Searched for: school:SOM
Department/Unit:Otolaryngology
Reported physical examination methods for screening of oral cancer and oral potentially malignant disorders: a systematic review
Louredo, Brendo VinÃcius Rodrigues; de Lima-Souza, Reydson Alcides; Pérez-de-Oliveira, Maria Eduarda; Warnakulasuriya, Saman; Kerr, Alexander Ross; Kowalski, Luiz Paulo; Hunter, Keith David; Prado-Ribeiro, Ana Carolina; Vargas, Pablo Agustin; Santos-Silva, Alan Roger Dos
OBJECTIVE:This systematic review aimed to describe the method followed during physical examination and the anatomical structures of the head and neck assessed in screening for oral cancer and oral potentially malignant disorders (OPMDs). STUDY DESIGN/METHODS:An extensive literature search was carried out using MEDLINE/PubMed, EMBASE, Scopus, LILACS, Web of Science, Cochrane databases, and gray literature. The risk of bias was available in all papers included. RESULTS:Of 9,688 records identified, 27 were included in this review, reporting data from 356,250 individuals screened and distributed across 11 countries. Most of these (n = 19) were based on 1 round of screening conducted by a dental professional or other health care workers. Most screening programs included visual inspection and palpation of the lips, oral cavity, and the most visible oropharyngeal sites, but the descriptions reported were imprecise. Additional inspection and palpation of the neck (submental, submandibular, cervical, and supraclavicular regions) to assess for the presence of swellings and any palpable neck nodes were also performed in 15 programs. CONCLUSION/CONCLUSIONS:In conclusion, there was considerable heterogeneity in the method of physical examination in screening programs for oral cancer and OPMDs among the included studies.
PMID: 37989648
ISSN: 2212-4411
CID: 5608902
Vocal Health Assessment of Professional Performers Returning to the Stage After the COVID-19 Pandemic Shutdown
Crosby, Tyler; Ezeh, Uche C; Achlatis, Stratos; Kwak, Paul E; Amin, Milan R; Johnson, Aaron M
OBJECTIVES/HYPOTHESIS/OBJECTIVE:This study assessed the vocal health of performers returning to full-time performance after the COVID-19 pandemic shutdown and investigated how differences in voice usage, exposure to voice care professionals, and vocal pathology before and during the pandemic contributed to variability in self-perceived and instrumental vocal outcome measures. STUDY DESIGN/METHODS:This was a prospective, case-control observational study conducted at a single outpatient site. METHODS:Twenty-two patients, 11 cases and 11 controls, were enrolled for the study. All participants were full-time singing professionals prior to the COVID-19 pandemic. Cases were recruited from patients presenting to a tertiary care voice center for vocal or pharyngeal complaints. Controls were healthy volunteers recruited from the general population of professional singers in the surrounding metropolitan area. All participants provided responses to the Voice Handicap Index-10, Evaluation of Ability to Sing Easily, and Laryngopharyngeal Measure of Perceived Sensation validated questionnaires as well as a study survey with questions regarding vocal use and history prior to and during the pandemic. All participants underwent instrumental acoustic and videostroboscopic voice evaluations. RESULTS:Cases had poorer outcome measures overall and were more likely to report their voices were worse at study enrollment when compared to their prepandemic perception (P = 0.027). Cases tended to be older and less likely to have pursued alternative employment during the pandemic that involved increased speaking voice use (27% vs 55%), but these differences were not statistically significant. CONCLUSIONS:There was a variable response among performers to the prolonged hiatus from performing during the COVID-19 pandemic. Those with poorer outcomes tended to be older and may have used their voice less during the pandemic. These findings are consistent with detraining periods in the exercise physiology literature and support the construct of treating vocal performers as vocal athletes.
