Otolaryngology Commons^™

Cognitive Changes In Patients Treated For Obstructive Sleep Apnea With Upper Airway Stimulation, Maxillomandibular Advancement, Or Expansion Sphincter Pharyngoplasty, Nicolas Zingas, Colin Huntley, Matthew Stewart, Ramez Philips

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a prevalent diagnosis that has been shown to not only affect sleepiness, but daytime cognitive function — specifically attention, working memory, and executive function. CPAP treatment is troublesome for some patients and it is possible that superior treatment options, specifically novel surgical techniques, are available, though none have been evaluated for their long-term effects on neurocognition. We hypothesize that treating patients with upper airway stimulation surgery (UAS) UAS, maxillomandibular advancement surgery (MMA), and expansion sphincter pharyngoplasty surgery (ESP) for OSA produces a significant improvement in cognition from baseline.

Methods: For inclusion in the study, …

Literature-Guided Recommendations For Otolaryngologists During The Covid-19 Pandemic: A Contemporary Review, Mausumi Syamal

Otolaryngology Head & Neck Surgery Faculty Publications

Objective: The objective of this study was to review the current literature and guidelines on management of the novel coronavirus 2019 (COVID-19 or 2019nCoV) with respect to the field of Otolaryngology.

Design: Contemporary literature review.

Methods: Systematic literature review of global medical literature databases and communications were queried to find all available literature recommendations, research, and guidelines applicable to otolaryngologists in the COVID-19 pandemic.

Results: Guidance on personal protective equipment, office visits, and surgical scheduling, as well as recommendations for safe airway management and tracheotomy performance during the COVID-19 pandemic were compiled and interpreted.

Conclusion: Little guidance exists for otolaryngologists …

Retrospective Review Of Fluoroscopic Swallowing Studies And Outcomes At An Academic Health Center, Rachel Strock, Priyha Mahesh, Baskaran Sundaram, Md, Gregory C. Kane, Md

Phase 1

Introduction: Aspiration is often associated with underlying medical conditions and can cause pneumonia or death. Aspiration risk can be assessed via video fluoroscopic swallowing study (VFSS) or barium swallow (BaSw). We aimed to assess the diagnoses and clinical course of patients who were evaluated for potential aspiration through VFSS or BaSw to determine if there is a degree of aspiration that increases the risk of developing pneumonia and/or death.

Methods: We conducted a retrospective chart review of 374 patients in TJUH who were evaluated via VFSS or BaSw from January 1 to June 30, 2017. We recorded the degree and …

Health Care Professionals’ Compliance To Tracheal Suctioning Policy At A Tertiary Care Hospital, Rozina Khimani, Fauziya Ali, Salma Amin Rattani, Mohammad Sohail Awan

Department of Surgery Docs

Objective: To assess the compliance of tracheal suctioning practices against the standard guidelines of a tertiary care hospital, with regard to the participants’ professional characteristics.
Methods: Using cross sectional study design, forty health care professionals (HCPs) were assessed twice, using a quantitative structured observational design, for tracheal suctioning practices, in one of the surgical care units of the tertiary care hospital. Tracheal suctioning policy which was used as a tool, its inter-rater reliability was tested and each step showed the Kappa value of 0.65 to 1.000. Data was analyzed using epidata info version 3.5.1 and SPSS version 19.
Results: From …

Covid-19 Sampling From The Middle Ear And Mastoid: A Case Report, George B Wanna, Zachary G Schwam, Vivian F Kaul, Maura K Cosetti, Enrique Perez, Peter Filip, Waleed Javaid, Avi Kandel, Alberto Paniz-Mondolfi, Satish Govindaraj, Eric M Genden

Faculty, Staff and Student Publications

No abstract provided.

Microbiotyping The Sinonasal Microbiome, Ahmed Bassiouni, Sathish Paramasivan, Arron Shiffer, Matthew R Dillon, Emily K Cope, Clare Cooksley, Mahnaz Ramezanpour, Sophia Moraitis, Mohammad Javed Ali, Benjamin S Bleier, Claudio Callejas, Marjolein E Cornet, Richard G Douglas, Daniel Dutra, Christos Georgalas, Richard J Harvey, Peter H Hwang, Amber U Luong, Rodney J Schlosser, Pongsakorn Tantilipikorn, Marc A Tewfik, Sarah Vreugde, Peter-John Wormald, J Gregory Caporaso, Alkis J Psaltis

Faculty, Staff and Student Publications

This study offers a novel description of the sinonasal microbiome, through an unsupervised machine learning approach combining dimensionality reduction and clustering. We apply our method to the International Sinonasal Microbiome Study (ISMS) dataset of 410 sinus swab samples. We propose three main sinonasal “microbiotypes” or “states”: the first is Corynebacterium-dominated, the second is Staphylococcus-dominated, and the third dominated by the other core genera of the sinonasal microbiome (Streptococcus, Haemophilus, Moraxella, and Pseudomonas). The prevalence of the three microbiotypes studied did not differ between healthy and diseased sinuses, but differences in their distribution were evident based …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

