Otolaryngology Commons^™

Identification Of An Atp/P2x7/Mast Cell Pathway Mediating Ozone-Induced Bronchial Hyperresponsiveness, Xiaomei Kong, William C Bennett, Corey M Jania, Kelly D Chason, Zachary German, Jennifer Adouli, Samuel D Budney, Brandon T Oby, Catharina Van Heusden, Eduardo R Lazarowski, Ilona Jaspers, Scott H Randell, Barry A Hedgespeth, Glenn Cruse, Xiaoyang Hua, Stephen A Schworer, Gregory J Smith, Samir Np Kelada, Stephen L Tilley

Faculty, Staff and Student Publications

Ozone is a highly reactive environmental pollutant with well-recognized adverse effects on lung health. Bronchial hyperresponsiveness (BHR) is one consequence of ozone exposure, particularly for individuals with underlying lung disease. Our data demonstrated that ozone induced substantial ATP release from human airway epithelia in vitro and into the airways of mice in vivo and that ATP served as a potent inducer of mast cell degranulation and BHR, acting through P2X7 receptors on mast cells. Both mast cell-deficient and P2X7 receptor-deficient (P2X7-/-) mice demonstrated markedly attenuated BHR to ozone. Reconstitution of mast cell-deficient mice with WT mast cells and P2X7-/- mast …

Sars-Cov-2: A Potential Trigger Of Dermato-Neuro Syndrome In A Patient With Scleromyxedema, Mike Fritz, Daniel Tinker, Alex W. Wessel, Gabriela M. Morris, Linda Goldenberg, Mark Fesler, Lokesh Rukmangadachar, M. Yadira Hurley

Otolaryngology--Head & Neck Surgery Faculty Publications

No abstract provided.

Unilateral Vocal Fold Paralysis In Adults: Etiological Factors In Yemen, Ali Obaid Muthanna

Hadhramout University Journal of Natural & Applied Sciences

Unilateral vocal fold paralysis is a common finding in otolaryngology practice. Various etiologies is known to cause this condition are neck surgery, cancer, neck trauma, neurological disorders and idiopathic The aim of this study was to determine the possible etiologies of unilateral vocal fold paralysis among adult patients. A prospective hospital based study was conducted at OtoLaryngology Department, at Al-Thawra Teaching Hospital, Sana'a, Yemen, during the period January 2015-June 2018.Patients have unilateral vocal fold paralysis were enrolling in this study. All patients underwent to history, clinical examination, laboratory investigations, and radiological studies. A total of 80 patients with unilateral vocal …

Revisiting The Controversy: The Role Of Fungi In Chronic Rhinosinusitis, Matthew A Tyler, Kent Lam, Michael J Marino, William C Yao, Isaac Schmale, Martin J Citardi, Amber U Luong

Faculty, Staff and Student Publications

In the last two decades, the development of culture-independent genomic techniques has facilitated an increased appreciation of the microbiota-immunity interactions and their role in a multitude of chronic inflammatory diseases such as chronic rhinosinusitis (CRS), asthma, inflammatory bowel disease and dermatitis. While the pathologic role of bacteria in chronic inflammatory diseases is generally accepted, the understanding of the role of fungi remains controversial.

Chronic rhinosinusitis, specifically the phenotype linked to nasal polyps, represents a spectrum of chronic inflammatory diseases typically characterized by a Type 2 immune response. Studies on the microbiota within sinus cavities from healthy and diseased patients have …

Cricopharyngeal Myotomy In National Surgical Quality Improvement Program (Nsqip): Complications For Otolaryngologists Versus Non-Otolaryngologists, Ellen M. Piccillo, David Adkins, Mohamed Elrakhawy, Michele M. Carr

Otolaryngology--Head & Neck Surgery Resident Research

OBJECTIVE: Comparing outcomes after cricopharyngeal myotomy (CM) performed by otolaryngologists (OTO) and non-otolaryngologists (NO).

METHODS: A retrospective analysis of the 2014-19 ACS-NSQIP database (American College of Surgeons National Surgical Quality Improvement Program) of patients who underwent open CM (CPT code 43030) as their primary procedure. Analyzed variables include medical comorbidities, operative time, the total length of stay, readmission, reoperation, concurrent procedures, postoperative complications, and postoperative diagnoses. 183 patients were included, 97 (53%) females and 86 (47%) males. 120 had surgery by OTO and 63 by NO.

