Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Otolaryngology
Total Results:
7768
Oral surgery, oral medicine, oral pathology & oral radiology. 2015:119(1):59-64.DOI: 10.1016/j.oooo.2014.09.027
Comparison of two mouthrinses in relation to salivary flow and perceived dryness
OBJECTIVE: To compare measures of dry mouth following extended use of an alcohol-based mouthrinse (LISTERINE Antiseptic [LA]) and a non-alcohol-based mouthrinse (Crest Pro-Health Rinse [CPH]) on healthy adults with "normal" salivary flow. METHODS: This single-site, randomized, observer-blinded, parallel study compared unstimulated whole salivary flow and perceived dryness following daily use at weeks 4 and 12 versus baseline. Noninferiority, between-treatment flow comparisons (0.15 mL/min margin), and between-treatment comparisons of the mean Bluestone Mouthfeel Questionnaire (BMQ) visual analog scale scores were made using analysis of covariance. RESULTS: Measures of dry mouth were comparable between mouthrinses, as demonstrated by both noninferiority of LA versus CPH flow (P < .001) and no significant differences between groups in the BMQ measures at 4 or 12 weeks. CONCLUSIONS: Extended use of an alcohol-based mouthrinse is no more likely to cause reduction in salivary flow or perceived dryness in individuals with normal salivary flow compared with a non-alcohol-based mouthrinse (CPH).
PMID: 25482548
ISSN: 2212-4411
CID: 1393782
Journal of the National Comprehensive Cancer Network : JNCCN. 2015:13(1):69-77.DOI: 10.6004/jnccn.2015.0010
Guideline Familiarity Predicts Variation in Self-Reported Use of Routine Surveillance PET/CT by Physicians Who Treat Head and Neck Cancer
BACKGROUND: Use of routine surveillance testing beyond guideline recommended levels is common in many oncologic disciplines, including head and neck cancer. The impact of guideline familiarity and other physician characteristics on surveillance imaging use are not well understood. METHODS: A cross-sectional national survey was performed of physicians responsible for surveillance of patients with head and neck squamous cell carcinoma (HNSCC). The primary outcome was self-reported use of routine surveillance PET/CT in asymptomatic patients. A secondary outcome was familiarity with guideline recommendations. Using multivariable regression, the impact of guideline familiarity and other physician characteristics on PET/CT use was examined. RESULTS: Of the 502 responders, 79% endorsed ever using PET/CT scans for routine surveillance imaging, and 39% were high imaging users (used PET/CT scans on more than half of their asymptomatic patients); 76% were familiar with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers recommending against routine surveillance PET/CT scans. Although guideline familiarity was associated with being a low imaging user or a never-user, among those who were familiar with guidelines, 31% were nonetheless high imaging users and 73% endorsed ever using PET/CT scans. In multivariable analysis controlling for physician characteristics, guideline familiarity was the strongest predictor of PET/CT use. CONCLUSIONS: Familiarity with the NCCN Guidelines predicts self-reported routine surveillance PET/CT use among physicians who treat patients with HNSCC. However, given the observed variation and high levels of imaging even among physicians who are familiar with the guidelines, further research should examine the reasons physicians choose to use surveillance PET/CT scans.
PMID: 25583771
ISSN: 1540-1405
CID: 1459782
Continued maturation of the click-evoked auditory brainstem response in preschoolers
BACKGROUND:Click-evoked auditory brainstem responses (ABRs) are a valuable tool for probing auditory system function and development. Although it has long been thought that the human auditory brainstem is fully mature by age 2 yr, recent evidence indicates a prolonged developmental trajectory. PURPOSE/OBJECTIVE:The purpose of this study was to determine the time course of ABR maturation in a preschool population and fill a gap in the knowledge of development. RESEARCH DESIGN/METHODS:Using a cross-sectional design, we investigated the effect of age on absolute latencies, interwave latencies, and amplitudes (waves I, III, V) of the click-evoked ABR. STUDY SAMPLE/METHODS:A total of 71 preschoolers (ages 3.12-4.99 yr) participated in the study. All had normal peripheral auditory function and IQ. DATA COLLECTION AND ANALYSIS/METHODS:ABRs to a rarefaction click stimulus presented at 31/sec and 80 dB SPL (73 dB nHL) were recorded monaurally using clinically-standard recording and filtering procedures while the participant sat watching a movie. Absolute latencies, interwave latencies, and amplitudes were then correlated to age. RESULTS:Developmental changes were restricted to absolute latencies. Wave V latency decreased significantly with age, whereas wave I and III latencies remained stable, even in this restricted age range. CONCLUSIONS:The ABR does not remain static after age 2 yr, as seen by a systematic decrease in wave V latency between ages 3 and 5 yr. This finding suggests that the human brainstem has a continued developmental time course during the preschool years. Latency changes in the age 3-5 yr range should be considered when using ABRs as a metric of hearing health.
