Otolaryngology Commons^™

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.

Role Of Contrast Enhanced Computed Tomography In Assessing Cervical Lymph Node Metastases In Oral Cavity Squamous Cell Carcinoma, Talha Ahmed Qureshi, Muhammad Wasif, Mohammad Sohail Awan, Adnan Yar Muhammad, Ainulakbar Mughal, Abdullah Ameen

Section of Otolaryngology, Head & Neck Surgery

Objective: To evaluate the diagnostic accuracy of contrast-enhanced computed tomography scan in detecting cervical nodal metastasis in oral cavity squamous cell carcinoma.
Methods: The retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. and comprised records from January 1, 2015, to October 31, 2016, of patients diagnosed with oral cavity squamous cell carcinoma and who underwent surgical resection of primary tumour along with neck dissection after having a contrast-enhanced computed tomography scan of head and neck. Diagnostic accuracy of the scans was calculated using final histopathology as the gold standard. All scans were reviewed by a consultant …

Hypoglossal Nerve Paraganglioma Depicting As Glomus Tumor Of Neck, Zaid Ahmed Shamsi, Fareed Ahmed Shaikh, Muhammad Wasif, Mustafa Belal Hafeez Chaudhry, Nadeem Ahmed Siddiqui, Ziad Sophie

Department of Surgery Docs

Introduction: Paraganglioma are infrequent neuroendocrine tumors that are most commonly found in the carotid body, ganglia of the vagus, jugular and tympanic nerve. Very rarely they can involve other cranial nerves outside the cranial cavity, we present one such case of hypoglossal nerve paraganglioma in neck.
Case report: A 48 years old male presented with 1-month history of right sided stroke and aphasia. Ultrasonography of neck revealed a highly vascular mass on the right side of the neck. CT angiogram confirmed a highly vascular mass arising above the carotid bifurcation. With the working diagnosis of Glomus tumor, he underwent right …

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 …

Free Tissue Transfer For Central Skull Base Defect Reconstruction: Case Series And Surgical Technique, S. Hamad Sagheer, Brian Swendseid, James Evans, Mindy Rabinowitz, Gurston Nyquist, Marc R. Rosen, Elina Toskala, Ryan Heffelfinger, Adam J. Luginbuhl, Joseph M. Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objectives: Local reconstruction of central skull base defects may be inadequate for large defects or reoperative cases; free tissue transfer may be necessary. Inset of the flap and management of the pedicle can be challenging. We report our experience and approach.

Methods: Retrospective review identifying seven patients with central skull base defects who underwent free flap reconstruction from 2016-2020.

Results: Four patients with recurrent nasopharyngeal carcinoma, one with recurrent craniopharyngioma, one with clival-cervical chordoma, and one with meningioma of the middle cranial fossa were analyzed. Six defects were closed with an anterolateral thigh free flap and one with a radial …

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 …

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 had malignant pathology (34.8%, n=46). …

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 …

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 …

Spliceosome-Targeted Therapies Trigger An Antiviral Immune Response In Triple-Negative Breast Cancer, Elizabeth A Bowling, Jarey H Wang, Fade Gong, William Wu, Nicholas J Neill, Ik Sun Kim, Siddhartha Tyagi, Mayra Orellana, Sarah J Kurley, Rocio Dominguez-Vidaña, Hsiang-Ching Chung, Tiffany Y-T Hsu, Julien Dubrulle, Alexander B Saltzman, Heyuan Li, Jitendra K Meena, Gino M Canlas, Srinivas Chamakuri, Swarnima Singh, Lukas M Simon, Calla M Olson, Lacey E Dobrolecki, Michael T Lewis, Bing Zhang, Ido Golding, Jeffrey M Rosen, Damian W Young, Anna Malovannaya, Fabio Stossi, George Miles, Matthew J Ellis, Lihua Yu, Silvia Buonamici, Charles Y Lin, Kristen L Karlin, Xiang H-F Zhang, Thomas F Westbrook

