Otolaryngology Commons^™

Decreased Langerhans Cell Responses To Il-36 Gamma: Altered Innate Immunity In Patients With Recurrent Respiratory Papillomatosis, J. Devoti, L. Hatam, A. Lucs, A. Afzal, A. Abramson, B. M. Steinberg, V. Bonagura

Journal Articles

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomaviruses (HPVs) types 6 and 11 that is characterized by the polarization of adaptive immune responses that support persistent HPV infection. Respiratory papillomas express elevated mRNA levels of IL-36 gamma, a proinflammatory cytokine in comparison to autologous clinically normal laryngeal tissues; however there is no evidence of inflammation in these lesions. Consistent with this, respiratory papillomas do not contain T(H)1-like CD4(+) T-cells or cytotoxic CD8(+) T-cells, but instead contain a predominance of T(H)2-like and T regulatory cells (Tregs). In addition, papillomas also are infiltrated with immature Langerhans cells …

Overexpressed Beta-Catenin Localizes To Plasma Membrane In Respiratory Papillomas, A. V. Lucs, A. L. Abramson, B. M. Steinberg

Journal Articles

No abstract provided.

Internal Maxillary Artery-Middle Cerebral Artery Bypass: Infratemporal Approach For Subcranial-Intracranial (Sc-Ic) Bypass, E. Nossek, P. Costantino, M. Eisenberg, A. R. Dehdashti, A. Setton, D. J. Chalif, R. A. Ortiz, D. J. Langer

Journal Articles

BACKGROUND:Internal maxillary artery (IMax)-middle cerebral artery (MCA) bypass has been recently described as an alternative to cervical extracranial-intracranial bypass. This technique uses a keyhole craniectomy in the temporal fossa that requires a technically challenging end-to-side anastomosis.OBJECTIVE:To describe a lateral subtemporal craniectomy of the middle cranial fossa floor to facilitate wide exposure of the IMax to facilitate bypass.METHODS:Orbitozygomatic osteotomy is used followed by frontotemporal craniotomy and subsequently laterotemporal fossa craniectomy, reaching its medial border at a virtual line connecting the foramen rotundum and foramen ovale. The IMax was identified by using established anatomic landmarks, neuronavigation, and micro Doppler probe (Mizuho Inc. …

Early Efficacy Trial Of Anakinra In Corticosteroid-Resistant Autoimmune Inner Ear Disease, A. Vambutas, M. Lesser, V. Mullooly, S. Pathak, G. Zahtz, L. M. Rosen, E. Goldofsky

Journal Articles

BACKGROUND. Autoimmune inner ear disease (AIED) is a rare disease that results in progressive sensorineural hearing loss. Patients with AIED initially respond to corticosteroids; however, many patients become unresponsive to this treatment over time, and there is no effective alternative therapy for these individuals. METHODS. We performed a phase I/II open-label, single-arm clinical trial of the IL-1 receptor antagonist anakinra in corticosteroid-resistant AIED patients. Given that the etiology of corticosteroid resistance is likely heterogeneous, we used a Simon 2-stage design to distinguish between an unacceptable (= 30%) response rate to anakinra therapy. Subjects received 100 mg anakinra by subcutaneous injection …

In Reference To "The Value Of Resident Presentations At Scientific Meetings", J. A. Eloy, P. F. Svider, A. J. Folbe, M. Setzen, S. Baredes

Journal Articles

No abstract provided.