PMCID:4914390
PMID: 25597458
ISSN: 2157-3107
CID: 3979402
Thyroarytenoid cross-innervation by the external branch of the superior laryngeal nerve in the porcine model
OBJECTIVES/HYPOTHESIS: Cross-innervation patterns to the thyroarytenoid (TA) muscle have long been sought after. We have identified in the porcine model, cross-innervation by way of the external branch of the superior laryngeal nerve (eSLN). STUDY DESIGN: Experimental study. METHODS: TA contraction was electromyographically recorded when electrically stimulating the eSLN in six porcine necks. The recurrent laryngeal nerve (RLN) was subsequently transected. The insertion of the cricothyroid (CT) muscle on the cricoid was then subsequently removed as well. RESULTS: Stimulation of the eSLN rendered a response from the TA muscle in 6/6 subject necks, with a mean latency of 2.76 msec. TA muscle contraction by way of eSLN stimulation persisted after the RLN was transected and after CT insertion release. CONCLUSIONS: The TA muscle is directly cross-innervated by a branch of the eSLN in the porcine model. This finding may have implications regarding possible future laryngeal pacing strategies and could be a target nerve for rehabilitation.
PMID: 25131261
ISSN: 1531-4995
CID: 2207562
Minimizing morbidity in microvascular surgery: small-caliber anastomotic vessels and minimal access approaches
IMPORTANCE: Minimizing morbidity when performing free flap reconstruction of the head and neck is important in the overall reconstructive paradigm. OBJECTIVE: To examine the indications and success rates of free tissue transfer using small-caliber facial recipient vessels and minimal access incisions. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of patients with head and neck defects undergoing free tissue transfer from May 2010 to June 2013 at 2 tertiary care academic medical centers. INTERVENTIONS: Free tissue transfer using small-caliber recipient vessels and minimal access approaches. MAIN OUTCOMES AND MEASURES: Postoperative complications, including flap failure, requirement for revision surgery, and nerve dysfunction. RESULTS: Eighty-nine flaps in 86 patients met inclusion criteria. Fifty flaps used the facial artery and vein distal to the facial notch, and 33 flaps used the superficial temporal vascular system. Six flaps used the angular artery and vein. A variety of flap donor sites were included. In most cases, free tissue transfer was indicated for the reconstruction of defects secondary to extirpation of malignant neoplasia. Overall success rate was 97.7% with 2 instances of total flap loss and 1 partial loss. One patient had transient nerve weakness (frontal branch), which resolved during a follow-up of 9 months. CONCLUSIONS AND RELEVANCE: Free tissue reconstruction of head and neck defects can be safely and reliably accomplished using small-caliber recipient vessels, such as the superficial temporal, distal facial, and angular vessels. Minimal access approaches for microvascular anastomosis may be performed with excellent cosmesis and minimal morbidity. LEVEL OF EVIDENCE: 4.
PMID: 25393515
ISSN: 2168-6092
CID: 2718872
Changes in the Jugular Bulb Associated With Sacrifice of the Internal Jugular Vein
OBJECTIVE: To determine whether sacrifice of the internal jugular vein (IJV) causes subsequent changes in the jugular bulb. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Patients were selected by CPT code for neck dissection and were included in the study if they had undergone unilateral neck dissection and had preoperative and postoperative computed tomographic scans through the temporal bone. INTERVENTIONS: The jugular bulb was measured in the axial plane for anteroposterior and mediolateral diameters. MAIN OUTCOME MEASURES: Cross-sectional area of the jugular bulb was calculated, and comparison was made between preoperative and postoperative studies in patients with or without ligation of the IJV. RESULTS: After unilateral neck dissection, the mean change in the size of the jugular bulb ipsilateral to surgery with sacrifice of the IJV was found to be -10.4 mm (95% confidence interval [95% CI], +/-8.54 mm); ipsilateral to surgery without sacrifice of the internal jugular, -0.2 mm (95% CI, +/-3.24 mm); contralateral to surgery with sacrifice of the IJV, +1.9 mm (95% CI, +/-11.12 mm); and contralateral to surgery without sacrifice of the IJVa, +1.0 mm (95% CI, +/-2.66 mm). Analysis of variance demonstrated a significant difference for changes in the jugular bulb area ipsilateral to surgery with sacrifice of the IJV (p = 0.03) when compared with contralateral to surgery without sacrifice of the IJV. CONCLUSION: Changes in size of the jugular bulb occur with surgical manipulation of the jugular vein. This study demonstrates a decrease in the size of the jugular bulb with ipsilateral IJV sacrifice.
