Otolaryngology Commons^™

Transoral Fundoplication Offers Durable Symptom Control For Chronic Gerd: 3-Year Report From The Tempo Randomized Trial With A Crossover Arm, Karim S. Trad, Mark Fox, Gilbert Simoni, Ahmad Shughoury, Peter Mavrelis, Mamoon Raza, Jeffrey Heise, William Barnes

Surgery Faculty Publications

Background

Four randomized controlled trials have demonstrated the short-term efficacy and safety of transoral esophagogastric fundoplication (TF) performed with the EsophyX® device in eliminating troublesome gastroesophageal reflux disease (GERD) symptoms in well-selected patient populations. The aim of this study was to assess the durability of these outcomes at 3 years post-procedure.

Methods

The TF EsophyX versus Medical PPI Open Label trial was conducted in seven US sites. Between June and August 2012, we enrolled patients with small (<2 cm) or absent hiatal hernias who suffered from troublesome GERD symptoms while on PPI therapy for at least 6 months and had abnormal esophageal acid exposure (EAE). Randomization was to TF group (n = 40) or to PPI group (n = 23). Following evaluation at 6 months, all remaining PPI patients (n …

A Dramaturgical Analysis Of The Miracle Worker, Abby Butzer

All Graduate Theses, Dissertations, and Other Capstone Projects

This document is a thesis submitted in partial fulfillment of the Master of Arts degree in theatre. It is a dramaturgical analysis for William Gibson's play The Miracle Worker, providing a reference for directors and actors. The thesis explores the play's medical and pedagogical history in six chapters: the physiology and psychology of language acquisition as it pertains to sight and/or hearing impaired children, a pedagogical comparison of Samuel G. Howe and Annie Sullivan, a modern diagnosis of the fever that destroyed Helen Keller's vision and hearing, the 19th century pathology and treatment options for the disease of the eye …

Patient-Reported Variables Associated With The Success Of Behavioral Intervention For Patients With Chronic Cough, Bridget Loomis

Graduate Student Theses, Dissertations, & Professional Papers

Purpose: To determine if patient-related variables exist that can potentially discriminate patients with refractory chronic cough (RCC) that are reasonable candidates for behavioral cough therapy (BCT). This study is a small sub-set of a larger, ongoing study, which aims to create and validate a screening tool that primary care physicians can use in order to refer patients early and appropriately for medical or behavioral intervention.

Methods: In this prospective, exploratory study, 20 adult participants, aged 29-68 years of age, answered a bank of questions developed by an expert panel, and the Leicester Cough Questionnaire (LCQ), before and after BCT. Questions …

Investigating The Efficacy Of Vocal Function Exercises In Improving Vocal Function In Adults Irradiated For Laryngeal Cancers: A Three Part Dissertation, Vrushali Angadi

Theses and Dissertations--Rehabilitation Sciences

Deterioration in voice quality following radiation therapy for the treatment of laryngeal cancers (LC) is well documented in literature. The majority of studies show that these voice problems are long term and in some cases permanent. Deterioration in voice quality, especially over a period of time could lead to significant communication difficulties in daily life or in some cases could even result in loss of profession. Despite the negative effects of radiation therapy on voice quality being well documented, few studies have focused on the efficacy of voice therapy in the irradiated LC population.

The purpose of this study was …

An Unusual Case Of Cauda Equina Secondary To Spinal Metastasis Of Thyroid Cancer, Shabbir Akhtar, Mohammad Adeel

Department of Surgery Docs

Abstract

INTRODUCTION:

Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity.

CASE REPORT:

We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of …

Connexin26 Gap Junction Mediates Mirna Intercellular Genetic Communication In The Cochlea And Is Required For Inner Ear Development, Yan Zhu, Liang Zong, Ling Mei, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

Organ development requires well-established intercellular communication to coordinate cell proliferations and differentiations. MicroRNAs (miRNAs) are small, non-coding RNAs that can broadly regulate gene expression and play a critical role in the organ development. In this study, we found that miRNAs could pass through gap junctions between native cochlear supporting cells to play a role in the cochlear development. Connexin26 (Cx26) and Cx30 are predominant isoforms and co-express in the cochlea. Cx26 deficiency but not Cx30 deficiency can cause cochlear developmental disorders. We found that associated with Cx26 deletion induced the cochlear developmental disorders, deletion of Cx26 but not Cx30 disrupted …

Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Tube Insertion In The Immediate Post-Partum Period For Head And Neck Cancer, Adil Aijaz Shah, Shabbir Akhtar, Nadeem Zuberi, Kamran Ali, Dania Aijaz Shah, Amir Hafeez Shariff

Department of Surgery Docs

Abstract

Percutaneous endoscopic gastrostomy (PEG) tube placement serves as a well-tolerated and efficacious technique for long-term enteral access in patients with medical conditions precluding oral food intake. The nutritional optimisation of patients with oral cancer is mostly achieved via PEG tube placement. However, certain special situations, such as pregnancy and the immediatepost-partum period, may render the placement of PEG tubes to be a challenge. A 28-year-old pregnant female patient presented to us with the diagnosis of squamous cell carcinoma of the tongue during her third trimester. Definitive surgical resection was planned post-delivery along with simultaneous PEG tube placement. Immediately following …

Is There Any Benefit Of Drain Placement On Postoperative Complications In Patients Undergoing The Sistrunk Procedure?, Talha Ahmed Qureshi, Anwar Suhail, Syed Sajjad Ali Zaidi, Wasif Siddiqui

Department of Surgery Docs

Abstract

Introduction Same-day, outpatient Sistrunk procedure is commonly performed to manage thyroglossal duct cyst anomalies and may lead to postoperative complications. Surgical drains are placed to prevent complications, but recent observations show no advantage and rather increased health care costs and patient discomfort. Objective The study evaluated if drain placement in the Sistrunk procedure offers any benefit on postoperative complications. Methods A retrospective analysis of patient records having undergone same-day, outpatient Sistrunk procedure from 2004 to 2014 was done. Of 58 (38 male and 20 female) patients included, 38 did not have drains placed and the remaining 20 had drains …

Endoscopic Management Of Idiopathic Subglottic Stenosis In Twenty-Five Patients, Katherine Mckee-Cole, Md, Ethan C. Bassett, Md, Maurits Boon, Md, Joseph Spiegel, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Introduction

While multiple causes exist for the development of subglottic stenosis, the mechanism responsible for idiopathic subglottic stenosis (ISS) remains unknown. Proposed etiologies include gastro-esophageal reflux (GERD) related exposure, telescoping of the first tracheal ring under the cricoid cartilage, a hormonal cause, and the possibility of an unidentified autoimmune process (1,3,6,8,12,18,19).

As ISS represents a rare disease of yet unknown etiology, the optimal management remains to be defined. The treatment options range from endoscopic management, which is less invasive but tends to show recurrence to open tracheal resection with anastomosis for those patients in whom endoscopic techniques are ineffective or …

Upper Airway Stimulation For Treatment Of Obstructive Sleep Apnea, Maurits Boon, Md

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

• What is OSA-Consequences of untreated OSA
• CPAP Therapy
• Why do we need alternatives to positive airway pressure (PAP) therapy
• How do we evaluate for alternative treatments
• Who is a candidate
• What are the alternatives

Laser Treatment Of Laryngeal Papillomatosis In A Young Child: Anaesthetic And Surgical Management, Faisal Shamim, Durriya Raza, Mubasher Ikram

Department of Surgery Docs

Abstract

The authors report the case of a 4-year boy who required anaesthetic and surgical care during LASER excision of laryngeal papillomatosis. He presented with hoarseness and stridor and underwent emergency tracheostomy after confirmation of laryngeal papillomas on CT scan. He required LASER treatment under general anaesthesia with a requirement of paediatric LASER-safe endotracheal tube but unfortunately, this was not available in the country. Balanced anaesthesia technique using inhalational anaesthetic, muscle relaxant and narcotic is used with modifications. After three successful surgical sessions, the airway became patent and tracheostomy was de-cannulated. The perioperative issues surrounding this process are discussed including …

Hibernoma Larynx With Large Multinodular Goitre: Unusual Airway Challenge, Haissan Iftikhar, Moghira Siddiqui

Department of Surgery Docs

Abstract

A 56-year-old man presented with a 6-month history of progressively increasing neck swelling, dysphagia and hoarseness of voice. CT scan revealed multi-nodular goitre and also showed a lesion in the supraglottis. It also showed another lesion in the supraglottis. Fine-needle aspiration cytology of thyroid revealed follicular cells. Routine flexible laryngoscopy was performed to evaluate vocal cord function; however, we found a smooth well-defined lesion just above the glottis, obstructing the direct view of the vocal cords, and an endangered airway. A provisional diagnosis of a laryngeal cyst was made. With all necessary precautions intubation was performed with a bougie …

