Otolaryngology Commons^™

Implementation Of A Tracheostomy Discharge Education Class For Nicu Nurses, Todd N. Chamoy

Doctor of Nursing Practice Final Manuscripts

Infants who are ventilator-dependent or have anatomic anomalies of their airway frequently require tracheostomy placement prior to discharge from the hospital in order to be cared for safely at home. At this large quaternary children’s hospital in Southern California, preparing these infants for discharge after tracheostomy placement has not been the role of the NICU nurse. There was no system in place on how to train caregivers, and the NICU staff felt unprepared. Evidence supports use of intensive educational programs to improve nurse knowledge and skills of tracheostomy care, allowing NICU nurses to provide improved care and pre-discharge teaching.

A …

Reducing Surgery For Pediatric Posttonsillectomy Hemorrhage Using Tranexamic Acid: A Quality Improvement Initiative, Laura A. Petrauskas, Janavi Sethurathnam, Ansley J. Kunnath, Rahul K. Sharma, John Ceremsak, Ryan H. Belcher, James D. Phillips, Jay A. Werkhaven, Amy S. Whigham, Lyndy J. Wilcox, Christopher T. Wootten, Frank W. Virgin, Jason S. Park

School of Medicine Faculty Publications

Objective: Evaluate the use of tranexamic acid (TXA) and observation as a management option for pediatric patients presenting with posttonsillectomy hemorrhage (PTH). Study Design: Retrospective analysis of a prospectively implemented quality improvement initiative with a historical control comparison group. Setting: Tertiary children's hospital. Methods: Patients < 18 years of age who underwent adenotonsillectomy (AT) and returned to the Emergency Department for PTH were included. Patients who were stable without large volume or active bleeding were given intravenous TXA and admitted for overnight observation. Data were compared in a before-and-after analysis: preprotocol (April 2022 to March 2023) versus postprotocol (April 2023 to March 2024). For cost-effectiveness analysis, we analyzed aggregated claims data from a commercial claims database. Results: Preprotocol 1800 adenotonsillectomies were performed, and 40 procedures were performed for control of hemorrhage (2.2 per 100 AT). Postprotocol 2356 adenotonsillectomies were performed, and 30 procedures were performed to control hemorrhage (1.3 per 100 AT) showing a significant reduction in return to the operating room (relative risk [RR] = 0.59, 95% confidence interval [CI] [0.358, 0.916], P-value.020). There were no reported adverse events attributable to TXA. An estimated 21 surgeries were avoided, and 26 additional patients were observed in the hospital during the postprotocol period, for an estimated net cost savings of $174,970. Conclusion: The implementation of a standardized TXA protocol significantly reduced the need for return to the operating room for PTH in pediatric patients, without complications and with net cost savings to the health care system.

Towards Universal Chemosensory Testing: Needs, Barriers, And Opportunities, Steven D. Munger, Kai Zhao, Linda A. Barlow, Duncan Boak, Katie Boateng, Susan E. Coldwell, Pamela Dalton, Richard L. Doty, Jennifer E. Douglas, Valerie Duffy, Frank A. Franklin, John E. Hayes, Howard J. Hoffman, Patrice Hubert, Paule V. Joseph, Jeb M. Justice, Joshua M. Levy, Julie A. Mennella, Marianna Obrist, M. Yanina Pepino, Jayant M. Pinto, Edmund A. Pribitkin, Christopher T. Simons, Mark W. Albers, Valentina Parma

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Millions of people in the United States experience a reduced or distorted ability to smell or taste. Chemosensory disorders such as anosmia (the inability to smell), parosmia (distorted smell), or dysgeusia (altered taste) have major impacts on health and quality of life including difficulty sensing dangers such as fire or spoilage, a diminished palatability of food and drink that can negatively influence diet and nutrition, feelings of social isolation, and an increased incidence of frailty, anxiety, and depression. Smell or taste dysfunction can also be symptoms of other health issues, including sinonasal disease, cancer, or neurodegenerative disease. Aging adults are …

Optimizing Intraoperative Parathyroid Hormone Testing Protocols To Improve Efficiency And Outcomes In Parathyroid Surgeries, Andrew Neeson, Bs, Hani Samarah, Bs, Bryan Renslo, Md, Eric Fei, Ba, Kalena Liu, Bs, Harleen K. Sethi, Do, Elizabeth E. Cottrill, Md

Health Equity and Quality Improvement (HEQI) Summit

Background:

• Intraoperative PTH (ioPTH) helps confirm the removal of hyperfunctioning glands by leveraging its short half-life (~3-5 minutes).
• Timely results are critical for minimizing unnecessary bilateral neck exploration and operative time.
• Delays in ioPTH processing can increase anesthesia time, OR costs, and patient risk.
• Anecdotal reports have suggested variation in ioPTH processing speeds across Jefferson Health surgical sites.

