Otolaryngology Commons^™

Targeted Inhibition Of Aurora Kinase A Promotes Immune Checkpoint Inhibition Efficacy In Human Papillomavirus-Driven Cancers, Soma Ghosh, Madison P O'Hara, Pragya Sinha, Tuhina Mazumdar, Lacin Yapindi, Jagannadha K Sastry, Faye M Johnson

Faculty, Staff and Student Publications

Background: Human papillomavirus (HPV)-driven cancers include head and neck squamous cell carcinoma and cervical cancer and represent approximately 5% of all cancer cases worldwide. Standard-of-care chemotherapy, radiotherapy, and immune checkpoint inhibitors (ICIs) are associated with adverse effects and limited responses in patients with HPV-driven cancers. The integration of targeted therapies with ICIs may improve outcomes. In a previous study, we demonstrated that Aurora kinase A (AURKA, Aurora A) inhibitors lead to apoptosis of human HPV-positive cancer cells in vitro and in vivo. Here, we explored the potential of Aurora A inhibition to enhance response to ICIs in immune-competent …

Recurrent And Metastatic Head And Neck Cancer: Mechanisms Of Treatment Failure, Treatment Paradigms, And New Horizons, William T. Barham, Marshall Patrick Stagg, Rula Mualla, Michael Dileo, Sagar Kansara

School of Medicine Faculty Publications

Background: Head and neck cancer is a deadly disease with over 500,000 cases annually worldwide. Metastatic head and neck cancer accounts for a large proportion of the mortality associated with this disease. Many advances have been made in our understanding of the mechanisms of metastasis. The application of immunotherapy to locally recurrent or metastatic head and neck cancer has not only improved oncologic outcomes but has also provided valuable insights into the mechanisms of immune evasion and ultimately treatment failure. Objectives: This review paper will review our current understanding of biological mechanisms of treatment failure and metastasis. Published and ongoing …

Time To Measure: A Proposed Theoretical Model For Head And Neck Cancer Intervals Of Care, Mary Jue Xu, Hannah Decker, Arianne Abreu, Rolvix H. Patterson, Hirwa Nteyumwete, Pier-Luc Beaudoin, David W. Hamilton, Aslam Nkya, Willybroad Massawe, Nicholas Correia, Furahini Yoram Paulo, Katherine Van Loon, Susan D. Emmett, Christina Reaves, Samuel Okerosi

Otolaryngology (ENT) Resident Research

Head and neck cancer care delays are challenging, given the complexity of cancer care pathways, which leads to delays throughout the patient journey, from the symptom onset to treatment completion. Current models and literature addressing cancer care are limited by heterogeneous definitions of care intervals, a focus on specific aspects of the patient journey instead of the whole care continuum, and limited use of implementation science to target gaps in implementing evidence-based interventions. Here, we propose the Head and Neck Cancer TImely aCess TO Care Model as an approach to conceptualize, measure, and address delays in diverse health systems.

An Account Of Roman Surgical Treatments For Ozena: Historical Review, Perry Hammond, Rebecca R. Benefiel, Kent Lam

Department of Otolaryngology (ENT) Faculty Publications

Objective: To analyze a first-century Roman account of surgery for ozena-a tetrad of nasal crusting, ulceration, bony involvement, and foul odor-with a focus on historical context, etymology, and surgical management.

Data Sources: This historical review draws from the authors' translation of De Medicina. Primary sources detailing Roman surgical instruments from the House of the Surgeon in Pompeii, as well as secondary sources of surgical techniques, were utilized.

Review methods: An in-depth review of Celsus' descriptions of surgical techniques for ozena was conducted using independent translation and exegetical analysis of primary sources. Archaeological findings were investigated to correlate surgical tools with …

Characterization Of Litigation After Tympanoplasty And Mastoidectomy In The United States, Alyssa D. Reese, Lauren A. Dinardo, Soumya Gupta, Kristina F. Powers, Samuel Colca, Michele M. Carr

Department of Otolaryngology (ENT) Faculty Publications

Introduction

Tympanoplasty and mastoidectomy are common procedures performed by otolaryngologists that can result in complications for which patients may seek compensation. Medical malpractice case analyses may offer insight into how clinicians can avoid risk and improve patient satisfaction. We aimed to comprehensively characterize litigation after mastoidectomies and tympanoplasties in the United States.

Methods

The Westlaw Campus Research legal database was searched for all available court decisions associated with claims of medical malpractice after tympanoplasty and/or mastoidectomy in the United States between 1975 and 2022. Information on the plaintiffs' relationships to the patients, patient characteristics, states where the procedures took place, …

Size Of Pediatric Tracheostomy Tube And Predictors Of Postoperative Complications, Soukaina Eljamri, Jordyn Lucas, Amber Shaffer, Basil Hashimi, Marina Rushchak, Reema Padia

Department of Otolaryngology (ENT) Faculty Publications

Objective

(1) To investigate weight as an alternative guide for trach tube choice. (2) Evaluate complications 3-month posttracheostomy and associations with patient and trach tube factors.

