Otolaryngology Commons^™

From Model To Mastery: High-Fidelity Cricothyrotomy Simulation With A 3d-Printed And Biological Tissue Model, Lauren E. Schlegel, Sruti Tekumalla, Sara Belko, Aarti Agarwal, Eva Varotsis, Julianna Rodin, Robert Pugliese, Morgan Hutchinson, Richard Goldman

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objective

Emergency cricothyroidotomy is a rare procedure utilized in the setting of patients who cannot be oxygenated or intubated. To enhance training in this critical skill, we developed and validated an immersive, high‐fidelity task trainer that integrates a 3D‐printed airway model with a porcine soft‐tissue layer, and we assessed its impact during simulation‐based training sessions.

Study Design

Observational.

Setting

Single institution (16 otolaryngology and 30 emergency medicine trainees).

Methods

Our trainer consisted of an accurate 3D‐printed airway model and neck incorporating anatomical structures and a biological soft‐tissue layer. A survey was administered before and after the simulation. The simulations were …

Effect Of Head Coverings On Directional Microphone Performance In Modern Hearing Aids: A Kemar-Based Laboratory Evaluation, Zahra Fekri, Mariam Mohamad, Ayasakanta Rout

Faculty Scholarship

Background/Objectives: Directional microphones are an established hearing aid technology for improving speech understanding in background noise. Although researchers have examined the influence of hair, spectacles, and earmold venting on directional performance, no systematic work has addressed head coverings, which people wear worldwide for cultural, religious, occupational, and personal reasons. This study determined whether a cotton head covering alters the directivity index (DI) of highest-level receiver-in-canal (RIC) hearing aids. Methods: A Knowles Electronics Manikin for Acoustic Research (KEMAR) was positioned in a double-walled, sound-treated booth, and DI was measured for omnidirectional and fixed directional microphone settings, with and without a two-layer …

Training Apart, Together: Team Dynamics In Individual Sports And Surgical Residency, W. Jack Palmer, Dylan Bertoni, Elizabeth E. Cottrill, Colin T. Huntley

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Surgeons in training share notable parallels with competitive athletes, including rigorous training, skill specialization, and functioning under pressure. Surgical educators have leveraged this comparison, incorporating techniques from sports psychology, such as mental imagery and mindfulness, to improve trainees' individual performance and well-being. Surgical trainees and athletes both rely on effective teamwork for optimal outcomes, suggesting that residency leaders can glean valuable team-level insights from sports psychology. This article examines how the structure of surgical residency influences team dynamics, using concepts from sports psychology to identify evidence-based strategies for improving program cohesion and resident well-being. The surgical literature typically conceptualizes surgery …

A Real-World Characterization Of Patients Receiving Biologics For Type 2 Inflammatory Diseases In A Tertiary Rhinology Practice, T. Blaise Marshall, Matthew Lelegren, Joseph K. Han, Kent Lam

Eastern Virginia Medical Journal

Background: Biologic therapies, such as omalizumab, mepolizumab, dupilumab, and benralizumab, are increasingly used in the treatment of various type 2 inflammatory diseases, including chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and atopic dermatitis. While these biologic therapies have demonstrated efficacy and safety in their respective clinical trials, real-world characterization of the use of biologic therapies provides insight into how these treatments are prescribed and utilized among the general population.

Objective: We aim to characterize the patient population in a single tertiary otolaryngology practice that is receiving biologic therapies for all type 2 inflammatory diseases.

Methods: We conducted a retrospective chart …

Patient-Specific Computational Fluid Dynamics Modeling Of Airway Collapse In Infants With Robin Sequence., Gautam Jalori, Michael Barbour, Michael Bindschadler, Kelly Evans, John P. Dahl, Alberto Aliseda

Manuscripts, Articles, Book Chapters and Other Papers

Robin Sequence (RS) is a congenital condition in which patients experience dynamic, periodic obstruction or collapse of the upper airway due to an underdeveloped jaw and a posteriorly displaced tongue. Current clinical techniques for evaluating airway obstruction do not provide quantifiable data and fail to account for the dynamic nature of obstruction or collapse. There is no standardized criterion to characterize obstruction or collapse severity. This study presents the first method that extracts airway motion from 4-dimensional computed tomography and performs a patient-specific, moving-mesh computational fluid dynamics (CFD) analysis of RS patients with complete airway collapse or obstruction. To quantify …

