Otolaryngology Commons^™

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 …

Human Papillomavirus Vaccine Discourse And Sentiment On Reddit Before And After Covid-19: Mixed Methods Retrospective Cross-Sectional Study, Marcin Marciniak, Sean A Setzen, Deeya Bhattacharya, Jamie Masliah, Robin Powszok, Erich M Sturgis, Vanessa C Stubbs, Mihir K Bhayani

Faculty, Staff and Students Publications

Background: Human papillomavirus (HPV) is a sexually transmitted virus that causes various oropharyngeal and anogenital cancers. The HPV vaccine provides protection against several strains of HPV and is a key preventative tool against HPV-related cancers; however, vaccination rates remain suboptimal in the United States due to variable state mandates and misperceptions of vaccine efficacy and risks. As social media becomes an increasingly popular avenue for health discussions, platforms such as Reddit offer opportunities to understand public vaccine discourse, particularly among underrepresented groups. Furthermore, vaccine hesitancy and mistrust generally increased during the COVID-19 pandemic, potentially impacting HPV vaccination rates.

Objective: This …

Cohort Study Of Opioid Utilization In Post-Tonsillectomy Pediatric Patients, Sainiteesh Maddineni, Varun Vendra, Hareem Khan, Noor Ali, Tulio Valdez, Anna Messner, Iram Ahmad

Faculty, Staff and Students Publications

Objectives: Prospective observational cohort study at a tertiary care academic center to evaluate the post-operative use of oxycodone in pediatric tonsillectomy patients and caregiver knowledge of opioid disposal.

Methods: Pediatric patients 6-18 years old undergoing tonsillectomy were enrolled. Patients were excluded if they required prolonged inpatient care, had a history of organ transplantation, chronic pain or narcotic use, congenital or chromosomal disorders, inability to take acetaminophen or ibuprofen, and other significant medical diagnoses that could potentially alter postoperative pain management. All patients were prescribed a standard amount of oxycodone to be used for breakthrough pain in addition to ibuprofen and …

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. …

Optical Coherence Tomography As An Emerging Technique For Identifying Pediatric Middle Ear Effusion, Roger Neuberger, Jeffrey Carter, Adriana Dives, Ana Sofia C Ibarrola, Maritsa Ixba, Elton Lambert, Yi-Chun Liu, Anna H Messner

Faculty, Staff and Students Publications

Objective: Acute otitis media (AOM) and otitis media with effusion (OME) rely on accurate characterization of middle ear effusion (MEE). Optical coherence tomography (OCT) is a potential modality for noninvasive analysis of MEE, thereby assisting with otitis media diagnosis. This study aims to compare the diagnostic performance of OCT with otoscopy and tympanometry in pediatric patients.

Methods: A prospective convenience sample of 164 pediatric patients aged 6 months to 12 years was recruited from two tertiary care pediatric otolaryngology clinics. During their visit, each child underwent otoscopy, tympanometry, and OCT evaluation. Scans were reviewed by both a fellowship-trained pediatric otolaryngologist …

Protecting Minors From Medical Malpractice Act: Implications For Otolaryngology-Head & Neck Surgery, Shiven Sharma, Margo K Mckenna, Julina Ongkasuwan, Michael J Brenner

Faculty, Staff and Students Publications

No abstract provided.

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.

Sound, Speech, And Synapses: Rebuilding The Brain Through Neuroplasticity, Sireen Khader

The Cardinal Edge

No abstract provided.

Quality Of Life In Patients With P16+ Oropharyngeal Cancer Receiving Accelerated Radiation Therapy With Either Cisplatin Or Cetuximab In The Nrg/Rtog 1016 Randomized Controlled Trial, Jolie Ringash, Pedro A Torres-Saavedra, Maura L Gillison, Jimmy J Caudell, David J Adelstein, Paul M Harari, Erich M Sturgis, Ethan Basch, Shlomo A Koyfman, Greg A Krempl, Dukagjin M Blakaj, James Edward Bates, Thomas J Galloway, Christopher U Jones, Beth M Beadle, Jonathan Harris, Quynh-Thu Le, Sue S Yom, Benjamin Movsas

Faculty, Staff and Students Publications

Purpose: NRG/RTOG 1016 was a phase III randomized noninferiority de-escalation trial comparing cetuximab versus cisplatin, concurrent with accelerated radiation 70 Gy/6 weeks, in p16+ oropharyngeal cancer. Quality of life (QOL) was a secondary endpoint.

Methods and materials: Eligible/consenting patients among the first 400 entered completed the EORTC QLQ-C30/H&N35 at baseline, end of treatment, 3, 6, and 12 months posttreatment, to provide 90% power to detect an effect size of 0.5 in the between-arm change in QOL scores from baseline to 6 months. We report completion, responsiveness, and patterns over time across domains between arms, considering a difference of >10 points …

Ergonomic Trends In Endoscopic Skull-Base Surgeons: A Survey To The North American Skull Base Society, Shreya Mandloi, Alexander Duffy, Praneet Kaki, Elina Toskala, Marc Rosen, Christopher Farrell, James Evans, Gurston G. Nyquist, Mindy Rabinowitz, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: Lack of ergonomic practices in the operating room results in significant musculoskeletal strain. This study obtains a current assessment of self-reported musculoskeletal strain associated with endoscopic endonasal and open skull base surgery as reported by members of the North American Skull Base Society (NASBS).

STUDY DESIGN: Online Survey.

SETTING: Online.

METHODS: A survey assessing current symptoms in endoscopic skull base surgery was distributed to members of the NASBS.

