Otolaryngology Commons^™

Giant Cell Tumor Of The Larynx Treated By Surgery And Adjuvant Denosumab: Case Report And Review Of The Literature, A. E. Yancoskie, D. K. Frank, J. E. Fantasia, S. Savona, N. Eiseler, I. Reder, L. B. Kahn

Journal Articles

Giant cell tumor of the larynx (GCTL) is a rare entity; only 34 cases have been reported in the literature. We report a case of GCTL in a 46 year-old male presenting clinical, radiographic, histological and therapeutic features. Previously reported cases are also reviewed.

Transmucosal Bleomycin For Tongue Lymphatic Malformations, E. W. Cerrati, T. M. O., D. Binetter, Y. Bernstein, M Waner

Journal Articles

No abstract provided.

Diagnosis And Management Of Infantile Hemangioma, D. H. Darrow, A. K. Greene, A. J. Mancini, A. J. Nopper, T. M. O

Journal Articles

Infantile hemangiomas (IHs) are the most common tumors of childhood. Unlike other tumors, they have the unique ability to involute after proliferation, often leading primary care providers to assume they will resolve without intervention or consequence. Unfortunately, a subset of IHs rapidly develop complications, resulting in pain, functional impairment, or permanent disfigurement. As a result, the primary clinician has the task of determining which lesions require early consultation with a specialist. Although several recent reviews have been published, this clinical report is the first based on input from individuals representing the many specialties involved in the treatment of IH. Its …

Comparative Analysis Of The Extracellular Matrix Composition In Proliferating And Involuted Infantile Hemangiomas, H. Park, H. Park, H. Y. Chung, T. M. O, M. Waner

Journal Articles

BACKGROUND: Changes in the composition of the extracellular matrix (ECM) occur between the proliferating and involuted phases of infantile hemangiomas (IH), and are associated with angiogenic growth. We examined the composition of the ECM in proliferating and involuted IHs and assessed correlations between the composition of the ECM and whether the IH was in the proliferating or the involuted phase. METHODS: We evaluated IH samples from a cohort of patients who had five proliferating IHs and five involuted IHs. The following ECM molecules were analyzed using enzyme-linked immunosorbent assays and immunohistochemistry: laminin, fibronectin, collagen type I, collagen type II, and …

Frequency-Place Map For Electrical Stimulation In Cochlear Implants: Change Over Time, K. Vermeire, D. M. Landsberger, P. H. Van De Heyning, M. Voormolen, A. Kleine Punte, R. Schatzer, C. Zierhofer

Journal Articles

The relationship between the place of electrical stimulation from a cochlear implant and the corresponding perceived pitch remains uncertain. Previous studies have estimated what the pitch corresponding to a particular location should be. However, perceptual verification is difficult because a subject needs both a cochlear implant and sufficient residual hearing to reliably compare electric and acoustic pitches. Additional complications can arise from the possibility that the pitch corresponding to an electrode may change as the auditory system adapts to a sound processor. In the following experiment, five subjects with normal or near-to-normal hearing in one ear and a cochlear implant …

The Relationship Between Insertion Angles, Default Frequency Allocations, And Spiral Ganglion Place Pitch In Cochlear Implants, D. M. Landsberger, M. Svrakic, J. T., Jr. Roland, M. Svirsky

Journal Articles

OBJECTIVES: Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hertz, but the electrode arrays are not designed to reach the most apical regions of the cochlea, which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal-hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear …

Oncologic Outcomes After Transoral Robotic Surgery : A Multi-Institutional Study, J. R. De Almeida, R. Li, J. S. Magnuson, R. V. Smith, E. Moore, G. Lawson, M. Remacle, I. Ganly, D. H. Kraus, F. C. Holsinger, +12 Additional Authors

Journal Articles

IMPORTANCE: Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. OBJECTIVES: To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. INTERVENTIONS: Select patients received radiation therapy and/or chemotherapy before or after TORS. MAIN OUTCOMES AND MEASURES: Locoregional …

Measurement Of Cochlear Implant Electrode Position From Intraoperative Post-Insertion Skull Radiographs: A Validation Study, M. Svrakic, D. R. Friedmann, P. M. Berman, A. J. Davis, J. T., Jr. Roland, M. A. Svirsky