Study design

Retrospective cohort study.

Setting

Single academic medical center.

Methods

Patients < 2 years old who underwent tracheostomy placement from 2017 to 2022 were identified. Associations between trach characteristics, trach size/length, chest x-ray (CXR) and intraoperative endoscopy measurements, and complications within 3 months posttracheostomy placement were evaluated.

Results

In total, 68 patients were included in the study, with a median age of 4 months (range: 1 day to 1.74 years) and weight of 4.1 kg (range: 1.8-11.6 kg) at the time of the procedure. The length of the trachea measured on CXR was more closely associated with weight (ρ = 0.403, P = .0007) than with age (ρ = …

Investigating The Ideal Candidate For The Fda’S Over-The-Counter Hearing Aids, Jamie N. Mayer

Capstone Showcase

Hearing loss is an underdiagnosed and undertreated medical condition affecting millions of Americans across a variety of ages and stages of life. Over-the-counter hearing aids are a new category of hearing aids created by the FDA. By targeting affordability and accessibility, over-the-counter hearing aids reduce barriers to care that individuals with hearing loss may face. There is a major impact of hearing loss on adults, specifically, for our elderly population who struggle with communication, staying engaged socially, and the additional stress of comorbid conditions. Elderly adults have the potential to derive immense benefit from over-the-counter hearing aids, specifically for those …

Development Of Adult Multidisciplinary Tracheostomy Rounding Teams: Prevalence, Template For Starting, And Analysis For Diffusion Of Innovation, Tony Satroplus, Teresa Y. Rodriguez, Bennett J. Berning, Sarah Schmoker, Robert Morrison, Jayme Dowdall

Posters and Presentations: Otolaryngology

Educational Objective: At the conclusion of this presentation, the participants should be able to (a) Describe the prevalence of adult tracheostomy teams in the Middle Section; (b) Outline the impact of dedicated tracheostomy rounding teams; (c) Craft strategies for multidisciplinary rounding team including the necessary personnel; (d) Identify accelerants and barriers to incorporation of the team at their institution or community. Objectives: Multidisciplinary tracheostomy rounding teams have been found to decrease days to speech and decannulation and decrease adverse events. The need of such teams and the characteristics that increase or inhibit the tracheostomy rounding team's implementation rates have not …

Improving The Usability And Usage Of A Tracheostomy Order Set, Tony Satroplus, Teresa Y. Rodriguez, Jordon Flynn, Carly Garcia, Bennett J. Berning, Jayme Dowdall

Posters and Presentations: Otolaryngology

Educational Objectives: At the conclusion of this presentation, the participants should be able to (a) understand the benefits of simplifying EMR order-sets; (b) simplify a commonly used procedure or order set which includes identifying stakeholders who should contribute to the discussions; (c) identify and overcome barriers that would inhibit implementation and efficiency Objectives: Usability of electronic medical records has been linked to concerns for patient safety and provider wellness. One concern is that an order set’s “end user” may be inexperienced with the complexities associated with the tracheostomy patient continuum. The formation and utility of an intuitive workflow in the …

Risk Analysis Of Radiosurgery For Vestibular Schwannoma: Systematic Review And Comparative Study Of 10-Year Outcomes, Kevin M. Guy, April A. Pace, Derek S. Tsang, Peter G. Volsky

Department of Otolaryngology (ENT) Faculty Publications

Background: Determine the benefit of stereotactic radiosurgery (SRS) compared to no treatment for sporadic vestibular schwannoma (VS) by calculating epidemiologic risk using 10-year data; apply the analysis to VS that have demonstrated linear growth.

Methods: PubMed, Google Scholar, Web of Science, and Cochrane Library are systematically reviewed for VS tumor control 10 years after SRS and compared to an historical cohort of untreated VS (primary risk analysis). Subgroups of VS limited by size and observed growth are compared to the untreated cohort (secondary analysis).

Results: Twenty-four studies of 4,079 SRS-treated VS exhibited tumor control in 90.93% (87.0%-100%; SD 4.1%), while …

Opioid Usage And Non-Opioid Alternatives In Septorhinoplasty: A Narrative Review, Robert M. Frederick, Eric Dobratz

Department of Otolaryngology (ENT) Faculty Publications

Background and Objective: Opioids are routinely prescribed following septorhinoplasty and oftentimes surgeons prescribe a larger number of tablets than patients require. Considering the high risk of developing opioid dependence and risk of diversion, it is imperative that surgeons practice safer, evidence-based prescribing habits. This review is intended to detail the current state of opioid usage after septorhinoplasty, focusing on articles that show pertinent and practice-altering findings. This will allow surgeons to reflect on their prescribing patterns and make evidence-based decisions to improve them.

