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Cvancara DJ, Wood HA, Aboueisha M, Marshall TB, Kao TC, Phillips JO, Humphreys IM, Abuzeid WM, Lehmann AE, Kojima Y, Jafari A. Cognition and saccadic eye movement performance are impaired in chronic rhinosinusitis. Int Forum Allergy Rhinol 2024. [PMID: 38268115 DOI: 10.1002/alr.23320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) can experience cognitive dysfunction. The literature on this topic mostly reflects patient-reported measurements. Our goal was to assess cognitive function in patients with CRS using objective measures, including saccadic eye movements-a behavioral response reflecting cognitive and sensory information integration that is often compromised in conditions with impaired cognition. METHODS Participants (N = 24 with CRS, N = 23 non-CRS healthy controls) enrolled from rhinology clinic underwent sinonasal evaluation, quality of life assessment (Sino-nasal Outcome Test 22 [SNOT-22]), and cognitive assessment with the Neuro-QOL Cognitive Function-Short Form, the Montreal Cognitive Assessment (MoCA), and recording of eye movements using video-oculography. RESULTS Participants with CRS were more likely to report cognitive dysfunction (Neuro-QOL; 45.8% vs. 8.7%; p = 0.005) and demonstrate mild or greater cognitive impairment (MoCA; 41.7% vs. 8.7%; p = 0.005) than controls. Additionally, participants with CRS performed worse on the MoCA overall and within the executive functioning and memory domains (all p < 0.05) and on the anti-saccade (p = 0.014) and delay saccade (p = 0.044) eye movement tasks. Poorer performance on the MoCA (r = -0.422; p = 0.003) and the anti-saccade (r = -0.347; p = 0.017) and delay saccade (r = -0.419; p = 0.004) eye movement tasks correlated with worse CRS severity according to SNOT-22 scores. CONCLUSION This study is the first to utilize objective eye movement assessments in addition to researcher-administered cognitive testing in patients with CRS. These patients demonstrated a high prevalence of cognitive dysfunction, most notably within executive functioning and memory domains, with the degree of dysfunction correlating with the severity of CRS.
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Affiliation(s)
- David J Cvancara
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Heather A Wood
- Department of Engineering, University of Washington, Seattle, Washington, USA
| | - Mohamed Aboueisha
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | - Thomas B Marshall
- School of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Tzu-Cheg Kao
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - James O Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Yoshiko Kojima
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Schwartz BS, Pollak JS, Bandeen-Roche K, Hirsch AG, Lehmann AE, Kern RC, Tan BK, Kato A, Schleimer RP, Peters AT. Sinus inflammation and chronic rhinosinusitis are associated with a diagnosis of new onset asthma in the following year. Allergy 2023; 78:2659-2668. [PMID: 37195236 PMCID: PMC10543467 DOI: 10.1111/all.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) and asthma commonly co-occur. No studies have leveraged large samples needed to formally address whether preexisting CRS is associated with new onset asthma over time. METHODS We evaluated whether prevalent CRS [identified in two ways: validated text algorithm applied to sinus computerized tomography (CT) scan or two diagnoses] was associated with new onset adult asthma in the following year. We used electronic health record data from Geisinger from 2008 to 2019. For each year we removed persons with any evidence of asthma through the end of the year, then identified those with new diagnosis of asthma in the following year. Complementary log-log regression was used to adjust for confounding variables (e.g., sociodemographic, contact with the health system, comorbidities), and hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. RESULTS A total of 35,441 persons were diagnosed with new onset asthma and were compared to 890,956 persons who did not develop asthma. Persons with new onset asthma tended to be female (69.6%) and younger (mean [SD] age 45.9 [17.0] years). Both CRS definitions were associated (HR, 95% CI) with new onset asthma, with 2.21 (1.93, 2.54) and 1.48 (1.38, 1.59) for CRS based on sinus CT scan and two diagnoses, respectively. New onset asthma was uncommonly observed in persons with a history of sinus surgery. CONCLUSION Prevalent CRS identified with two complementary approaches was associated with a diagnosis of new onset asthma in the following year. The findings may have clinical implications for the prevention of asthma.
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Affiliation(s)
- Brian S. Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, United States of America
| | - Jonathan S. Pollak
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Annemarie G. Hirsch
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, United States of America
| | - Ashton E. Lehmann
- Department of Otolaryngology, Geisinger, Danville, Pennsylvania, United States of America
| | - Robert C. Kern
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Bruce K. Tan
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Atsushi Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Robert P. Schleimer
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Anju T. Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Jafari A, Adappa ND, Anagnos VJ, Campbell RG, Castelnuovo P, Chalian A, Chambers CB, Chitguppi C, Dallan I, El Rassi E, Freitag SK, Fernandez Miranda JC, Ferreira M, Gardner PA, Gudis DA, Harvey RJ, Huang Q, Humphreys IM, Kennedy DW, Lee JYK, Lehmann AE, Locatelli D, McKinney KA, Moreau A, Nyquist G, Palmer JN, Prepageran N, Pribitkin EA, Rabinowitz MR, Rosen MR, Sacks R, Sharma D, Snyderman CH, Tonya Stefko S, Stokken JK, Wang EW, Workman AD, Wu AW, Yu JY, Zhang MM, Zhou B, Bleier BS. Orbital resection by intranasal technique (ORBIT): A new classification system for reporting endoscopically resectable primary benign orbital tumors. Int Forum Allergy Rhinol 2023; 13:1852-1863. [PMID: 36808854 DOI: 10.1002/alr.23141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/05/2023] [Accepted: 02/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND The Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system has become the gold standard for outcomes reporting in endoscopic orbital surgery for orbital cavernous hemangiomas (OCHs). A recent systematic review demonstrated similar outcomes between OCHs and other primary benign orbital tumors (PBOTs). Therefore, we hypothesized that a simplified and more comprehensive classification system could be developed to predict surgical outcomes of other PBOTs. METHODS Patient and tumor characteristics as well as surgical outcomes from 11 international centers were recorded. All tumors were retrospectively assigned an Orbital Resection by Intranasal Technique (ORBIT) class and stratified based on surgical approach as either exclusively endoscopic or combined (endoscopic and open). Outcomes based on approach were compared using chi-squared or Fisher's exact tests. The Cochrane-Armitage test for trend was used to analyze outcomes by class. RESULTS Findings from 110 PBOTs from 110 patients (age 49.0 ± 15.0 years, 51.9% female) were included in the analysis. Higher ORBIT class was associated with a lower likelihood of gross total resection (GTR). GTR was more likely to be achieved when an exclusively endoscopic approach was utilized (p < 0.05). Tumors resected using a combined approach tended to be larger, to present with diplopia, and to have an immediate postoperative cranial nerve palsy (p < 0.05). CONCLUSION Endoscopic treatment of PBOTs is an effective approach, with favorable short-term and long-term postoperative outcomes as well as low rate of adverse events. The ORBIT classification system is an anatomic-based framework that effectively facilitates high-quality outcomes reporting for all PBOTs.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vincent J Anagnos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raewyn G Campbell
- Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Ara Chalian
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Chandala Chitguppi
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Iacopo Dallan
- Ear, Nose, Throat (ENT) Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Edward El Rassi
- Department of Otolaryngology-Head & Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Manuel Ferreira
