Otolaryngology Commons^™

Non-Dental Oral Cavity Findings In Gastroesophageal Reflux Disease: A Systematic Review And Meta-Analysis, Madalina-Gabriela Indre, Darius Sampelean, Vlad Taru, Angela Cozma, Dorel Sampelean, Mircea Vasile Milaciu, Olga Hilda Orasan

Journal of Mind and Medical Sciences

Gastroesophageal reflux disease (GERD) is known as the most prevalent gastrointestinal disorder in the United States, leading to substantial morbidity, although associated mortality is rare. Based on the appearance of esophageal mucosa on upper endoscopy, GERD is divided into erosive esophagitis (ERD) and nonerosive reflux disease (NERD). Heartburn and acid regurgitation are the typical symptoms of the disease, although some patients may present atypical manifestations such as epigastric pain, nausea, asthma, chronic cough, pharyngitis, laryngitis, sleep disturbances, otitis, and sinusitis. Other signs, such as oral mucosal lesions may result from GERD by direct acid or acidic vapor contact in the ...

Novel Fusion Ktn1-Prkd1 In Cribriform Adenocarcinoma Of Salivary Glands Located In The Parotid Gland: Case Report Including Cytologic Findings, Treeva K. Jassim, T. Sheng, Shulin Zhang, Sainan Wei, Susanne M. Arnold, Alexandra E. Kejner, Therese J. Bocklage, Julie C. Dueber

Pathology and Laboratory Medicine Faculty Publications

Background
Cribriform adenocarcinoma of salivary glands (CASG) is a rare, predominantly minor salivary gland tumor first described in 1999. Because the tumor shares morphologic and molecular features with polymorphous adenocarcinoma (PAC), in 2017, the World Health Organization (WHO) included CASG within the spectrum of PAC. Almost 75% of CASG harbor molecular alterations in the PRKD (Protein kinase D) gene family, and some cases show ARID1A (AT-rich interaction domain 1A)-PRKD1 or DDX3X (DEAD-Box Helicase 3 X-Linked)-PRKD1 fusions.

Case presentation
A 39-year-old man presented with headache and painless right cheek mass of two years duration. Imaging showed a well-circumscribed, lobulated ...

Challenges In Medicine: The Odyssey Of A Patient With Isolated Igg4-Related Eosinophilic Angiocentric Fibrosis Presenting As A Locally Destructive Sinonasal Mass, Snigdha Nutalapati, Richard O'Neal, William O'Connor, Brett T. Comer, Gerhard C. Hildebrandt

Otolaryngology--Head & Neck Surgery Faculty Publications

Eosinophilic angiocentric fibrosis (EAF) is an exceeding rare clinical entity and is considered a part of the spectrum of IgG4-related disease (IgG4RD). We hereby present such an unusual case of a 60-year-old female who presented to us with recurrent sinonasal mass, after a decade long haul of multiple clinical evaluations, biopsies, and debulking surgery without a definitive diagnosis. Over this period, the mass eroded through the ethmoid cells along with nasal septal destruction leading to saddle nose deformity, extended superiorly through the cribriform plates to right frontal lobe, and compressed the optic nerve leading to visual loss. Although initial biopsy ...

Delayed Endoscopic Assisted Percutaneous Reduction Of Anterior Table Frontal Sinus Fractures, Thomas J. Gal, Robin Pappal

Otolaryngology--Head & Neck Surgery Faculty Publications

Endoscopic approaches to the management of frontal sinus fractures continue to become more commonplace. Anterior table fractures amenable to reduction by these techniques are optimally managed within the first five to ten days to avoid fibrosis of the injury. We present a case of endoscopic transnasal reduction of an anterior table frontal sinus fracture over six weeks after the injury.

