Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Otolaryngology
Total Results:
7768
Bilateral Loudness Balancing and Distorted Spatial Perception in Recipients of Bilateral Cochlear Implants
OBJECTIVE: To determine whether bilateral loudness balancing during mapping of bilateral cochlear implants (CIs) produces fused, punctate, and centered auditory images that facilitate lateralization with stimulation on single-electrode pairs. DESIGN: Adopting procedures similar to those that are practiced clinically, direct stimulation was used to obtain most-comfortable levels (C levels) in recipients of bilateral CIs. Three pairs of electrodes, located in the base, middle, and apex of the electrode array, were tested. These electrode pairs were loudness-balanced by playing right-left electrode pairs sequentially. In experiment 1, the authors measured the location, number, and compactness of auditory images in 11 participants in a subjective fusion experiment. In experiment 2, the authors measured the location and number of the auditory images while imposing a range of interaural level differences (ILDs) in 13 participants in a lateralization experiment. Six of these participants repeated the mapping process and lateralization experiment over three separate days to determine the variability in the procedure. RESULTS: In approximately 80% of instances, bilateral loudness balancing was achieved from relatively small adjustments to the C levels (
PMCID:5613176
PMID: 25985017
ISSN: 1538-4667
CID: 1742462
Temporal and Physiologic Measurements of Deglutition in the Upright and Supine Position with Videofluoroscopy (VFS) in Healthy Subjects
Cross-sectional imaging has long been employed to examine swallowing in both the sagittal and axial planes. However, data regarding temporal swallow measures in the upright and supine positions are sparse, and none have employed the MBS impairment profile (MBSImP). We report temporal swallow measures, physiologic variables, and swallow safety of upright and supine swallowing in healthy subjects using videofluoroscopy (VFS). Twenty healthy subjects ages 21-40 underwent VFS study upright and supine. Subjects were viewed in the sagittal plane and swallowed 5 mL liquid and pudding barium. Oral transit time, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, and total swallow duration were measured. Penetration/aspiration scores and 14 MBSImP variables were analyzed in both positions. All subjects completed swallows supine, although one aspirated on one liquid bolus. Temporal measures of swallowing were similar for pudding upright and supine. Pharyngeal phase swallow measures were longer for liquids in supine. MBSImP physiologic measures revealed a pharyngeal delay in both positions. Although Pen/Asp range was higher supine, more subjects penetrated upright. Temporal measures were increased for liquids in supine. Although Pen/Asp range was higher in supine, more subjects penetrated upright. These results provide support for cross-sectional supine imaging of swallowing for pudding, but perhaps not thin liquids for dysphagic patients. Slightly thicker liquids might prove reliable in supine without compromising swallow safety. Future research should examine swallow physiology in both positions in dysphagic and older healthy subjects.
PMID: 25966654
ISSN: 1432-0460
CID: 1718982
Cephalosporin use in penicillin-allergic patients: A survey of otolaryngologists and literature review
OBJECTIVES/HYPOTHESIS: This study investigated the differences between the standard guidelines and the practice patterns of otolaryngologists in managing "penicillin-allergic" patients. A major goal was to identify factors influencing an otolaryngologist's choice of antibiotic. STUDY DESIGN: Cross-sectional survey. METHODS: Four hundred seventy members of the American Society of Pediatric Otolaryngologists (ASPO) and 150 general otolaryngologists from the Florida Society of Otolaryngology (FSO) were surveyed. RESULTS: Ninety-six ASPO members (20.4%) and 22 members of FSO (14.6%) responded. When asked about the management of a pediatric patient with acute otitis media and a history of a nonsevere immunoglobulin E (IgE)-mediated amoxicillin allergy, 54% of ASPO respondents indicated they would initiate guideline-recommended cefdinir, whereas only 27% of FSO respondents chose cefdinir (P = .02). Otolaryngologists who are fellowship trained in pediatrics or have pediatric-focused practices were significantly more likely to prescribe cefdinir. Overall, 57% of respondents indicated that they were familiar with the literature regarding the cross-reactivity of beta-lactams, but only 25% of respondents felt that they could easily differentiate a potentially life-threatening IgE-mediated allergy from a non-IgE-mediated drug intolerance. CONCLUSIONS: The data show differences between the current recommendations and the behavior of otolaryngologists. Pediatric otolaryngologists were more familiar with the guideline-recommended therapy, likely from their frequent exposure to patients requiring a beta-lactam. Nevertheless, most otolaryngologists could benefit from increased awareness of the current literature. Patients may be receiving less than optimal medication management due to a misidentification of those at risk of life- threatening allergic cross-reactions. LEVEL OF EVIDENCE: NA Laryngoscope, 2015.