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David A Gudis
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard J Harvey
- Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Qian Huang
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head & Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Y K Lee
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashton E Lehmann
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale Di Circolo E Fondazione Macchi, University of Insubria, Varese, Italy
| | - Kibwei A McKinney
- Department of Otolaryngology-Head & Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Annie Moreau
- Department of Ophthalmology, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Gurston Nyquist
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Narayanan Prepageran
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Edmund A Pribitkin
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Mindy R Rabinowitz
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Marc R Rosen
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Raymond Sacks
- Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia
- Department of Otolaryngology-Head & Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
| | - Dhruv Sharma
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - S Tonya Stefko
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janalee K Stokken
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alan D Workman
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jen Y Yu
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew M Zhang
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Bing Zhou
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head & Neck Surgery, Ministry of Education, Beijing, China
| | - Benjamin S Bleier
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Hirsch AG, Schwartz BS, Nordberg C, Tan BK, Schleimer RP, Kern RC, Peters AT, Bandeen-Roche K, Lehmann AE. Risk of new-onset and prevalent disease in chronic rhinosinusitis: A prospective cohort study. Int Forum Allergy Rhinol 2023; 13:1715-1725. [PMID: 36756720 PMCID: PMC10716683 DOI: 10.1002/alr.23136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is accompanied by burdensome comorbid conditions. Understanding the relative timing of the onset of these conditions could inform disease prevention, detection, and management. OBJECTIVE To evaluate the association between CRS and new-onset and prevalent asthma, noncystic fibrosis bronchiectasis (NCFBE), chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), and obstructive sleep apnea (OSA). METHODS We conducted a prospective cohort study among primary care patients using a detailed medical and symptom questionnaire in 2014 and again in 2020. We used questionnaire and electronic health record (EHR) data to determine CRS status: CRSSE (moderate to severe symptoms with EHR evidence), CRSE (limited symptoms with EHR evidence), CRSS (moderate to severe symptoms without EHR evidence), CRSneg (limited symptoms and no EHR evidence; reference). We evaluated the association between CRS status and new-onset and prevalent disease using logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS There were 7847 and 4445 respondents to the 2014 and 2020 questionnaires, respectively. CRSSE (vs CRSneg ) was associated with increased odds of new-onset asthma (OR, 1.74 [CI, 1.09-2.77), NCFBE (OR, 1.87 [CI, 1.12-3.13]), COPD (OR, 1.73 [CI, 1.14-2.68]), GERD (OR, 1.95 [CI, 1.61-2.35]), and OSA (OR, 1.91 [CI, 1.39-2.62]). Similarly, increased odds were observed for associations with the prevalence of these conditions. CONCLUSION The findings from the study support further exploration of CRS as a target for the prevention and detection of asthma, NCFBE, COPD, GERD, and OSA.
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Affiliation(s)
- Annemarie G Hirsch
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Brian S Schwartz
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cara Nordberg
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Bruce K Tan
- Department of Otolaryngology Head and Neck Surgery, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert P Schleimer
- Department of Otolaryngology Head and Neck Surgery, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert C Kern
- Department of Otolaryngology Head and Neck Surgery, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashton E Lehmann
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
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Cvancara DJ, Baertsch HC, Lehmann AE, Humphreys IM, Farrell NF, Marshall TB, Bhatt NK, Abuzeid WM, Jafari A. Postmarketing Reporting of Paxlovid-Related Dysgeusia: A Real-World Pharmacovigilance Study. Otolaryngol Head Neck Surg 2023. [PMID: 36821807 DOI: 10.1002/ohn.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A novel COVID-19 therapeutic, nirmatrelvir/ritonavir (Paxlovid), is commonly associated with reports of dysgeusia. The Food and Drug Administration Adverse Event Reporting System (FAERS) database was used to determine the real-world reporting of Paxlovid-associated dysgeusia (PAD), identify associated factors, and describe the relative reporting rates of dysgeusia for Paxlovid compared to other COVID-19 therapeutics (OCT), ritonavir alone, and other protease inhibitors (OPI). STUDY DESIGN Observational retrospective. SETTING Tertiary academic medical center. METHODS We collected patient and adverse event characteristics reported in the FAERS database between January 1968 and September 2022. Disproportionality analyses were used to compare the reporting of PAD to dysgeusia reported for OCT, ritonavir, and OPI. RESULTS 345,229 adverse events were included in the present study. Dysgeusia was a frequently reported Paxlovid-associated adverse event (17.5%) and was associated with nonserious COVID-19 infection (reporting odds ratio [ROR] 1.4; 95% confidence interval [CI] 1.2, 1.7) and female sex (ROR = 1.7; 95% CI 1.6, 1.9). Paxlovid was more likely to be associated with the reporting of dysgeusia compared to OCT (ROR 305.4; 95% CI 164.1, 568.5), ritonavir (ROR 28.0; 95% CI 24.1, 32.7), and OPI (ROR 49.0; 95% CI 42.8, 56.1). CONCLUSION Dysgeusia is much more likely to be reported by patients receiving Paxlovid than those receiving OCT, ritonavir alone, or OPI. These findings suggest a potential mechanism of dysgeusia that causes distorted taste out of proportion to the background effects of COVID-19 infection and specific to nirmatrelvir. Future studies are needed to determine the underlying pathophysiology and long-term clinical implications for patients who report dysgeusia with Paxlovid.
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Affiliation(s)
- David J Cvancara
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Hans C Baertsch
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Thomas B Marshall
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Lehmann AE, Sneidern M, Shen SA, Humphreys IM, Abuzeid WM, Jafari A. Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta‐analysis. World J Otorhinolaryngol Head Neck Surg 2022; 8:25-35. [PMID: 35619927 PMCID: PMC9126164 DOI: 10.1002/wjo2.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high‐quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices. Methods Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ2, Fisher's exact, and independent t tests. Results Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps (n = 15, 44.1%) and free mucosal grafts (n = 11, 32.4%). Rigid reconstruction was uncommon (n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise (p < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis (p < 0.001), larger tumor size (p = 0.001), and operative exposure of orbital fat (p < 0.001) and extraocular muscle (p = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term postoperative diplopia when reconstruction was foregone (p = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia. Conclusion Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review. Question: Does orbital reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors? Findings: In this systematic review and meta‐analysis of 60 patients included from 24 studies, there were no statistically significant differences between the reconstruction (n = 34, 56.7%) and non‐reconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term (<2 years) post‐operative diplopia when reconstruction was foregone (p = 0.041). Meaning: Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review.
