Faculty Bibliography

OBJECTIVE:Metabolic syndrome (MetS) has previously been linked to increased risk of postoperative morbidity and mortality in other surgical undertakings. Because MetS is a consequence of endocrine dysfunction, and given the thyroid's crucial role in endocrine homeostasis, we sought to evaluate the association between MetS and postoperative outcomes of thyroidectomy. METHODS:Data were acquired from the ACS-NSQIP database from years 2005 to 2017. Patients with obesity, diabetes, and hypertension were defined as having MetS. Odds ratios (OR) were obtained for outcomes to quantify risk with multivariate logistic regression. RESULTS:Outcomes significantly affected by MetS included overall complication (OR: 2.00), extended postoperative stay (OR: 1.52), medical complication (OR: 1.48), surgical complication (OR: 1.62), and mortality (OR: 2.33). CONCLUSIONS:Patients with MetS undergoing thyroidectomy are at increased risk of an increased length of stay, overall complications, and mortality.

OBJECTIVE:The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck. DATA SOURCES:PubMed/MEDLINE, Cochrane Library, and Embase. REVIEW METHODS:The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion. RESULTS:= .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively. CONCLUSION:Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.

OBJECTIVES/HYPOTHESIS:Thyroid cancer with distant metastasis (TCDM) at diagnosis has significantly worse survival rates when compared to localized/regional thyroid cancer. This study sought to report on the characteristics of patients presenting with TCDM and the potential survival advantage of surgical resection. STUDY DESIGN:Data were acquired from the Surveillance, Epidemiology, and End Results (SEER) database with cases from 2004 to 2015. METHODS:TCDM cases (n = 2,558) were identified from the SEER database. The Bonferroni correction was applied for multivariate analysis. Kaplan-Meier analysis was utilized to obtain disease-specific survival (DSS) rates. Cox regression analysis was utilized to identify independent factors significantly associated with survival. RESULTS:The average age of diagnosis of TCDM was 62.0 (±17.5) years. Patients were predominantly white (74.6%), female (54.6%), in a relationship (56.0%), and between ages 36 and 80 years (76.4%). Cases consisted of papillary (57.2%), follicular (16.0%), medullary (8.9%), anaplastic (17.9%) TCDM histological variants. Overall 1-, 5-, and 10-year DSS rates were 72.0%, 56.8%, and 43.8%, respectively. Anaplastic and medullary variants had the worst 10-year DSS (0% and 25.5%, respectively). Patients who underwent surgical resection only and surgical resection with radiation were 49% and 59% less likely to die, respectively. Treatment, age, histology, T staging, relationship status, and metastasis site were determined to be significant predictors of survival. CONCLUSIONS:Surgical resection with radiation was found to be a significant predictor of survival after applying the Bonferroni correction for all thyroid cancer variants except medullary. To increase survival, surgical intervention should be recommended in patients who are deemed to be medically tolerant of surgery. LEVEL OF EVIDENCE:4 Laryngoscope, 131:1026-1034, 2021.

OBJECTIVES/OBJECTIVE:A software tool (EasyMDT) that measures temporal modulation detection thresholds of a broadband noise carrier is presented. EasyMDT is designed to be both easy and quick to promote the use in environments where testing time is limited, and testers may not have extensive technical expertise to use typical research software. In addition, by providing a standardized stimulus and protocol, data collected by all groups using the software can be compared directly. Details of EasyMDT, including a description of the protocol, stimuli, interface and how to obtain the software, are provided along with representative sample data from both normal-hearing listeners and cochlear implant (CI) users. Performance with the EasyMDT is compared with speech understanding metrics as well as a metric of spectral-temporal resolution. DESIGN/METHODS:A "Full Curve" of modulation detection thresholds is measured using a three-interval forced-choice adaptive task in a single block for 7 modulation frequencies (10, 50, 75, 100, 150, 200, and 300 Hz). Similarly, the modulation detection thresholds were measured for only one modulation frequency in a block (either 100 Hz or 150 Hz). Modulation detection thresholds and block duration were recorded. In addition, performance on speech recognition tasks (CNC words, consonant identification, vowel identification, and AzBio sentences in noise) and a spectral-temporal resolution task (SMRT; Aronoff and Landsberger) were measured. Modulation detection thresholds were measured for both normal-hearing listeners and CI users. Only CI users participated in the speech and spectral-temporal tests. RESULTS:Modulation detection thresholds measured with EasyMDT were consistent with those previously reported from other laboratories. Modulation detection thresholds at a single modulation frequency (100 Hz or 150 Hz) were predictive of modulation detection thresholds measured as part of the Full Curve consisting of all 7 modulation frequencies. Testing durations for CI users dropped from an average of over 18 minutes for the Full Curve to under 3 minutes for either of the single modulation frequency measures. Modulation detection thresholds at 100 Hz correlated with CNC words, consonant identification, and AzBio sentences in noise, but not vowel identification. No correlations were found between modulation detection and spectral-temporal resolution. CONCLUSIONS:The EasyMDT is designed to be an easy-to-use tool that provides a nonlinguistic measure that can predict speech understanding. The test duration is short enough that it can be incorporated into clinical practice or as part of an experimental battery. The software is available for free download at https://www.ear-lab.org/software-downloads.html. The software is designed to have a minimum barrier of entry as well as provide a standardized protocol allowing direct comparison of modulation detection thresholds across studies and groups.