Should H2-Blockers Be Used For The Treatment Of Laryngopharyngeal Reflux?, Sophia Linguiti, W. Jack Palmer, Janvi J. Shukla, Kathleen Tibbetts, Colin Huntley, Joseph Spiegel

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Laryngopharyngeal reflux (LPR) is a highly prevalent condition in otolaryngology practice, characterized by reflux of gastric contents into the pharynx and larynx. Although proton pump inhibitors (PPIs) remain first-line therapy, many patients report persistent symptoms. In refractory cases, histamine-2 receptor antagonists (H2RAs) are often employed as adjunctive or standalone therapy due to their rapid onset and accessibility. However, their utility as daily therapy is limited by tachyphylaxis, with significant loss of acid suppression within days of continuous use. Despite longstanding evidence from gastroenterology literature discouraging daily H2RA therapy, these agents remain frequently prescribed in otolaryngology practice. Contemporary ear, nose, and …

Definitive Radiation Therapy For Schneiderian Inverted Papilloma Of The Soft Palate And Uvula., Rahul Sinha, Arianne J Abreu, Christopher E Fundakowski, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Schneiderian inverted papilloma is a benign, locally aggressive tumor that typically arises in the respiratory mucosa of the nasal cavity and paranasal sinuses. These tumors are often asymptomatic but can cause unilateral nasal obstruction, discharge, hyposmia and epistaxis. They warrant attention particularly due to the potential for malignant transformation. They are treated most often with surgical excision. This case report describes a patient with Schneiderian inverted papilloma arising outside its usual location and managed with definitive radiation therapy instead of surgical excision due to concerns for functional impairment. Remission was obtained with radiation therapy, although the patient experienced treatment-related side …

Endotyping Obstructive Sleep Apnea In Infants With Micrognathia, Alexis Dominic, Zarmina Ehsan, Baha Al-Shawwa Md, Karishma Rao, Blake A. Welker, Meghan Tracy, Andrew Li, Alessandra Manoylova-Vedder, Shiyuan Chen, Shu-Ching Chen, Members Of The Data Science And Analytics Innovation Center (Dsaic), John P. Dahl, Janelle Noel-Macdonnell

Posters

No abstract provided.

Cartilage Ring Formation In Chick Trachea, Yashica Sharma, Samuel Q. Mellentine, John Dahl, Jennifer C. Kasemeier

Posters

No abstract provided.

Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea: A Systematic Review And Meta-Analysis On Responder-Based Outcomes And Between-Study Heterogeneity, Clemens Heiser, Marcel Braun, Colin Huntley, Michael Hutz, Thomas Michael Kaffenberger, Maurits Boon

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Hypoglossal nerve stimulation (HNS) is an established surgical therapy for adults with moderate-to-severe obstructive sleep apnea (OSA) who are intolerant to positive airway pressure. Although aggregate response rates of ~70–80% have been reported, substantial variability across clinical settings remains poorly understood. Prior meta-analyses have largely emphasized pooled continuous outcomes, limiting interpretation of responder-based endpoints and drivers of between-study heterogeneity. Methods: A PRISMA-compliant systematic review and meta-analysis was performed. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception through 31 December 2025. Eligible studies enrolled adults with OSA treated with implantable HNS, reported Sher-defined response (≥50% AHI reduction and residual …

An Unusual Case Of Bilateral Upper And Lower Oral Cavity Cysts In A Newborn, Frances Rodriguez Lara, Jillian L. Chen, Jennifer N. Shehan, Jessica R. Levi

HCA Healthcare Journal of Medicine

Background

Oral mucosal lesions in newborns have a broad differential diagnosis, ranging from benign, transient conditions to potential early signs of systemic disease. Most of these lesions are resolved without intervention, but delayed recognition can lead to complications, such as airway obstruction. Early identification is crucial for appropriate management. This case report discusses an unusual presentation of multiple oral mucosal cysts in a newborn, emphasizing the challenges of diagnosis and management.