Malignancy Rate In Thyroid Nodules Classified As Bethesda Category Iii (Aus/Flus), A. S. Ho, E. E. Sarti, K. S. Jain, H. J. Wang, I. J. Nixon, A. R. Shaha, J. P. Shah, D. Kraus, R. Ghossein, L. G. T. Morris, +3 Addiltional Authors

Journal Articles

Background: The Bethesda System for Reporting Thyroid Cytopathology is the standard for interpreting fine needle aspiration (FNA) specimens. The atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category, known as Bethesda Category III, has been ascribed a malignancy risk of 5-15%, but the probability of malignancy in AUS/FLUS specimens remains unclear. Our objective was to determine the risk of malignancy in thyroid FNAs categorized as AUS/FLUS at a comprehensive cancer center. Methods: The management of 541 AUS/FLUS thyroid nodule patients treated at Memorial Sloan-Kettering Cancer Center between 2008 and 2011 was analyzed. Clinical and radiologic features were examined as …

Squamous Cell Carcinoma Of The Tonsil Managed By Conventional Surgery And Postoperative Radiation, R. Rahmati, S. Dogan, O. Pyke, F. Palmer, M. Awad, N. Lee, D. Kraus, J. P. Shah, S. G. Patel, I. Ganly

Journal Articles

BACKGROUND: The purpose of this study was to report the long-term outcome of patients with squamous cell cancer (SCC) of the tonsil managed by surgery followed by postoperative radiotherapy (PORT). METHODS: Eighty-eight patients treated between 1985 and 2005 were analyzed. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome were determined by univariate and multivariate analysis. RESULTS: Forty-eight percent of patients had T3 to T4 disease and 75% had a positive neck. Five-year OS, DSS, and RFS were 66%, 82%, and 80%, respectively. The status of the neck was …

Cochlear Development And Auditory Function In The Absence Of Thyroid Hormone Transporters Mct8 And Oatp1c1, Richard Sinn

All Graduate Theses, Dissertations, and Other Capstone Projects

Thyroid hormone (TH) is essential for the development and maturation of the nervous system. The thyroid gland secretes an active form of TH, triiodothyronine, and a prohormone, thyroxine, into the blood. TH is charged, which prevents it from passively diffusing across cell membranes and thus requires cell membrane transporters to facilitate its movement into and out of cells. However, whether TH transporters are required for TH-mediated developmental events, including the auditory system, is largely unknown.

The purpose of the present study was to investigate two specific TH transporters, monocarboxylate transporter 8 (Mct8) and organic anion transporting polypeptide 1c1 (Oatp1c1), and …

A Preliminary Report Of Percutaneous Craniofacial Osteoplasty In A Rat Calvarium., William Parkes, Jewel Greywoode, Brian J O'Hara, Ryan N. Heffelfinger, Howard Krein

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatability and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model.

STUDY DESIGN: Randomized controlled animal model METHODS: Fourteen adult Sprague Dawley rats were injected in the parietal skull with 0.2 ml of hydroxylapatite (10 animals) or a carrier gel control (4 animals), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, 3 rats (1 negative control, 2 variables) were sacrificed and calvaria were harvested. At 12 months, the remaining 5 rats were …

Incidence And Management Of Rhinosinusitis After Complex Orbitofacial Reconstruction., William Parkes, Gurston G. Nyquist, Christopher Rizzi, Sarah Zhang, James J. Evans, Ryan N. Heffelfinger, Marc Rosen, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To examine the sinus-related sequelae of free flap reconstruction for complex orbitofacial defects.

STUDY DESIGN: Retrospective chart review METHODS: Demographic, clinical, and radiographic data on a series of 55 patients who had undergone free tissue transfer for orbitofacial reconstruction was retrospectively reviewed. Follow-up of ≥ 3 months was available for 49 patients. Outcome measures studied included clinical or radiographic evidence of sinusitis and the need for sinus surgery.

RESULTS: The most commonly involved sinuses were the ethmoid (n=40) and maxillary (n=38) sinuses, and the anterolateral thigh was the most common flap used (n=41). Clinical and/or radiographic sinusitis was evident …

Incidence And Management Of Rhinosinusitis After Complex Orbitofacial Reconstruction, Wiliam Parkes, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Objective:

To discuss the incidence and management of rhinosinusitis after complex orbitofacial reconstruction.

