Otolaryngology Commons^™

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 …

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 …

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 …

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 …

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 …

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.

Dupilumab Beyond The Airway: Decreased Morbidity In A Real-World Analysis, Emma J. Anisman, Spencer Short, Emma Tam, Benjamin F. Bitner, Abdulghafoor Alani, Marc Rosen, Mindy Rabinowitz, Damaris Pena Evertz, Elina Toskala, Gurston G. Nyquist

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Post hoc analyses of clinical trials have characterized dupilumab's adverse effects, yet the real-world impact in chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma is not well described. This study aims to characterize the risks of lymphoma, cardiovascular events, eosinophilia, joint pain, inflammatory arthritis, and sleep apnea in dupilumab-treated CRSwNP and/or asthma patients compared to those not taking dupilumab, and to other biologics.

Methods: This retrospective cohort study used TriNetX, a de-identified database containing over 100 million patient records. Demographics and adverse effects associated with immunotherapy use were collected.

Results: We identified 21,249 dupilumab-treated CRSwNP and/or asthma patients. After …

Comparative Analysis Of Fsrt And Srs For Vestibular Schwannoma Using A Large Multi-Institutional Dataset, Ian Argento, Bs, Daniel Uralov, Md, Jacob Beiriger, Md, Anika Walia, Bs, Kalena Liu, Bs, Wenyin Shi, Md, Jacob B. Hunter, Md

Alpha Omega Alpha Research Symposium Posters

Purpose: Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) both achieve high control rates of vestibular schwannomas (VS), but their comparative effects on functional outcomes remain uncertain. Prior studies are limited by small sample sizes and heterogeneous methods.

Methods: Deidentified data were analyzed from 100 healthcare organizations through TriNetX. Adults with VS (ICD-10: D33.3) and sensorineural hearing loss (H90.A/H90.1–H90.8) were included. Patients with neurofibromatosis or prior surgical resection were excluded. Treatment cohorts consisted of single-session SRS or ≥2-sessions of FSRT. Propensity score matching (1:1) yielded 909 patients per cohort. Outcomes—including hearing loss, cerebral edema, hydrocephalus, and cranial nerve …

Multi-Institutional Modified Delphi For Genomics In Expert Consensus Survey Of Genomic Testing For Anterior Skull Base Malignancies, Anirudh Saraswathula, Shreya Sriram, Corinna Levine, Nyall R London, Shirley Y Su, Mathew Geltzeiler, Sanjeet V Rangarajan, Ian Witterick, Brian Thorp, Kathleen Kelly Gallagher, Kenneth Byrd, Ricardo Carrau, Waleed Abuzeid, Eric Wang, Carl Snyderman, Erin L Mckean

Faculty, Staff and Students Publications

Objectives: The use of genomic testing for patients with anterior skull base malignancies has grown dramatically. There are no clear guidelines on indications for testing. As the literature on the subject is still in early stages, there is a need for expert consensus. We conducted a modified Delphi expert consensus process with high-volume North American cranial base surgical programs.

Design setting participants: A modified Delphi consensus approach was used, following the method laid out by the American Academy of Otolaryngology-Head and Neck Surgery, and included 13 high-volume care centers. An otolaryngologist was appointed at each location to serve as the …

Evaluation Of Large Language Models As Decision Support Tools For Head And Neck Cancer Management: A Blinded Multidisciplinary Simulation Study, Sholem Hack, Ron J. Karni, Antonino Maniaci, Christopher E. Fundakowski, Luca Castellani, Fabiola Incandela, Remo Accorona, Miguel Mayo-Yanez, Martina Violati, Lorenzo Giannini, Niccolo' Mevio, Alberto Maria Saibene

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: The management of head and neck cancer relies on multidisciplinary expertise; however, access to tumor boards remains variable. Large language models (LLMs) may support guideline-based decision-making, although performance in complex oncologic scenarios is not well defined.