PMID: 38296764
ISSN: 1873-4588
CID: 5627182
Current guidelines for the application of radiofrequency ablation for thyroid nodules: a narrative review
Lui, Michael S; Patel, Kepal N
BACKGROUND AND OBJECTIVE/UNASSIGNED:Thyroid nodules are frequently incidentally found on physical exam or imaging for an unrelated work-up. Although surgery remains the gold standard for treating symptomatic benign and/or malignant thyroid nodules, radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option for high risk patients and those who decline surgery. The novel application of RFA to treat thyroid disease was originally described for symptomatic, benign thyroid nodules. Since then, several studies have tried to expand its indication to treat primary and recurrent well-differentiated thyroid cancer. The high success rates and the low complication profile, has allowed for quick adoption of RFA as a treatment option for well-selected patients with benign thyroid nodules and locoregional recurrent thyroid malignancy. As such, multidisciplinary guidelines and consensus statements were developed to standardize indications, techniques, outcome measures, and follow-up to ensure the best patient care. This article summarizes the current indications and recommendations to help guide clinicians on how best to effectively and safely utilize RFA to treat thyroid disease. METHODS/UNASSIGNED:A PubMed/MEDLINE search between 2000-2022 using a combination of "radiofrequency ablation", "RFA", "thyroid nodule", and "guidelines" was conducted. The inclusion criteria were articles published in English which offered recommendations on RFA use for thyroid nodules. KEY CONTENT AND FINDINGS/UNASSIGNED:For symptomatic, benign thyroid nodules, RFA is effective at significantly reducing nodule volume. For large nodules, multiple RFA sessions may be needed to achieve clinically significant volume reduction. Patients undergoing RFA for autonomously functioning thyroid nodules may see symptomatic relief but success rates are variable. RFA may serve a curative or palliative role in recurrent well-differentiated thyroid cancers. There is little data describing the use of RFA for primary well-differentiated thyroid cancer >1 cm and the role of RFA for thyroid microcarcinomas remains controversial. CONCLUSIONS/UNASSIGNED:RFA is a safe minimally invasive technique and may be considered, in appropriate circumstances, a first-line treatment option for benign thyroid nodules. Practices adopting RFA will likely increase as more clinicians become familiar with this technique, highlighting the importance of developing standardized guidelines.
PMCID:10839702
PMID: 38323237
ISSN: 2227-684x
CID: 5632662
Early cochlear implantation for children with single sided deafness
Spitzer, Emily R; Attlassy, Younes; Roland, J Thomas; Waltzman, Susan B
OBJECTIVES/OBJECTIVE:Single-sided deafness (SSD) can have consequences for a child's language, educational, and social development. A cochlear implant (CI) is the only device which can restore true binaural hearing, yet they are only approved for children with (SSD) over the age of five in the United States. Reports on speech perception outcomes for children implanted at a younger age are limited. The present study aims to examine the effects of age at implantation, duration of deafness, hearing loss etiology, and presence of additional disabilities on device usage and speech perception outcomes. METHODS:A retrospective chart review was used to examine demographics and speech perception outcomes for 18 children implanted at age five or younger. RESULTS:Speech perception results were highly variable, with some children deriving significant benefit and others demonstrating no sound awareness through the implant alone. Age at implantation and duration of deafness did not have a clear impact on outcomes. Device usage was low in many children, often those with anatomical abnormalities such as a hypoplastic cochlear nerve. There are challenges to assessing speech perception in young children with SSD, leading to a lack of standardized outcome measures. CONCLUSIONS:Early CI for children with SSD may improve speech perception, but benefit is not guaranteed. Candidacy evaluation should consider both medical and audiological factors, in addition to the degree of family support and realistic expectations. Caution is especially warranted in children with significant anatomical anomalies.
PMID: 38244481
ISSN: 1872-8464
CID: 5628882
Astrocyte growth is driven by the Tre1/S1pr1 phospholipid-binding G protein-coupled receptor
Chen, Jiakun; Stork, Tobias; Kang, Yunsik; Nardone, Katherine A M; Auer, Franziska; Farrell, Ryan J; Jay, Taylor R; Heo, Dongeun; Sheehan, Amy; Paton, Cameron; Nagel, Katherine I; Schoppik, David; Monk, Kelly R; Freeman, Marc R
Astrocytes play crucial roles in regulating neural circuit function by forming a dense network of synapse-associated membrane specializations, but signaling pathways regulating astrocyte morphogenesis remain poorly defined. Here, we show the Drosophila lipid-binding G protein-coupled receptor (GPCR) Tre1 is required for astrocytes to establish their intricate morphology in vivo. The lipid phosphate phosphatases Wunen/Wunen2 also regulate astrocyte morphology and, via Tre1, mediate astrocyte-astrocyte competition for growth-promoting lipids. Loss of s1pr1, the functional analog of Tre1 in zebrafish, disrupts astrocyte process elaboration, and live imaging and pharmacology demonstrate that S1pr1 balances proper astrocyte process extension/retraction dynamics during growth. Loss of Tre1 in flies or S1pr1 in zebrafish results in defects in simple assays of motor behavior. Tre1 and S1pr1 are thus potent evolutionarily conserved regulators of the elaboration of astrocyte morphological complexity and, ultimately, astrocyte control of behavior.