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Affiliation(s)
- Ashton E. Lehmann
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Otolaryngology‐Head and Neck Surgery Geisinger Medical Center Danville Pennsylvania USA
| | - Manuela Sneidern
- Department of Otolaryngology‐Head and Neck Surgery New York University School of Medicine New York New York USA
| | - Sarek A. Shen
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Ian M. Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology‐Head and Neck Surgery University of Washington Seattle Washington USA
| | - Waleed M. Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology‐Head and Neck Surgery University of Washington Seattle Washington USA
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology‐Head and Neck Surgery University of Washington Seattle Washington USA
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von Sneidern M, Lehmann AE, Jafari A, Vlasakov IK, Shen SA, Goss D, Bleier BS. Reflecting on the COVID-19 Surgical Literature Surge: A Scoping Review of Pandemic Otolaryngology Publications. Otolaryngol Head Neck Surg 2021; 167:65-72. [PMID: 34491871 DOI: 10.1177/01945998211041933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the high-volume 2020 COVID-19-related surgical literature, with special attention to otolaryngology articles in regard to content, level of evidence, citations, and public attention. STUDY DESIGN A scoping literature review was performed with PubMed and Web of Science, including articles pertaining to COVID-19 and surgical specialties (March 20-May 19, 2020) or otolaryngologic subspecialties (March 20-December 31, 2020). SETTING Scoping literature review. METHODS Otolaryngology-specific COVID-19-related articles were reviewed for publication date, county of origin, subspecialty, content, level of evidence, and Altmetric Attention Score (a weighted approximation of online attention received). Data were analyzed with Pearson correlation coefficients, analysis of variance, independent t tests, and univariable and logistic regressions. RESULTS This review included 773 early COVID-19 surgical articles and 907 otolaryngology-specific COVID-19-related articles from 2020. Otolaryngology was the most represented surgical specialty within the early COVID-19-related surgical literature (30.4%). The otolaryngology-specific COVID-19 surgical literature responsively reflects the unique concerns within each otolaryngologic subspecialty. Although this literature was largely based on expert opinion (64.5%), articles with stronger levels of evidence received significantly more citations (on Web of Science and Google Scholar, P < .001 for both) and public attention (according to Altmetric Attention Scores, P < .001). CONCLUSION Despite concerns of a surge in underrefereed publications during the COVID-19 pandemic, our review of the surgical literature offers some degree of reassurance. Specifically, the COVID-19 otolaryngology literature responsively reflects the unique concerns and needs of the field, and more scholarly citations and greater online attention have been given to articles offering stronger levels of scientific evidence.
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Affiliation(s)
- Manuela von Sneidern
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Otolaryngology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | | | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Deborah Goss
- Howe Library, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Benjamin S Bleier
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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8
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Jafari A, Shen SA, Qualliotine JR, Lehmann AE, Humphreys IM, Abuzeid WM, Bergmark RW, Gray ST. Socioeconomic Factors Affect Presentation Stage and Survival in Sinonasal Squamous Cell Carcinoma. Laryngoscope 2021; 131:2421-2428. [PMID: 33844294 DOI: 10.1002/lary.29568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Socioeconomic factors affect oncologic outcome in sinonasal squamous cell carcinoma (SNSCC). However, the relationship between these factors and stage at presentation (SAP)-a critical, early point in the care cycle-is not known. This study sought to determine the role of race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors in SAP and survival among patients with advanced SNSCC. STUDY DESIGN Retrospective cohort study. METHODS Using the National Cancer Database, 6,155 patients with SNSCC were identified and divided into those with "early" (Stage I or II; 2,212 (35.9%)) versus "advanced" (Stage III or IV; 3,943 (64.1%)) disease. Associations between sociodemographic and socioeconomic factors on SAP and survival were analyzed using multivariable logistic regression and Cox proportional hazard models. RESULTS Black (odds ratio [OR]: 2.18, CI: 1.74-2.76), Asian and Pacific Islander (API) (OR: 2.37, CI: 1.43-4.14), and Medicaid or uninsured (OR: 2.04, CI: 1.66-2.53) patients were more likely to present with advanced disease. Among patients with advanced disease, API patients demonstrated the highest 10-year survival rate (30.2%), and Black patients had the lowest 2-, 5-, and 10-year survival rates (47.7%, 31.9% and 19.2%, respectively). Older age (HR:1.03, CI:1.03-1.04), Black race (HR:1.39, CI:1.21-1.59), Medicaid or uninsured status (HR:1.48, CI:1.27-1.71), and treatment at a community hospital (HR:1.25, CI:1.14-1.37) were associated with poorer overall survival among patients with advanced disease. CONCLUSIONS Factors including race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors influence SAP and survival in SNSCC. An improved understanding of how these factors relate to outcomes may elucidate opportunities to address gaps in education and access to care in vulnerable populations. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jesse R Qualliotine
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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9
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Patel KR, Lehmann AE, Jafari A, Faden DL. Prolapsed Nasal Polyp Causing Acute Airway Obstruction: An Exceptional Presentation. ORL J Otorhinolaryngol Relat Spec 2021; 83:203-205. [PMID: 33657548 DOI: 10.1159/000513564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022]
Abstract
Although nasal polyposis is a common clinical entity, there is limited literature describing the rare presentation of sudden prolapse of a massive nasal polyp resulting in an airway emergency in an adult. We present the first case report to our knowledge of a patient without any preceding sinonasal symptoms or history of anticoagulation who experienced acute upper airway obstruction due to sudden hemorrhage and prolapse of a large nasal polyp. Based on our experience treating this patient, we discuss special considerations in all phases of care to ensure safe and effective management of such an exceptional clinical scenario.
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Affiliation(s)
- Krupa R Patel
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA,
| | - Ashton E Lehmann
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Aria Jafari
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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10
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Jafari A, von Sneidern M, Lehmann AE, Shen SA, Shishido S, Freitag SK, Bleier BS. Exclusively endoscopic endonasal resection of benign orbital tumors: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2020; 11:924-934. [PMID: 33350602 DOI: 10.1002/alr.22745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) classification system was developed to standardize prospective outcome analysis following orbital cavernous hemangioma (OCH) resection. The goal of this study was to retroactively apply the CHEER system to all prior existing reports of endoscopic resection of primary benign orbital tumors (BOTs) to: (1) compare patient presentations, perioperative characteristics, and outcomes between OCH and other BOTs; and (2) determine whether the CHEER categorization regime could be expanded to other BOTs. METHODS A systematic review of studies reporting exclusively endoscopic resections of OCH and other BOTs (eg, solitary fibrous tumor, schwannoma, and meningioma) was performed. Patient, tumor characteristics, and operative outcomes were recorded. All tumors with adequate reporting were retrospectively assigned a CHEER stage. Outcomes were compared using chi-square or Fisher's exact tests. RESULTS Ninety-three studies met inclusion criteria, and sufficient data were available in 36 studies, comprising 105 tumors (n = 87 OCHs; n = 18 other BOTs). Baseline patient and tumor characteristics, as well as intraoperative and short-term postoperative outcomes were not significantly different between OCHs and other BOTs. Long-term outcomes (eg, visual deficits, diplopia, eye position, and recurrence) also did not differ when controlling for CHEER stage. CONCLUSION This review represents the largest collection of outcomes data following exclusively endoscopic endonasal resection of BOTs. Short-term and long-term outcomes appear similar between OCHs and other BOTs. These results suggest that exclusively endoscopic resection of orbital tumors may be effective in a range of benign pathologies. Furthermore, these results support a broader application of the CHEER system to other benign primary orbital tumors.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | | | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD
| | - Sachie Shishido
- Faculty of Arts and Sciences, Fung Library, Harvard University, Cambridge, MA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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11
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Lehmann AE, Raquib AR, Siddiqi SH, Meier J, Durand ML, Gray ST, Holbrook EH. Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double-blind, placebo-controlled noninferiority clinical trial. Int Forum Allergy Rhinol 2020; 11:1047-1055. [PMID: 33340285 DOI: 10.1002/alr.22756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgeons commonly prescribe prophylactic antibiotics after endoscopic sinus surgery (ESS), yet minimal data exist to support this practice. In this study we aimed to assess the impact of post-ESS antibiotics on infection, quality of life (QOL), and endoscopic scores. METHODS This was a randomized, double-blind, placebo-controlled, noninferiority trial comparing amoxicillin-clavulanate vs placebo after ESS (NCT01919411, ClinicalTrials.gov). Adults (N = 77) with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS were randomized to antibiotics (N = 37) or placebo (N = 40) and followed clinically (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9 weeks postoperatively). At baseline and follow-up, QOL was measured with 22-item Sino-Nasal Outcome Test questionnaires and Lund-Kennedy endoscopic scores were evaluated. Outcomes were analyzed with repeated-measures analysis of variance and analysis of covariance and z tests for proportions. RESULTS Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT-22 scores (β = 0.18, 2-tailed p < 0.05). There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time (p = 0.63) or in postoperative infection rates (2.6% vs 2.4%, respectively; p = 0.96). The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8; p = 0.02). CONCLUSION Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal-specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group. These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post-ESS and significantly increases the rate of diarrhea.