Faculty, Staff and Students Publications

Many oncogenic insults deregulate RNA splicing, often leading to hypersensitivity of tumors to spliceosome-targeted therapies (STTs). However, the mechanisms by which STTs selectively kill cancers remain largely unknown. Herein, we discover that mis-spliced RNA itself is a molecular trigger for tumor killing through viral mimicry. In MYC-driven triple-negative breast cancer, STTs cause widespread cytoplasmic accumulation of mis-spliced mRNAs, many of which form double-stranded structures. Double-stranded RNA (dsRNA)-binding proteins recognize these endogenous dsRNAs, triggering antiviral signaling and extrinsic apoptosis. In immune-competent models of breast cancer, STTs cause tumor cell-intrinsic antiviral signaling, downstream adaptive immune signaling, and tumor cell death. Furthermore, RNA …

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 …

Assessment Of Narcotic Use In Management Of Post-Op Pain After Functional Endoscopic Sinus Surgery., Kurren S. Gill, Chandala Chitguppi, Michelle Haggerty, Tawfiq Khoury, Judd Fastenberg, Gurston Nyquist, Elina Toskala, Marc Rosen, Mindy Rabinowitz

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objectives: Pain and analgesic requirements after functional endoscopic sinus surgery (FESS) vary widely. This study aims to quantify pain after routine FESS and determine the most commonly used pain management regimen.

Methods: Retrospective chart review of 100 patients who underwent FESS from Oct 2017 to May 2019. Patients prospectively completed a daily pain diary and reported pain levels that were categorized into no pain (0), mild (1-3), moderate (4-7), or severe (8-10). Patients were categorized into narcotics, non-narcotics, combination, or none based on type of analgesic used.

Results: Sixty-nine patients were included. Majority of patients reported either mild (39%) or …

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 …

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 …

Bilateral Sensorineural Hearing Loss In The Setting Of Acute Methamphetamine Overdose, Jeremy Reich, Harleen Sethi, Robert Sataloff

Otolaryngology (ENT) Resident Research

Substance abuse is a rare but known cause of sensorineural hearing loss (SNHL). We report a case of acute SNHL in a 28-year-old man following an overdose of methamphetamine and incidental ingestion of fentanyl. On initial encounter, he had moderate-to-severe hearing loss in the right ear and severe-to-profound hearing loss in the left ear in addition to acute kidney injury, liver failure, and lactic acidosis. The patient was treated with a two-week course of high-dose steroids and expressed a subjective improvement in hearing. This case highlights the importance of auditory testing following a drug overdose and is one of the …

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, a significant number or patients, 12 (19.4%) were prone to malnourishment, …

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 …

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 …

N95 Respirator Reuse, Decontamination Methods, And Microbial Burden: A Randomized Controlled Trial, Zi Yang Jiang, Zhen Huang, Isaac Schmale, Eric L Brown, Michael C Lorenz, Scott J Patlovich, Karan Goswami, Hannah B Wilson, Jumah Ahmad, Ronda Alexander, William Bryan, Luke Burke, Martin J Citardi, Jose Elias, Tang Ho, Jack Jacob, Garren Low, Pedro Miramón, Aniruddha U Patki, William C Yao, Amber U Luong

Faculty, Staff and Student Publications

PURPOSE: To evaluate the effectiveness and ease of N95 respirator decontamination methods in a clinic setting and to identify the extent of microbial colonization on respirators associated with reuse.

METHODS: In a prospective fashion, N95 respirators (n = 15) were randomized to a decontamination process (time, dry heat, or ultraviolet C light [UVC]) in outpatient clinics. Each respirator was re-used up to 5 separate clinic sessions. Swabs on each respirator for SARS-CoV-2, bacteria, and fungi were obtained before clinic, after clinic and post-treatment. Mask integrity was checked after each treatment (n = 68). Statistical analyses were performed to determine factors …