Problem Statement: Significant delays in ioPTH turnaround time at one surgical site may prolong operative and anesthesia times, compromising patient safety.

Project Aim: To identify and compare ioPTH processing times across three surgical sites to pinpoint workflow inefficiencies and propose future improvements.

Intertrial Coherence As A Measure Of Synchrony In Ocular Vestibular Evoked Myogenic Potentials And The Effect Of Gaze Angle, Sydney Brown

Dissertations, 2020-current

Ocular vestibular evoked myogenic potentials (oVEMPs) are produced by highly synchronous bursts of extraocular muscle activity in response to stimuli. These responses reflect utricular function and can be recorded using surface electromyography electrodes. Traditional analysis of oVEMPs is limited to time-domain waveform measurements, such as amplitude and latency of response peaks. Objective synchrony-based measures have not yet been applied to the analysis of oVEMPs, particularly in the comparison of synchrony across gaze angles. We followed the new time-frequency method of analysis developed by Clinard et al. (2022) that was successfully applied to cervical VEMPs to quantify response synchrony. Air-conducted oVEMPs …

Assessments Of Social Vulnerability On Laryngeal Cancer Treatment & Prognosis In The Us: Epidemiology, David J. Fei-Zhang, Camaren M. Cuenca, Angela D. Haskins, Andrew P. Stein, David G. Lott, Urjeet A. Patel, Stephanie S. Smith, Amy L. Dimachkieh, Nosayaba Osazuwa-Peters, Jill N. D’Souza, Anthony M. Sheyn, Jeffrey C. Rastatter, Daniel C. Chelius

School of Medicine Faculty Publications

Background: Previous social determinants of health (SDoH) studies on laryngeal cancer (LC) have assessed individual factors of socioeconomic status and race/ethnicity but seldom investigate a wider breadth of SDoH-factors for their effects in the real-world. This study aims to delineate how a wider array of SDoH-vulnerabilities interactively associates with LC-disparities. Methods: This retrospective cohort study assessed 74,495 LC-patients between 1975 and 2017 from the Surveillance-Epidemiology-End Results (SEER) database using the Social Vulnerability Index (SVI) from the CDC, total SDoH-vulnerability from 15 SDoH variables across specific vulnerabilities of socioeconomic status, minority-language status, household composition, and infrastructure/housing and transportation, which were measured …

Postoperative Caregiver Decision Regret Following Velopharyngeal Dysfunction Surgery, Rohit Nallani, Nathan Farrokhian, Meghan Tracy, Kevin Sykes, Jill M. Arganbright

Research Days

Background

Decision regret (DR) is a powerful factor in medical decision-making, particularly for surgical decisions which carry multiple risks, impact quality of life (QOL), and have uncertain outcomes. While prior studies have investigated caregiver DR after tonsillectomy and otologic surgery, there is a paucity of data assessing DR following pediatric otolaryngology procedures. The aim of this study is to measure DR following velopharyngeal dysfunction (VPD) surgery.

Methods

A cross-sectional survey study with chart review was performed of caregivers of children who had VPD surgery performed by a single surgeon at a tertiary children’s hospital. Demographic, medical, and surgical history were …

Impact Of The Covid-19 Pandemic On Pediatric Complicated Sinusitis: A Single Institutional Experience, Rohit Nallani, Mackenzie O'Donnell, Nathan Farrokhian, Meghan Tracy, David Garcia, Jill M. Arganbright

Research Days

Background: Institutions around the world have noted increasing trends in complicated sinogenic infections in children following the start of the COVID-19 pandemic. Treatment of these infections often requires combined medical and surgical management. Further study is needed to understand changing epidemiology, microbiology, and contributing demographic factors for these infections. We noted increasing trend of surgically managed complicated sinusitis during the COVID-19 pandemic at our institution and hypothesized there were higher rates of intracranial complications.

Methods: We performed a retrospective cohort study with chart review of all children under the age of 18 treated surgically for complicated sinusitis between January 1, …

Comparative Analysis Of Drug-Induced Sleep Endoscopy With Positive Airway Pressure And Therapeutic Continuous Positive Airway Pressure In The Treatment Of Obstructive Sleep Apnea, Elliott M. Sina, Nicole Molin, Praneet C. Kaki, Henry Ideker, Stephen White, Maurits Boon, Colin Huntley

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

No abstract provided.