Epidermal Growth Factor Mediated Healing In Stem Cell-Derived Vocal Fold Mucosa, Liliana Palencia, Amritava Das, Sean P. Palecek, Susan L. Thibeault, Ciara Leydon

Communication Disorders Faculty Publications

Background: The goal of vocal fold wound healing is the reconstitution of functional tissue, including a structurally and functionally intact epithelium. Mechanisms underlying reepithelialization in vocal folds are not known, although it is suspected that healing involves the interplay between several growth factors. We used a three-dimensional human embryonic stem cell-derived model of vocal fold mucosa to examine the effects of one growth factor, exogenous epidermal growth factor (EGF), on wound healing. Materials and methods: A scratch wound was created in the in vitro model. Rate of wound healing, epidermal growth factor receptor (EGFR) activation, and cell proliferation after injury …

Venous Thromboembolism-Incidence Of Deep Venous Thrombosis And Pulmonary Embolism In Patients With Head And Neck Cancer: A Tertiary Care Experience In Pakistan, Naeem Sultan Ali, Ahmad Nawaz, Montasir Junaid, Maliha Kazi, Shabbir Akhtar

Department of Surgery Docs

Abstract

Introduction Although venous thromboembolism (VTE) is seen with morbidity and mortality in various surgical specialties, scarce data are available in the head and neck surgery domain. Objective We aim to determine the incidence of VTE in patients receiving surgery for head and neck cancer. Methods Four hundred thirteen patients who underwent head and neck surgery procedures between 2005 and 2013 were reviewed retrospectively. All patients with head and neck surgery had received thromboprophylaxis (i.e., compression stockings and subcutaneous heparin). Patient demographics, operating time, and length of hospital stay were analyzed. The incidence of symptomatic deep venous thrombosis (DVT) and …

The Effects Of Formalized Team Training On Transitions In Patient Care In The Otolaryngology Head And Neck Surgery Residency, Natalie Vercillo, Md, David Cognetti, Md, Brittany Czarick, Pa-C, Heather Rozencwaig, Crnp, Troy Derose, Crnp, Rnfa, Ancc-C, Maurits Boon, Md

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

BACKGROUND

With increasing regulations from the ACGME for resident work hours, the number of patient care hand-offs inevitably rises. Work hour restrictions have the potential to significantly reduce the incidence of medical mistakes related to excessive fatigue only if the transitions of care are do not create further errors as a result of miscommunication. For this reason, transitions of care must be thorough and complete, yet efficient as patient care must not cease during these hand-off periods.

At Thomas Jefferson University Hospital, the Otolaryngology-Head and Neck Surgery service has both a full inpatient census and consult census. Given the trend …

Pannexin1 Channels Dominate Atp Release In The Cochlea Ensuring Endocochlear Potential And Auditory Receptor Potential Generation And Hearing, Jin Chen, Yan Zhu, Chun Liang, Jing Chen, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

Pannexin1 (Panx1) is a gap junction gene in vertebrates whose proteins mainly function as non-junctional channels on the cell surface. Panx1 channels can release ATP under physiological conditions and play critical roles in many physiological and pathological processes. Here, we report that Panx1 deficiency can reduce ATP release and endocochlear potential (EP) generation in the cochlea inducing hearing loss. Panx1 extensively expresses in the cochlea, including the cochlear lateral wall. We found that deletion of Panx1 in the cochlear lateral wall almost abolished ATP release under physiological conditions. Positive EP is a driving force for current through hair cells to …

Cellular And Deafness Mechanisms Underlying Connexin Mutation-Induced Hearing Loss - A Common Hereditary Deafness, Jeffrey C. Wingard, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

Hearing loss due to mutations in the connexin gene family, which encodes gap junctional proteins, is a common form of hereditary deafness. In particular, connexin 26 (Cx26, GJB2) mutations are responsible for ~50% of non-syndromic hearing loss, which is the highest incidence of genetic disease. In the clinic, Cx26 mutations cause various auditory phenotypes ranging from profound congenital deafness at birth to mild, progressive hearing loss in late childhood. Recent experiments demonstrate that congenital deafness mainly results from cochlear developmental disorders rather than hair cell degeneration and endocochlear potential reduction, while late-onset hearing loss results from reduction of active …

Transarterial Chemoembolization Is Ineffective For Neuroendocrine Tumors Metastatic To The Caudate Lobe: A Single Institution Review., Lawrence A Shirley, Megan Mcnally, Ravi Chokshi, Natalie Jones, Patrick Tassone, Gregory Guy, Hooman Khabiri, Carl Schmidt, Manisha Shah, Mark Bloomston

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Caudate lobe liver metastases occur commonly in patients with neuroendocrine tumors. It is unknown, however, how these lesions respond to regional therapy and how their presence impacts outcomes. We reviewed our experience treating these lesions using transarterial chemoembolization (TACE).