Angioembolisation For The Treatment Of Pseudo-Aneurysm Of Internal Maxillary Artery, Muhammad Azeemuddin, Anosha Khan, Atif Hafeez Siddiqui, Asad Shakil, Basit Salam, Raza Sayani

Department of Radiology

Pseudo-aneurysm of internal maxillary artery, following a road traffic accident, is a rare clinical scenario. The consequence of pseudo-aneurysm may be spontaneous rupture of the arterial wall, which may eventually lead to life-threatening hemorrhage. We report a case of a 20-year male who presented with recurrent epistaxis. CT scan was performed, which revealed a pseudo-aneurysm of the internal maxillary artery; this was successfully treated by angioembolisation. Similar cases of traumatic pseudo-aneurysms have been reported, however, none presented with recurrent epistaxis after management of pan-facial fractures. Key Words: Epistaxis, Pseudo-aneurysm, Angioembolisation, Pan-facial fracture.

Avoidance Of Maxillary Swing For Nasopharyngectomy Via Combined Open Lateral And Endoscopic Approach, S. Hamad Sagheer, Bs, Brian Swendseid, Md, Joseph M. Curry, Md, Mindy Rabinowitz, Md, Gurston Nyquist, Md, Marc R. Rosen, Md, James Evans, Md, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: Nasopharyngectomy performed via a solely endoscopic approach has limitations in access and feasibility, particularly regarding management of the carotid artery. To address these limitations, we report three cases with one cadaver dissection where nasopharyngectomy was performed via a combined open lateral an endoscopic approach. We highlight the benefits and technical considerations for this operative technique.

Study Design: Case Series

Methods: Patients diagnosed with recurrent nasopharyngeal carcinoma (NPC) that underwent combined open lateral and endoscopic nasopharyngectomy from 2016-2020 were analyzed. A cadaver dissection was also performed.

Results: We present the details of the approach and follow-up in three patients with ...

Otologic Opioid Usage And Pain Control In The Postoperative Period, Matthew Stewart, Eric Mastrolonardo, Joann Butkus, Raphael Banoub, Md, Tingting Zhan, Phd, Sophia Dang, Md, David Cognetti, Md, Rebecca Chiffer, Md, Thomas Wilcox, Md

Phase 1

Introduction: Patients’ unused prescription opioids can be diverted and increase the overall opioid burden on society. Therefore, otolaryngologists can reduce opioid influx by minimizing excess tablets in opioid prescriptions. We hypothesize that otology patients at TJUH receive more opioid tablets than needed to effectively manage postoperative pain.

Methods: Patients ages ≥18 years old who received otologic surgery at TJUH were included in this prospective observational study between November 2019 and August 2020. Patients were provided a survey for recording pain on postoperative days 0, 1, 3, and 7 and the amount of remaining opioids from their prescription. Opioid amounts were ...

Intraoperative Evaluation Of Nasal Valve Repair Interventions: A Prospective Analysis, Kurren Gill, Md, S. Hamad Sagheer, Bs, Cory Bovenzi, Md, Brian Yan, Ba, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: To allow for early identification and treatment of inadequate nasal valve repair interventions in the intraoperative setting, based on degree of nasal valve collapse quantified by suction-assisted pressure readings. Patient outcomes were measured by comparison of pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) surveys.

Study Design: Prospective study.

Methods: All enrolled patients undergo suction-assisted evaluation of nasal valve collapse before surgical intervention. Patients randomized into the experimental group underwent repeat assessment after various nasal valve interventions, compared to a control group where adequacy of interventions was assessed by palpation of the nasal ala.

Results: 20 patients who underwent ...

Fat Graft For Parotidectomy Defect Reconstruction In The Setting Of Malignant Disease, S. Hamad Sagheer, Bs, Alexander Knops, Ba, Kurren Gill, Md, Vivian Xu, Bs, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: Currently, limited data examines the safety of utilizing fat transfers in the setting of malignant parotid disease. Here we evaluate the safety of fat graft reconstruction of parotidectomy defects in the setting of malignant disease.

Study Design: Retrospective cohort study

Methods: Electronic chart review of patients who underwent parotidectomy from 2012-2020 were reviewed.

