Jennifer Johnson, Margaret Kasner, William Kevin Kelly, Sarah Osipowicz, Rachael Dampman, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Progress in the management of rare diseases, including rare cancers, is dependent upon clinical trials; however, as many as 32% of rare-disease trials go uncompleted or unpublished due to insufficient accrual. Monitoring practices may differ between institutions. We sought to survey the regulatory standards for various trial types among major U.S. cancer centers. A 10-question survey was designed using Qualtrics assessment software. The survey was sent via email to an internal server of member institutions of the Association of American Cancer Institutes (AACI). Of 103 AACI centers, 31% completed the survey (n = 32). Respondents differed in their definitions …

Patient With Multiple Genetically Distinct Thyroid Nodules Including Papillary Thyroid Carcinoma Harboring Novel Ywhag-Braf Fusion, Ruihe Lin, Zi-Xuan Wang, Elizabeth Cottrill, Nitika Badjatia, Stacey Gargano

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Next-generation sequencing (NGS) analysis of thyroid samples aids in risk stratification of cytologically indeterminate nodules and contributes to our understanding of molecular mechanisms in thyroid neoplasia. Several genes, including BRAF, RAS, and EIF1AX, are known to play a role in thyroid tumorigenesis. Here we report a case of papillary thyroid carcinoma (PTC) in which a single lesion harbored a novel YWHAG-BRAF fusion and EIF1AX mutation and displayed mixed morphological findings. The patient is a 74-year-old female with multiple incidentally discovered thyroid nodules, two of which were sampled by ultrasound-guided fine needle aspiration (FNA). Cytologic diagnosis for both nodules was suspicious …

Otolaryngology Subspecialty Surgical Rescheduling Rates During The Covid-19 Pandemic, Emily S Sagalow, Alexander Duffy, Priyanga Selvakumar, David Cognetti

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objective: In the beginning of the COVID-19 pandemic in spring 2020, elective and oncologic surgical cases were cancelled. After adequate safety protocols were established, each subspecialty within otolaryngology faced unique challenges in reengaging patients for surgical scheduling.

Study design: Retrospective review from March to May 2020.

Setting: Single academic institution.

Methods: Patients whose otolaryngology surgery was cancelled due to COVID-19 hospital precautions were identified. Rescheduling rates were analyzed by subspecialty. Case completion was determined as the percentage of initially cancelled cases that were completed within 6 months of their original planned dates.

Results: Of 833 otolaryngology cases scheduled between March …

Tadalafil Enhances Immune Signatures In Response To Neoadjuvant Nivolumab In Resectable Head And Neck Squamous Cell Carcinoma, Adam J. Luginbuhl, Jennifer Johnson, Larry Harshyne,, Alban J Linnenbach, Sanket Kumar Shukla, Angela Alnemri, Gaurav Kumar, David Cognetti, Joseph Curry, Nikita Kotlov, Zoya Antysheva, Sandrine Degryse, Kyle Mannion, Michael K Gibson, James Netterville, Brandee Brown, Rita S. Axelrod, Ralph G. Zinner, Madalina Tuluc, Stacey Gargano, Benjamin E Leiby, Ayako Shimada, M G Mahoney, Ubaldo E. Martinez-Outshoorn, Ulrich Rodeck, Young J Kim, Andrew P. South, Athanassios Argiris

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Purpose: We hypothesize that the addition of the phosphodiesterase-5 inhibitor tadalafil to the PD-1 inhibitor nivolumab, is safe and will augment immune-mediated antitumor responses in previously untreated squamous cell carcinoma of the head and neck (HNSCC).

Patients and methods: We conducted a two-arm multi-institutional neoadjuvant randomized trial in any-stage resectable HNSCC (NCT03238365). Patients were stratified at randomization by human papillomavirus (HPV) status. Patients in both arms received nivolumab 240 mg intravenously on days 1 and 15 followed by surgery on day 28. Those in the combination therapy arm also received tadalafil 10 mg orally once daily for 4 weeks. Imaging, …

Otitis Media Practice During The Covid-19 Pandemic., Tal Marom, Jacob Pitaro, Udayan Shah, Sara Torretta, Paola Marchisio, Ayan Kumar, Patrick Barth, Sharon Ovnat Tamir