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Affiliation(s)
- Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Aaishah R Raquib
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Josh Meier
- School of Medicine, University of Nevada, Reno, Reno, NV.,Nevada ENT and Hearing Associates, Reno, NV
| | - Marlene L Durand
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
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12
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Jafari A, Lehmann AE, Wolkow N, Juliano AF, Bleier BS, Reinshagen KL. Radioanatomic Characteristics of the Posteromedial Intraconal Space: Implications for Endoscopic Resection of Orbital Lesions. AJNR Am J Neuroradiol 2020; 41:2327-2332. [PMID: 33122203 DOI: 10.3174/ajnr.a6822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Imaging is essential in the diagnostic work-up of patients with orbital lesions. The position of an orbital lesion relative to the inferomedial muscular trunk of the ophthalmic artery determines endoscopic resectability, anticipated technical difficulty, and patient morbidity. Although the inferomedial muscular trunk is not readily identifiable on preoperative imaging, we hypothesize that it is spatially approximate to the location where the ophthalmic artery crosses the optic nerve. Our aim was to determine whether the ophthalmic artery-optic nerve crosspoint anatomically approximates the inferomedial muscular trunk in a cadaver study and can be appreciated on imaging of known posteromedial orbital lesions. MATERIALS AND METHODS Dissection was performed on 17 fresh-frozen cadaver orbits to assess the relationship between the inferomedial muscular trunk and ophthalmic artery-optic nerve crosspoint. Retrospective review of imaging in 9 patients with posteromedial orbital lesions assessed posteromedial orbital compartment characteristics and the ability to locate the ophthalmic artery-optic nerve crosspoint. RESULTS In our cadaver study, the mean distance between the ophthalmic artery-optic nerve crosspoint and the inferomedial muscular trunk was 1.21 ± 0.64 mm. Retrospectively, the ophthalmic artery-optic nerve crosspoint was identifiable in 9/9 patients, whereas the inferomedial muscular trunk was not identifiable in any patient. Total or partial effacement of the posteromedial intraconal fat triangle was observed in 9/9 patients. CONCLUSIONS This study of neurovascular relationships within the posteromedial orbit demonstrates that the ophthalmic artery-optic nerve crosspoint closely approximates the inferomedial muscular trunk and can be seen in patients with posteromedial orbital lesions. Posteromedial intraconal fat effacement may help to localize these lesions. These findings may facilitate multidisciplinary communication and help predict lesion resectability and patient outcomes.
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Affiliation(s)
- A Jafari
- From the Department of Otolaryngology-Head & Neck Surgery (A.J., A.E.L., B.S.B.) .,Department of Otolaryngology-Head & Neck Surgery (A.J.), University of Washington, Seattle, Washington
| | - A E Lehmann
- From the Department of Otolaryngology-Head & Neck Surgery (A.J., A.E.L., B.S.B.)
| | | | - A F Juliano
- Radiology (A.F.J., K.L.R.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - B S Bleier
- From the Department of Otolaryngology-Head & Neck Surgery (A.J., A.E.L., B.S.B.)
| | - K L Reinshagen
- Radiology (A.F.J., K.L.R.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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13
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Jafari A, Lehmann AE, Shen SA, Banks CG, Scangas GA, Metson R. Infection After Endoscopic Dacryocystorhinostomy: Incidence and Implications. Am J Rhinol Allergy 2020; 35:375-382. [PMID: 32938219 DOI: 10.1177/1945892420958905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Endoscopic dacryocystorhinostomy (EN-DCR) is an increasingly common procedure performed by otolaryngologists. While EN-DCR has a high rate of success at relieving blockage of the lacrimal system, little is known regarding associated postoperative infection (POI) rates and risk factors. OBJECTIVE The purpose of this study was to identify factors associated with the occurrence of postoperative orbital and rhinologic infection in a large cohort of patients undergoing EN-DCR. METHODS A retrospective review of 582 patients who underwent EN-DCR was performed. All patients received antibiotic prophylaxis as a single intraoperative intravenous administration and a ten-day postoperative oral course. Clinical and demographic information was reviewed, including the occurrence of acute orbital or rhinologic infection within 30 days of surgery. Multivariable analysis was performed to identify risk factors associated with POI. RESULTS Fifteen of 582 patients (2.6%) developed POI following EN-DCR. The most common POI was acute rhinosinusitis (10/15, 66.7%), followed by acute dacryocystitis (2/15, 13.3%), preseptal cellulitis (2/15,13.3%), and acute bacterial conjunctivitis (1/15, 6.7%). The majority of patients (464/582, 79.7%) underwent concurrent endoscopic sinus surgery (ESS). In most cases (302/464, 65.1%), ESS was performed to address comorbid rhinosinusitis, whereas 7.8% (36/464) of patients underwent surgery to enhance surgical access to the lacrimal sac. Patients who underwent concurrent ESS were less likely to develop POI (OR: 0.17, CI: 0.04-0.80, p < 0.05). Evidence of mucopurulence at surgery increased the likelihood of POI (OR: 6.24, CI: 1.51-25.84, p < 0.05). CONCLUSION Mucopurulence at the time of surgery significantly increased the risk of POI, whereas concurrent ESS, performed most commonly to address comorbid rhinosinusitis, significantly decreased the risk of POI. Awareness of risk factors for POI and appropriate surgical management of concurrent rhinosinusitis can lead to reduced infectious complications after EN-DCR.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Sarek A Shen
- School of Medicine, University of California San Diego, La Jolla, California
| | - Catherine G Banks
- Department of Otolaryngology, Prince of Wales and Sydney and Sydney Eye Hospital, University of New South Wales, Randwick, Sydney, Australia
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
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14
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Lehmann AE, Scangas GA, Jafari A, Metson R. Endoscopic Transoral Image-Guided Retrieval of Infratemporal Fossa Foreign Bodies. OTO Open 2020; 4:2473974X20947026. [PMID: 32844142 PMCID: PMC7416146 DOI: 10.1177/2473974x20947026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
Removal of foreign bodies from the infratemporal fossa is surgically challenging
and fraught with risks. This report describes our experience with a minimally
invasive transoral technique, utilizing endoscopic and image guidance
technology, for retrieval of infratemporal fossa foreign bodies in 6 patients.
The technique was successfully applied in all cases with identification and
retrieval of the foreign bodies, which included 4 hypodermic needles broken off
during dental injections, a cottonoid surgical sponge lost during a facial
fracture repair, and a maxillary molar displaced during attempted extraction.
Complications were limited to transient postoperative lingual and inferior
alveolar nerve sensory deficits in 1 patient.