PMID: 25514783
ISSN: 1531-7129
CID: 1411182
Cross-Disorder Genome-Wide Analyses Suggest a Complex Genetic Relationship Between Tourette's Syndrome and OCD
Objective: Obsessive-compulsive disorder (OCD) and Tourette's syndrome are highly heritable neurodevelopmental disorders that are thought to share genetic risk factors. However, the identification of definitive susceptibility genes for these etiologically complex disorders remains elusive. The authors report a combined genome-wide association study (GWAS) of Tourette's syndrome and OCD. Method: The authors conducted a GWAS in 2,723 cases (1,310 with OCD, 834 with Tourette's syndrome, 579 with OCD plus Tourette's syndrome/chronic tics), 5,667 ancestry-matched controls, and 290 OCD parent-child trios. GWAS summary statistics were examined for enrichment of functional variants associated with gene expression levels in brain regions. Polygenic score analyses were conducted to investigate the genetic architecture within and across the two disorders. Results: Although no individual single-nucleotide polymorphisms (SNPs) achieved genome-wide significance, the GWAS signals were enriched for SNPs strongly associated with variations in brain gene expression levels (expression quantitative loci, or eQTLs), suggesting the presence of true functional variants that contribute to risk of these disorders. Polygenic score analyses identified a significant polygenic component for OCD (p=2x10-4), predicting 3.2% of the phenotypic variance in an independent data set. In contrast, Tourette's syndrome had a smaller, nonsignificant polygenic component, predicting only 0.6% of the phenotypic variance (p=0.06). No significant polygenic signal was detected across the two disorders, although the sample is likely underpowered to detect a modest shared signal. Furthermore, the OCD polygenic signal was significantly attenuated when cases with both OCD and co-occurring Tourette's syndrome/chronic tics were included in the analysis (p=0.01). Conclusions: Previous work has shown that Tourette's syndrome and OCD have some degree of shared genetic variation. However, the data from this study suggest that there are also distinct components to the genetic architectures of these two disorders. Furthermore, OCD with co-occurring Tourette's syndrome/chronic tics may have different underlying genetic susceptibility compared with OCD alone.
PMCID:4282594
PMID: 25158072
ISSN: 0002-953x
CID: 1162352
Geographic and temporal trends in frontal sinus surgery
BACKGROUND: The purpose of this study was to evaluate geographic and temporal trends in frontal sinus surgery procedures. METHODS: Medicare Part B data files from 2000 to 2011 were examined for temporal trends in various frontal sinus procedures, and the most recent year containing geographic information (2010) was evaluated for Current Procedural Terminology (CPT) code use. Additionally, nationwide charges per procedure were recorded. Regional populations of individuals >/=65 years old were obtained from the 2010 U.S. Census, and surgical society websites were used to determine the number of practicing rhinologists and otolaryngologists in each region. RESULTS: The use of open approaches declined by one third, while endoscopic procedures went from 6463 to 19262 annually, with the most marked increases occurring from 2006 through 2011. Geographic variation was noted, with practitioners in the South Atlantic states performing the greatest number of endoscopic procedures in 2010, whereas the East South Central states had the greatest number when controlling for population. There was an inverse relationship between endoscopic procedures performed and number of fellowship-trained rhinologists (controlling for regional populations) (R2 = 0.66). The first year frontal sinus ballooning had a unique CPT code illustrated decreased reimbursements for non-balloon endoscopic surgery ($609) relative to balloon approaches ($2635). CONCLUSION: Declines in open frontal sinus surgery and marked increases in endoscopic approaches have potential implications for residency training. Potential reasons for marked increases in endoscopic approaches include the rising popularity of balloon technologies, although this is speculative. Geographic variation exists in frontal sinus surgery patterns, including an inverse relationship between endoscopic approaches and the number of fellowship-trained rhinologists.
PMID: 25367305
ISSN: 2042-6984
CID: 1341062
Is an endoscopic approach superior to external dacryocystorhinostomy for nasolacrimal obstruction?
PMID: 24866834
ISSN: 0023-852x
CID: 1443562
Facial nerve paralysis after pre-operative embolization of a paraganglioma
Vascular tumors pose a challenging problem in treatment, as surgical planning can be extensive. Often times, pre-operative embolization is required to minimize blood loss during surgery. With the advent of new biochemical compounds, embolization modalities have evolved over the past decade. Although rare, side effects and complications of embolic materials have been cited sporadically in the literature. We present an interesting case of a patient afflicted with facial paralysis and other cranial neuropathies following embolization of a paraganglioma, along with the appropriate imaging that confirms the etiology of her paralysis.
PMID: 25241031
ISSN: 0196-0709
CID: 1259102