Case Presentation

A 1-day-old male was evaluated at Boston Medical Center for cystic oral lesions identified during newborn screening. The infant was born at 36 weeks and 2 days’ …

Early Adoption Of Thyroid Radiofrequency Ablation In Canada: Physician Experiences, Barriers, And Facilitators To Implementation, Harrison Gao, David Liu, Ben B. Levy, Justin Shapiro, Kevin M. Higgins, Diana E. Khalil, Elizabeth E. Cottrill, Courtney Poon, Pabiththa Kamalraj, Justine Philteos, Antoine Eskander

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

IMPORTANCE: Thyroid radiofrequency ablation (RFA) is a minimally invasive alternative to surgery for thyroid nodules. Despite strong international evidence, thyroid RFA was only approved by Health Canada in April 2023. Understanding the experiences of early adopters can inform the broader adoption of RFA in Canada and other healthcare systems.

OBJECTIVE: To describe the implementation experiences of early adopters of thyroid RFA in Canada and identify barriers and facilitators to adoption.

DESIGN: Multiple methods.

SETTING: All 8 listed RFA facilities in Canada.

PARTICIPANTS: Physicians performing thyroid RFA (n = 9).

MAIN OUTCOME MEASURES: Survey and semi-structured interviews.

RESULTS: Most participants reported …

Esophageal Innominate Artery Fistula After Delayed Recognition Of Esophageal Foreign Body., Arianne J Abreu, Rahul Sinha, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Esophageal innominate artery fistula (EIF) is a rare cause of life-threatening gastrointestinal hemorrhage. This condition occurs most often secondary to an aneurysm, tumor, or esophageal foreign body. After stabilization of airway and circulation, the management options vary from open to endoscopic and endovascular repair. The initial presentation, diagnosis and management of EIF in the literature focuses on adults primarily. In this case report, the clinical presentation of EIF in a pediatric patient, secondary to delayed recognition of a foreign body, highlights management considerations in this population.

Virtual Patient-Specific 3-Dimensional Specimen Maps For Adjuvant Radiation Therapy Planning In Mucosal Head And Neck Squamous Cell Carcinoma, Whitney Jin, Michael C. Topf, Marina Aweeda, Kavita Prasad, Olivia Prosak, Sindhura Sridhar, Zachary Kohutek, Sean All, D. W. Nathan Kim, Anthony Cmelak, Ryan Whitaker, Alexander Langerman, Kyle Mannion, Melanie Hicks, Sarah Rohde, Robert Sinard, Eben Rosenthal, Natalie A. Lockney

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

PURPOSE: Adjuvant radiation therapy planning for mucosal head and neck squamous cell carcinoma is challenging due to postoperative anatomic changes, contributing to variability in clinical target volume (CTV) delineation and risk of geographic miss or unnecessary dose expansion. Patient-specific 3-dimensional (3D) specimen maps may offer a novel approach to improve the localization of high-risk margins and facilitate multidisciplinary communication.

METHODS AND MATERIALS: In this prospective, noninterventional feasibility study, 3D scanning and virtual pathologic mapping of surgical specimens were performed as part of routine pathologic processing. Annotated 3D maps were integrated into the radiation therapy planning workflow and reviewed by the …

Recurrent Laryngeal Nerve Variations And Strategies For Injury Prevention: A Systematic Review, Hana Abdelmeguid, Bamdad Tayyari, Yuvedha Senthil Velan, Michael J. Montalbano Md

Medical Student Research Symposium

Objective

Anatomical variations in the recurrent laryngeal nerve (RLN), namely extra-laryngeal terminal bifurcation and non-recurrent inferior laryngeal nerve, are known risk factors for RLN injury during surgery and represent a considerable jeopardy for iatrogenic damage like vocal cord paralysis. This systematic review aims to identify strategies for protecting RLN during thyroid surgery from nerve damage.