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome …

Multi-Institutional Study Validates Safety Of Intraoperative Cesium-131 Brachytherapy For Treatment Of Recurrent Head And Neck Cancer, Adam J. Luginbuhl, Alyssa Calder, David Kutler, Chad Zender, Trisha Wise-Draper, Jena Patel, Michael Cheng, Vidhya Karivedu, Tingting Zhan, Bhupesh Parashar, Shuchi Gulati, Min Yao, Pierre Lavertu, Vinita Takiar, Alice Tang, Jennifer Johnson, William M. Keane, Joseph Curry, David Cognetti, Voichita Bar-Ad

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Introduction: Surgery is the primary treatment for resectable, non-metastatic recurrent head and neck squamous cell carcinoma (HNSCC). We explore the safety and oncologic benefit of intraoperative Cesium-131 (Cs-131) brachytherapy combined with salvage local and/or regional surgical resection.

Methods and materials: Findings were reported from a single arm multi-institutional prospective phase 1/2 trial involving surgery plus Cs-131 (surgery + Cs-131) treatment. The results of two retrospective cohorts-surgery alone and surgery plus intensity modulated radiation therapy (surgery + ReIMRT)-were also described. Included patients had recurrent HNSCC and radiation history. Safety, tumor re-occurrence, and survival were evaluated.

Results: Forty-nine patients were enrolled in …

Evaluation Of Asthma Control In Patients With And Without Sinonasal Polyps Following Treatment With Biologic Agents, Prachi Patel, Chandala Chitguppi, Md, Alan Gandler, Md, Kira Murphy, Md, Tawfiq Khoury, Md, Stephanie Bork, Crnp, Pamela Monostra, Pa, Elina Toskala, Md, Phd, Mindy Rabinowitz, Md, Marc Rosen, Md, Gurston Nyquist, Md, Jessica Most, Md

The Medicine Forum

Background: The effects of biologics on severe asthmatics with chronic rhinosinusitis with sinonasal polyposis (CRSwNP) have not been well established. This study evaluates overall control of asthma in patients with and without sinonasal polyps following initiation of biologics therapy.

Methods: Retrospective review of patients with asthma treated with a biologic agent (benralizumab, omalizumab, dupilumab, mepolizumab) and CRSwNP. Charts were assessed for ACT scores at time of biologic enrollment and at 4-7 months.

Results:82 patients met inclusion criteria; 42 (52.5%) patients with asthma and 40 (47.5%) with concurrent sinonasal polyps. The average ACT score for the non-polyp cohort was 13.16 …

3d Printed Midface Models For Percutaneous Nasal Osteotomy Surgical Education, Raphael G. Banoub, Kurren S. Gill, Alice R. Karp, Jared M. Goldfarb, Emily S. Sagalow, Roxana Moayer, Howard Krein, Md, Joel J. Stanek, Robert S. Pugliese, Ryan N. Heffelfinger

Department of Otolaryngology Data Sets

No abstract provided.

Preoperative Immunotherapy In The Multidisciplinary Management Of Oral Cavity Cancer., Ramez Philips, Md, Chihun Han, Brian Swendseid, Md, Joseph Curry, Athanassios Argiris, Adam Luginbuhl, Jennifer Johnson, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Despite advances in multimodal treatment for oral cavity squamous cell carcinoma, recurrence rates remain high, providing an opportunity for new therapeutic modalities that may improve oncologic outcomes. Much recent attention has been paid to the molecular interactions between the tumor cells with the adjacent peritumoral microenvironment, in which immunosuppressive molecular changes create a landscape that promotes tumor progression. The rationale for the introduction of immunotherapy is to reverse the balance of these immune interactions in a way that utilizes the host immune system to attack tumor cells. In the preoperative setting, immunotherapy has the advantage of priming the unresected tumor …

Targeted Treatment Of Head And Neck (Pre)Cancer: Preclinical Target Identification And Development Of Novel Therapeutic Applications, Anne Van Harten, Ruud H. Brakenhoff

Department of Cancer Biology Faculty Papers

Head and neck squamous cell carcinomas (HNSCC) develop in the mucosal lining ofthe upper-aerodigestive tract. In carcinogen-induced HNSCC, tumors emerge from premalignantmucosal changes characterized by tumor-associated genetic alterations, also coined as ‘fields’ that areoccasionally visible as leukoplakia or erythroplakia lesions but are mostly invisible. Consequently,HNSCC is generally diagnosedde novoat more advanced stages in about 70% of new diagnosis.Despite intense multimodality treatment protocols, the overall 5-years survival rate is 50–60% forpatients with advanced stage of disease and seems to have reached a plateau. Of notable concern isthe lack of further improvement in prognosis despite advances in treatment. This can be attributedto …