RESULTS: There were no differences in preoperative morbidity. OTO had more outpatient surgeries compared …

The Impact Of The Covid-19 Pandemic On Newborn Hearing Screening Programs In Western States, Nathan A. Blaseg, Hannah M. Williams, Shelby Jepperson, Jessica J. Messersmith

Journal of Early Hearing Detection and Intervention

The primary objective of this study was to determine the impact of the COVID-19 pandemic on newborn hearing screening guideline adherence and the respective rates of screening, diagnosis, and intervention. This was a review of newborn hearing screening data compiled from the Departments of Health of six states for the time periods of March-September 2019 and March-September 2020. Endpoints included the numbers of live births as well as the numbers and timeframes of screening, diagnostic, and intervention events. Two-tailed paired t-tests were performed to determine statistical significance. 181,662 births in six states were assessed. Compared to March-September 2019, March-September 2020 …

Computer-Assisted Analysis Of Oral Antifungal Therapy In Chronic Rhinosinusitis With Airway Mycosis: A Retrospective Cohort Analysis, Evan Li, Michael Scheurer, Farrah Kheradmand, Amber U Luong, David B Corry

Faculty, Staff and Student Publications

Environmental fungi are etiologically related to chronic rhinosinusitis (CRS) with airway mycosis, but their infectious role remains uncertain, in part because of potentially inadequate methods of disease quantitation. Our objective was to determine objective radiographic and symptomatic outcomes of oral antifungal therapy in adult patients with CRS and airway mycosis by using computer-assisted analysis. We conducted a retrospective study of 65 patients with CRS and culture-proven airway mycosis in a single-center referral-based academic practice, comparing paired sinus computed tomography (CT) scans and symptom scores prior to and during chronic oral antifungal therapy using computer-assisted analysis of sino-mucosal area (CAASMA). A …

Neuroimaging Referral For Reassurance In Evaluation Of Headache With Low-Risk Features, Omar E. Fernandez

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Howard L, Wessely S, Leese M, et al. Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry. 2005;76(11):1558-1564. https://doi.org/10.1136/jnnp.2004.057851

for a patient with daily headache.

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 …

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 …

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.

Early Functional And Cognitive Declines Measured By Auditory-Evoked Cortical Potentials In Mice With Alzheimer’S Disease, Ling Mei, Li-Man Liu, Kaitian Chen, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

Alzheimer’s disease (AD) is characterized by a progressive loss of memory and cognitive decline. However, the assessment of AD-associated functional and cognitive changes is still a big challenge. Auditory-evoked cortical potential (AECP) is an event-related potential reflecting not only neural activation in the auditory cortex (AC) but also cognitive activity in the brain. In this study, we used the subdermal needle electrodes with the same electrode setting as the auditory brainstem response (ABR) recording and recorded AECP in normal aging CBA/CaJ mice and APP/PS1 AD mice. AECP in mice usually appeared as three positive peaks, i.e., P1, P2, and P3, …

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.

Apobec Mutagenesis Is Concordant Between Tumor And Viral Genomes In Hpv-Positive Head And Neck Squamous Cell Carcinoma, Daniel L. Faden, Krystle A. Lang Kuhs, Maoxuan Lin, Adam Langenbucher, Maisa Pinheiro, Meredith Yeager, Michael Cullen, Joseph F. Boland, Mia Steinberg, Sara Bass, James S. Lewis, Michael S. Lawrence, Robert L. Ferris, Lisa Mirabello

Epidemiology and Environmental Health Faculty Publications

APOBEC is a mutagenic source in human papillomavirus (HPV)-mediated malignancies, including HPV+ oropharyngeal squamous cell carcinoma (HPV + OPSCC), and in HPV genomes. It is unknown why APOBEC mutations predominate in HPV + OPSCC, or if the APOBEC-induced mutations observed in both human cancers and HPV genomes are directly linked. We performed sequencing of host somatic exomes, transcriptomes, and HPV16 genomes from 79 HPV + OPSCC samples, quantifying APOBEC mutational burden and activity in both host and virus. APOBEC was the dominant mutational signature in somatic exomes. In viral genomes, there was a mean of five (range 0–29) mutations per …