Results: Three hundred and sixty-one patients were identified at a single institution who underwent parotidectomy, and 113 (31.3%) were for malignancy. One hundred and thirty-two patients underwent fat graft reconstruction (49.2%, n=65 for umbilical, 50.8%, n=67 for dermal). One-third of patients ...

Transoral Approach To Excision Of Massive Dermoid Cysts In Pediatric Patients: A Case Series, Bryce R. Noblitt, Harper L. Wilson, Kenneth C. Iverson

Otolaryngology--Head & Neck Surgery Faculty Publications

Floor of mouth (FOM) dermoid cysts are a rare but clinically significant lesion of the head and neck. Classically, large cysts have been excised via a transcervical approach, although the limits of the transoral approach are expanding. The majority of FOM dermoid cysts present in the midline, but true lateral cysts have been reported. In this case series, we describe 3 pediatric patients who all underwent successful transoral excision of massive dermoid cysts, along with a literature review. Massive cystic lesions were identified on preoperative imaging. The dermoid cysts averaged 6 × 4.3 × 5 cm and were successfully removed via ...

Cross-Reactivity In Skin Prick Test Results Of Members Within Pooideae Subfamily, Brette C. Harding, Brian P. Kinealy, Christine B. Franzese

Otolaryngology--Head & Neck Surgery Resident Research

Objective: Molecular similarities of grass pollen antigens have led to the view that cross-reactivity exists within members of the Pooideae subfamily of grasses. This has resulted in testing for only the most antigenically representative member of Pooideae, Timothy grass (Phleum pratense), despite little literature to support the claim that Phleum is the most representative member or that in vitro cross-reactivity correlates with in vivo cross-reactivity. The aim of the study was to determine if patients with allergic rhinitis symptoms and positive skin prick test results to meadow fescue (Festuca pratensis) also have positive results to Timothy grass.

Study Design: Retrospective ...

Excess Extracellular K+ Causes Inner Hair Cell Ribbon Synapse Degeneration, Hong-Bo Zhao, Yan Zhu, Li-Man Liu

Otolaryngology--Head & Neck Surgery Faculty Publications

Inner hair cell (IHC) ribbon synapses are the first synapse in the auditory system and can be degenerated by noise and aging, thereby leading to hidden hearing loss (HHL) and other hearing disorders. However, the mechanism underlying this cochlear synaptopathy remains unclear. Here, we report that elevation of extracellular K⁺, which is a consequence of noise exposure, could cause IHC ribbon synapse degeneration and swelling. Like intensity dependence in noise-induced cochlear synaptopathy, the K⁺-induced degeneration was dose-dependent, and could be attenuated by BK channel blockers. However, application of glutamate receptor (GluR) agonists caused ribbon swelling but not degeneration. In ...

Use Of Endoscope In Teaching Of Otolaryngology Residents About Site And Size Of Tympanic Membrane Perforation And Its Impact On Degree Of Hearing Loss In Adult Patients: A Cross Sectional Study, Muntazir Hussain, Muhammad Wasif, Mohammad Sohail Awan, Shayan Khalid, Zeeshan Sheikh, Haissan Iftikhar

Section of Otolaryngology, Head & Neck Surgery

Objective: To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing.
Methods: The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane ...

Lateral Modified Brandt-Daroff Exercises: A Novel Home Treatment Technique For Horizontal Canal Bppv, Michael T. Teixido, Ryan Casserly, Lauren E Melley

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: Brandt-Daroff exercises (BDEs) are commonly used as an at-home treatment for posterior canalithiasis, but their efficacy in the treatment of benign paroxysmal positional vertigo (BPPV) of the horizontal canal (HC-BPPV) has not been previously studied. Using biomechanical model simulation, we investigated modifications that may optimize BDE use for HC-BPPV treatment.

MATERIALS AND METHODS: The BPPV Viewer, a three-dimensional model of the human labyrinth, was used to analyze BDE for HC-BPPV treatment. While moving the model through sequential BDE positions, the expected position of otoliths was demonstrated. Treatment steps were adjusted to maximize otolith movement around the canal circumference without ...