PMID: 38096817
ISSN: 1097-4199
CID: 5588882
Impact of Rare and Multiple Concurrent Gene Fusions on Diagnostic DNA Methylation Classifier in Brain Tumors
Galbraith, Kristyn; Serrano, Jonathan; Shen, Guomiao; Tran, Ivy; Slocum, Cheyanne C; Ketchum, Courtney; Abdullaev, Zied; Turakulov, Rust; Bale, Tejus; Ladanyi, Marc; Sukhadia, Purvil; Zaidinski, Michael; Mullaney, Kerry; DiNapoli, Sara; Liechty, Benjamin L; Barbaro, Marissa; Allen, Jeffrey C; Gardner, Sharon L; Wisoff, Jeffrey; Harter, David; Hidalgo, Eveline Teresa; Golfinos, John G; Orringer, Daniel A; Aldape, Kenneth; Benhamida, Jamal; Wrzeszczynski, Kazimierz O; Jour, George; Snuderl, Matija
UNLABELLED:DNA methylation is an essential molecular assay for central nervous system (CNS) tumor diagnostics. While some fusions define specific brain tumors, others occur across many different diagnoses. We performed a retrospective analysis of 219 primary CNS tumors with whole genome DNA methylation and RNA next-generation sequencing. DNA methylation profiling results were compared with RNAseq detected gene fusions. We detected 105 rare fusions involving 31 driver genes, including 23 fusions previously not implicated in brain tumors. In addition, we identified 6 multi-fusion tumors. Rare fusions and multi-fusion events can impact the diagnostic accuracy of DNA methylation by decreasing confidence in the result, such as BRAF, RAF, or FGFR1 fusions, or result in a complete mismatch, such as NTRK, EWSR1, FGFR, and ALK fusions. IMPLICATIONS/UNASSIGNED:DNA methylation signatures need to be interpreted in the context of pathology and discordant results warrant testing for novel and rare gene fusions.
PMID: 37870438
ISSN: 1557-3125
CID: 5625782
The use of botulinum toxin for oral-ocular synkinesis in facial paralysis
Saeedi, Arman; Varelas, Antonios N.; von Sneidern, Manuela; Lee, Judy W.
Oral-ocular synkinesis is a common, uncomfortable, and disfiguring sequela of facial nerve palsy. Despite widespread use of chemodenervation as a non-surgical intervention, limited literature exists on optimal dosage and administration techniques in these patients. This study aims to describe a reliable chemodenervation injection technique and report objective measurements and subjective satisfaction outcomes. Prospective pre-post interventional study where new, consecutive patients with previously untreated oral-ocular synkinesis secondary to facial nerve palsy were included. Patients completed a Synkinesis Assessment Questionnaire and standardized photographs were taken before and after botulinum toxin injections. Palpebral fissure symmetry was measured from photographs, with the unaffected side functioning as the control. Sixteen patients were included in the prospective study. Mean age was 48 years old and 56% male. Botulinum toxin was injected into the upper and lower medial preseptal, upper and lower lateral pretarsal, and lateral orbital orbicularis oculi (10-13 units). Standardized photographic comparison demonstrated significant improvement in palpebral fissure height with smile (p < 0.01) and lip pucker (p < 0.01). Relevant items on the Synkinesis Assessment Questionnaire also significantly improved (p < 0.01). This reliable botulinum toxin injection technique for oral-ocular synkinesis demonstrated significant improvement in subjective quality of life metrics and objective palpebral fissure height during both smile and pucker.
SCOPUS:85188739814
ISSN: 1043-1810
CID: 5693202
Pediatric-type follicular lymphoma in adolescence: A case series
Ezeh, Uche C.; Tesema, Naomi; Hasnie, Sukaina; Taufique, Zahrah; Ward, Nicholas; April, Max M.