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Affiliation(s)
- Ashton E Lehmann
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aria Jafari
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ralph Metson
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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15
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Jafari A, Lehmann AE, Metson R. Is Olfactory Training Effective Treatment for Postinfectious Smell Loss? Laryngoscope 2020; 131:1198-1199. [PMID: 32615000 DOI: 10.1002/lary.28902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/30/2020] [Accepted: 06/10/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
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16
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Parikh AS, Fuller JC, Lehmann AE, Goyal N, Gray ST, Lin DT. Prognostic Impact of Adverse Pathologic Features in Sinonasal Squamous Cell Carcinoma. J Neurol Surg B Skull Base 2020; 82:e114-e119. [PMID: 34306926 DOI: 10.1055/s-0040-1710516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022] Open
Abstract
Objective This study aimed to describe the impact of adverse clinical and pathologic features in sinonasal squamous cell carcinoma (SCC). Design This study is designed with retrospective chart review. Setting The present study is conducted at a tertiary care institution. Participants All patients treated surgically for sinonasal SCC at our tertiary care institution between January 2006 and December 2013. Main Outcome Measures Overall survival (OS) and disease free survival (DFS) are the final measurement of this study. Results Forty-eight patients were identified. Mean age at surgery was 65.8 years, and mean follow-up time was 40.7 months. Eighteen patients (38%) had T1-T3 disease, while 30 patients (63%) had T4 disease. Seven patients (8.3%) had nodal disease at presentation. At 2, 5, and 10 years, OS was 71, 54, and 48%, respectively, while DFS was 64, 51, and 45%, respectively. Twelve patients (25%) experienced local recurrences with mean time to recurrence of 15.3 months. Twenty-five patients (52%) had positive margins, 24 (50%) had high-grade tumors, 18 (38%) had perineural invasion (PNI), and 15 (31%) had lymphovascular invasion (LVI). In the univariate analysis, T4 disease (risk ratio [RR] = 2.7) and high grade (RR = 2.4) had a significant association with DFS. In the multivariate analysis, high grade (RR = 4.0 and 4.5) and LVI (RR = 4.1 and 4.7) had a significant association with OS and DFS. Conclusion Our single-institution experience of 48 patients suggests that high grade and LVI are independently associated with survival outcomes in sinonasal SCC, while PNI and microscopically positive margins do not have a significant impact.
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Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Jennifer C Fuller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton E Lehmann
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State University, Hershey, Pennsylvania, United States
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
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17
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Lehmann AE, Scangas GA, Jafari A, Banks CG, Fullerton ZH, Metson R. Predictors of long‐term success and failure in primary and revision endoscopic dacryocystorhinostomy. Int Forum Allergy Rhinol 2020; 10:374-380. [DOI: 10.1002/alr.22483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ashton E. Lehmann
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | - George A. Scangas
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | - Aria Jafari
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | - Catherine G. Banks
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
| | | | - Ralph Metson
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of Otolaryngology‒Head and Neck SurgeryMassachusetts Eye and Ear Boston MA
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Rodarte AI, Parikh AS, Gadkaree SK, Lehmann AE, Faquin WC, Holbrook EH, Lin DT. Human Papillomavirus Related Multiphenotypic Sinonasal Carcinoma: Report of a Case with Early and Progressive Metastatic Disease. J Neurol Surg Rep 2019; 80:e41-e43. [PMID: 31737465 PMCID: PMC6855919 DOI: 10.1055/s-0039-3399571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/25/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction
Human papillomavirus (HPV) related multiphenotypic sinonasal carcinoma (HMSC) is a newly described entity. The prognosis of this neoplasm is not well understood, but cases often demonstrate high-grade features and paradoxically indolent behavior.
Case Report
We present the case of a 65-year-old man referred with unilateral nasal congestion and epistaxis. Nasal endoscopy and imaging revealed an expansile mass filling the left nasal cavity. The patient underwent endoscopic-assisted medial maxillectomy, with complete resection and negative margins. Pathology revealed a basaloid tumor consisting of solid nests with multiple foci of cribriform architecture, with positivity for high-risk HPV, thus supporting the diagnosis of HMSC. Postoperatively, the patient received 66.6-Gy adjuvant three-dimensional proton therapy. Twenty-three months after surgical resection, he developed enlarging pulmonary nodules with biopsy features consistent with the primary sinonasal tumor. He was treated with three cycles of chemotherapy and eight cycles of immunotherapy, progressing on both therapies. He remains on palliative chemotherapy.
Conclusion
Here, we present a case of HMSC with early and progressive distant metastasis. We aim to add to an understanding of the behavior of this entity. Although this neoplasm may typically be indolent, further classification of high-risk features is necessary to identify rare aggressive cases.
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Affiliation(s)
- Alejandro I Rodarte
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anuraag S Parikh
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Shekhar K Gadkaree
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton E Lehmann
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - William C Faquin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Eric H Holbrook
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
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Lehmann AE, Scangas GA, Bergmark RW, El Rassi E, Stankovic KM, Metson R. Periostin and Inflammatory Disease: Implications for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2019; 160:965-973. [PMID: 30935271 DOI: 10.1177/0194599819838782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a comprehensive overview of the emerging role of periostin, an extracellular matrix protein, as a key component in the development, diagnosis, and treatment of patients with chronic rhinosinusitis. DATA SOURCES Medline database. REVIEW METHODS A state of the art review was performed targeting English-language studies investigating the role of periostin in cardiopulmonary, neoplastic, and inflammatory diseases, with emphasis on recent advances in the study of periostin in chronic rhinosinusitis. CONCLUSIONS Periostin has emerged as a novel biomarker and therapeutic target for numerous human pathologies, including cardiac, pulmonary, and neoplastic disease. The upregulation of periostin in chronic rhinosinusitis suggests the potential for similar roles among patients with sinonasal disease. IMPLICATIONS FOR PRACTICE Chronic rhinosinusitis is a widespread disease with major clinical and societal impact. A critical limitation in the current treatment of patients with chronic rhinosinusitis is the absence of clinically relevant biomarkers to guide diagnosis and treatment selection. A review of the literature supports a likely role of periostin as a biomarker of chronic rhinosinusitis, as well as a novel therapeutic target in the future treatment of patients with sinonasal disease.
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Affiliation(s)
- Ashton E Lehmann
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - George A Scangas
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Regan W Bergmark
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Edward El Rassi
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Konstantina M Stankovic
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ralph Metson
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Sethi RKV, Miller AL, Bartholomew RA, Lehmann AE, Bergmark RW, Sedaghat AR, Gray ST. Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery. Laryngoscope 2018; 129:1046-1052. [PMID: 30582624 DOI: 10.1002/lary.27672] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Opioid-related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient-reported opioid use after endoscopic sinus surgery (ESS). STUDY DESIGN Retrospective chart review. METHODS Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription. RESULTS One hundred fifty-five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow-up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039). CONCLUSIONS Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1046-1052, 2019.