Noise-Induced Tinnitus Using Individualized Gap Detection Analysis And Its Relationship With Hyperacusis, Anxiety, And Spatial Cognition, Edward Pace, Jinsheng Zhang

Communication Sciences and Disorders Faculty Research Publications

Tinnitus has a complex etiology that involves auditory and non-auditory factors and may be accompanied by hyperacusis, anxiety and cognitive changes. Thus far, investigations of the interrelationship between tinnitus and auditory and non-auditory impairment have yielded conflicting results. To further address this issue, we noise exposed rats and assessed them for tinnitus using a gap detection behavioral paradigm combined with statistically-driven analysis to diagnose tinnitus in individual rats. We also tested rats for hearing detection, responsivity, and loss using prepulse inhibition and auditory brainstem response, and for spatial cognition and anxiety using Morris water maze and elevated plus maze. We …

Sentinel Node Localisation Using Pre-Operative Lymphoscintigraphy And Intraoperative Gamma Probe In Early Oral Cavity Cancer, Mubasher Ikram, Shabbir Akhtar, Montasir Junaid, Tariq Dhari, Maseeh-Uz Zaman, Riffat Hussain, Zubair Ahmad

Section of Otolaryngology, Head & Neck Surgery

Objectives: To assess the diagnostic value of sentinel lymph node localisation using pre-operative lymphoscintigraphy and intra-operative gamma probe radio localisation in Pakistani patients suffering from early stage squamous cell carcinoma of the oral cavity.
Methods: The prospective case series was conducted between September 2007 and April 2010 at the Aga Khan University Hospital, Karachi. It comprised patients with T1and T2 oral cavity cancer with clinically and radiologically negative neck. Pre-operative lymphoscintigraphy was performed one day before surgery and intra-operative gamma probe was used to detect sentinel node. Final histo-pathological evaluation was taken as the gold standard.
Results: The study comprised …

Marine-Lenhart Harboring Papillary Thyroid Cancer, Brian Y. Chou, Md, Sharon Segal, Do, Edmund A. Pribitkin, Md, Jeffery L. Miller, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Introduction

Graves' disease with functioning nodules is referred to as Marine-Lenhart Syndrome. Only 2.7% of the patients with Graves’disease have concomitant functioning nodules.¹ Thyroid scintigraphy often definitively confirms the diagnosis. However, in addition to a hyperfunctioning (i.e. "hot") nodule, the thyroid scan may reveal isofunctioning (i.e. "warm"), and or a nonfuntioning (i.e. "cold") nodule as compared to the normal surrounding thyroid. Since hyperfuntioning nodules rarely harbor malignancy, if one is found that corresponds to the nodule in question, no cytologic evaluation is usually necessary.² Conversely, the majority of all nonfunctioning nodules may be benign or less frequently malignant, …

Frequency And Predisposing Factors Of Pharyngocutaneous Fistula After Total Laryngectomy, Asif Ali Arain, Mubasher Ikram, Shabbir Akhtar, Muhammad Shaheryar Ahmed Rajput, Mohammad Adeel, Moaz Maqbool Choudhary

Section of Otolaryngology, Head & Neck Surgery

Objective

The objective of our study was to determine the frequency and predisposing factors of pharyngocutaneous fistula in postlaryngectomy patients.

Materials and methods

Charts of those patients who were treated with total laryngectomy for laryngeal carcinoma in our department from 2000 to 2008 were reviewed. Total 77 patients were included in the study. The variables studied for the development of pharyngocutaneous fistula (PCF) after total laryngectomy were: age and gender, diabetes mellitus, post-operative hemoglobin, ischemic heart disease, chronic obstructive pulmonary disease, tumor characteristics including tumor site, stage, differentiation and extension into pyriform sinus, pre-operative radiotherapy, pre-operative chemotherapy, pre-operative tracheostomy and …

Toluidine Blue: Yet Another Low Cost Method For Screening Oral Cavity Tumour Margins In Third World Countries, Montasir Junaid, Anwar Suhail, Beena Umer, Mubasher Ikram, Zain-Ul-Abedeen Sobani, Naeem Sultan Ali, Ahmad Nawaz

