Otolaryngology Commons^™

Development Of Adult Multidisciplinary Tracheostomy Rounding Teams: Prevalence, Template For Starting, And Analysis For Diffusion Of Innovation, Tony Satroplus, Teresa Y. Rodriguez, Bennett J. Berning, Sarah Schmoker, Robert Morrison, Jayme Dowdall

Posters and Presentations: Otolaryngology

Educational Objective: At the conclusion of this presentation, the participants should be able to (a) Describe the prevalence of adult tracheostomy teams in the Middle Section; (b) Outline the impact of dedicated tracheostomy rounding teams; (c) Craft strategies for multidisciplinary rounding team including the necessary personnel; (d) Identify accelerants and barriers to incorporation of the team at their institution or community. Objectives: Multidisciplinary tracheostomy rounding teams have been found to decrease days to speech and decannulation and decrease adverse events. The need of such teams and the characteristics that increase or inhibit the tracheostomy rounding team's implementation rates have not …

Improving The Usability And Usage Of A Tracheostomy Order Set, Tony Satroplus, Teresa Y. Rodriguez, Jordon Flynn, Carly Garcia, Bennett J. Berning, Jayme Dowdall

Posters and Presentations: Otolaryngology

Educational Objectives: At the conclusion of this presentation, the participants should be able to (a) understand the benefits of simplifying EMR order-sets; (b) simplify a commonly used procedure or order set which includes identifying stakeholders who should contribute to the discussions; (c) identify and overcome barriers that would inhibit implementation and efficiency Objectives: Usability of electronic medical records has been linked to concerns for patient safety and provider wellness. One concern is that an order set’s “end user” may be inexperienced with the complexities associated with the tracheostomy patient continuum. The formation and utility of an intuitive workflow in the …

How Long Does It Take To Master Laryngeal Visualization Using Flexible Nasolaryngoscopy In Children?, Kieran Boochoon, Julina Ongkasuwan, Annie Ahn, Mary Musso, Yi-Chun Carol Liu

Graduate Medical Education Research Journal

Background: To assess when residents become proficient in performing flexible nasolaryngoscopy (FNL) in the pediatric population.

Objective: To objectively evaluate the quality of FNL by year of residency training.

Methods: Ninety-five pediatric FNL’s were performed by otolaryngology residents and pediatric otolaryngology fellows (postgraduate year [PGY] 1 – 6). Three pediatric otolaryngologists rated the FNL videos (anonymized and without sound) using the Modified Cormack-Lehane scoring system (MCLS). Data analysis was performed using two-way ANOVA and Tukey-Kramer adjustment.

Results: Overall, there was a significant difference in the quality of the FNL based on the year of training (p

Conclusion: The quality …

Systemic Inflammation Is Associated With Disease Extent And Survival In Oral Cavity Squamous Cell Carcinoma, Brendan Coutu, Dallin N. Christensen, Evan Ryan, Elizabeth Bradford Bell, Weining Zhen, Zafar Sayed

Graduate Medical Education Research Journal

Background: Although systemic immune-inflammation index (SII) correlates with patient survival in various solid malignancies limited information is available in the setting of oral cavity squamous cell carcinoma (OCSCC).

Methods: We retrospectively reviewed 222 patients who underwent a resection of curative intent for patients with OCSCC. SII was determined prior to surgical resection as platelet count × neutrophil count/lymphocyte count.

Results: At a median follow-up of 30.6 months, 2-year disease-free survival (DFS) and overall survival (OS) rates were 63.9% and 76.4%, respectively. A high SII (>1047) was associated with poor performance status and disease extent. A low SII was independently …

Seasonal Variation Of Hip Fractures In Patients With Benign Paroxysmal Positional Vertigo, Steven D. Curry, Pooja M. Varman, Alessandro Carotenuto, Justin C. Siebler, Jonathan L. Hatch

Graduate Medical Education Research Journal

Introduction: Seasonal variation of benign paroxysmal positional vertigo (BPPV) presentation has been reported, with higher rates of presentation in months associated with times of lower serum vitamin D levels. The purpose of this study was to examine the association between the timing of hip fracture in patients with BPPV.

Methods: A retrospective review (2013 to 2019) of adult patients was performed at a tertiary care academic center to identify patients with hip fracture due to ground level fall (ICD-10 code S72) and a previously established diagnosis of vestibular disorder (ICD-10 codes H81-83, A88.1, and R42). Included patients were …

Chronic Invasive Fungal Sinusitis Due To Scedosporium Apiospermum Causing Orbital Apex Syndrome, Dallin N. Christensen, Christie Barnes, Matthew Miller

Graduate Medical Education Research Journal

Abstract

Introduction:

Chronic invasive fungal sinusitis (CIFS) is defined as fungal invasion of the sinonasal submucosa for greater than 12 weeks. Common causes are dematiaceous molds followed by Aspergillus species, but can rarely be caused by other pathogens

Case:

A 71-year-old immunocompetent male presented with orbital apex syndrome found to be due to chronic invasive fungal sinusitis caused by Scedosporium apiospermum. After surgical debridement and appropriate systemic antifungal therapy, he made a near full recovery.