Elevated Apobec Mutational Signatures Implicate Chronic Injury In Etiology Of An Aggressive Head-And-Neck Squamous Cell Carcinoma: A Case Report., Jena Patel, Nicoline Y. Den Breems, Madalina Tuluc, Jennifer Johnson, Joseph M. Curry, Andrew P. South, Raymond J. Cho

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Aggressive squamous cell carcinomas (SCCs) present frequently in the context of chronic skin injury occurring in patients with the congenital blistering disease recessive dystrophic epidermolysis bullosa. Recently, these cancers were shown to harbor mutation signatures associated with endogenous deaminases of the active polynucleotide cytosine deaminase family, collectively termed APOBEC, and clock-like COSMIC [Catalogue of Somatic Mutations in Cancer] signatures, which are associated with normal aging and might result from cumulative DNA replication errors. We present a case of a nasal septal SCC arising in the context of recurrent injury, but also modest past tobacco use. Our genetic analysis of …

Avoidance Of Maxillary Swing For Nasopharyngectomy Via Combined Open Lateral And Endoscopic Approach, S. Hamad Sagheer, Bs, Brian Swendseid, Md, Joseph M. Curry, Md, Mindy Rabinowitz, Md, Gurston Nyquist, Md, Marc R. Rosen, Md, James Evans, Md, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: Nasopharyngectomy performed via a solely endoscopic approach has limitations in access and feasibility, particularly regarding management of the carotid artery. To address these limitations, we report three cases with one cadaver dissection where nasopharyngectomy was performed via a combined open lateral an endoscopic approach. We highlight the benefits and technical considerations for this operative technique.

Study Design: Case Series

Methods: Patients diagnosed with recurrent nasopharyngeal carcinoma (NPC) that underwent combined open lateral and endoscopic nasopharyngectomy from 2016-2020 were analyzed. A cadaver dissection was also performed.

Results: We present the details of the approach and follow-up in three patients with …

Free Tissue Transfer For Central Skull Base Defect Reconstruction: Case Series And Surgical Technique, S. Hamad Sagheer, Brian Swendseid, James Evans, Mindy Rabinowitz, Gurston Nyquist, Marc R. Rosen, Elina Toskala, Ryan Heffelfinger, Adam J. Luginbuhl, Joseph M. Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objectives: Local reconstruction of central skull base defects may be inadequate for large defects or reoperative cases; free tissue transfer may be necessary. Inset of the flap and management of the pedicle can be challenging. We report our experience and approach.

Methods: Retrospective review identifying seven patients with central skull base defects who underwent free flap reconstruction from 2016-2020.

Results: Four patients with recurrent nasopharyngeal carcinoma, one with recurrent craniopharyngioma, one with clival-cervical chordoma, and one with meningioma of the middle cranial fossa were analyzed. Six defects were closed with an anterolateral thigh free flap and one with a radial …

Otologic Opioid Usage And Pain Control In The Postoperative Period, Matthew Stewart, Eric Mastrolonardo, Joann Butkus, Raphael Banoub, Md, Tingting Zhan, Phd, Sophia Dang, Md, David Cognetti, Md, Rebecca Chiffer, Md, Thomas Wilcox, Md

Phase 1

Introduction: Patients’ unused prescription opioids can be diverted and increase the overall opioid burden on society. Therefore, otolaryngologists can reduce opioid influx by minimizing excess tablets in opioid prescriptions. We hypothesize that otology patients at TJUH receive more opioid tablets than needed to effectively manage postoperative pain.

Methods: Patients ages ≥18 years old who received otologic surgery at TJUH were included in this prospective observational study between November 2019 and August 2020. Patients were provided a survey for recording pain on postoperative days 0, 1, 3, and 7 and the amount of remaining opioids from their prescription. Opioid amounts were …

Fat Graft For Parotidectomy Defect Reconstruction In The Setting Of Malignant Disease, S. Hamad Sagheer, Bs, Alexander Knops, Ba, Kurren Gill, Md, Vivian Xu, Bs, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: Currently, limited data examines the safety of utilizing fat transfers in the setting of malignant parotid disease. Here we evaluate the safety of fat graft reconstruction of parotidectomy defects in the setting of malignant disease.