Comparing Treatment Effectiveness And Patient-Reported Outcome Measures Of Four Treatment Options For Obstructive Sleep Apnea, Robert Diecidue, Dmd, Md, Phd, Mba, Msph, Joseph Harrington, Bs, Erika L. Manning, Phd, Md, Mph, Colin T. Huntley, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Abstract

- There are four common treatment modalities for obstructive sleep apnea (OSA)

• CPAP, MAD, UAS, MMA

- Retrospective data was examined to compare efficacies between these treatments for patients treated with one of these four OSA therapies.

• Primary outcome: Mean disease alleviation (MDA) - calculated value based on improvement of AHI adjusted by compliance.
• Secondary outcomes: Patient reported outcome measures (PROMs) - ESS, PRAQ, SAQLI

- It was found that the greatest mean disease alleviation was found in patients who underwent MMA. PROMs showed the most significant improvement in daytime sleepiness (ESS) for MMA.

A Multimodal Intervention To Improve Treatment And Clinical Outcomes In Children With Recurrent Otitis Media, Daniel Courtaney

Evidence-Based Practice Project Reports

Acute otitis media is the number one cause for primary health care visits and antibiotic prescriptions in the pediatric population (El Feghaly & Jackson, 2023). Upwards of 27% of children experience multiple episodes of otitis media (OM) that meet recurrent otitis media (ROM) diagnosis criteria (Pelton & Marchisio, 2023). Guided by the Iowa Model (Iowa Model Collaborative, 2017), the project’s purpose was to implement a multimodal intervention to decrease recurrent OM and repeat clinic visits. A comprehensive literature search of 5 databases yielded 16 sources ranging from levels I-IV (Melnyk & Fineout-Overholt, 2023). Using the AGREE II and JBI Critical …

Artificial Intelligence-Based Virtual Staining Platform For Identifying Tumor-Associated Macrophages From Hematoxylin And Eosin-Stained Images, Arpit Aggarwal, Mayukhmala Jana, Amritpal Singh, Tanmoy Dam, Himanshu Maurya, Tilak Pathak, Sandra Orsulic, Kailin Yang, Deborah Chute, Justin A Bishop, Farhoud Faraji, Wade M Thorstad, Shlomo Koyfman, Scott Steward, Qiuying Shi, Vlad Sandulache, Nabil F Saba, James S Lewis, Germán Corredor, Anant Madabhushi

Faculty, Staff and Students Publications

Background: Virtual staining is an artificial intelligence-based approach that transforms pathology images between stain types, such as hematoxylin and eosin (H&E) to immunohistochemistry (IHC), providing a tissue-preserving and efficient alternative to traditional IHC staining. However, existing methods for translating H&E to virtual IHC often fail to generate images of sufficient quality for accurately delineating cell nuclei and IHC+ regions. To address these limitations, we introduce VISTA, an artificial intelligence-based virtual staining platform designed to translate H&E into virtual IHC.

Methods: We applied VISTA to identify M2-subtype tumor-associated macrophages (M2-TAMs) in H&E images from 968 patients with HPV+ oropharyngeal squamous cell …

Case Report: Haemophilus Influenzae Meningitis In A 65 Year Old Female, Kaywan Saed, Russell Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with fever, altered mental status, and neck stiffness. Cerebrospinal fluid (CSF) analysis confirmed Haemophilus influenzae meningitis. The differential diagnosis of bacterial meningitis in older adults is broad and includes Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, and Haemophilus influenzae. However, in the post-Hib vaccine era, non-typeable H. influenzae has emerged as a significant cause of invasive disease in older adults, particularly in those with underlying comorbidities.

Older patients often present with atypical symptoms, which may delay diagnosis and treatment. In this case, early recognition and prompt administration of empiric antibiotic therapy …

The Relevance Of Age, Bmi, And Right Versus Left Ear Surgery To The Incidence Of Taste Disturbance After Stapes Surgery, Jonathan Ong, Dennis Bojrab Ii

Posters

• Many factors such as age and body mass index (BMI) have been shown to influence post-operative outcomes in patients undergoing stapedectomy/stapedotomy.

• This study examines these factors to see if they have any impact on the incidence of taste disturbance, a commonly reported complication of stapes surgery.1

• Our study predicts that BMI and age are correlated with the incidence of taste disturbance post-operatively following stapes surgery.