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Affiliation(s)
- Rosh K V Sethi
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Ashley L Miller
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | | | - Ashton E Lehmann
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Regan W Bergmark
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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21
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Lehmann AE, Scangas GA, Sethi RKV, Remenschneider AK, El Rassi E, Metson R. Impact of Age on Sinus Surgery Outcomes. Laryngoscope 2018; 128:2681-2687. [DOI: 10.1002/lary.27285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Ashton E. Lehmann
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - George A. Scangas
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Rosh K. V. Sethi
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Aaron K. Remenschneider
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Edward El Rassi
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Ralph Metson
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
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Saxena RC, Lehmann AE, Hight AE, Darrow K, Remenschneider A, Kozin ED, Lee DJ. Social media utilization in the cochlear implant community. J Am Acad Audiol 2018; 26:197-204. [PMID: 25690778 DOI: 10.3766/jaaa.26.2.8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND More than 200,000 individuals worldwide have received a cochlear implant (CI). Social media Websites may provide a paramedical community for those who possess or are interested in a CI. The utilization patterns of social media by the CI community, however, have not been thoroughly investigated. PURPOSE The purpose of this study was to investigate participation of the CI community in social media Websites. RESEARCH DESIGN We conducted a systematic survey of online CI-related social media sources. Using standard search engines, the search terms cochlear implant, auditory implant, forum, and blog identified relevant social media platforms and Websites. Social media participation was quantified by indices of membership and posts. STUDY SAMPLE Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned one of six functional categories based on its description. INTERVENTION No intervention was performed. DATA COLLECTION AND ANALYSIS We conducted all online searches in February 2014. Total counts of each CI-related social media source were summed, and descriptive statistics were calculated. RESULTS More than 350 sources were identified, including 60 Facebook groups, 36 Facebook pages, 48 Twitter accounts, 121 YouTube videos, 13 forums, and 95 blogs. The most active online communities were Twitter accounts, which totaled 35,577 members, and Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum contained approximately 9,500 topics with roughly 127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%). CONCLUSIONS The CI community engages in the use of a wide range of online social media sources. The CI community uses social media for support, advocacy, rehabilitation information, research endeavors, and sharing of personal experiences. Future studies are needed to investigate how social media Websites may be harnessed to improve patient-provider relationships and potentially used to augment patient education.
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Affiliation(s)
- Rajeev C Saxena
- Department of Otolaryngology, Tufts University School of Medicine, Boston, MA
| | - Ashton E Lehmann
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA
| | - A Ed Hight
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Keith Darrow
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA; Department of Communication Sciences and Disorders, Worcester State University, Worcester, MA
| | - Aaron Remenschneider
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Elliott D Kozin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Daniel J Lee
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA
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Maxfield AZ, Landegger LD, Brook CD, Lehmann AE, Campbell AP, Bergmark RW, Stankovic KM, Metson R. Periostin as a Biomarker for Nasal Polyps in Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2017; 158:181-186. [PMID: 29040053 DOI: 10.1177/0194599817737967] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Periostin is an extracellular matrix protein that is elevated in the sinonasal tissues of patients with chronic rhinosinusitis (CRS). The purpose of this study was to determine whether serum periostin could serve as a molecular biomarker of nasal polyp burden in sinonasal disease. Study Design Prospective cohort study. Setting Academic medical center. Subjects and Methods Serum periostin levels were measured by ELISA on blood samples collected from patients undergoing sinus surgery for CRS (n = 71), further stratified by phenotype as defined by nasal polyps and asthma. Results were compared with assays performed on control subjects (n = 62). Results Mean serum periostin levels were markedly elevated in patients with CRS versus controls (66.1 ng/mL [95% CI, 51.6-80.6] vs 38.7 ng/mL [95% CI, 34.4-42.9], respectively, P = .004). In addition, mean periostin levels were significantly higher in CRS patients with nasal polyps as compared with those without polyps (94.8 ng/mL [95% CI, 67.3-122.4] vs 41.1 ng/mL [95% CI, 35.2-47.0], respectively, P < .001). Periostin levels did not correlate with sex ( P = .473), smoking history ( P = .748), aspirin-exacerbated respiratory disease status ( P = .136), oral steroid use within 1 month of surgery ( P = .281), use of topical steroid nasal spray ( P = .864), or number of prior sinus operations ( P = .973). Conclusion Serum periostin appears to be a novel molecular biomarker for the presence of nasal polyps and may serve as an indicator of CRS endotypes.
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Affiliation(s)
- Alice Z Maxfield
- 1 Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lukas D Landegger
- 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Christopher D Brook
- 4 Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ashton E Lehmann
- 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Adam P Campbell
- 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Regan W Bergmark
- 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Konstantina M Stankovic
- 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ralph Metson
- 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Scangas GA, Lehmann AE, Remenschneider AK, Su BM, Shrime MG, Metson R. The value of frontal sinusotomy for chronic rhinosinusitis with nasal polyps-A cost utility analysis. Laryngoscope 2017; 128:43-51. [PMID: 28815611 DOI: 10.1002/lary.26783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/26/2017] [Accepted: 06/05/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS The number of surgical procedures performed for frontal sinusitis and the associated costs have increased dramatically over the past decade. The purpose of this study was to evaluate the cost-effectiveness of endoscopic frontal sinusotomy (EFS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). STUDY DESIGN Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS Matched cohorts of CRSwNP patients who underwent endoscopic sinus surgery (ESS) with (n = 139) and without (n = 49) EFS were compared to each other and to patients (n = 139) from the Medical Expenditures Survey Panel database who underwent medical management for chronic rhinosinusitis. Multi-year health utility values were calculated from responses to the EuroQol 5-Dimension instrument. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS Decision analysis showed that ESS without EFS proved more cost-effective than ESS with EFS or medical management. ESS without EFS compared to medical management yielded an ICER of $9,004/quality-adjusted life year (QALY). ESS with EFS compared to ESS without EFS yielded an ICER of $62,310/QALY. At a willingness-to-pay (WTP) threshold of $50,000/QALY, ESS without EFS was more cost-effective than ESS with EFS with 52.1% certainty. These results were robust to one-way analysis and probabilistic sensitivity analysis. CONCLUSIONS ESS remains a cost-effective intervention compared to medical therapy alone for patients with CRSwNP. In this study, the addition of frontal sinusotomy during ESS for patients with CRSwNP was not found to be cost-effective at a WTP threshold of $50,000/QALY, but may be cost effective at a higher threshold of $100,000/QALY. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:43-51, 2018.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Ashton E Lehmann
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Brooke M Su
- School of Medicine, University of California-San Francisco, San Francisco, California, U.S.A
| | - Mark G Shrime
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Ralph Metson
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Lehmann AE, Kozin ED, Sethi RKV, Wong K, Lin BM, Gray ST, Cunningham MJ. Resident responses to after-hours otolaryngology patient phone calls: An overlooked aspect of residency training? Laryngoscope 2017; 128:E163-E170. [PMID: 28782193 DOI: 10.1002/lary.26784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Otolaryngology residents are often responsible for triaging after-hours patient calls. However, residents receive little training on this topic. Data are limited on the clinical content, reporting, and management of otolaryngology patient calls. This study aimed to characterize the patient concerns residents handle by phone and their subsequent management and reporting. STUDY DESIGN Retrospective review. METHODS Five hundred consecutive after-hours patient calls in a tertiary pediatric hospital were reviewed. Data collected included patient and caller demographics, clinical concerns, surgical history, recommendations, and subsequent emergency department (ED) visits. RESULTS On average, 3.7 calls occurred per shift, 2.8 on weekday and 5.9 on weekend shifts. Mean patient age was 6.6 years. Mothers (71%) called most frequently. The majority of calls were postoperative (64.2%). Of postoperative calls, most occurred within 3 days of surgery (52.3%). Most calls were for surgical site bleeding (19.9%). Residents recommended ED evaluation for 17.2% of calls, of which 20.9% returned to the primary institution ED. ED evaluation was recommended more frequently for postoperative patients (P = .040), particularly following adenotonsillectomy (51.2%) or surgical site bleeding (18.6%). With respect to documentation, 32.8% of medical record numbers were absent, 11.8% had name errors, and 2.2% of patients could not be identified. CONCLUSIONS This is the first study to analyze the management and reporting of patient calls by otolaryngology residents. A wide array of clinical concerns are triaged by phone conversations. The study has implications for both resident and patient education. LEVEL OF EVIDENCE 4. Laryngoscope, 128:E163-E170, 2018.
