Otolaryngology Commons^™

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

Research Symposium

Background: 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.

Methods: CDC population-level incidence and mortality rate per 100,000 of OC/OP cancer among patients in the RGV counties of Hidalgo …

Social Determinants Of Health And Stage Of Presentation Of Oral Cavity Squamous Cell Carcinoma, Taha Al Hassan, Saba Suleman, Adam Bender-Heine, Rachel A. Giese

Research Symposium

Objectives: The purpose of this study is to investigate the risk factors that contribute to the development of oral cavity squamous cell carcinoma (SCC) in the Rio Grande Valley and understand factors that may be associated with advance stage at presentation.

Methods: Initially 1,609 charts from the University of Texas Rio Grande Valley outpatient clinics were evaluated for a diagnosis of SCC and 69 patients were identified for potential inclusion. 44 patients were included for final analysis. Data were analyzed using SPSS 28.0.0. Descriptive and inferential statistics were conducted.

Results: Patients without insurance coverage were more likely to present with …

A Case Report: A Patient Rescued By Va-Ecmo After Cardiac Arrest Triggered By Trigeminocardiac Reflex After Nasal Surgery, Xu Zhang, Bin Sun, Chen Pac-Soo, Daqing Ma, Liwei Wang

Faculty, Staff and Student Publications

Rationale:

Cardiac arrest (CA) caused by trigeminocardiac reflex (TCR) after endoscopic nasal surgery is rare. Hence, when a patient suffers from TCR induced CA in the recovery room, most doctors may not be able to find the cause in a short time, and standard cardiopulmonary resuscitation and resuscitation measures may not be effective. Providing circulatory assistance through venous-arterial extracorporeal membrane oxygenation (VA-ECMO) can help healthcare providers gain time to identify the etiology and initiate symptom-specific treatment.

Patient concerns:

We report a rare case of CA after endoscopic nasal surgery treated with VA-ECMO.

Diagnoses:

We excluded myocardial infarction, pulmonary embolism, allergies, …

The Effectiveness Of Serotonin And Tricyclic Antidepressants In Tinnitus Management: A Rapid Review, Dr. Emilie Vos, Dr. Nannette Nicholson, Melinda Johnson, Dr. Karah Gottschalk

Internet Journal of Allied Health Sciences and Practice

Background: Tinnitus can be defined as a health condition characterized by the perception of sound, either in the head and/or ears, in the absence of any external acoustic stimulus. Perception is often quantified by self-report, or the use of patient reported outcome measures (PROMs). The purpose of this rapid review was to evaluate the level and quality of evidence regarding the use of serotonin and norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), and tricyclic antidepressants as measured by tinnitus patient-reported outcome measures (PROMs) and/or Visual Analog Scales (VAS). Methods: The Cochrane Rapid Review guidelines were followed. The PICO …

International Consensus Statement On Allergy And Rhinology: Sinonasal Tumors, Edward C. Kuan, Eric W. Wang, Nithin D. Adappa, Daniel M. Beswick, Nyall R. London, Shirley Y. Su, Marilene B. Wang, Waleed M. Abuzeid, Borislav Alexiev, Jeremiah A. Alt, Paolo Antognoni, Michelle Alonso-Basanta, Pete S. Batra, Mihir Bhayani, Diana Bell, Manuel Bernal-Sprekelsen, Christian S. Betz, Jean Yves Blay, Benjamin S. Bleier, Juliana Bonilla-Velez, Claudio Callejas, Ricardo L. Carrau, Roy R. Casiano, Paolo Castelnuovo, Rakesh K. Chandra, Vasileios Chatzinakis, Simon B. Chen, Alexander G. Chiu, Stephen C. Hernandez, Et Al

School of Medicine Faculty Publications

Background; Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology; Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. Methods; In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the …

Perioperative Opioids And Survival Outcomes In Resectable Head And Neck Cancer: A Systematic Review., Eric V Mastrolonardo, Derek S Mann, Harleen K. Sethi, Bo H Yun, Elliott M Sina, Maria Armache, Brooke Worster, Christopher E Fundakowski, Leila J Mady

Otolaryngology (ENT) Resident Research

BACKGROUND: Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC).

METHODS: A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included.