METHODS: We reviewed radiographic response to TACE in 86 patients with metastatic neuroendocrine tumors to the liver. We determined the impact of caudate lesions on outcomes in comparison to the cohort of patients without caudate lesions, as well as response of caudate lesions to TACE versus lesions elsewhere in the liver.

RESULTS: Caudate lesions were identified in 45 (52%) patients. …

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 …

Bilayer Button Graft For Endoscopic Repair Of High-Flow Cranial Base Defects, Chris Luminais, M. L. Otten, A. A. Farag, P. Soni, W. Mohiuddin, N. Ziegler, G. G. Nyquist, C. Farrell, M. R. Rosen, J. J. Evans

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

Closure of dural defects in trans-nasal, extended, endoscopic techniques remains a challenge, and published cerebrospinal fluid (CSF) leak rates are higher than rates for trans-cranial approaches. Development of a technique that used a vascularized, nasoseptal flap (NSF) significantly reduced the rate of CSF leak, and several groups have developed ways to buttress the NSF. A closure technique developed at our institution uses a bilayer “button” of fascia lata. The initial series of twenty patients repaired with this method from 2007 to July 1, 2009 were presented, with a CSF leak rate of 10% (Luginbuhl et al 2010).

Adult Tracheal Stenosis Causes And Therapies, Colin Huntley, Md

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

Outline:

• History of Tracheotomy
• Tracheal Stenosis-Etiology, Signs/Symptoms, Workup, Treatment Modalities

Note: No audio, only PowerPoint slides.

Surgeon Motivations Behind The Timing Of Breast Reconstruction In Patients Requiring Postmastectomy Radiation Therapy, M. Lee, E. Reinertsen, E. Mcclure, S. Liu, L. Kruper, N. Tanna, J. Brian Boyd, J. W. Granzow

Journal Articles

OBJECTIVES: Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT. METHODS: Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were …

Integrating Biodegradable 3-Dimensional-Printing Into Tracheal Reconstruction, T. Goldstein, L. Smith, B. Smith, D. Grande, D. Zeltsman

Journal Articles

No abstract provided.

The Macrophage Inhibitor Cni-1493 Blocks Metastasis In A Mouse Model Of Ewing Sarcoma Through Inhibition Of Extravasation, A. J. Hesketh, C. Maloney, C. A. Behr, M. C. Edelman, R. D. Glick, Y. Al-Abed, M. Symons, S. Z. Soffer, B. M. Steinberg

Journal Articles

Metastatic Ewing Sarcoma carries a poor prognosis, and novel therapeutics to prevent and treat metastatic disease are greatly needed. Recent evidence demonstrates that tumor-associated macrophages in Ewing Sarcoma are associated with more advanced disease. While some macrophage phenotypes (M1) exhibit anti-tumor activity, distinct phenotypes (M2) may contribute to malignant progression and metastasis. In this study, we show that M2 macrophages promote Ewing Sarcoma invasion and extravasation, pointing to a potential target of anti-metastatic therapy. CNI-1493 is a selective inhibitor of macrophage function and has shown to be safe in clinical trials as an anti-inflammatory agent. In a xenograft mouse model …

Probable Immunoglobulin Subtype-G4-Related Disease In The Head And Neck From Foreign Body Injection: A Case Report, M. J. Highstein, J. Mallen, T. Tham, T. Brennan, A. Boubour, E. Opher, V. Wolf, P. Singh, P. Costantino

