Otolaryngology Commons^™

End-Stage Head And Neck Cancer: Coping Mechanism, Bogdan Popescu, Oana Paun, Razvan V. Scăunaşu, Serban V.G. Berteşteanu

Journal of Mind and Medical Sciences

Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness …

Progressive Age-Dependence And Frequency Difference In The Effect Of Gap Junctions On Active Cochlear Amplification And Hearing, Liang Zong, Jin Chen, Yan Zhu, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

Mutations of Connexin 26 (Cx26, GJB2), which is a predominant gap junction isoform in the cochlea, can induce high incidence of nonsyndromic hearing loss. We previously found that targeted-deletion of Cx26 in supporting Deiters cells and outer pillar cells in the cochlea can influence outer hair cell (OHC) electromotility and reduce active cochlear amplification leading to hearing loss, even though there are no gap junction connexin expressions in the auditory sensory hair cells. Here, we further report that hearing loss and the reduction of active amplification in the Cx26 targeted-deletion mice are progressive and different at high and low …

Macrophage Type 2 Differentiation In A Patient With Laryngeal Squamous Cell Carcinoma And Metastatic Prostate Adenocarcinoma To The Cervical Lymph Nodes., Michael C. Topf, Madalina Tuluc, Larry A. Harshyne, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: The tumor microenvironment often polarizes infiltrating macrophages towards a type 2, or M2 phenotype, that is characterized by expression of various cysteine-rich, scavenger receptors, including CD163. The primary function of M2 macrophages is to facilitate wound healing. As such, they are capable of providing metabolic support to a growing tumor, neovascularization, as well as protection from cytotoxic T cells. The tumor microenvironment contains a milieu of secreted factors and vesicles, which in certain circumstances can gain access to lymphatic vessels that drain to local lymph nodes.

CASE PRESENTATION: We report a 59-year-old male with recurrent T4 squamous cell carcinoma …

Biochemical Effects Of Exercise On A Fasciocutaneous Flap In A Rat Model., Edita Aksamitiene, Adam L. Baker, Sudeep Roy, Salini Hota, Li-Hui Zhang, Julianna Rodin, Kealan Hobelmann, Jan B. Hoek, Edmund A. Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Importance: An overwhelming amount of data suggest that cardiovascular exercise has a positive effect on the mind and body, although the precise mechanism is not always clear.

Objective: To assess the clinical and biochemical effects of voluntary cardiovascular exercise on pedicled flaps in a rodent model.

Design, Setting, and Participants: Eighteen adult Sprague-Dawley male rats were randomized into a resting animal group (RAG) (n=9) and an exercise animal group (EAG) (n=9) for 14 days (July 23, 2013, through July 30, 2013). A pedicled transposition flap was performed on the ventral surface of the rat, and biopsy specimens were taken from …

Clinical Anatomy Of The Frenulum Of The Oral Vestibule., Joe Iwanaga, Naoshi Takeuchi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Introduction The frenula of the oral vestibule include the labial and buccal frenula. Abnormal labial and buccal frenula can affect facial esthetics and oral cavity function by retracting the gingival margin, creating a median diastema, and limiting lip movement. Because of the lack of information on these structures, we aimed to clarify their anatomy. Methods A total of 34 sides from 17 fresh frozen cadaveric Caucasian heads were used in the present study. The specimens were derived from 11 male and 6 female adult cadavers. The relationships between the frenulum of the mucosa and the tissue underneath the mucosa was …

Correlation Of Tp53 Overexpression And Clinical Parameters With Five-Year Survival In Oral Squamous Cell Carcinoma Patients, Syed A. Ali, Hamza A Khan, Omar Irfan, Adeel Samad, Yamna Mirza, Mohammad Sohail Awan

Section of Otolaryngology, Head & Neck Surgery

Abstract

Introduction TP53 mutation and overexpression have been correlated with poor survival in many cancers including oral squamous cell carcinoma (OSCC). We aim to understand the role of TP53 overexpression in OSCC in our population and correlate it with five-year survival to test its viability as a prognostic marker for OSCC patients. Materials and methods Patients with biopsy proven OSCC at Aga Khan University Hospital from January 2000 to January 2008 were recruited. Immunohistochemistry was used to establish TP53 status and the results were published. Following up on these patients, five-year data were collected and correlated with TP53 status and …

Hypothesis Of K+-Recycling Defect Is Not A Primary Deafness Mechanism For Cx26 (Gjb2) Deficiency, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

K⁺-recycling defect is a long-standing hypothesis for deafness mechanism of Connexin26 (Cx26, GJB2) mutations, which cause the most common hereditary deafness and are responsible for >50% of nonsyndromic hearing loss. The hypothesis states that Cx26 deficiency may disrupt inner ear gap junctions and compromise sinking and recycling of expelled K⁺ ions after hair cell excitation, causing accumulation of K⁺-ions in the extracellular space around hair cells producing K⁺-toxicity, which eventually induces hair cell degeneration and hearing loss. However, this hypothesis has never been directly evidenced, even though it has been widely referred …

Pediatric Intrafalcine Empyema From A Sinogenic Origin: A Case Report., Kyle Mueller, John Myseros

Neurological Surgery Faculty Publications

Sinusitis and otitis are common within the pediatric population. If left untreated, these can extend intracranially and lead to the development of infections in the various intracranial compartments resulting in a high rate of morbidity and mortality. We report the first case of an intrafalcine empyema, absent subdural purulence, in a patient with the likely spread from a sinogenic origin. This case illustrates the novelty of this as a pathological entity as well as the surgical considerations for intrafalcine purulence in the absence of expected subdural collections.