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Affiliation(s)
- Ashton E Lehmann
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Rosh K V Sethi
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Kevin Wong
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Brian M Lin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Michael J Cunningham
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
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Abt NB, Sethi RK, Lehmann AE, Kozin ED, Justicz N, Naunheim MR, Curtin HD, Emerick KS. Plunging ranula with prestyloid parapharyngeal space, masticator space, and parotid gland extension. B-ENT 2017; 13:57-60. [PMID: 29557564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
UNLABELLED Plunging ranula with prestyloid parapharyngeal space, masticator space, and parotid gland extension. INTRODUCTION Ranulas develop from mucous extravasation secondary to sublingual gland duct obstruction or trauma. Plunging ranula usually dive into the submandibular space. METHODS This is the first reported case of a plunging ranula with direct extension to the prestyloid parapharyngeal space, masticator space, and parotid gland with avoidance of the submandibular space. RESULTS The patient presented with a tender parotid mass, of which the differential is broad, including parotitis, parotid malignancy, metastatic malignancy, lymphoma, as well as other infectious etiologies. When an intraoral component is not identified, other differential considerations would be thyroglossal duct cyst, branchial cleft cyst, parathyroid cyst, cervical thymic cyst, dermoid cyst, cystic hygroma, or benign teratoma. CONCLUSION The case is unique due to ranula extension into multiple spaces. For optimal treatment, the sublingual gland along with its tract and contents needs to completely removed.
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Kozin ED, Gulati S, Kaplan AB, Lehmann AE, Remenschneider AK, Landegger LD, Cohen MS, Lee DJ. Systematic review of outcomes following observational and operative endoscopic middle ear surgery. Laryngoscope 2015; 125:1205-14. [PMID: 25418475 PMCID: PMC4467784 DOI: 10.1002/lary.25048] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Middle ear surgery increasingly employs endoscopes as an adjunct to or replacement for the operative microscope. We provide a systematic review of endoscope applications in middle ear surgery with an emphasis on outcomes, including the need for conversion to microscope, audiometric findings, length of follow-up, as well as disease-specific outcomes. DATA SOURCES PubMed, Embase, and Cochrane CENTRAL database. METHODS A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Articles were categorized based on study design, indication, and use of an endoscope either as an adjunct to or as a replacement for a microscope. Qualitative and descriptive analyses of studies and outcomes data were performed. RESULTS One-hundred three articles met inclusion and exclusion criteria. Of the identified articles, 38 provided outcomes data. The majority of these studies were moderate quality, retrospective, case-series reports. The indications for use of the endoscope were broad, with the most common being resection of cholesteatoma. In cholesteatoma surgery, endoscope approaches routinely identified residual cholesteatoma in primary and second-look cases. Other outcomes, including robust audiometric data, operating room times, wound healing, and quality of life surveys were not well described. CONCLUSIONS Endoscopes have consistently been used as an adjunct to the microscope to improve visualization of the tympanic cavity. Recent reports utilize the endoscope exclusively during surgical dissection; however, data comparing patient outcomes following the use of an endoscope to a microscope are lacking. Areas in need of additional research are highlighted. LEVEL OF EVIDENCE NA
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Affiliation(s)
- Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, Boston, Massachusetts, U.S.A; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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Kozin ED, Darrow KN, Hight AE, Lehmann AE, Kaplan AB, Brown MC, Lee DJ. Direct visualization of the murine dorsal cochlear nucleus for optogenetic stimulation of the auditory pathway. J Vis Exp 2015:52426. [PMID: 25650555 DOI: 10.3791/52426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Investigation into the use of virus-mediated gene transfer to arrest or reverse hearing loss has largely been relegated to the peripheral auditory system. Few studies have examined gene transfer to the central auditory system. The dorsal cochlear nucleus (DCN) of the brainstem, which contains second order neurons of the auditory pathway, is a potential site for gene transfer. In this protocol, a technique for direct and maximal exposure of the murine DCN via a posterior fossa approach is demonstrated. This approach allows for either acute or survival surgery. Following direct visualization of the DCN, a host of experiments are possible, including injection of opsins into the cochlear nucleus and subsequent stimulation by an optical fiber coupled to a blue light laser. Other neurophysiology experiments, such as electrical stimulation and neural injector tracings are also feasible. The level of visualization and the duration of stimulation achievable make this approach applicable to a wide range of experiments.
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Affiliation(s)
- Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School;
| | - Keith N Darrow
- Department of Communication Sciences and Disorders, Worcester State University
| | - Ariel E Hight
- Department of Otology and Laryngology, Harvard Medical School
| | | | - Alyson B Kaplan
- Department of Otology and Laryngology, Harvard Medical School
| | | | - Daniel J Lee
- Department of Otology and Laryngology, Harvard Medical School
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Chambers KJ, Lehmann AE, Remenschneider A, Dedmon M, Meier J, Gray ST, Lin DT. Incidence and survival patterns of sinonasal undifferentiated carcinoma in the United States. J Neurol Surg B Skull Base 2014; 76:94-100. [PMID: 25844294 DOI: 10.1055/s-0034-1390016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/14/2014] [Indexed: 10/24/2022] Open
Abstract
Objective To determine trends in sinonasal undifferentiated carcinoma (SNUC) survival patterns in the United States. Design Retrospective review of national database. Participants All cases of SNUC in the National Cancer Institute's Surveillance Epidemiology and End Results program from 1973 to 2010 were examined. Main Outcome Measures Age-adjusted incidence and survival rates were calculated and stratified by demographic information and treatment modality. Cohort analysis was performed to analyze survival patterns over time. Results A total of 318 SNUC cases were identified. Age-adjusted incidence rate (IR) was 0.02 per 100,000. Incidence was greater in males (IR: 0.03) than females (IR: 0.01; p = 0.03). Overall 5- and 10-year relative survival rate was 34.9% and 31.3%, respectively. Overall median survival was 22.1 months. Median survival following surgery combined with radiation was 41.9 months. Five-year relative survival rate following surgery, radiation, or surgery combined with radiation was 38.7%, 36.0%, and 39.1%, respectively. Median survival from 1973-1986 and 1987-2010 was 14.5 and 23.5 months, respectively. Conclusions This study provides new data regarding survival patterns of SNUC in the United States, confirming survival benefit with surgery and radiation as well as identifying a trend toward improved survival in recent decades.
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Affiliation(s)
- Kyle J Chambers
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton E Lehmann
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Aaron Remenschneider
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew Dedmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Josh Meier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
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Lehmann AE, Kozin ED, Hight AE, Darrow K, Boyden E, Brown C, Lee DJ. Histologic Analysis of Chronos in an Optogenetic-Based Auditory Brainstem Implant Model. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Optogenetics affords the potential for improved spatial resolution compared with electric stimulation in future auditory neuroprostheses. No histologic studies have yet examined the virally-mediated gene transfer of Chronos, a new opsin, to the murine cochlear nucleus (CN). Herein, we aim to (1) identify CN regions and neurons receptive to gene transfer of Chronos and (2) describe the morphology of putative cell types that express Chronos. Methods: CBA/CaJ mice underwent CN-targeted injection of Chronos. The Chronos construct consisted of an adeno-associated viral vector (AA2/8), CAG promoter, and a fluorescent marker. Following a 4-week incubation period, mice were sacrificed and intravascularly fixed with paraformaldehyde, and brains were extracted, sucrose cryoprotected, and cryostatically sectioned. Sections of 35-µm thickness were co-labeled with neuron-specific markers microtubule associated protein-2 and anti-tubulin, beta III isoform and DAPI-fluoromounted. Sections of 60-µm thickness were DAPI-fluoromounted, and confocal microscopy revealed cellular morphologies. Results: Opsin-linked fluorescence demonstrates Chronos expression throughout the dorsal CN with contiguous extension routinely into the ventral CN and variably into the auditory nerve and inferior cerebellar peduncle. Chronos localizes to neuronal-specific and nonneuronal populations. Confocal microscopy suggests involvement of a wide array of CN cell types, including morphologies consistent with pyramidal cells and giant cells. Conclusions: Our histologic analyses confirm widespread infection of multiple neuronal populations throughout the CN. This work sets the stage for correlation with ongoing neurophysiology experiments. Future work with CN-specific promoters to target neuronal subpopulations may further improve clinical potential for an optogenetics-based auditory neuroprosthesis.