A Rare Case Of Bleeding Epiphrenic Esophageal Diverticulum From Arteriovenous Malformations., Franklin L. Thelmo, Harvey Guttmann, Waqas Ullah, Ahmad Arslan, Eugen Brailoiu

Abington Jefferson Health Papers

Epiphrenic esophageal diverticula (EED) is a rare condition that usually presents with dysphagia in patients with a known motility disorder. In this article, we present a unique case of EED presenting with hemoptysis with clinical workup negative for any pulmonary pathology. Esophagogastroduodenoscopy revealed arteriovenous malformations within the EED successfully managed with argon plasma coagulation (APC), leading to a resolution of the patient's symptoms.

Lifestyle Management For Vestibular Disorders, Michelle Pock

Student Capstone Papers

Individuals with vestibular disorders have concerns that impact lifestyle including limiting activities of daily living, limiting participation in social events, difficulty driving, and difficulty working (Cohen, 2014). Occupational therapists are able to help individuals with vestibular disorders by task analyzing symptom provoking activities, assessing the impact of symptoms on occupations, providing adaptations, and providing ways to modify environments (Gronski, Neville, Kannenberg, & Cohen, 2017). While occupational therapists are qualified to provide services to sustain and improve the occupational performance of individuals with vestibular disorders, occupational therapy is not well represented in this area particularly in addressing lifestyle components for vestibular …

Virtual Surgical Planning In Subscapular System Free Flap Reconstruction Of Midface Defects., Brian P. Swendseid, Dylan F. Roden, Swar Vimawala, Tony Richa, Larissa Sweeny, Richard A. Goldman, Adam Luginbuhl, Ryan N. Heffelfinger, Shachika Khanna, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position.

MATERIALS AND METHODS: Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution.

RESULTS: Nine cases with VSP were compared to fourteen cases …

Mutation Signature Analysis Identifies Increased Mutation Caused By Tobacco Smoke Associated Dna Adducts In Larynx Squamous Cell Carcinoma Compared With Oral Cavity And Oropharynx., Andrew P. South, Nicoline Y Den Breems, Tony Richa, Uche Nwagu, Tingting Zhan, Shiv Poojan, Ubaldo E. Martinez-Outshoorn, Jennifer M. Johnson, Adam J. Luginbuhl, Joseph Curry

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Squamous cell carcinomas of the head and neck (HNSCC) arise from mucosal keratinocytes of the upper aero-digestive tract. Despite a common cell of origin and similar driver-gene mutations which divert cell fate from differentiation to proliferation, HNSCC are considered a heterogeneous group of tumors categorized by site of origin within the aero-digestive mucosa, and the presence or absence of HPV infection. Tobacco use is a major driver of carcinogenesis in HNSCC and is a poor prognosticator that has previously been associated with poor immune cell infiltration and higher mutation numbers. Here, we study patterns of mutations in HNSCC that are …

Lifestyle Management For Individuals With Vestibular Disorders, Michelle Pock, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

Individuals with vestibular disorders have concerns that impact lifestyle including limiting activities of daily living, limiting participation in social events, difficulty driving, and difficulty working (Cohen, 2014). Occupational therapists are able to help individuals with vestibular disorders by task analyzing symptom provoking activities, assessing the impact of symptoms on occupations, providing adaptations, and providing ways to modify environments (Gronski, Neville, Kannenberg, & Cohen, 2017). While occupational therapists are qualified to provide services to sustain and improve the occupational performance of individuals with vestibular disorders, occupational therapy is not well represented in this area particularly in addressing lifestyle components for vestibular …

Reconstructive Trends And Complications Following Parotidectomy: Incidence And Predictors In 11,057 Cases., Cory D Bovenzi, Peter Ciolek, Meghan Crippen, Joseph M Curry, Howard Krein, Ryan Heffelfinger

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.