Introduction: Pediatric-type follicular lymphoma (PTFL) is a rare B-cell lymphoma that primarily affects the head and neck, accounting for approximately 1.5"“2% of childhood lymphomas. Distinguishing between follicular lymphoma and PTFL is critical due to their distinct clinical characteristics, which influence prognosis and treatment. Case presentation: Two patients, a 14-year-old male (Case 1) and a 17-year-old male (Case 2), presented to the pediatric otolaryngology clinic with complaints of an isolated neck and parotid masses, respectively. In Case 1, physical examination revealed a 5 cm upward-growing neck mass without accompanying B symptoms or discomfort. CT scan, needle biopsy, and MRI with contrast confirmed the presence of the mass, which was subsequently surgically excised. In Case 2, the patient had an enlarging left-sided parotid mass, along with night sweats, fatigue, and arthralgias. Ultrasound and contrast-enhanced MRI confirmed a well-defined solid vascular mass within the left parotid gland, which was subsequently surgically excised. Pathological examination confirmed PTFL in both cases, leading to a positron emission tomography (PET)/CT scan for further evaluation and staging. Conclusion: This case series underscores the importance of pediatric surgeons to consider PTFL in the differential diagnosis of head and neck masses, as it can be effectively cured through surgical excision.
SCOPUS:85176726110
ISSN: 2213-5766
CID: 5614582
Characterizing Hearing Outcomes Following Treatment of Cerebellopontine Angle Meningiomas
Papazian, Michael; Cottrell, Justin; Pan, Lydia; Kay-Rivest, Emily; Friedmann, David R.; Jethanamest, Daniel; Kondziolka, Douglas; Pacione, Donato; Sen, Chandranath; Golfinos, John G.; Roland, J. Thomas; McMenomey, Sean O.
Objectives To characterize treatment and hearing outcomes for cerebellopontine angle (CPA) meningiomas with inherent risks of hearing loss and identify predictors of hearing loss for surgically treated lesions. Design Retrospective chart review. Setting Tertiary care medical center. Participants Adult patients with CPA meningiomas impinging upon cranial nerve VIII and/or pretreatment hearing loss managed with microsurgery or stereotactic radiosurgery (SRS) with Gamma Knife at our center between 2012 and 2023. Main Outcome Measures Hearing preservation rate was determined from analysis of patients with pretreatment serviceable hearing for whom hearing-preserving treatment was attempted. Surgical patients were further analyzed using multivariable Cox proportional hazards regression models to identify factors predictive of postoperative hearing loss. Results We identified 80 patients with CPA meningiomas meeting inclusion criteria who were managed with either microsurgery (43, 54%) or radiosurgery (37, 46%). Following SRS, hearing was preserved in 88% of cases. Following microsurgery, hearing was preserved in 71% of patients-all patients who lost hearing had tumors involving the internal auditory canal (IAC). Among surgical patients only, multivariable analysis accounting for preoperative hearing, recurrence status, lesion size, and patient age, the preoperative imaging finding that the CPA meningioma surrounded the vestibulocochlear nerve was significantly associated with hearing loss (hazard ratio: 10.3, 95% confidence interval: 1.3-81.4, p = 0.02). Conclusion Most patients with meningiomas of the CPA can experience preservation of hearing, even when there is risk of hearing loss based on pretreatment evaluation. IAC invasion and surrounding of eighth nerve by tumor may portend poorer hearing outcomes in surgically managed patients.
SCOPUS:85204132363
ISSN: 2193-6331
CID: 5716162
Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study
Niranjan, Ajay; Faramand, Andrew; Raju, Sudesh S; Lee, Cheng-Chia; Yang, Huai-Che; Nabeel, Ahmed M; Tawadros, Sameh R; El-Shehaby, Amr M N; Abdelkarim, Khaled; Emad, Reem M; Reda, Wael A; Ãlvarez, Roberto MartÃnez; Moreno, Nuria E MartÃnez; Liscak, Roman; May, Jaromir; Mathieu, David; Langlois, Anne-Marie; Snyder, M Harrison; Shepard, Matthew J; Sheehan, Jason; Muhsen, Baha'eddin A; Borghei-Razavi, Hamid; Barnett, Gene; Kondziolka, Douglas; Golfinos, John G; Attuati, Luca; Picozzi, Piero; McInerney, James; Daggubati, Lekhaj Chand; Warnick, Ronald E; Feliciano, Caleb E; Carro, Eric; McCarthy, David; Starke, Robert M; Landy, Howard J; Cifarelli, Christopher P; Vargo, John A; Flickinger, John; Lunsford, L Dade
BACKGROUND AND OBJECTIVES/OBJECTIVE:An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS:Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS:The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION/CONCLUSIONS:SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
PMID: 37523519
ISSN: 1524-4040
CID: 5613382