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Kozin ED, Lehmann AE, Carter MS, Hight E, Cohen MS, Nakajima HH, Lee DJ. Temperature Changes Associated with Middle Ear Endoscopy in a Human Temporal Bone Model. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Endoscopic ear surgery is rapidly gaining popularity as a minimally invasive approach to address chronic ear disease. However, little is known about the potentially damaging temperature increases associated with endoscopy in the middle ear. Specifically, neither temperature change nor heat distribution associated with the endoscope has been quantified. In this study, we aim to measure temperature changes throughout the middle ear during rigid endoscopy in a human temporal bone model. Methods: Fresh human temporal bones were maintained at physiologic temperature during middle ear endoscopy with a 3-mm 0° Hopkins rod. Temperature changes were measured as a function of the distance between the endoscope tip and the round window membrane. Thermal gradient was determined by infrared imaging. Control studies conducted at room temperature were also performed. Results: An endoscope with a xenon or light-emitting diode light source on maximal power induced a rapid temperature elevation up to 46°C within 0.5-1 mm of the tip of the endoscope within 30-124 seconds. Elevated temperatures occurred at distances up to 8mm from the endoscope tip. Temperatures rapidly returned to baseline within 20-88 seconds after turning off the light source. Conclusions: Our findings have direct implications for endoscopic ear surgery and affirm the importance of avoiding excessive temperature elevation. We recommend employing submaximal light intensity and repositioning the endoscope frequently to provide rapid cooling. Ongoing studies use an animal model to explore the in vivo effects of prolonged middle ear endoscopy and evaluate for potential threshold shifts in auditory brainstem responses.
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Saxena RC, Lehmann AE, Hight AE, Kozin ED, Lee DJ. Current Landscape of Social Media and Blogosphere in the Cochlear Implant Community. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Over 200,000 individuals worldwide have received a cochlear implant (CI). Social media websites may provide a paramedical community for CI users, although their utilization patterns have not been thoroughly investigated. Herein, we aim to (1) analyze how CI users exchange information online and (2) quantify and characterize participation in social media. Methods: Social media sources included Facebook, Twitter, YouTube, blogs, and online forums. Each source was assigned 1 of 6 functional categories based on its description. Using standard search engines, such as Google, we used the search terms cochlear implant, auditory implant, forum, and blog to identify relevant blogs and online forums. Website participation was quantified. Results: Over 350 sources were identified, including 122 YouTube videos, 111 blogs and forums, 57 Facebook groups, 32 Facebook pages, and 50 Twitter accounts. The most active online communities were Facebook groups, which totaled 17,971 members. CI users participated in Facebook groups primarily for general information/support (68%). Online forums were the next most active online communities by membership. The largest forum had ~9500 topics with ~127,000 posts. CI users primarily shared personal stories through blogs (92%), Twitter (71%), and YouTube (62%). Conclusions: This is the first known comprehensive review of utilization patterns of social media in the CI community. CI users engage in a wide range of online platforms predominately to provide general information and share personal stories. Analyses of how CI users participate in social media may enable clinicians to identify key concerns of this specialized patient population.
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Lehmann AE, Ennis K, Georgieff MK, Rao R, Tran PV. Evidence for a hyporesponsive limbic-hypothalamic-pituitary-adrenal axis following early-life repetitive hypoglycemia in adult male rats. Am J Physiol Regul Integr Comp Physiol 2011; 301:R484-90. [PMID: 21593429 DOI: 10.1152/ajpregu.00678.2010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The developing limbic-hypothalamic-pituitary-adrenal (LHPA) axis is highly vulnerable to programming by early-life environmental factors, including exposure to synthetic glucocorticoids and nutrient deficiencies. Early-life repetitive hypoglycemia (RHG) is a common complication of insulin therapy for type-1 diabetes that may have long-term consequences in adulthood. Recent observations in a rat model of early RHG suggest persistent changes in LHPA axis function, including changes in relevant hormones and affective behaviors, which support a hyperresponsive LHPA axis. Thus, we hypothesized that early RHG would alter the expression of key genes regulating LHPA axis function in adulthood. The present study employed a rat model of insulin-induced RHG spanning postnatal days (P)24-28, a neurodevelopmental equivalent of early childhood in humans, to assess the long-term effects on mRNA levels for proteins relevant to the LHPA function and the corticosterone responses to ACTH stimulation of dispersed adrenocortical cells in vitro and restraint stress in vivo at adulthood. This early RHG model resulted in a hyporesponsive LHPA axis characterized by impaired corticosterone response, increased hippocampal glucocorticoid and mineralocorticoid receptor (GR and MR), decreased hypothalamic corticotropin-releasing hormone, increased adrenal steroidogenic-acute-regulatory protein and GR, and decreased adrenal MR, melanocortin-type-2 receptor and low-density lipoprotein receptor expression. Our findings highlight a complex environmental-gene interaction between RHG and LHPA axis during development that influences regulation of this axis in adulthood. The findings are consistent with the developmental origins of disease and underscore the influences of early-life events on the programming of a major regulatory system.
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Affiliation(s)
- Ashton E Lehmann
- Center for Neurobehavioral Development, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Fuglestad AJ, Lehmann AE, Kroupina MG, Petryk A, Miller BS, Iverson SL, Johnson DE, Georgieff MK. Iron deficiency in international adoptees from Eastern Europe. J Pediatr 2008; 153:272-7. [PMID: 18534235 DOI: 10.1016/j.jpeds.2008.02.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 01/29/2008] [Accepted: 02/28/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess iron deficiency (ID) in international adoptees after adoption. STUDY DESIGN Participants (n = 37) were adopted into the United States from Eastern Europe before they were 24 months of age. Baseline (within 1 month post-adoption) and follow-up (6 months post-adoption) assessments included routine post-adoption clinical evaluations, anthropometrics, dietary intakes, and iron measures (hemogram and serum analysis). RESULTS At adoption and follow-up, mean percent transferrin saturation and mean corpucuscular volume were low compared with the US population. Mean serum ferritin concentration became lower than the US population at follow-up, although the mean daily iron intake was more than the Recommended Dietary Allowance. Participants with Giardia lamblia at baseline had more compromised iron status at baseline and follow-up. Growth rate (change in z-score/months between assessments) was negatively correlated with change in serum ferritin concentrations between baseline and follow-up (r = -0.34; P < .05). CONCLUSIONS International adoptees had compromised iron status, with ID more prevalent in participants with G lamblia, a parasite that may interfere with iron absorption. The persistent ID at follow-up was likely caused by the erythropoietic demands of catch-up growth.
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Affiliation(s)
- Anita J Fuglestad
- Department of Pediatrics, Institute of Child Development, International Adoption Program, Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN 55455, USA
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