Methods: A literature search was performed in November 20, 2024 via PubMed using keywords such as ‘opioid …

Categorizing Clinical Response To Mepolizumab For Patients With Chronic Rhinosinusitis With Nasal Polyps: Synapse Trial, Claire Hopkins, Larry Borish, Jared Silver, Peter Howarth, Robert Chan, Priya Dsilva, Joseph K. Han

Department of Otolaryngology (ENT) Faculty Publications

[Introduction] Chronic rhinosinusitis with nasal polyps (CRSwNP) can substantially affect quality of life (QoL), and is often challenging to manage.¹ First-line treatment for the management of CRSwNP involves intranasal corticosteroids, with short courses of systemic corticosteroids (SCS) for exacerbations, and sinus surgery for uncontrolled disease.² Biologics targeting type 2 inflammation (eg, dupilumab, omalizumab, and mepolizumab) have become a treatment option for refractory CRSwNP. With the advent of disease-modifying treatments such as biologics, control, defined as patients reporting no/low-symptom levels, has increasingly become the treatment goal for CRSwNP.³ However, the optimal use of biologics for symptom control in individual patients remains …

Head And Neck Gross Tumor Volume Automatic Segmentation Using Pocketnet, Awj Twam, Adrian Celaya, Evan Lim, Khaled Elsayes, David Fuentes, Tucker Netherton

Faculty, Staff and Student Publications

Head and neck cancer (HNC) represents a significant global health burden, often requiring complex treatment strategies, including surgery, chemotherapy, and radiation therapy. Accurate delineation of tumor volumes is critical for effective treatment, particularly in MR-guided interventions, where soft tissue contrast enhances visualization of tumor boundaries. Manual segmentation of gross tumor volumes (GTV) is labor intensive, time-consuming and prone to variability, motivating the development of automated segmentation techniques. Convolutional neural networks (CNNs) have emerged as powerful tools in this task, offering significant improvements in speed and consistency. In this study, we participated as Team Pocket in Task 1 of the HNTS-MRG …

Predicting Sinonasal Inverted Papilloma Attachment Using Machine Learning: Current Lessons And Future Directions, Sean P Mckee, Xiaomin Liang, William C Yao, Brady Anderson, Jumah G Ahmad, David Z Allen, Salman Hasan, Andy J Chua, Chinmay Mokashi, Samia Islam, Amber U Luong, Martin J Citardi, Luca Giancardo

Faculty, Staff and Student Publications

Background: Hyperostosis is a common radiographic feature of inverted papilloma (IP) tumor origin on computed tomography (CT). Herein, we developed a machine learning (ML) model capable of analyzing CT images and identifying IP attachment sites.

Methods: A retrospective review of patients treated for IP at our institution was performed. The tumor attachment site was manually segmented on CT scans by the operating surgeon. We used a nnU-Net model, a state-of-the-art deep learning-based segmentation algorithm that automatically configures image preprocessing, network architecture, training, and post-processing to identify the IP attachment site. The model was trained and evaluated using a 5-fold cross …

Optimal Timing Of Organs-At-Risk-Sparing Adaptive Radiation Therapy For Head-And-Neck Cancer Under Re-Planning Resource Constraints, Fatemeh Nosrat, Cem Dede, Lucas B Mccullum, Raul Garcia, Abdallah S R Mohamed, Jacob G Scott, James E Bates, Brigid A Mcdonald, Kareem A Wahid, Mohamed A Naser, Renjie He, Aysenur Karagoz, Amy C Moreno, Lisanne V Van Dijk, Kristy K Brock, Jolien Heukelom, Seyedmohammadhossein Hosseinian, Mehdi Hemmati, Andrew J Schaefer, Clifton D Fuller

Faculty, Staff and Student Publications

Background and purpose: Prior work on adaptive organ-at-risk (OAR)-sparing radiation therapy has typically reported outcomes based on fixed-number or fixed-interval re-planning, which represent one-size-fits-all approaches and do not account for the variable progression of individual patients' toxicities. The purpose of this study was to determine the personalized optimal timing of re-planning in adaptive OAR-sparing radiation therapy, considering limited re-planning resources, for patients with head and neck cancer (HNC).