Introduction: TERT promoter mutations in thyroid carcinoma suggest worse prognosis based on findings of a small number of studies. Additionally, pathologic features and clinical behavior of indeterminate thyroid nodules (ITN) with TERT promoter mutations remain less studied. Our study aims to explore the clinicopathologic features of ITN with TERT promoter mutations.
Material(s) and Method(s): A search conducted in our electronic medical record between 2015-2018 identified 18 cases with indeterminate thyroid fine-needle aspiration (FNA) cytology (Bethesda Class III, IV, and V) and a TERT mutation on molecular testing. 17 patients underwent thyroidectomy and were the subjects of this study.
Result(s): The mean age was 65 (range 38-83) with a female to male ratio of 9:8. The FNA Bethesda diagnoses were Class III in 9, IV in 8, and V in 1. Majority of patients who underwent thyroidectomy had malignant nodules (14,78%). Thyroidectomy diagnoses included classic PTC (5,29%), FVPTC (5,29%), follicular variant of papillary carcinoma (3,17%), poorly differentiated thyroid carcinoma (1, 6%), follicular adenoma (2,11%) and NIFTP (1,6%). Additional alterations were present in 11 cases, including NRAS(6), KRAS(2), and BRAF V600E (3). Of three cases with concurrent BRAF V600E mutation, two were metastatic, and one had tall cell features. Of two follicular adenoma cases, one had a concomitant NRAS mutation, and the other displayed negative results on Afirma testing. Malignant cases tended to occur in older patients, the majority exhibited follicular architecture, frequent oncocytic morphology, and higher pathologic stage (pT3 in 92%, pT2 in 8%).
Conclusion(s): Most TERT promoter mutations in ITN cytology are associated with high risk of malignancy and these malignancies are associated with unfavorable features such as advanced stage, capsular/vascular invasion, and metastatic disease. Few TERT promoter mutations have a benign outcome. Further studies on ITNs with TERT mutations are needed to determine the optimal management of these nodules.
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OBJECTIVE:Miscommunication and poor coordination among surgical teams are known causes of preventable medical harms and operating room inefficiencies and inhibit surgical training. Technology may help overcome these challenges. This study used the personal experience of one of the authors as a former Air Force F-15 pilot to design a combat aviation pre- and postoperative communication workflow in the neurosurgery department and tested its effect on safety, efficiency, and education. The authors hypothesized that the adoption of this workflow through a tailored technological platform will increase compliance and improve the chances of sustainability. METHODS:Data were prospectively collected from neurosurgery cases before (January-May 2020) and after (June-October 2020) implementation of this workflow. Briefing and debriefing were executed using a custom mobile platform and were defined as nonmandatory for all participants. All faculty and residents who operated at NYU Langone Medical Center (Tisch campus) during the intervention period were enrolled on the platform. Primary outcomes were morbidity and mortality per the department's criteria, and intraoperative last-minute requests as reported by operating room staff in a double-blinded fashion. Secondary outcomes were user responses on the subjective questionnaires. RESULTS:Data were collected from 637 and 893 cases during the preintervention and intervention periods, respectively. The average briefing rates for residents and surgeons were 71% and 81%, respectively, and the average debriefing rates for residents and surgeons were 67% and 88%. There was no significant difference in preoperative risk score between the preintervention and intervention patient populations (p = 0.24). The rate of intraoperative last-minute requests significantly decreased from 16.6% (35/211) to 10.5% (35/334, p = 0.048). There was no significant change in morbidity and mortality between the preintervention and intervention periods. On subjective questionnaires there was a statistically significant improvement in safety, efficiency, and educational aspects of the cases during the intervention period. CONCLUSIONS:Implementation of aviation-like structured team communication practices in the neurosurgery department through a technological platform improved education and communication between surgical teams and led to a reduction in last-minute surgical requests that could impact costs.