Study Design: Retrospective cohort study

Methods: Electronic chart review of patients who underwent parotidectomy from 2012-2020 were reviewed.

Results: Three hundred and sixty-one patients were identified at a single institution who underwent parotidectomy, and 113 (31.3%) were for malignancy. One hundred and thirty-two patients underwent fat graft reconstruction (49.2%, n=65 for umbilical, 50.8%, n=67 for dermal). One-third of patients had malignant pathology (34.8%, n=46). …

Intraoperative Evaluation Of Nasal Valve Repair Interventions: A Prospective Analysis, Kurren Gill, Md, S. Hamad Sagheer, Bs, Cory Bovenzi, Md, Brian Yan, Ba, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: To allow for early identification and treatment of inadequate nasal valve repair interventions in the intraoperative setting, based on degree of nasal valve collapse quantified by suction-assisted pressure readings. Patient outcomes were measured by comparison of pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) surveys.

Study Design: Prospective study.

Methods: All enrolled patients undergo suction-assisted evaluation of nasal valve collapse before surgical intervention. Patients randomized into the experimental group underwent repeat assessment after various nasal valve interventions, compared to a control group where adequacy of interventions was assessed by palpation of the nasal ala.

Results: 20 patients who underwent …

Assessment Of Narcotic Use In Management Of Post-Op Pain After Functional Endoscopic Sinus Surgery., Kurren S. Gill, Chandala Chitguppi, Michelle Haggerty, Tawfiq Khoury, Judd Fastenberg, Gurston Nyquist, Elina Toskala, Marc Rosen, Mindy Rabinowitz

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objectives: Pain and analgesic requirements after functional endoscopic sinus surgery (FESS) vary widely. This study aims to quantify pain after routine FESS and determine the most commonly used pain management regimen.

Methods: Retrospective chart review of 100 patients who underwent FESS from Oct 2017 to May 2019. Patients prospectively completed a daily pain diary and reported pain levels that were categorized into no pain (0), mild (1-3), moderate (4-7), or severe (8-10). Patients were categorized into narcotics, non-narcotics, combination, or none based on type of analgesic used.

Results: Sixty-nine patients were included. Majority of patients reported either mild (39%) or …

Lateral Modified Brandt-Daroff Exercises: A Novel Home Treatment Technique For Horizontal Canal Bppv, Michael T. Teixido, Ryan Casserly, Lauren E Melley

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: Brandt-Daroff exercises (BDEs) are commonly used as an at-home treatment for posterior canalithiasis, but their efficacy in the treatment of benign paroxysmal positional vertigo (BPPV) of the horizontal canal (HC-BPPV) has not been previously studied. Using biomechanical model simulation, we investigated modifications that may optimize BDE use for HC-BPPV treatment.

MATERIALS AND METHODS: The BPPV Viewer, a three-dimensional model of the human labyrinth, was used to analyze BDE for HC-BPPV treatment. While moving the model through sequential BDE positions, the expected position of otoliths was demonstrated. Treatment steps were adjusted to maximize otolith movement around the canal circumference without …

Cancer-Associated Fibroblast Density, Prognostic Characteristics, And Recurrence In Head And Neck Squamous Cell Carcinoma: A Meta-Analysis., Alexander M Knops, Andrew South, Ulrich Rodeck, Ubaldo Martinez-Outschoorn, Larry A Harshyne, Jennifer Johnson, Adam J Luginbuhl, Joseph M Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Introduction: The progression and clinical course of head and neck squamous cell carcinoma (HNSCC) relies on complex interactions between cancer and stromal cells in the tumor microenvironment (TME). Among the most abundant of these stromal cells are cancer-associated fibroblasts (CAFs). While their contribution to tumor progression is widely acknowledged, and various CAF-targeted treatments are under development, the relationship between CAF density and the clinicopathologic course of HNSCC has not been clearly defined. Here we examine the published evidence investigating the relationship of cancer-associated fibroblasts to local recurrence and indicators of prognostic significance in HNSCC.

Methods: We conducted a meta-analysis of …