RESULTS: Three thousand three hundred seventy-eight studies met initial inclusion …

Revision Tracheotomy Complicated By History Of Follicular B-Cell Lymphoma, Sarah Ustrell, Jordan K Simmons, Garrett Henkle, Adam R Szymanowski

Faculty, Staff and Students Publications

This case report presents a 65-year-old woman with multiple complications during a revision tracheotomy including subcutaneous emphysema and a pneumothorax. Management of her airway was complicated by a history of recurrent follicular B-cell lymphoma associated with extensive cervical lymphadenopathy. We detail the importance of heightened clinical awareness and the use of intraoperative safety adjuncts when performing revision tracheostomies.

Screening People On Standing Balance With Romberg Testing And Walking Balance With Tandem Walking, Helen S Cohen

Faculty, Staff and Students Publications

The goal of this protocol is to inform readers about the exact procedures to use to perform two screening tests for vestibular disorders: tandem walking (TW) with eyes closed, also known as heel-toe walking, and the Clinical Test of Sensory Integration and Balance (CTSIB), which is also known as the modified Romberg. The study describes the steps for performing each test and each of the three CTSIB subtests so that the reader will be able to replicate the test conditions for use in the clinic, in the clinical laboratory, or in any other situation needing valid and reliable screening for …

Longitudinal Diffusion And Volumetric Kinetics Of Head And Neck Cancer Magnetic Resonance On A 15 T Mr-Linear Accelerator Hybrid System: A Prospective R-Ideal Stage 2a Imaging Biomarker Characterization/Pre-Qualification Study, Joint Head And Neck Radiation Therapy-Mri Development Cooperative, Mr-Linac Consortium Head And Neck Tumor Site Group

Faculty, Staff and Student Publications

OBJECTIVES: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort.

METHODS: Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters …

Outcomes Of Treatment With Neoadjuvant Cemiplimab For Patients With Advanced, Resectable Cutaneous Squamous Cell Carcinoma Of The Head And Neck: Secondary Analysis Of A Phase 2 Clinical Trial, Renata Ferrarotto, Priyadharsini Nagarajan, Jacob M Maronge, Jason M Johnson, David I Rosenthal, Jeffrey N Myers, Neil D Gross

Faculty, Staff and Student Publications

This secondary analysis of a phase 2 clinical trial examines long-term survival for resectable cutaneous squamous cell carcinoma of the head and neck according to pathologic response.

Hypothyroidism Following Radiotherapy For Head And Neck Cancer: A Systematic Review Of The Literature And Opportunities To Improve The Therapeutic Ratio, Michael K Rooney, Lauren M Andring, Kelsey L Corrigan, Vincent Bernard, Tyler D Williamson, Clifton D Fuller, Adam S Garden, Brandon Gunn, Anna Lee, Amy C Moreno, William H Morrison, Jack Phan, David I Rosenthal, Michael Spiotto, Steven J Frank

Faculty, Staff and Student Publications

(1) Background: Radiotherapy (RT) is a central component for the treatment of many head and neck cancers. In this systematic review of the literature, we aimed to characterize and quantify the published evidence on RT-related hypothyroidism, including estimated incidence, clinical risk factors, and dosimetric parameters that may be used to guide clinical decision making. Furthermore, we aimed to identify potential areas of improvement in the prevention and clinical management of RT-induced hypothyroidism, including the role of modern advanced therapeutic techniques. (2) Methods: We conducted a systemic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and …

A Survey Of Microvascular Technique Preferences Among American Head Neck Society Members, Ramez Philips, Keisha A. Best, Aarti Agarwal, Hamad Sagheer, Yamil Selman, Larissa Sweeney, Mark Wax, Howard Krein, Ryan Heffelfinger, Adam Luginbuhl, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To identify practices in microvascular techniques in routine and challenging scenarios.

STUDY DESIGN: Cross-sectional study.

METHODS: A national survey addressing practices related to microvascular free flap reconstruction was distributed to AHNS members between October and November 2021.

RESULTS: The respondents encompassed 95 microvascular surgeons. Median years of practice was 6 (interquartile range, 2-13) and median flaps per year was 35 (22-50). Common practices in arterial anastomosis included limited cleaning of artery (84.2%), use of a double approximating clamp (64.2%), and use of interrupted suture (88.4%). Common practices in venous anastomosis included limited cleaning (89.5%), downsizing the coupler (53.7%), and …

Two-Year Outcomes Of Temperature-Controlled Radiofrequency Device Treatment Of The Nasal Valve For Patients With Nasal Airway Obstruction, William C Yao, Jordan Pritikin, Michael J Sillers, Henry P Barham

Faculty, Staff and Student Publications

BACKGROUND: The objective of this study was to evaluate long-term symptom improvements in patients with nasal airway obstruction (NAO) secondary to nasal valve collapse (NVC) following minimally invasive temperature-controlled radiofrequency (TCRF) treatment.