Journal Articles

OBJECTIVE: To validate a method of measuring angular depth of insertion (aDOI) as well as positional depth of each electrode contact in a cochlear implant by using intraoperative postinsertion skull radiographs. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Intraoperative postinsertion radiographs obtained from 18 cochlear implant recipients were chosen for analysis. One high-resolution computer tomography scan of the head with the electrode in place was also analyzed. One cadaveric temporal bone with an inserted electrode provided additional data for analysis. INTERVENTION: aDOI and position of each electrode contact were measured from the radiographs using readily available software. High-resolution …

Practices Of Tracheal Suctioning Technique Among Health Care Professionals: Literature Review, Rozina Khimani, Fauziya Ali Dr., Salma Rattani, Mohammad Sohail Awan

Department of Surgery Docs

The current study aims to assess tracheal suctioning practices among health care practitioners; nurses, critical care technicians and physiotherapist. Employing literature review as the methodology, multiple databases were searched focusing on three phases of tracheal suctioning (a) the pre suctioning phase, (b) the suctioning phase, (c) the post suctioning phase and complications related to tracheal suctioning. It was concluded that to provide quality care it is important that the evidence based practice guidelines should be followed.

Kimura’S Disease Of Head And Neck: A Rare Case Presentation, Talha Ahmed Qureshi, Moghira Siddiqui, Muhammad Tariq

Department of Surgery Docs

Kimura's disease (KD) is a rare, unusual occurrence, predominantly seen in Asian men, and poses a diagnostic challenge, often manifesting with allergic, eosinophilic hyperplasia, and nonspecific lymphadenitis. A 39-year-old man presented with mobile, well circumscribed, facial and neck swelling. His earlier biopsy showed a reactive lymph node hyperplasia on ultrasound neck and was suggestive of lipomatosis. As definitive diagnosis could not be made, the patient was planned for excision and biopsy. Subsequent histopathology demonstrated eosinophilic infiltration of lymphoid follicles and expansion of interfollicular area with interfollicular eosinophilic abscess formation and capillary venule proliferation. This was quite interesting as the previously …

Epithelial Cells Are Active Participants In Vocal Fold Wound Healing: An In Vivo Animal Model Of Injury, Ciara Leydon, Mitsuyoshi Imaizumi, Rebecca S. Bartlett, Sarah F. Wang, Susan L. Thibeault

Communication Disorders Faculty Publications

Vocal fold epithelial cells likely play an important, yet currently poorly defined, role in healing following injury, irritation and inflammation. In the present study, we sought to identify a possible role for growth factors, epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGFβ1), in epithelial regeneration during wound healing as a necessary first step for uncovering potential signaling mechanisms of vocal fold wound repair and remodeling. Using a rat model, we created unilateral vocal fold injuries and examined the timeline for epithelial healing and regeneration during early and late stages of wound healing using immunohistochemistry (IHC). We observed time-dependent …

Ent Educational Patient Bedside Tool, Alina M. Toma

Master's Projects and Capstones

Early educational and discharge preparations are an advantage to patients, the interdisciplinary team, and hospital. It was determined that lack in communication and coordination among staff members led to inadequate patient teaching, therefore an educational tool that is kept at the bedside may facilitate accountability and smoother transition to home.

The aim of the project is to improve the education of patients with tracheostomies and laryngectomies, and enhance staff communication and coordination by December 2014.

Analysis methods used included Failure Mode Effects Analysis (FMEA), fishbone diagram, process map, and SWOT analysis. The social learning theory is the framework chosen for …

Comprehensive Management Of The Paranasal Sinuses In Patients Undergoing Endoscopic Endonasal Skull Base Surgery., Gurston G Nyquist, Md, Marc R Rosen, Md, Mark E. Friedel, Md, D David Beahm, Md, Christopher J Farrell, Md, James J. Evans, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: The endonasal route often provides the most direct and safe approach to skull base pathology. In this article we review the literature with regard to management of the paranasal sinuses in the setting of skull base surgery.

METHODS: We describe our institutional experience and review the literature of concurrent management of the sinusitis in patients undergoing endoscopic skull base surgery.