PMID: 25752938
ISSN: 0023-852x
CID: 1494652
Oral surgery, oral medicine, oral pathology & oral radiology. 2015:120(2):185-206.DOI: 10.1016/j.oooo.2014.10.027
World Workshop on Oral Medicine VI: clinical implications of medication-induced salivary gland dysfunction
OBJECTIVE: This study aimed to systematically review the available literature on the clinical implications of medication-induced salivary gland dysfunction (MISGD). STUDY DESIGN: The systematic review was performed using PubMed, Embase, and Web of Science (through June 2013). Studies were assessed for degree of relevance and strength of evidence, based on whether clinical implications of MISGD were the primary study outcomes, as well as on the appropriateness of study design and sample size. RESULTS: For most purported xerogenic medications, xerostomia was the most frequent adverse effect. In the majority of the 129 reviewed papers, it was not documented whether xerostomia was accompanied by decreased salivary flow. Incidence and prevalence of medication-induced xerostomia varied widely and was often associated with number and dose of medications. Xerostomia was most frequently reported to be mild-to-moderate in severity. Its onset occurred usually in the first weeks of treatment. There was selected evidence that medication-induced xerostomia occurs more frequently in women and older adults and that MISGD may be associated with other clinical implications, such as caries or oral mucosal alterations. CONCLUSIONS: The systematic review showed that MISGD constitutes a significant burden in many patients and may be associated with important negative implications for oral health.
PMID: 25861957
ISSN: 2212-4411
CID: 1528952
Oral surgery, oral medicine, oral pathology & oral radiology. 2015:120(2):132-42.e61.DOI: 10.1016/j.oooo.2015.01.022
World Workshop on Oral Medicine VI: a systematic review of the treatment of mucocutaneous pemphigus vulgaris
OBJECTIVE: To determine the efficacy and safety of interventions for pemphigus vulgaris (PV). STUDY DESIGN: We conducted a systematic review from 2003 to 2013 according to the Cochrane Collaboration methodology. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) and observational studies were conducted along with diagnosis confirmed by clinical, histopathologic, and immunofluorescence criteria. Primary outcomes were disease remission and mortality; several relevant secondary outcomes were also included. RESULTS: Fourteen RCTs or CCTs and 110 observational studies were included in the final analyses. RCTs or CCTs demonstrated considerable heterogeneity in outcome measures, and all had a high risk of bias for at least 1 of 8 domains. Of the studies, 96.8% (120) described the use of oral corticosteroids. Azathioprine and mycophenolate-mofetil were the most commonly cited treatments. An increasing number of studies described biologic therapies (rituximab, intravenous immunoglobulin [IVIg]). Evidence supporting recent comprehensive treatment guidelines was reviewed. CONCLUSIONS: We found persisting wide variations in treatment practice and inadequate quality of research supporting optimal PV treatment.
PMID: 25934414
ISSN: 2212-4411
CID: 1556022
Reconstruction of the Lateral Mandibular Defect: A Review and Treatment Algorithm
Reconstruction of the lateral mandibular defect presents a complex challenge to the reconstructive surgeon, often involving interconnected soft-tissue and bone requirements. This review examines the current literature on functional outcomes of lateral mandibular reconstruction and presents an algorithm on selecting an optimal reconstructive choice for patients with lateral mandibular defects resulting from oncologic ablative surgery or trauma. PubMed and Medline searches on reconstructing lateral mandibular defect were performed of the English literature. Search terms included lateral mandibular defect, outcomes of mandibular reconstruction, and free flap reconstruction of mandible. Although most of the articles presented are retrospective reviews, priority was given to the articles with high-quality level of evidence. Restoration of function, including speech and swallow, and acceptable cosmetic result are the primary objectives of lateral mandibular reconstruction. When reconstructing the mandible in a patient following tumor extirpation, the patient's overall prognosis, medical comorbidities, and need for adjuvant therapy should be considered. In the patient with aggressive malignant disease and a poor prognosis, a less complex reconstruction, such as soft-tissue flap with or without a reconstruction plate, may be adequate. In a dentate patient with favorable prognosis, a durable reconstruction, such as osseocutaneous microvascular free flap, is often preferred. Various reconstructive options are available for patients with lateral mandibular defects. Depending on the predominance of the soft-tissue or bony components of the defect, with consideration of the patient's characteristics and functional and aesthetic goals, the surgeon can wisely select from these reconstructive possibilities.