Methods

A search was conducted using EMBASE, MEDLINE, and PUBMED for articles published till February 2023 while strictly adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Subject headings and keywords related to anatomical variations, recurrent laryngeal nerve, and surgical prevention …

Sex-Biased Intratumoral Microbiome Influences Tumor Molecular And Immune Landscape And Disease Outcomes, Yuting Shan, Yingbo Huang, Adam Lee, Radwa M. Elmorsi, Tuyen Phan, Indrajit Chaudhury, Tom Corbiere, Lindsey B. Collins, Elizabeth B. Hirsch, Benjamin A. Weinberg, Jennifer M. Johnson, Emmanuel S. Antonarakis, Emil Lou, R. Stephanie Huang

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

The intratumoral microbiome is increasingly recognized as a regulator of cancer biology, yet sex-specific patterns and their relevance to cancer disparities remain poorly understood. We perform a multi-kingdom analysis of more than 5,000 tumors from seven datasets to identify sex-differential microbial taxa across aerodigestive and gastrointestinal cancers. We identify and validate 22 taxa with consistent sex-biased abundance, including in real-world cohort. These microbes show cancer-type- and microbe-specific associations with tumor transcriptomes, oncogenic pathways, and immune cell infiltration. Female-enriched microbes are linked to increased estrogen signaling and interferon responses, whereas male-enriched taxa show opposing patterns. In gastric cancer, intratumoral Epstein-Barr virus …

Anatomy Of The Orbit: Radiologic And Surgical Anatomy Of Anterior And Medial Approaches, Emily Garvey, Benjamin Bitner, Mindy R. Rabinowitz

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Purpose of Review: To review relevant medial orbital anatomy as well as the most commonly used approaches to this space. Recent Findings: The use of the endoscopic endonasal approach for access to the medial orbit, including the intraconal space, has expanded allowing for removal of previously “inoperable” pathology. Summary: Each approach has their strength when considering access to the medial orbit, the transcaruncular incision allows for fast access with limited dissection while the transpalebral approach allows for visualization of the medial orbit but also extended access to the superior and lateral orbit. Conversely, the conjunctival approach allows for wider access …

Anthropometric Measurements Inform Complete Concentric Collapse Status In Patients With Obstructive Sleep Apnea, Jordan Weiner, Eugene Chio, Raj Dedhia, Colin Huntley, Michael Hutz, Phillip Huyett, Daniel Lee, Philip Losavio, Ilya Perepelitsyn, Ryan Soose, David Kent

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: Hypoglossal nerve stimulation in the US requires drug-induced sleep endoscopy to exclude patients with complete concentric collapse. This is an expensive and time-consuming requirement. We hypothesized that supine pharyngeal width, and other demographic and polysomnographic variables would associate with complete concentric collapse.

STUDY DESIGN: Prospective, multicenter cohort study.

SETTING: 10 centers in the United States with experience selecting patients for and performing airway surgeries for sleep apnea including hypoglossal nerve stimulation implantation.

METHODS: 600 patients meeting criteria for hypoglossal nerve stimulation underwent measurement of supine pharyngeal width and collection of demographic and polysomnographic data followed by drug-induced sleep endoscopy. …

Multifocal Papillary Thyroid Carcinoma With Ret P.V804m, Eml4-Alk Fusion, And Braf V600e Positivity, Jacob Beiriger, Leonard Estephan, Lubna Zuberi, Stacey Gargano, Elizabeth Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Multifocal papillary thyroid cancer (PTC) can arise from independent primaries with discordant drivers in parallel clonal evolution rather than a single-clone pattern. We present a 31-year-old female with multifocal PTC harboring 3 distinct oncogenic alterations: a germline RET p.V804M mutation, low-frequency EML4-ALK fusion, and BRAF V600E mutation. The RET and ALK alterations were identified in a midpole nodule, whereas BRAF positivity was seen in a separate lower pole tumor. Ultrasound revealed multiple right-lobe thyroid nodules; the dominant 2.1-cm lesion was hypoechoic with calcifications. Fine needle aspiration revealed Bethesda III cytology, prompting thyroid lobectomy and an ipsilateral central neck dissection was …

Bilateral Vocal Process Avulsion: A Rare Complication Of Laryngeal Trauma., Hye Rhee Chi, Omar Ramadan, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Vocal process avulsion is a rare and often overlooked complication of laryngeal trauma, most commonly associated with endotracheal intubation. It involves detachment of the vocal process from the body of the arytenoid cartilage, leading to dysphonia, dysphagia, voice fatigue, and/or aspiration. While strobovideolaryngoscopy and laryngeal electromyography may suggest underlying structural disruption, diagnosis can be challenging when findings are subtle or imaging is inconclusive. Definitive diagnosis and management typically involves surgical evaluation and repair to restore vocal fold tension and glottic competence. We present the first documented case of bilateral vocal process avulsion following endotracheal intubation.