Journal Articles

Introduction Immunoglobulin subtype G4-related disease (IgG4-RD) is a fibroinflammatory disease of unknown etiology, with manifestations involving nearly every organ system. Its association with foreign bodies is not established. Here, we present a novel case of IgG4-RD in response to foreign body injection. Case Description A 58-year-old woman presented with history of persistent left facial pain, xerophthalmia, blurred vision, and trismus. The patient's medical history was significant for left-sided temporomandibular joint (TMJ) reconstruction with silicone injection into the joint. Magnetic resonance imaging revealed a lesion in the left skull base. Biopsies demonstrated the cardinal histopathological features of IgG4-RD. The patient was …

Immune Dysregulation In Patients Persistently Infected With Human Papillomaviruses 6 And 11, A. V. Lucs, J. A. Devoti, L. Hatam, A. Afzal, A. L. Abramson, B. M. Steinberg, V. R. Bonagura

Journal Articles

Human Papillomaviruses (HPVs) 6 and 11 are part of a large family of small DNA viruses, some of which are commensal. Although much of the population can contain or clear infection with these viruses, there is a subset of individuals who develop persistent infection that can cause significant morbidity and on occasion mortality. Depending on the site of infection, patients chronically infected with these viruses develop either recurrent, and on occasion, severe genital warts or recurrent respiratory papillomas that can obstruct the upper airway. The HPV-induced diseases described are likely the result of a complex and localized immune suppressive milieu …

Presurgical Ct Evaluation Of Congenital Aural Atresia, V. T. Nguyen, G. Paek, J. Hu, L. P. Smith

Journal Articles

Congenital aural atresia occurs in approximately 1 in 10,000‐20,000 births and may be surgically repaired if the middle ear malformation is limited in character. External auditory canal atresia is difficult to repair surgically, with significant risks and complications. Surgical candidacy in congenital aural atresia is based on multiple factors, central to which are the anatomy of the temporal bone and audiometric findings. High-resolution multidetector CT is the imaging technique of choice for anatomy delineation, although there are some specific indications for MR imaging in presurgical assessment. Various CT grading systems have been developed to determine surgical candidacy and are described …

N-Acetylcysteine Attenuates Tumor Necrosis Factor Alpha Levels In Autoimmune Inner Ear Disease Patients, S. Pathak, C. Stern, A. Vambutas

Journal Articles

Autoimmune inner ear disease (AIED) is a poorly understood disease marked by bilateral, rapidly progressive hearing loss triggered by unknown stimuli, which is corticosteroid responsive in 60 % of patients. Although the mechanism of the disease is not precisely understood, a complex interaction of cytokines is believed to contribute toward the inflammatory disease process and hearing loss. Previously, we showed the role of TNF-alpha in steroid-sensitive and IL-1beta in steroid-resistant immune-mediated hearing loss. N-Acetylcysteine (NAC), a broad spectrum antioxidant, has been effective in other autoimmune disorders. Other studies have shown NAC to have a protective adjunct role in human idiopathic …

Poly(I:C) Induces Controlled Release Of Il-36gamma From Keratinocytes In The Absence Of Cell Death, A. A. Rana, A. V. Lucs, J. Devoti, L. Blanc, J. Papoin, R. Wu, C. J. Papayannakos, A. Abramson, V. R. Bonagura, B. M. Steinberg

Journal Articles

The epithelium is part of an integrated immune system where cytokines, toll-like receptors and their ligands, and extracellular vesicles play a crucial role in initiating an innate immune response. IL-36gamma is a pro-inflammatory member of the IL-1 family that is mainly expressed by epithelial cells, but regulation of its expression and release are only beginning to be understood. Previous studies reported that IL-36gamma is abundant in recurrent respiratory papillomatosis, a rare but devastating disease caused by human papillomaviruses (HPV) types 6 and 11, in which papillomas recurrently grow in and block the airway. Despite the overexpression of IL-36gamma, papilloma tissues …

Multiportal Combined Transorbital And Transnasal Endoscopic Resection Of Fibrous Dysplasia, T. Tham, P. Costantino, M. Bruni, D. Langer, J. Boockvar, P. Singh

Journal Articles

Introduction Historically, access to the anterior skull base was achieved with open procedures. The paradigms to this approach were challenged with the advent of minimally disruptive endoscopic surgical techniques and supporting technology. The next step in the evolution of minimally disruptive surgery was the combination of multiportal endoscopic surgery. Results The patient was an 18-year-old man who presented with right-sided proptosis. Further diagnostic tests revealed a fibrous dysplasia (FD) occupying the skull base and orbit. The lesion was successfully resected. Conclusions The location of the tumor in this case was challenging, in which surgeons at some centers would have opted …