PMID: 26204563
ISSN: 2168-6092
CID: 2541432
Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy
CONTEXT: Fatigue is a distressing, persistent sense of physical tiredness that is not proportional to a person's recent activity. Fatigue impacts patients' treatment decisions and can limit their self-care activities. While significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy (CTX). OBJECTIVES: To determine whether demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of evening fatigue. METHODS: A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N=586) completed demographic and symptom questionnaires a total of six times over two cycles of CTX. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling (HLM) was used to answer the study objectives. RESULTS: A large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were White, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, child care responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment. CONCLUSION: This study identified both non-modifiable (e.g., ethnicity) and modifiable (e.g., child care responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.
PMCID:4526403
PMID: 25828560
ISSN: 1873-6513
CID: 1519372
An algorithm for treating extracranial head and neck schwannomas
Surgical resection of extracranial head and neck schwannomas (ECHNS) may be associated with major morbidity, but some ECHNSs can be safely treated expectantly. The aim of this study is to present a large case series and an algorithm for therapeutic decision-making in the management of ECHNS. The clinical records of patients diagnosed and treated for ECHNS between 1999 and 2012 at The Tel Aviv Sourasky Medical Center were reviewed retrospectively. All relevant demographic and medical data were extracted, among them presenting symptoms, surgical approaches, nerve of origin, complications and follow-up. A total of 53 patients with ECHNS were included in this clinical study. There were 29 males and 24 females whose mean age was 49.2 years, and all were treated surgically. The schwannomas originated from the brachial plexus, sympathetic chain, vagus nerve, trigeminal nerve, lip, hypoglossal nerve and larynx. Intracapsular enucleation was performed in 32 (60 %) patients, and the remaining 21 (40 %) patients underwent complete excision of the tumor with the involved nerve segment. Thirty-two patients (60 %) had postoperative neurological deficits. This study provides an algorithm to serve as a guideline in the decision-making process for this patient population. Although there is abundant evidence regarding the efficacy of radiotherapy for acoustic schwannoma, the value of radiotherapy as a treatment alternative for patients with ECNHS, especially those unsuitable for surgery, has not been established and further studies are warranted.
PMID: 24961439
ISSN: 1434-4726
CID: 4951572
In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs
PMCID:5365030
PMID: 26211600
ISSN: 1942-5546
CID: 1734782
Isolated congenital maxillomandibular synechiae
INTRODUCTION: Congenital maxillomandibular syngnathia, or fusion of the jaws, is a rare condition that has a broad spectrum of presentations. The restricted mouth opening can lead to issues with feeding, swallowing, and respiration resulting in failure to thrive and temporomandibular joint ankylosis. Early recognition and treatment is necessary for proper growth and development. CASE REPORT: We report a 1-day-old male with isolated bilateral soft tissue alveolar fibrous bands. He presented with difficulty feeding secondary to trismus. No bony or muscular involvement in the synechiae was noted and the remainder of the physical exam was unremarkable. The bilateral alveolar synechiae were divided under local anesthesia using surgical scissors. The patient immediately showed improvement in mouth opening and had resolution of his feeding problems. He is now gaining weight and developing appropriately. DISCUSSION: The accompanying review of the literature demonstrates only 11 cases worldwide of isolated maxillomandibular fusion. Depending upon the composition of the synechiae, simple surgical division under local anesthesia can be curative.
PMID: 25957707
ISSN: 1532-818x
CID: 1578992