Screening For Malnutrition In Oral Cavity Cancer Patients Prior To Treatment: A Cross-Sectional Study, Haissan Iftikhar, Anwar Suhail, Amna Urooba, Karim Rizwan Nathani, Zeeshan Shaikh, Muhammad Wasif

Section of Otolaryngology, Head & Neck Surgery

This study was conducted to assess the frequency of pre-operative malnourishment in patients being treated for oral cavity squamous cell carcinoma. A retrospective chart review was carried out at the Aga Khan University Hospital, Karachi, on 62 patients. Patients were screened pre-operatively through a standard nutritional assessment tool at the time of admission to assess for malnutrition. Mean age of presentation was 48.34±13.11 years, mean height was 165 ± 8.62cm, weight 66.09±14.98 kg and BMI of 24.09±4.84. Males were 82.3% and 17.7% were females. At the time of admission ...

Training In Temporal Bone Surgery: A Review Of Current Practices, Muhammad Wasif, Abdul Basit Shah Vardag, Ainulakbar Mughal, Syed Akbar Abbas, Shayan Khalid, Hamdan Ahmed Pasha

Section of Otolaryngology, Head & Neck Surgery

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only ...

Drug-Induced Sleep Endoscopy (Dise) With Simulation Bite To Predict The Success Of Oral Appliance Therapy In Treating Obstructive Sleep Apnea/Hypopnea Syndrome (Osahs), Pietro De Luca

Translational Medicine @ UniSa

Oral appliances have gained their place in the treatment of obstructive sleep apnea (OSA) where custom-made titratable mandibular advancement devices (MAD) have become the oral appliance of choice. This study aimed to asses the value of the drug-induced sleep endoscopy (DISE) using a MAD in the prediction of treatment outcome for OSAHS

This is a prospective, single-center cohort study that enrolled sixty-six consecutive patients with diagnosed OSA (5 events/h < apnea-hypopnea index (AHI) < 50 events/h) to be treated with a custom-made titratable MAD. The patients were evaluated polysomnographically with the MAD in situ after the adaptation and titration period of 3 months. The associations between findings during DISE and treatment outcome were assessed.

The subjects showed a wide range of severity of OSAHS pre-treatment: median AHI was 43.10 with a range from 20.13 to 66.07. The simulation bite was associated ...

A Case Of A Nonpetrous Cholesterol Granuloma Presenting As A Temporal Mass, Nathaniel Reeve, Jacob Kahane, Matthew Ng

School of Medicine Faculty Publications

Objective. A case of a skull base cholesterol granuloma (CG) of the squamosal temporal bone. This is the first ever reported case of CG in a well-pneumatized squamous temporal bone. Design. Case report and review of the literature. Discussion. CG is a cystic mass typically found in the petrous apex and occasionally in the paranasal sinuses and orbit. Experience with the treatment of these expansile and inflammatory processes has largely been garnered from those occurring in the petrous apex, where they are surgically drained, via a transtympanic, transmastoid, or middle fossa approach. We report a case of cholesterol granuloma situated ...

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

Graduate Medical Education Research Journal

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

Congenital Nasal Pyriform Aperture Stenosis Repair: A Case Series And Discussion Of Postoperative Care, Harper L. Wilson, Nicholas Van Maele, Kenneth C. Iverson

Otolaryngology--Head & Neck Surgery Faculty Publications

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition related to holoprosencephaly in which bony overgrowth of the medial nasal process of the maxilla narrows the pyriform aperture. CNPAS presents in neonates with signs of upper airway obstruction ranging from mild to severe respiratory distress and failure to thrive. Surgical intervention is indicated after failed conservative measures and generally includes temporary stent placement. We report a series of 3 cases of CNPAS treated surgically, examine postoperative care recommendations in the literature, and present a comprehensive postoperative care regimen with a novel method to maintain stent patency.