METHODS: A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the …

An Unusual Presentation Of Subglottic Stenosis Necessitating Urgent Tracheostomy, Jacob Burdett, Alexander Manteghi

Otolaryngology (ENT) Resident Research

By definition, the subglottis is the area of the larynx immediately below the vocal folds extending to the level of the inferior border of the cricoid cartilage. This area represents the narrowest portion of the pediatric airway and is the most common site of iatrogenic stenosis. This stenosis is generally secondary to increased rates of intubation in infants of prematurity. Evaluation and treatment for subglottic stenosis represents one of the most common airway consultations within pediatric otolaryngology. Goals of therapy include securing a safe airway and restoring subglottic patency. In this clinical case, we present a unique pattern and presentation …

An Interesting Secondary Airway Lesion In An Infant With Laryngomalacia, William L. Valentino, David Lafferty, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 2-month-old male with a prior diagnosis of laryngomalacia (LM) presented to the emergency department in respiratory distress with worsening inspiratory stridor, suprasternal retractions, and a dry cough. A chest X-ray and lateral neck radiograph were performed and demonstrated no abnormalities. Flexible laryngoscopy revealed the same, previously observed moderately prolapsed arytenoids and an omega-shaped epiglottis with shortened aryepiglottic (AE) folds. He also had a right lower neck mass. He was scheduled for a direct laryngoscopy and bronchoscopy (DLB) and supraglottoplasty. During the DLB, LM and anterior compression of the midtrachea was noted. Lysis of the AE folds was performed in …

Epstein-Barr Virus-Positive Large Cell Neuroendocrine Carcinoma Of The Nasopharynx: Report Of One Case And Review Of The Literature, Zhenjian Cai, Mei Lin, Angel I Blanco, Jing Liu, Hui Zhu

Faculty, Staff and Student Publications

Epstein-Barr Virus (EBV)-positive neuroendocrine carcinoma (NEC) of the nasopharynx is exceedingly rare, only two cases have been reported in the literature. While EBV infection is strongly associated with nasopharyngeal carcinoma, which is carcinoma with squamous differentiation, the link between EBV and NEC is not well known, and can be diagnostically challenging. In this study, we report the third case of EBV-positive large cell NEC of nasopharynx with neck lymph node metastasis. The patient was treated with combined radiation and chemotherapy and showed complete clinical and radiological response. Similar treatment response has been reported in another patient with high stage EBV-positive …

Prognostic Significance Of Tumor-Associated Macrophage Content In Head And Neck Squamous Cell Carcinoma: A Meta-Analysis., Ayan Tyagi Kumar, Alexander Knops, Brian Swendseid, Md, Ubaldo E. Martinez-Outshoorn, Larry Harshyne, Nancy Philp, Ulrich Rodeck, Adam Luginbuhl, David Cognetti, Jennifer Johnson, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Head and neck squamous cell carcinoma (HNSCC) exists within a microenvironment rich in immune cells. Macrophages are particularly abundant in and around tumor tissue, and have been implicated in the growth, malignancy, and persistence of HNSCC (1). However, current literature reports variable degrees of association between the density of tumor-associated macrophages (TAMs) and clinicopathologic markers of disease (2, 3). These inconsistent findings may be a result of differences in approach to TAM detection. Authors have measured total TAMs in tumor tissue, while others have stained tumor samples for individual subtypes of TAMs, which include pro-inflammatory (M1-like) and immunosuppressive (M2-like). …

Moisture Chamber For Eye Care After Facial Nerve Injury, Ryan Rimmer, Md, Lauren Bogdan, Md, Gregory Epps, Md, Nikolaus Hjelm, Md, Erin Reilly, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

• Patients with various lesions of the head and neck may have compromise of facial nerve function.
• Facial nerve (CN VII) has various roles, including movement of facial muscles and, importantly, eye closure.
• When facial nerve is sacrificed or damaged during a surgical cases, steps are often taken intraop to surgically correct the deficit and allow eye closure. However, these patients may not immediately realize the benefit of these interventions.
• In the postop period, appropriate eye care is critical to prevent exposure keratopathy due to inability to close eye.
• Exposure keratopathy is damage to the cornea that occurs primarily due …

Treatment Summaries For Head And Neck Cancer Survivors: Improving Patient Self Efficacy And Survivorship Care, Michael C. Topf, Md, Jena Patel, Ramez Philips, Md, David Cognetti, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

• To determine if receiving treatment summaries enhances patient understanding and recall of cancer and treatment details, improves patient self efficacy, and serves as a useful patient tool after completion of head and neck (HNC) therapy

Carotid Dosimetry After Re-Irradiation With 131cs Permanent Implant Brachytherapy In Recurrent, Resected Head And Neck Cancer, Amanda Walsh, Emily Hubley, Laura Doyle M, David Cognetti, Joseph Curry, Voichita Bar-Ad, Adam Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Purpose: Permanent seed implant cesium-131 (¹³¹Cs) brachytherapy provides highly localized radiation for patients with recurrent head and neck cancer (HNC), who may be ineligible for external beam radiation therapy due to a high-risk of toxicity. As carotid blowout is a concern in the setting of re-irradiation, a dose to the carotid artery was examined for ¹³¹Cs brachytherapy implants.

Material and methods: Eleven patients were implanted with¹³¹Cs adjacent to carotid at the time of resection for recurrent HNC. Vascularized tissue flaps were used in some patients. The carotid artery was contoured on the post-implant brachytherapy treatment …