Going Global: Interest In Global Health Among Us Otolaryngology Residents, Julia Toman, Melynda Barnes Oussayef, J. Zachary Porterfield

Otolaryngology--Head & Neck Surgery Faculty Publications

Background: To meet the rising interest in surgical global health, some surgical residency programs offer global health experiences. The level of interest in these programs, however, and their role in residency recruitment and career planning has not been systematically evaluated.

Objective: (1) Define interest in global health among Otolaryngology residents in the USA. (2) Assess engagement of Otolaryngology residencies in global health training. (3) Determine barriers to global health training in residency.

Methods: A survey questionnaire was developed and sent to all Otolaryngology Residency Program Directors for distribution to all current Otolaryngology residents in the US.

Results: A total of …

Resilience And Its Associated Factors In Head And Neck Cancer Patients In Pakistan: An Analytical Cross-Sectional Study, Nida Zahid, Wajeeha Zahid, Wardah Khalid, Syed Iqbal Azam, Mubasher Ikram, Aneesa Hassan, Haissan Iftikhar, Shireen Shehzad Bhamani, Adnan Jabbar, Shabbir Akhtar, Moghira Siddiqui, Mohammad Sohail Awan, Nargis Asad, Khabir Ahmad

Department of Surgery Docs

Introduction: The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan.
Methods: An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed …

The Immunoregulatory Landscape Of Human Tuberculosis Granulomas, Evan Li, Antony Rodriguez, Amber U Luong, David Allen, John Morgan Knight, Farrah Kheradmand, David B Corry

Faculty, Staff and Student Publications

The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by T H 2 and TH 17 cell predominant immune responses, the production of IgE antibody, and atypical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection,recognized as …

Management Of Peritonsillar Abscess Within A Local Emergency Department: A Quality Analysis Study., Briana K Ortega, Spencer Short, Bryan G. Kane Md, Robert M. Dedio Md

Department of Emergency Medicine

OBJECTIVE: Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting thousands of people annually with high treatment costs. The purpose of this project was to determine how in-network emergency departments (EDs) adhere to generally accepted guidelines regarding diagnosis and management of potential PTAs.

METHODS: The authors performed a retrospective chart review to identify patients with PTA in five EDs in one year. Information pertaining to diagnostic tests, treatment, and airway status was also collected. Descriptive analysis was used to assess if EDs were consistent with generally accepted guidelines.

RESULTS: Six hundred twenty-one patient …

Synchronous Primary Diffuse Large B-Cell Lymphoma And Papillary Thyroid Carcinoma: A Case Report Highlighting "Lymphoma First Approach", Rahim Dhanani, Ambreen Abdullah Unar, Muhammad Hassan Danish, Hamdan Ahmed Pasha, Ummiya Tahir, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Papillary thyroid carcinoma (PTC) is the most common type of all thyroid carcinomas and accounts for up to 90% of all thyroid malignancies. It is the most indolent form of the disease and has an excellent prognosis. On the other hand, Primary thyroid lymphoma (PTL) is a rare entity accounting for only about 1% to 5% of all thyroid malignancies and only 2% of extranodal lymphomas. Synchronous PTC and PTL is a very rare condition and only a few cases have been reported in the literature up till now. We report one such case in a 52-year-old lady who was …

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 …

Anatomy And Physiology Of The Palatine Tonsils, Adenoids, And Lingual Tonsils., Alexandra Arambula, Jason R. Brown, Laura Neff

Manuscripts, Articles, Book Chapters and Other Papers

Objective: This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils, with reference to how this foundational understanding may affect patient management and surgical procedures in these regions of the upper airway.

Methods: A literature search was performed using PubMed and Google Scholar using the MeSH terms tonsils, adenoids, anatomy, physiology, and adenotonsillectomy. Primary sources were excluded if they were abstracts only, non-English language, or non-human studies. Thirty-five sources were included in this review.