METHODS: Fourteen synthetic cases based on real tumor board encounters were evaluated. Five blinded comparator arms produced recommendations: a human expert, Non-RAG-GPT-4, Non-RAG-GPT-5, RAG-GPT-4, and RAG-GPT-5. Eight head and neck oncologic surgeons scored each recommendation for appropriateness, clarity, specificity, and feasibility using 5-point Likert scales. Paired permutation testing and inter-rater reliability were assessed.

RESULTS: LLM outputs showed close alignment with expert recommendations. RAG-based …

Accuracy Of Frozen Section For Hpv-Associated Squamous Cell Carcinoma Of Unknown Primary, Sindhura Sridhar, Annie Moroco, Shravan Gowrishankar, Mitra Mehrad, Kim Ely, James Lewis, Madalina Tuluc, Stacey Gargano, Melanie Hicks, Kyle Mannion, Arielle Thal, Adam Luginbuhl, Joseph Curry, David Cognetti, Michael Topf

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

INTRODUCTION: Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP.

METHODS: A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed.

RESULTS: 77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 …

Circulating Tumor Dna: Reducing Burden In Hpv+ Oropharyngeal Cancer Surveillance, Liza M. Joseph Pa-C

Lynchburg Journal of Medical Science

This review examines the rising prevalence of human papillomavirus-related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) and evaluates the role of circulating tumor HPV DNA (ctHPVDNA) in diagnosis and post-treatment surveillance. A comprehensive literature search of electronic databases, including PubMed, Medline, Cochrane Library, and Google Scholar, identified studies that validated ctHPVDNA as a biomarker with high sensitivity and specificity, assessed its cost-effectiveness, and explored patient and provider perceptions. Clinical evidence supports that plasma-based ctHPVDNA is the most accurate method for detecting disease recurrence and quantifying tumor burden. Patient perception studies reported high confidence in ctHPVDNA testing, while providers viewed it as …

Safety And Efficacy Findings From A Phase Ib/Ii Study Of Asp-1929 Photoimmunotherapy With Pembrolizumab In Recurrent And/Or Metastatic Head And Neck Squamous Cell Carcinoma, David M. Cognetti, Joseph M. Curry, Jennifer Johnson, Michael Kwon, Shirley Y. Su, Francisco Civantos, Coral Olazagasti, Joseph Valentino, Susanne Arnold, R. Bryan Bell, Michael K. Gibson, Kyle Mannion, Kathryn M. Van Abel, Katharine A. Price, Haiying Dong, Amy H. Thorne, Toshiaki Suzuki, Ann M. Gillenwater

Otolaryngology--Head & Neck Surgery Faculty Publications

Background: ASP-1929 photoimmunotherapy—cetuximab conjugated to IRDye 700DX and red light (690 nm) for localized drug activation—results in rapid, selective cell killing.

Methods: This phase Ib/II open-label study evaluated ASP-1929 photoimmunotherapy plus pembrolizumab in patients with recurrent/metastatic HNSCC (≥ 1 accessible lesion, PD-L1 combined positive score ≥ 1, ineligible for standard locoregional ther- apy). Primary objectives were safety/tolerability and objective response rate (ORR). Secondary objectives included overall sur- vival (OS) and progression-free survival (PFS).

Results: Eighteen patients (median age 63 years, 74% male) comprised the photoimmunotherapy-evaluable population. The confirmed ORR was 27.8% (95% CI 9.7–53.5); four of five responders had complete …

Assessment Of Hearing Health Among Adults In Rural Health Clinics, Mit A. Patel, David Adkins, Laura Bellnier, Anthony Mahairas, Matthew L. Bush

Otolaryngology--Head & Neck Surgery Faculty Publications

Objective: Hearing loss (HL) negatively impacts all aspects of health, yet poor access to hearing healthcare (HHC) among adults is a pervasive public health problem. The inaccessibility of HHC is amplified in rural adults. Rural health clinics (RHC) are a critical healthcare system tasked with improving health in rural communities and the objective of this study is to assess the prevalence of HL and the utilization of HHC within RHCs.

Methods: Using cross-sectional study design, adults were recruited from 10 RHC throughout rural Kentucky, mostly within Appalachia. The primary outcomes were (1) presence of HL on screening and (2) history …