RESULTS: Patients should be optimized preoperatively to ensure the endonasal route is a safe corridor to enter the intracranial cavity. Often the paranasal sinuses can be surgically addressed at the same time as endoscopic skull base surgery. We describe …

Inferior Meatus Maxillary Antrostomy: Time To Revisit A Previously Abandoned Surgical Technique?, Natalie Ziegler, Bs, Alfred Marc C. Lloreta, Md, Alexander Farag, Md, Ting Ting Zhan, Phd, Gurston G. Nyquist, Md, Marc Rosen, Md

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

Background: A small subset of patients have dysfunctional maxillary sinus mucosa. These patients require more aggressive surgical treatment to allow for gravity dependent mucous drainage, intra-operative and office debridements, and the delivery of irrigations and topical treatments. The aim of this study is to examine the use of inferior meatus maxillary antrostomy (IMMA) in combination with traditional maxillary antrostomy, in this challenging patient population.

Methods: We performed a retrospective study from February, 2008 until April, 2014 with a 118 patients undergoing a total of 128 IMMA procedures. Data was gathered regarding patient demographic, prior therapy, post-operative medical therapy, IMMA patency, …

Nut Midline Carcinoma In A Pregnant Woman, Jill N. D'Souza, Md, David M. Cognetti, Md, Ryan N. Heffelfinger, Md, James J. Evans, Md, Madalina Tuluc, Md, Jurij R. Bilyk, Marc R. Rosen, Md

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

NUT midline carcinoma is a rare, highly aggressive tumor that involves midline structures, particularly in the head, neck and mediastinum. It is characterized by NUT gene translocations on chromosome 15. It typically impacts teenagers or young adults, and has a fulminant course leading to death in less than a year in most cases despite aggressive chemoradiotherapy. Due to its location, this tumor is frequently considered inoperable. We present a case of a sinonasal NUT midline carcinoma with orbital invasion discovered during the workup of sinusitis in a young, pregnant woman. The tumor was managed with definitive excision to negative margins …

Cervical Spine Osteomyelitis After Esophageal Dilation In Patients With A History Of Laryngectomy Or Pharyngectomy And Pharyngeal Irradiation, Richard A. Goldman, Md, Jill N. D'Souza, Md, Adam J. Luginbuhl, Md, Joshua E. Heller, Md, Joseph M. Curry, Md, David M. Cognetti, Md

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

Dysphagia is a common sequela of the treatment of head and neck cancer and is frequently managed with esophageal dilation in patients with dysphagia secondary to hypopharyngeal stenosis. Reported complications of esophageal dilation include bleeding, esophageal perforation, and mediastinitis. We examine four cases of cervical spine osteomyelitis presenting as a delayed complication of esophageal dilation for hypopharyngeal stenosis in patients with a history of laryngectomy or pharyngectomy and radiation with or without chemotherapy. The history of head and neck surgery and radiation in these patients further complicates the management of the cervical spine osteomyelitis.

Postoperative Non-Steroidal Anti-Inflammatory Drugs And Risk Of Bleeding In Pediatric Intracapsular Tonsillectomy, Jill N. D'Souza, Md, Julie P. Adelman, Bs, Richard J. Schmidt, Md, Heather C. Nardone, Md

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

Tonsillectomy with or without adenoidectomy is one of the most frequently performed surgeries in the United States, with over 500,000 performed annually. Post-tonsillectomy hemorrhage is one of the most feared complications; thus, medications that could increase the risk of postoperative bleeding traditionally have been avoided. With recent FDA guidelines encouraging a departure from codeine-based medications in pediatric patients undergoing tonsillectomy, we examined the use of ibuprofen for post-tonsillectomy pain control. The records of 449 children who underwent tonsillectomy and received ibuprofen for postoperative pain control were reviewed and compared to a cohort of 1731 children who received codeine for pain …

Physiology And Advancements In Wound Healing, Adam Baker, Md

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

Outline of presentation:

Fundamentals

Advances

• -Growth Factors
• -Platelet Rich Plasma
• -Engineered skin
• -Hyperbaric Oxygen Therapy

Research

Nasal T Cell Lymphoma: A Rare Entity, Maliha Kazi, Mubasher Ikram, Montasir Junaid