Section of Otolaryngology, Head & Neck Surgery

Objective: To use toluidine blue intra-operatively to identify tumour involved margins after the removal of oral cavity squamous cell carcinoma, and to compare the findings with those of final histopathology.
Methods: The study was conducted at the Aga Khan University Hospital from December 1, 2009, to March 14, 2010, and comprised 56 consecutive patients with biopsy-proven squamous cell carcinoma of oral cavity regardless of grade and stage of tumour. Intra-operatively toluidine blue was used on the resected tumour margins and the staining patterns were assessed. Results were then compared with the final histopathology report.
Results: A total of 11(19.64%) margins …

Cochlear Implant In A Patient With Mondini's Deformity Of The Cochlea: Pilot Patient In Pakistan, Sadaf Qadeer Ahmed, Montasir Junaid, Zainul Abedeen Sobani, N Naila, Mohammad Sohail Awan

Department of Surgery Docs

Abstract

Autosomal-recessive genes account for about 80% of the patients of non-syndromic deafness, and a major portion of those lead to cochlear pathology. Given the strong cultural practice of consanguineous marriages and the lack of awareness regarding screening modalities, a high prevalence of hereditary pre-lingual deafness is seen in Pakistan. Considering the situation, cochlear implant surgery was introduced by Aga Khan University Hospital (AKUH), Karachi, Pakistan, in 2003. Recently we decided to expand the profile and services available and conducted the first ever cochlear implant on an anatomically-challenged cochlea. The case report relates to the experience of our pilot patient …

A Preliminary Report Of Percutaneous Craniofacial Osteoplasty In A Rat Calvarium, William J. Parkes, Md, Jewel Greywoode, Md, Brian J. O'Hara, Md, Ryan N. Heffelfinger, Md, Howard Krein, Md, Phd

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Objective: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatibility and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model.

Methods: Fourteen adult Sprague Dawley rats were injected in the parietal skull with hydroxylapatite (n=10) or a carrier gel control (n=4), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, 3 rats (1 negative control, 2 variables) were sacrificed. At 12 months, the remaining 5 rats were sacrificed. After each harvest, the calvaria were examined under both light and polarized microscopy.

Results: …

Treatment Of Intractable Neurogenic Cough With Cricopharyngeal Myotomy, Anne Lee Durstenfeld, Bs, Joseph Spiegel, Md, Mauritis Boon, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Objectives: Neuropathic cough that is incompletely responsive to medical therapy may be due to cricopharyngeal hypertonicity. The objective was to describe the utility of cricopharyngeal myotomy in alleviating symptoms of intractable neuropathic cough.

Study Design: Retrospective review.

Methods: A retrospective chart review was performed for three patients who underwent cricopharyngeal myotomy for intractable cough. Trigger phenomena, previous evaluation and treatment, and outcomes after surgery, namely patient perception of improvement and medication use after surgery, were assessed and documented.

Results: After cricopharyngeal myotomy, all three patients noted symptomatic improvement and were weaned off medication. Continued improvement was noted at follow …

Utility Of Clinical Examination And Ct Scan In Assessment Of Penetrating Neck Trauma, Maliha Kazi, Montasir Junaid, Mumtaz Jamshed Khan, Naeem Sultan Ali, Aria Masoom

Section of Otolaryngology, Head & Neck Surgery

Managing penetrating injuries adequately and effectively depends a great deal on proper assessment of the injury. This study carried out was done at The Aga Khan University Hospital to assess the role of clinical examination and CT scan imaging in evaluation of penetrating neck injuries. A total of 68 students were included, with ages ranging from 3 to 74 years. The involved zones and the injured structures were noted. Results showed a high sensitivity of clinical examination in assessing vascular (81%) and airway trauma (77%), with a low sensitivity for esophageal trauma (34%). For CT scan the sensitivity was 90% …