Osa And Primary Snoring: Palatal Surgery And Office-Based Procedures, Adam Vasconcellos, Md

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

PowerPoint slide deck. (No audio)

6-Year Experience Of Outpatient Total And Completion Thyroidectomy, Ethan Frank, Joshua Park Md, Alfred Simental, Christopher Vuong Md, Steve Lee Md, Phd, Pedro Andrade Filho Md, Daniel Kwon Md, Yuan Liu Md

Loma Linda University Student Journal

Outpatient thyroidectomy has become slowly accepted with various published reports predominantly examining partial or subtotal thyroidectomy. Concerns regarding the safety of outpatient total and completion thyroidectomy remain, especially in regards to vocal fold paralysis, hypocalcemia, and catastrophic hematoma. We aimed to evaluate the safety of outpatient thyroid surgery in a large cohort. We conducted a retrospective review comparing outcomes in those who underwent outpatient (n=251) versus inpatient (n= 291) completion or total thyroidectomy between February 2009 and February 2015. Outpatient completion and total thyroidectomy had lower rates of temporary hypocalcemia (6% vs. 24.4%; p< 0.001) and no significant difference in rates of return to emergency department (1.2% vs. 1.4%), hematoma formation (0.8% vs. 0.7%), temporary (2% vs. 4.1%) or permanent (0.4% vs. 0.7%) vocal fold paralysis, or permanent hypocalcemia (0.4% vs. 0%) compared to the inpatient group. Outpatients requiring calcium replacement had shorter duration of postoperative calcium supplementation (44.4±59.3 days vs. 63.3 ±94.4 days; p < 0.001). Our data demonstrates similar safety in outpatient and inpatient total and completion thyroidectomy.

Management Of Forehead Scars, Ryan N. Heffelfinger, Akshay Sanan, Lucas M. Bryant

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

This article provides an overview of scar management within the forehead region. It addresses the unique challenges specific to the treatment of forehead wounds. A logical, stepwise approach is used. A subsite based treatment algorithm is provided along with a review of current best practices. Pertinent case examples are included for demonstration purposes.

Correlation Of Positron Emission Tomography/Computed Tomography Scan With Smoking, Tumor Size, Stage And Differentiation In Head And Neck Cancer Patients, Jordan L. Pleitz, Partha Sinha, Emily V. Dressler, Rony K. Aouad

Otolaryngology--Head & Neck Surgery Faculty Publications

The goal of this study was to identify associations between positron emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) in patients presenting with head and neck squamous cell carcinoma (SCC) with tumor site, size, histologic differentiation, smoking, and diabetes. Charts of patients with oropharyngeal and laryngeal SCC who underwent ¹⁸F-fluorodeoxyglucose PET/CT scans were reviewed between May 2007 and August 2013. Statistical analyses included modeling log-transformed SUVmax values by tumor site, size, histologic differentiation, smoking status, and diabetes using unadjusted linear regressions. Differences were considered statistically significant for P< 0.05. A total of 111 patients (54 with oropharynx and 57 with larynx cancers) were included, 83 men and 28 women with an average age of 57.5 years old. There was a significantly higher pack-year smoking history (P = 0.005) in the larynx cancer group. While tumor …

Elimination Of Pain Improves Specificity Of Clinical Diagnostic Criteria For Adult Chronic Rhinosinusitis, Scott D. Hirsch, Evan R. Reiter, Laurence J. Dinardo, Wen Wan, Theodore A. Schuman

Otolaryngology Publications

Objective

Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis.

Study Design

Retrospective cohort study.

Methods

History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache.

Results

Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, …

Promotion Of Early Pediatric Hearing Detection Through Patient Navigation, Matthew L. Bush

Theses and Dissertations--Clinical and Translational Science

Congenital hearing loss is the most common neonatal sensory disorder and it is crucial to diagnose hearing loss as soon as possible after birth in order to facilitate rapid treatment. Universal standards of infant hearing healthcare dictate that infant hearing screening should be completed by one month of age and abnormal screening tests should be followed with definitive audiological testing by three months of age. Obtaining diagnostic testing can be complicated by limited access to care in rural areas, breakdowns in communication, lack of parental support, and poor coordination of care. There is no established method to address appointment non-adherence …

Head And Neck Manifestations Of Eosinophilic Granulomatosis With Polyangiitis: A Systematic Review., Jared M. Goldfarb, Mindy R. Rabinowitz, Shristi Basnyat, Gurston G. Nyquist, Marc R. Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To conduct the first and only systematic review of the existing literature on head and neck manifestations of eosinophilic granulomatosis with polyangiitis to guide clinical decision making for the otolaryngologist.