Materials and methods: A novel Markov decision process (MDP) model was developed to determine optimal timing of re-planning based on the patient's expected toxicity, characterized by normal tissue complication probability (NTCP), for …

Interobserver Variability Regarding Adequacy Of Oropharyngeal Exposure For Transoral Robotic Surgery May Necessitate Staging Endoscopy: Evaluating Tors Exposure, Colleen Schinderle, Kevin J. Carlson, Reem Sharaf Alddin, Jeffery J. Houlton, Matthew J. Bak, Daniel W. Karakla, Jonathan R. Mark

Department of Otolaryngology (ENT) Faculty Publications

[First paragraph] Transoral robotic surgery (TORS) for the treatment of oropharyngeal cancer has become centered at tertiary referral centers. To avoid treatment delays or multiple anesthetics, the need for repeat operative endoscopy may be questioned when the diagnosis has been made at an outside institution. However, inadequate visualization of relevant anatomy can preclude TORS candidacy and may lead to procedure abortion or conversion to an open technique.²,³ To evaluate this dilemma, we explored the ability to assess oropharyngeal exposure for TORS candidacy via operative endoscopic photo-documentation.

Semi-Automated Virtual Endoscopy Of The Frontal Recess, Ali Jafar, William Yao, Martin Citardi

Faculty, Staff and Student Publications

Introduction: Virtual endoscopy (VE) is the computer-based reprocessing of diagnostic imaging to simulate endoscopy of an anatomic region of interest. VE of the Frontal Sinus Outflow Tract (FSOT) may assist surgical planning and education.

Method: VE was performed on 16 normal sinus computed tomography (CT) scans for a total of 32 sides using the "path-to-target" tool on the TruDi surgical navigation system (ver. 2.3; Acclarent, Irving, CA, USA). To aid orientation during VE, planning points were placed on the middle turbinate, ethmoidal bulla, and skull base. The VE representation of anatomy and FSOT accuracy was manually confirmed by reviewing the …

Three-Year Outcomes After Temperature-Controlled Radiofrequency Treatment Of Nasal Airway Obstruction, William C Yao, Randall Ow, Michael J Sillers, Nathan E Nachlas, Curtis D Johnson, Dale Ehmer, Jordan Pritikin, Henry P Barham

Faculty, Staff and Student Publications

Objective: To evaluate the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) treatment of nasal valve collapse (NVC) in patients with nasal airway obstruction (NAO).

Study design: This is an extended follow-up from a prospective, multicenter, single-arm study. The initial study included participants from 12 sites across the United States who were followed for 24 months and additionally agreed to participate in the extended 36-month follow-up.

Setting: Procedure was performed in-office with an in-person follow-up at 3 months and subsequent follow-up assessment remotely.

Methods: Participants received TCRF treatment of only the nasal valve and participated in the extended 36-month follow-up. …

Semi-Quantitative Assessment Of Surgical Navigation Accuracy During Endoscopic Sinus Surgery In A Real-World Environment, David Z Allen, Jason Talmadge, Martin J Citardi

Faculty, Staff and Student Publications

Introduction: Although surgical navigation is commonly used in rhinologic surgery, data on real world performance are sparse because of difficulties in collecting measurements for target registration error (TRE). Despite publications showing submillimeter TRE, surgeons do report TRE of >3 mm. We describe a novel method for assessing TRE during surgery and report findings with this technique.

Methods: The TruDi navigation system (Acclarent, Irving, CA) was registered using a contour-based protocol. The surgeon estimated target registration error (e-TRE) at up to 8 points (anatomic regions of interest [ROI]) during endoscopic sinus surgery (ESS). System logs were used to simulate the localization …

Cochlear Implantation With Sporadic Inner Ear Schwannomas: Outcomes In 106 Patients From An International Multi-Institutional Study, John P. Marinelli, Torsten Rahne, James R. Dornhoffer, Christine M. Lohse, Justin Cottrell, J. Thomas Roland, Nicholas J. Thompson, Kevin D. Brown, Jacob C. Lucas, Seilesh C. Babu, Nathan R. Lindquist, Elizabeth L. Perkins, Donald Tan, John I. Lane, Jacob B. Hunter, Erin Harvey, Nicholas L. Deep, Samantha Y. Cerasiello, Matthew L. Kircher, Mana Espahbodi, Evan L. Tooker, Niels Cramer West, Per Caye-Thomasen, Matthew L. Carlson, Stefan K. Plontke

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate cochlear implant speech perception among patients with sporadic inner ear schwannoma who underwent ipsilateral implantation.

STUDY DESIGN: Retrospective multi-institutional cohort study.

SETTING: Eleven tertiary academic medical centers across Germany, Denmark, and the United States.

PATIENTS: One hundred six patients with sporadic inner ear schwannoma who received an ipsilateral cochlear implant from 2011 to 2022.

INTERVENTIONS: Ipsilateral cochlear implantation with observation, stereotactic radiosurgery, or microsurgery for tumor management.

MAIN OUTCOME MEASURES: Monosyllabic speech perception testing scores and rates of open-set speech perception.

RESULTS: Among 106 patients studied, 101 (95%) achieved open-set speech perception with a median of 24 …