Multidisciplinary Team Care In Plastic Surgery: Vascular Anomalies, Josephine L Schmidt, Vamsi C Mohan, Richard Appel, Tara L Rosenberg, Jessica A Ching

Faculty, Staff and Students Publications

Vascular anomalies consist of a wide range of diagnoses relating to abnormal vasculature. These lesions can affect a variety of anatomical structures, requiring the expertise of numerous specialists. Over the past few decades, the formation of multidisciplinary vascular anomalies clinics has allowed patients to meet multiple providers within the same clinic visit, leading to improved communication between patients and providers. Furthermore, diagnostic and treatment plans are discussed in multidisciplinary conferences allowing for enhanced diagnostic accuracy and more comprehensive management plans. The purpose of this article is to provide an overview of the multidisciplinary management of vascular anomalies, including descriptions of …

The Impact Of Biomaterial Characteristics On Macrophage Phenotypes In Tissue Engineering: A Review, Julian Jackson, Hani Samarah, William Palmer, Zachary Kaplan, Marianna Nicodem, Parvesh Kumar, Spenser Short, Kelly Bridgham, Larry Harshyne, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Macrophages are highly plastic cells central to pathogen removal, tissue regeneration, and inflammation, making them key targets in biomaterial design for improved clinical outcomes. Foreign body responses (FBRs) to implanted biomaterials often involve excessive macrophage-mediated inflammation, leading to fibrotic encapsulation, infection, and implant failure. Advances in tissue engineering demonstrate that macrophage polarization - the transition from pro-inflammatory M1 to anti-inflammatory M2 phenotypes - can be influenced by biomaterial properties to mitigate these responses and enhance regeneration. This review synthesizes the relationship between biomaterial properties, such as surface chemistry, structure, and stiffness, and their ability to modulate macrophage behavior. Key innovations, …

Editorial: Women In Science: Allergy Research, Gemma Carreras-Badosa, Vanesa Esteban, Vivian Hernandez-Trujillo, Elina Toskala, Manali Mukherjee, Saba Al Heialy, Karin Fieten

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

No abstract provided.

Characterizing Radiation-Related Laryngotracheal Stenosis, Natalia Queenan, Jay Trivedi, Dylan Bertoni, Sana Siddiqui, Austin Yap, Kathleen Tibbetts

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Radiation-related laryngotracheal stenosis (RLTS) develops due to fibrosis of the airway after radiotherapy. We aim to characterize the presentation, management, and outcomes of patients with RLTS and compare these to patients with iatrogenic laryngotracheal stenosis (ILTS).

METHODS: In a single-center retrospective cohort study, patients diagnosed with RLTS between 2017 and 2022 were identified. Demographic data, risk factors, cancer history and treatment, presentation of stenosis, primary stenosis intervention, and outcomes were extracted. Patients were compared to a cohort of patients with ILTS and no history of radiation therapy. Data were analyzed using Fisher's Exact Tests and paired t-tests.

RESULTS: Seven …

Unmet Supportive Care Needs In Patients With Advanced Cancer And Its Impact On Distress, Kayla W Miranda, Benjamin L Musher, Hoda J Badr

Faculty, Staff and Students Publications

Purpose: Patients with advanced cancer endure considerable physical and emotional distress without sufficient supportive care. This cross-sectional study examined the relationship between cancer-related symptoms, supportive care needs, and distress levels in patients with advanced lung, head and neck, or gastrointestinal cancers.

Methods: 158 patients were assessed for symptom burden and distress levels using the M.D. Anderson Symptom Inventory (MDASI) and unmet needs using the Supportive Care Needs Survey (SCNS-34) within one month of treatment initiation. Pearson correlations and multiple regression analyses were used to explore associations between supportive care needs and distress.

Results: Distress levels were moderate across the study …

Dysphagia And Covid-19 In Adults: A Prospective Clinical Trial With Fiberoptic Endoscopic Evaluation Of Swallowing, Gökhan Can Törpü, Müberra Tanrıverdi, Nahide Öztoprak, Ömer Faruk Çalım, Orhan Özturan

Internet Journal of Allied Health Sciences and Practice

Purpose: Coronavirus disease 2019 (COVID-19) is distinguished by its impact on various tissues and organs across the body. It is known that COVID-19-related conditions are associated with swallowing function. This prospective study aimed to investigate the correlation between COVID-19 and dysphagia in adults. Methods: Adults who applied to the swallowing disorders outpatient clinic participated in this study. According to polymerase chain reaction (PCR) testing, participants were divided into two groups: COVID-19 and non-COVID-19 group. Swallowing disorders were evaluated using fiberoptic endoscopic evaluation of swallowing and scored with the Penetration-Aspiration Scale (PAS). PAS score > 1 was considered as dysphagia. Oral …