Discussion:

Scedosporium apiospermum is an emerging pathogen and a rare cause of chronic invasive fungal sinusitis. The diagnostic and treatment dilemmas involved with …

Does Full Transfixion Incision Decrease Tip Projection In Endonasal Septoplasty With Spreader Grafts?, William Wesley Heckman Md, Tyler Bliss Md, Sarah Schmoker Md, Katie Geelan-Hansen Md

Graduate Medical Education Research Journal

The classic teaching is that full transfixion incision decreases nasal tip projection by disrupting the attachment of the medial crura to the caudal septum. A significant decrease in tip projection after endonasal septoplasty with spreader grafts through a full transfixion incision has not been identified at our institution. A retrospective cohort study was performed at our institution. Inclusion criteria consisted of patients undergoing endonasal septoplasty with spreader graft placement and available preoperative and one-year postoperative photos. Patients who had undergone an open approach, cosmetic rhinoplasty, had intercartilaginous incisions, or other procedures to affect tip projection were excluded. A query identified …

The Advantages Of A Rural Resident Rotation In Otolaryngology Training: Comparing Surgical Case Volumes Of A Rural Rotation With A University Rotation, Mark Miller, Paul J. Brosnihan, Christie Barnes, Jayme Dowdall

Graduate Medical Education Research Journal

Objective: Rural residency rotations have played a significant role in encouraging surgical residents to pursue a career in a rural community. This study reviews the resident caseload of an otolaryngology residency rural rotation in comparison with a traditional primary university-based urban location.

Methods: The Accreditation Council for Graduate Medical Education (ACGME) case log system was used to review cases logged by residents during their rural rotations from July 2017 to December 2018. Case log data were compared with a matched resident of similar training experience on the university service during the same time period.

Results: Rural residents reported more cases …

Costs Associated With Recurrent Epistaxis In A Patient With A Ventricular Assist Device, Eric T. Rohe, Evan M. Ryan, Jayme R. Dowdall, Dwight T. Jones

Graduate Medical Education Research Journal

Mucosal bleeding is a well-known complication of having a ventricular assist device and commonly presents with epistaxis. Although the frequency of epistaxis as a complication in patients with a ventricular assist device has been documented in the literature, to our knowledge the cost of this complication has not been reported. This case report examines the financial burden of ventricular assist device-associated epistaxis in a single patient from September 2018 to December 2019 using ICD 10 diagnostic codes. The patient was found to have accumulated $138,020 in costs over 38 encounters. This case report not only highlights the recurrent nature and …

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 …

Laryngeal Histoplasmosis In Patients With Crohn’S Disease Undergoing Treatment With Humira (Adalimumab): A Case Series, Jenna Berg, Jonathan Blecha, Chris Bingcang, Justin Oltman, Jayme Dowdall, Subodh M. Lele

Graduate Medical Education Research Journal

The FDA has advocated for increasing awareness of histoplasmosis for patients undergoing TNF blockers as delay in diagnosis can lead to a poor outcome.¹ Laryngeal histoplasmosis is a rare entity that should be part of the differential diagnosis in patients receiving immune suppression for Crohn’s disease. Patients with laryngeal histoplasmosis often report hoarseness, mucosal ulcerations, dysphagia, and odynophagia. We present a series of two cases of laryngeal histoplasmosis in patients with Crohn’s. These cases illustrate the high index of suspicion required to make the diagnosis of laryngeal histoplasmosis, especially in the Midwestern United States. Diagnosis is made quickly and …

Irrigation For Cerumen Removal Causing Meningitis – Case Report, Steven Tenny, Pashayar Lookian, Andre Wakim, Daniel Surdell

Graduate Medical Education Research Journal

Introduction: Cerumen impaction is a common problem seen in primary care clinics. There are a variety of methods to deal with impacted cerumen including water irrigation but meningitis after water irrigation cerumen removal has not been previously reported.

Methods: We describe the case of a 59-year-old female with otitis media who developed meningitis with empyema after water-jet irrigation for impacted cerumen.

Results: Our patient presented 24-hours after water-jet irrigation for impacted cerumen with worsening headaches. Workup included positive CSF cultures and empyema on MRI consistent with meningitis. She also had ear drainage from the treated ear which was positive for …

Changes In The Transverse Dimension Of The Nasomaxillary Complex Following Rapid Palatal Expansion – A Post-Retention, Cbct Evaluation, Allison Schubert

Theses & Dissertations

Purpose: The purpose of this investigation was to evaluate the immediate and long-term effects of palatal expansion on the transverse dimension of the nasomaxillary complex.

Materials and Methods: Twenty-eight patients’ CBCTs were obtained at four time points: pre-expansion (T₁), post-expansion (T₂), pre-treatment (T₃), and middle or end of orthodontic treatment (T₄). The patients’ age, sex, cervical vertebral maturation stage, and the number of instructed expander turns were recorded. Measurements of the nasal floor, nasal passage, maxillary sinus, maxillary first molar mesiolingual cusp, maxillary first molar palatal cusp, maxillary first molar buccal cortical …

Alcohol Drives Oxidation-Dependent Desensitization Of Airway Cilia Motility Responsiveness, Michael Price

Theses & Dissertations

Alcohol abuse, which can impair clearance of pathogens and debris from the airway, is associated with an increase in complications and a higher mortality rate during the progression of pneumonia. With prolonged alcohol exposure, mucociliary clearance (MCC), which depends on the coordinated beating of cilia, is dysfunctional. Effective MCC relies on cAMP-dependent protein kinase (PKA) activation of ciliary beat frequency (CBF). PKA activation and stimulation of CBF are blunted with chronic exposure to alcohol. This phenomenon is known as alcohol-induced ciliary dysfunction (AICD). Previous studies have shown that concomitant feeding of mice with alcohol and antioxidants prevents AICD, suggesting a …