METHODS: A prospective, single-arm, multicenter study in patients >18 years with NAO due to NVC. Inclusion criteria were response to nasal valve dilation (e.g., modified Cottle maneuver) and baseline Nasal Obstruction Symptom Evaluation (NOSE) Scale score ≥60. Patients were treated in the nasal valve region with a TCRF device and followed through 2 years. A responder was ≥20% reduction NOSE Scale score or ≥1 reduction in severity class. …

Machine Learning Driven Index Of Tumor Multinucleation Correlates With Survival And Suppressed Anti-Tumor Immunity In Head And Neck Squamous Cell Carcinoma Patients, Can F Koyuncu, Mitchell J Frederick, Lester D R Thompson, Germán Corredor, Sirvan Khalighi, Zelin Zhang, Bolin Song, Cheng Lu, Reetoja Nag, Vidya Sankar Viswanathan, Michael Gilkey, Kailin Yang, Shlomo A Koyfman, Deborah J Chute, Patricia Castro, James S Lewis, Anant Madabhushi, Vlad C Sandulache

Faculty, Staff and Students Publications

OBJECTIVES: Matching treatment intensity to tumor biology is critical to precision oncology for head and neck squamous cell carcinoma (HNSCC) patients. We sought to identify biological features of tumor cell multinucleation, previously shown by us to correlate with survival in oropharyngeal (OP) SCC using a machine learning approach.

MATERIALS AND METHODS: Hematoxylin and eosin images from an institutional OPSCC cohort formed the training set (D

RESULTS: MuNI correlated with overall survival. A multivariable nomogram that included MuNI, age, race, sex, T/N stage, and smoking status yielded a C-index of 0.65, and MuNI was prognostic of overall survival (2.25, 1.07-4.71, 0.03), …

Deployment Of Cisplatin In Veterans With Oropharyngeal Cancer: Toxicity And Impact On Oncologic Outcomes, Ola Soliman, David C Wilde, Jan O Kemnade, Anita L Sabichi, George Chen, Albert Chen, Samantha N Little, Andrew T Huang, David J Hernandez, Vlad C Sandulache

Faculty, Staff and Students Publications

OBJECTIVE: Cisplatin forms the backbone of systemic chemotherapy treatment for oropharyngeal squamous cell carcinoma (OPSCC). The ideal cisplatin dosing regimen remains yet to be fully defined for achieving optimal efficacy and toxicity profiles in patients with comorbidity.

METHODS: We retrospectively reviewed oncologic and toxicity data for patients with OPSCC treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2000 and 2020 who initiated curative intent, definitive chemo-radiation with one of three single agent regimens: high dose (HD) cisplatin, low dose (LD) cisplatin or cetuximab.

RESULTS: Patients with HPV-associated tumors and nonsmokers demonstrated improved overall and disease-free survival along …

Outcomes After Definitive Treatment For Cutaneous Angiosarcomas Of The Face And Scalp: Reevaluating The Role Of Surgery And Radiation Therapy, Alison K Yoder, Ahsan S Farooqi, Cort Wernz, Aparna Subramaniam, Vinod Ravi, Ryan Goepfert, Erich M Sturgis, Devarati Mitra, Andrew J Bishop, B Ashleigh Guadagnolo

Faculty, Staff and Student Publications

INTRODUCTION: We investigated outcomes and prognostic factors for patients treated for cutaneous angiosarcoma (CA).

METHODS: We conducted a retrospective review of patients treated for CA of the face and scalp from 1962 to 2019. All received definitive treatment with surgery, radiation (RT), or a combination (S-XRT). The Kaplan-Meier method was used to estimate outcomes. Multivariable analyses were conducted using the Cox proportional hazards model.