RESULTS: Sixty-six responses were completed and analyzed. 95% of respondents indicated they had musculoskeletal strain at the neck and C-spine. There was no significant difference in average operating time per week …

Ergonomic Trends In Endoscopic Skull-Base Surgeons: A Survey To The North American Skull Base Society, Shreya Mandloi, Alexander Duffy, Praneet C. Kaki, Elina Toskala, Marc Rosen, Christopher Farrell, James J. Evans, Gurston G. Nyquist, Mindy R. Rabinowitz

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: Lack of ergonomic practices in the operating room results in significant musculoskeletal strain. This study obtains a current assessment of self-reported musculoskeletal strain associated with endoscopic endonasal and open skull base surgery as reported by members of the North American Skull Base Society (NASBS).

STUDY DESIGN: Online Survey.

SETTING: Online.

METHODS: A survey assessing current symptoms in endoscopic skull base surgery was distributed to members of the NASBS.

RESULTS: Sixty‐six responses were completed and analyzed. 95% of respondents indicated they had musculoskeletal strain at the neck and C‐spine. There was no significant difference in average operating time per week …

Tongue Reduction For Pediatric Obstructive Sleep Apnea: A Systematic Review., Adrian Williamson, Rohit Nallani, Jason R. Brown

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Obstructive sleep apnea (OSA) is a prevalent pediatric disorder that, if untreated, can result in substantial developmental and health consequences. Tongue reduction procedures, such as midline posterior glossectomy (MPG), are increasingly used to address tongue base obstruction. This systematic review evaluates the effectiveness and safety of tongue reduction procedures for pediatric OSA.

DATA SOURCES: Embase, PubMed, and Web of Science databases were queried for studies from inception to September 20, 2023.

REVIEW METHODS: Studies reporting on outcomes of pediatric patients (≤21 years) undergoing tongue reduction surgery for OSA were included.

RESULTS: From 477 abstracts, 9 studies met the inclusion …

Exploring Adolescent Hearing Aid Usage And Appearance Of Psychiatric Symptoms In Adolescents Using Hearql-28 Surveys, Courtney J. Austin, Dylan Chan

MEDI 9331 Scholarly Activities Clinical Years

Approximately 2% of DHH people in need of mental health services actually receive these services. Among pediatric hearing loss populations, co-occurring cognitive and physical impairments are risk factors for poor mental health status. Due to language barriers and isolation, more children with hearing loss do not have access to mental health services. Cochlear implants have been shown to improve mental health status among the DHH population. Current literature focuses on the mental health status of children with cochlear implants, with little focus on hearing aid users. Using HEAR28 data and surveys, we can quantify the incidence of psychiatric symptoms among …

How Does Frailty Impact Peri-Operative And Speech Recognition Outcomes For Cochlear Implants In Veterans?, Kaitlyn A Brooks, Benjamin D Lovin, Alex D Sweeney, Angela S Peng, Nathan R Lindquist

Faculty, Staff and Students Publications

Objective: To investigate the association of frailty with post-cochlear implant (CI) admission, morbidity, and CI-aided word recognition outcomes in veterans.

Study design: Retrospective cohort.

Setting: Single-institution tertiary care Veterans Health Administration (VHA) hospital.

Methods: Veterans who underwent cochlear implantation between 1998 to 2024 were included. The Modified 5-Item Frailty Index (mFI-5) score was used to characterize preoperative frailty. Outcomes of interest were admission from post-anesthesia care unit (PACU), relative risk (RR) of admission among frail patients, and relationship between frailty and post-CI word recognition score (WRS). Ordinal data were analyzed via logistic regression and Chi square tests; a multivariate linear …

Neutrophil-To-Lymphocyte Ratio As A Prognostic Factor Of Survival Outcomes In Head And Neck Squamous Cell Carcinoma Receiving Neoadjuvant Immunotherapy, Pablo Llerena, Praneet C. Kaki, Kathryn Nunes, Eric Mastrolonardo, Kelly Bridgham, Annie Moroco, Hani Samarah, Mouadh Barbirou, David Baek, Chun Wang, Voichita Bar-Ad, David Cognetti, Joseph Curry, Jennifer M. Johnson, Hushan Yang, Larry A. Harshyne, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) is a prognostic marker in cancers treated with immune checkpoint inhibitors (ICI), reflecting the link between inflammation and cancer immune response. This study examines NLR's prognostic value in head and neck squamous cell carcinoma (HNSCC) patients receiving neoadjuvant ICI therapy, focusing on its potential as an independent predictor of overall survival (OS) and disease-free survival (DFS).

METHODS: We conducted a retrospective cohort study including three neoadjuvant trials: durvalumab ± metformin, nivolumab ± tadalafil, or nivolumab ± BMS-986205 from 2017 to 2022. Pre-treatment NLR was calculated using absolute neutrophil and absolute lymphocyte counts obtained before neoadjuvant …

A Patient-Needs Assessment In The Management Of Vestibular Schwannoma, Eric Martinez, Alexandra Jackson, Gavriel Kohlberg, Andy Saultz

Pacific Journal of Health

Background: Decision aids have evolved as a tool utilizing evidence-based information to help patients understand treatment options and are nascent in the field of neurotology. Vestibular schwannoma management consists of observation, microsurgery, and / or radiation. A decision aid has the potential to help patients understand treatment options regarding vestibular schwannomas while functioning in a patient-centered environment.

Objective: To conduct a patient needs assessment in the diagnosis and management of vestibular schwannoma to inform draft decision aid development.

Setting and Participants: Eight patients between 45 and 74 years of age who received a diagnosis of a unilateral vestibular schwannoma and …

Combination Lingual Compression And Maxillomandibular Fixation For Persistent Acquired Macroglossia: A Case Report, Emma De Ravin, Annie Moroco, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

No abstract provided.