DATA SOURCES: PubMed, Cochrane Library, Scopus, and LILACS.

REVIEW METHODS: A systematic review of the aforementioned sources was conducted per the PRISMA guidelines.

RESULTS: From an initial 574 studies, 28 trials and reports were included, accounting for a total of 1175 patients with eosinophilic granulomatosis with polyangiitis. Among clinical and cohort studies, 48.0% to 96.0% of all included patients presented with head and neck manifestations. In a distinct group …

Using Low-Dose Radiation To Potentiate The Effect Of Induction Chemotherapy In Head And Neck Cancer: Results Of A Prospective Phase 2 Trial, Susanne M. Arnold, Mahesh Kudrimoti, Emily V. Dressler, John F. Gleason, Natalie L. Silver, William F. Regine, Joseph Valentino

Internal Medicine Faculty Publications

Purpose: Low-dose fractionated radiation therapy (LDFRT) induces effective cell killing through hyperradiation sensitivity and potentiates effects of chemotherapy. We report our second investigation of LDFRT as a potentiator of the chemotherapeutic effect of induction carboplatin and paclitaxel in locally advanced squamous cell cancer of the head and neck (SCCHN).

Experimental Design: Two cycles of induction therapy were given every 21 days: paclitaxel (75 mg/m²) on days 1, 8, and 15; carboplatin (area under the curve 6) day 1; and LDFRT 50 cGy fractions (2 each on days 1, 2, 8, and 15). Objectives included primary site complete response …

Frequency Of Sensorineural Hearing Loss In Chronic Suppurative Otitis Media, Syed Sajjad Ali Zaidi, Hamdan Ahmed Pasha,, Anwar Suhail,, Talha Ahmed Qureshi

Department of Surgery Docs

Abstract Chronic suppurative otitis media (CSOM) is defined as chronic otorrhea (i.e., lasting > 6-12 weeks) through a perforated tympanic membrane. It is generally associated with some degree of conductive hearing loss. However, recurrent ear infections due to perforated eardrum result in absorption of toxins and macromolecules into the cochlea leading to sensorineural hearing loss (SNHL). We planned to determine the frequency of sensorineural hearing loss in chronic suppurative otitis media. A descriptive cross-sectional study was conducted at Aga Kgan University Hospital, Karachi, from October 2013 to March 2014. Average threshold of speech frequencies was calculated via pure tone audiogram for …

The Use Of Hyperbaric Oxygen Therapy In Idiopathic Sensorineural Hearing Loss: A Case Study, Chad B. Crigger, Md, Stephen L. Wilson, Md

Marshall Journal of Medicine

Idiopathic sudden sensorineural hearing loss (ISSHL) is an otologic emergency that can provoke anxiety in the patient and can be clinically challenging for the practitioner. The natural history of the condition can be as varied as its possible etiologies. Adding to the clinical challenge is the current debate of treatment modalities available. In what follows, we provide a case detailing our treatment course, including the novel use of hyperbaric oxygen therapy (HBOT) as an emerging therapy for sensorineural hearing loss. Additionally, we provide a brief review of the current state of treatment options available in the armament for ISSHL. As …

Relationship Of Tumor Thickness With Neck Node Metastasis In Buccal Squamous Cell Carcinoma: An Experience At A Tertiary Care Hospital, Sadaf Qadeer Ahmed, Montasir Junaid, Sohail Awan, Moaz M. Choudhary, Maliha Kazi, Aria Masoom, Hareem Usman Khan

Department of Surgery Docs

Introduction Squamous cell carcinoma is the most common malignancy of the head and neck, with the buccal mucosa being the most common site involved. Early locoregional metastasis is a hallmark of this disease, and early stage tumors may harbor metastatic nodes that are occult. Certain parameters can help identify high-risk patients for whom the pattern of occult nodal metastasis can be predicted. Tumor thickness is one such objective parameter. Objective To determine the relationship of tumor thickness with neck node metastasis in squamous cell carcinoma of the buccal mucosa. Methods A retrospective chart review of 102 patients with biopsy-proven squamous …

Gastric Pepsin In Post-Tympanostomy Tube Otorrhea, Jill N. D'Souza, Md, Erin Fields, Pa-C, Zhaoping He, Phd, Robert O' Reilly, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Introduction

Otorrhea is the most common complication following tympanostomy tube placement, with an incidence commonly reported at around 20%. Topical otic antibiotic drops are typically used for relief of otorrhea in children with tympanostomy tubes. In children with recurrent otorrhea, gastroesophageal reflux and extraesophageal reflux have been postulated to be involved in the pathogenesis of otitis media with effusion¹. Middle ear inflammation is thought to be mediated by proteolytic activity of pepsin, as well as by the decrease in pH associated with reflux of gastric acid through Eustachian tube. The goal of this study is to examine the …