Section of Otolaryngology, Head & Neck Surgery

Nasal type of Natural Killer (NK)/T cell lymphoma manifests in the nasal cavity. Approximately 95% of them are associated with EBV(Ebstein Barr Virus) with a strong predilection for the Asian population. It has certain systemic and localized symptoms which aid in diagnosis of the condition. However, the histological criteria is pivotal in confirming the diagnosis as well as aiding in confirming the association of EBV. Nasal type of NK/T cell lymphoma has a guarded prognosis. Treatment plan include radiotherapy with concurrent chemotherapy. Despite all this, the 5-year survival rate ranges from 15-75%. A 35 years old male presented with an …

A Novel In Vivo Model For Evaluating Functional Restoration Of A Tissue-Engineered Salivary Gland., Swati Pradhan-Bhatt, Daniel A Harrington, Randall L Duncan, Mary C Farach-Carson, Xinqiao Jia, Robert L Witt

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: To create a novel model for development of a tissue-engineered salivary gland from human salivary gland cells that retains progenitor cell markers useful for treatment of radiation-induced xerostomia.

STUDY DESIGN: A three-dimensional (3D) hyaluronic acid (HA)-based hydrogel scaffold was used to encapsulate primary human salivary gland cells and to obtain organized acini-like spheroids. Hydrogels were implanted into rat models, and cell viability and receptor expression were evaluated.

METHODS: A parotid gland surgical resection model for xenografting was developed. Salivary cells loaded in HA hydrogels formed spheroids and in vitro were implanted in the three-fourths resected parotid bed of athymic …

Laryngeal Myxoma: A Case Report And Review Of The Literature, A. Ritchie, J. Youngerman, J. E. Fantasia, L. B. Kahn, R. S. Cocker

Journal Articles

Myxomas are a rare benign neoplasm of uncertain mesenchymal cell origin, typically involving the heart. Laryngeal myxomas are uncommon, and are usually misdiagnosed as laryngeal polyp. To the best of our knowledge, there are only nine reported cases in the English literature. We report a case of a laryngeal myxoma presenting clinically as a left vocal cord polyp in a 77 year old male, and review the literature related to this rare entity.

Decreased Langerhans Cell Responses To Il-36 Gamma: Altered Innate Immunity In Patients With Recurrent Respiratory Papillomatosis, J. Devoti, L. Hatam, A. Lucs, A. Afzal, A. Abramson, B. M. Steinberg, V. Bonagura

Journal Articles

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomaviruses (HPVs) types 6 and 11 that is characterized by the polarization of adaptive immune responses that support persistent HPV infection. Respiratory papillomas express elevated mRNA levels of IL-36 gamma, a proinflammatory cytokine in comparison to autologous clinically normal laryngeal tissues; however there is no evidence of inflammation in these lesions. Consistent with this, respiratory papillomas do not contain T(H)1-like CD4(+) T-cells or cytotoxic CD8(+) T-cells, but instead contain a predominance of T(H)2-like and T regulatory cells (Tregs). In addition, papillomas also are infiltrated with immature Langerhans cells …

Overexpressed Beta-Catenin Localizes To Plasma Membrane In Respiratory Papillomas, A. V. Lucs, A. L. Abramson, B. M. Steinberg

Journal Articles

No abstract provided.

Internal Maxillary Artery-Middle Cerebral Artery Bypass: Infratemporal Approach For Subcranial-Intracranial (Sc-Ic) Bypass, E. Nossek, P. Costantino, M. Eisenberg, A. R. Dehdashti, A. Setton, D. J. Chalif, R. A. Ortiz, D. J. Langer

Journal Articles

BACKGROUND:Internal maxillary artery (IMax)-middle cerebral artery (MCA) bypass has been recently described as an alternative to cervical extracranial-intracranial bypass. This technique uses a keyhole craniectomy in the temporal fossa that requires a technically challenging end-to-side anastomosis.OBJECTIVE:To describe a lateral subtemporal craniectomy of the middle cranial fossa floor to facilitate wide exposure of the IMax to facilitate bypass.METHODS:Orbitozygomatic osteotomy is used followed by frontotemporal craniotomy and subsequently laterotemporal fossa craniectomy, reaching its medial border at a virtual line connecting the foramen rotundum and foramen ovale. The IMax was identified by using established anatomic landmarks, neuronavigation, and micro Doppler probe (Mizuho Inc. …