Results and conclusions: The pharyngeal and palatine tonsils are compact yet physiologically complex mucosa-associated lymphoid tissues that make up a …

Characterization Of Oral Cavity And Oropharyngeal Cancer In The Texas Rio Grande Valley, Jared A. Sperling, Rachel Giese

MEDI 9331 Scholarly Activities Clinical Years

Cancers of the oral cavity (OC) and oropharynx (OP) account for 3% of cancers diagnosed in the United States each year. A primary cause of death among the Hispanic population in the United States is cancer, accounting for 20% of annual mortality. The Rio Grande Valley (RGV) is a medically-underserved area of South Texas with a large Hispanic population facing health disparities. In this study, we examine the incidence and mortality of OC and OP cancer in the RGV. CDC population-level incidence and mortality rate per 100,000 of OC/OP cancer among patients in the RGV counties of Hidalgo and Cameron …

Adenoid Cystic Carcinoma Of External Auditory Canal: A Rare Disease, Abdul Basit Shah Vardag, Muhammad Hassan Danish, Mohammad Sohail Awan, Muhammad Usman Tariq, Omaima Anis Bhatti, Muhammad Hammad Deewani

Section of Otolaryngology, Head & Neck Surgery

External auditory canal, like other epithelialized surfaces is predisposed to malignancies such as Squamous cell carcinomas (SCC), melanomas and adenocarcinomas. In this background, malignancies like adenoid cystic carcinoma (ACC) are a rare occurrence and need to be thoroughly evaluated both locally and for distant extension. The malignancy needs to be addressed with an aggressive approach surgically with adequate marginal clearance. The role of radiation is debatable considering the outcomes in the limited data. Here we present the case of a 35-year-old female who came in with otalgia and otorrhea associated with a mass in the external auditory canal. After biopsy …

Lymphatic Dissemination And Axillary Web Syndrome In Primary Cutaneous Tuberculosis Secondary To Needlestick Injury, Alexandre E Malek, Caroline E Fife, John C Rasmussen, Ron J Karni, John R Morrow, Audrey Wanger, Eva M Sevick-Muraca, Luis Ostrosky-Zeichner

Faculty, Staff and Student Publications

Cutaneous tuberculosis secondary to skin inoculation of Mycobacterium tuberculosis is uncommon but it can occur in the health care settings. Herein, we report an unusual case of primary cutaneous tuberculosis of the thumb following a needlestick injury. The infection progressed with a necrotic granuloma, lymphatic dysfunction as visualized by near-infrared fluorescence lymphatic imaging, and the development of an axillary web syndrome.

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 …

Update On The Safety Of Anesthesia In Young Children Presenting For Adenotonsillectomy., Stephanie R. Mcguire, Nichole M. Doyle

Manuscripts, Articles, Book Chapters and Other Papers

Tonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is …

Pharmacologic Management Of Post-Tonsillectomy Pain In Children., Daniel R. Jensen

Manuscripts, Articles, Book Chapters and Other Papers

Tonsillectomy is a very common procedure in children, often performed on an outpatient basis. Severe postoperative pain is common, and can be prolonged. Despite a large number of available analgesic medications, often employed in combination, achieving adequate pain control remains a persistent challenge. Research suggests a tendency among caregivers to undertreat pain, and a need for detailed care instructions and education to ensure adequate pain management. Furthermore, ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results. This review …

Vitamin D Status And Pulmonary Exacerbations In Children And Adolescents With Cystic Fibrosis: Experience From A Tertiary Care Center, Danish Abdul Aziz, Syeda Khadija Fatima, Haissan Iftikhar, Fatima Mir

Department of Paediatrics and Child Health

Background: The function of Vitamin D in preventing inflammation and infection has been studied previously for different pathologies in different populations globally. Relationships between serum Vitamin D levels and its effect on pulmonary exacerbations in the cystic fibrosis (CF) population are not well studied in our part of the world. Therefore, we aimed to ascertain the Vitamin D status in pediatric and adolescent CF patients and its association with pulmonary exacerbations.
Materials and methods: A retrospective study was conducted at The Aga Khan University Hospital from 2015 to 2018. Patients of CF with sweat chloride value >60 mmol/l and who …