RESULTS: For the 143 patients evaluated median follow-up was 33 months. Five-year LC was 51% and worse in patients with tumors >5 cm, multifocal tumors, those treated pre-2000, and with single modality therapy (SMT). These remained …

Prospective Evaluation Of In Vivo And Phantom Repeatability And Reproducibility Of Diffusion-Weighted Mri Sequences On 15 T Mri-Linear Accelerator (Mr-Linac) And Mr Simulator Devices For Head And Neck Cancers, Brigid A Mcdonald, Travis Salzillo, Samuel Mulder, Sara Ahmed, Alex Dresner, Kathryn Preston, Renjie He, John Christodouleas, Abdallah S R Mohamed, Marielle Philippens, Petra Van Houdt, Daniela Thorwarth, Jihong Wang, Amita Shukla Dave, Michael Boss, Clifton D Fuller

Faculty, Staff and Student Publications

INTRODUCTION: Diffusion-weighted imaging (DWI) on MRI-linear accelerator (MR-linac) systems can potentially be used for monitoring treatment response and adaptive radiotherapy in head and neck cancers (HNC) but requires extensive validation. We performed technical validation to compare six total DWI sequences on an MR-linac and MR simulator (MR sim) in patients, volunteers, and phantoms.

METHODS: Ten human papillomavirus-positive oropharyngeal cancer patients and ten healthy volunteers underwent DWI on a 1.5 T MR-linac with three DWI sequences: echo planar imaging (EPI), split acquisition of fast spin echo signals (SPLICE), and turbo spin echo (TSE). Volunteers were also imaged on a 1.5 T …

Development And Validation Of An Automated Image-Based Deep Learning Platform For Sarcopenia Assessment In Head And Neck Cancer, Zezhong Ye, Anurag Saraf, Yashwanth Ravipati, Frank Hoebers, Paul J Catalano, Yining Zha, Anna Zapaishchykova, Jirapat Likitlersuang, Christian Guthier, Roy B Tishler, Jonathan D Schoenfeld, Danielle N Margalit, Robert I Haddad, Raymond H Mak, Mohamed Naser, Kareem A Wahid, Jaakko Sahlsten, Joel Jaskari, Kimmo Kaski, Antti A Mäkitie, Clifton D Fuller, Hugo J W L Aerts, Benjamin H Kann

Faculty, Staff and Student Publications

Importance: Sarcopenia is an established prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC); the quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical skeletal muscle segmentation and cross-sectional area. However, manual muscle segmentation is labor intensive, prone to interobserver variability, and impractical for large-scale clinical use.

Objective: To develop and externally validate a fully automated image-based deep learning platform for cervical vertebral muscle segmentation and SMI calculation and evaluate associations with survival and treatment toxicity outcomes.

Design, setting, and participants: For this prognostic study, …

Long-Term Patient-Reported Outcomes In A Population-Based Cohort Following Radiotherapy Vs Surgery For Oropharyngeal Cancer, Michael J Dohopolski, Kevin Diao, Katherine A Hutcheson, Neil S Akhave, Ryan P Goepfert, Weiguo He, Xiudong Jennifer Lei, Susan K Peterson, Yu Shen, Baran D Sumer, Benjamin D Smith, David J Sher

Faculty, Staff and Student Publications

IMPORTANCE: Oncologic outcomes are similar for patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery or radiotherapy. However, comparative differences in long-term patient-reported outcomes (PROs) between modalities are less well established.

OBJECTIVE: To determine the association between primary surgery or radiotherapy and long-term PROs.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the Texas Cancer Registry to identify survivors of OPSCC treated definitively with primary radiotherapy or surgery between January 1, 2006, and December 31, 2016. Patients were surveyed in October 2020 and April 2021.

EXPOSURES: Primary radiotherapy and surgery for OPSCC.

MAIN OUTCOMES AND MEASURES: Patients completed …

Optimizing The Timing Of Biologic And Surgical Therapy For Patients With Refractory Chronic Rhinosinusitis With Nasal Polyposis (Crswnp), Emily Garvey, Bita Naimi, Alexander Duffy, Paavali Hannikainen, Chase Kahn, Douglas Farquhar, Marc Rosen, Mindy R. Rabinowitz, Elina Toskala, Gurston G. Nyquist

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

INTRODUCTION: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is often treated with endoscopic sinus surgery (ESS); however, patients may require revision surgery due to recurrence. To date, no studies have compared outcomes for combined surgery and biologic therapy for CRSwNP compared with biologic therapy alone.

METHODS: Retrospective case-control study of CRSwNP patients who underwent ESS while on dupilumab or mepolizumab (ESS-biologic cohort) compared with CRSwNP patients on biologic therapy (biologic-only controls). Cohorts were matched according to indication, aspirin-exacerbated respiratory disease (AERD), sinonasal outcome test-22 (SNOT-22), and total polyp scores.

RESULTS: Sixteen patients underwent ESS while on biologic therapy (13 dupilumab and …