Early Efficacy Trial Of Anakinra In Corticosteroid-Resistant Autoimmune Inner Ear Disease, A. Vambutas, M. Lesser, V. Mullooly, S. Pathak, G. Zahtz, L. M. Rosen, E. Goldofsky

Journal Articles

BACKGROUND. Autoimmune inner ear disease (AIED) is a rare disease that results in progressive sensorineural hearing loss. Patients with AIED initially respond to corticosteroids; however, many patients become unresponsive to this treatment over time, and there is no effective alternative therapy for these individuals. METHODS. We performed a phase I/II open-label, single-arm clinical trial of the IL-1 receptor antagonist anakinra in corticosteroid-resistant AIED patients. Given that the etiology of corticosteroid resistance is likely heterogeneous, we used a Simon 2-stage design to distinguish between an unacceptable (= 30%) response rate to anakinra therapy. Subjects received 100 mg anakinra by subcutaneous injection …

In Reference To "The Value Of Resident Presentations At Scientific Meetings", J. A. Eloy, P. F. Svider, A. J. Folbe, M. Setzen, S. Baredes

Journal Articles

No abstract provided.

Malignancy Rate In Thyroid Nodules Classified As Bethesda Category Iii (Aus/Flus), A. S. Ho, E. E. Sarti, K. S. Jain, H. J. Wang, I. J. Nixon, A. R. Shaha, J. P. Shah, D. Kraus, R. Ghossein, L. G. T. Morris, +3 Addiltional Authors

Journal Articles

Background: The Bethesda System for Reporting Thyroid Cytopathology is the standard for interpreting fine needle aspiration (FNA) specimens. The atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category, known as Bethesda Category III, has been ascribed a malignancy risk of 5-15%, but the probability of malignancy in AUS/FLUS specimens remains unclear. Our objective was to determine the risk of malignancy in thyroid FNAs categorized as AUS/FLUS at a comprehensive cancer center. Methods: The management of 541 AUS/FLUS thyroid nodule patients treated at Memorial Sloan-Kettering Cancer Center between 2008 and 2011 was analyzed. Clinical and radiologic features were examined as …

Squamous Cell Carcinoma Of The Tonsil Managed By Conventional Surgery And Postoperative Radiation, R. Rahmati, S. Dogan, O. Pyke, F. Palmer, M. Awad, N. Lee, D. Kraus, J. P. Shah, S. G. Patel, I. Ganly

Journal Articles

BACKGROUND: The purpose of this study was to report the long-term outcome of patients with squamous cell cancer (SCC) of the tonsil managed by surgery followed by postoperative radiotherapy (PORT). METHODS: Eighty-eight patients treated between 1985 and 2005 were analyzed. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome were determined by univariate and multivariate analysis. RESULTS: Forty-eight percent of patients had T3 to T4 disease and 75% had a positive neck. Five-year OS, DSS, and RFS were 66%, 82%, and 80%, respectively. The status of the neck was …

Cochlear Development And Auditory Function In The Absence Of Thyroid Hormone Transporters Mct8 And Oatp1c1, Richard Sinn

All Graduate Theses, Dissertations, and Other Capstone Projects

Thyroid hormone (TH) is essential for the development and maturation of the nervous system. The thyroid gland secretes an active form of TH, triiodothyronine, and a prohormone, thyroxine, into the blood. TH is charged, which prevents it from passively diffusing across cell membranes and thus requires cell membrane transporters to facilitate its movement into and out of cells. However, whether TH transporters are required for TH-mediated developmental events, including the auditory system, is largely unknown.

The purpose of the present study was to investigate two specific TH transporters, monocarboxylate transporter 8 (Mct8) and organic anion transporting polypeptide 1c1 (Oatp1c1), and …

A Preliminary Report Of Percutaneous Craniofacial Osteoplasty In A Rat Calvarium., William Parkes, Jewel Greywoode, Brian J O'Hara, Ryan N. Heffelfinger, Howard Krein

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatability and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model.

STUDY DESIGN: Randomized controlled animal model METHODS: Fourteen adult Sprague Dawley rats were injected in the parietal skull with 0.2 ml of hydroxylapatite (10 animals) or a carrier gel control (4 animals), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, 3 rats (1 negative control, 2 variables) were sacrificed and calvaria were harvested. At 12 months, the remaining 5 rats were …