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Lovin BD, Gorelik D, Lin KF, Vrabec JT. Vestibular Hypofunction Screening in Older Cochlear Implant Candidates. Otolaryngol Head Neck Surg 2024. [PMID: 38686585 DOI: 10.1002/ohn.800] [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: 09/22/2023] [Revised: 03/03/2024] [Accepted: 04/13/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Vestibular loss is associated with increasing age and hearing loss. Cochlear implantation (CI) may be performed in these patients; however, CI can induce vestibular hypofunction (VH) postoperatively. If CI is performed in the "better balancing ear," patients may experience vestibulopathy from new bilateral VH. The objective of this study was to evaluate the rates of VH in older CI candidates, thereby helping to identify patients at increased risk for bilateral VH after CI. STUDY DESIGN Retrospective cohort study from 2019 to 2022 of patients age 60 to 80 years old who underwent videonystagmography (VNG). SETTING Tertiary care neurotology practice. METHODS VNG, including spontaneous nystagmus, cervical vestibular evoked myogenic potential (cVEMP), caloric stimulation, and rotary chair, was reviewed and stratified by CI candidacy. Patients with prior CI or known vestibular diagnosis were excluded. RESULTS Thirty-three patients were CI candidates and 184 patients were controls. cVEMP demonstrated a significantly greater rate of unilateral VH in CI candidates (P = .018). Caloric stimulation demonstrated an elevated rate of bilateral VH and presbyvestibulopathy in CI candidates (P = .057 and P = .036, respectively). Rotary chair demonstrated a significantly higher rate of bilateral VH and incomplete vestibular compensation based on reduced gain and gain asymmetry, respectively, in CI candidates (P < .001 and P = .043, respectively). Mean bithermal slow phase velocity sum and rotary chair gain were significantly lower in the CI candidate group (P = .002 and P < .001, respectively). Preoperative identification of VH determined the side of implantation in 4 patients (15%). CONCLUSION VH and incomplete vestibular compensation are common and more frequently seen in CI candidates compared to age-matched controls. Vestibular screening can play a role in surgical counseling and planning, and should be considered in older patients undergoing CI.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Kenny F Lin
- Houston Methodist ENT Specialists, Houston, Texas, USA
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Ahmad JG, Lovin BD, Lee A, Nader ME, Gidley PW. Cochlear Implantation After Head and Neck Radiation: A Case Series, Systematic Review, and Meta-analysis. Otol Neurotol 2024; 45:352-361. [PMID: 38361317 PMCID: PMC10940186 DOI: 10.1097/mao.0000000000004127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To determine if cochlear implant (CI) is safe and effective in patients with radiation therapy (XRT)-induced sensorineural hearing loss and to discuss considerations in this population through a retrospective cohort review, systematic review, and meta-analysis. DATABASES REVIEWED PubMed, Cochrane Library, and Embase. METHODS We retrospectively reviewed all CI cases after head and neck (HN) XRT at our institution, noting intraoperative findings, postoperative complications, and hearing outcomes. Change in speech discrimination scores (SDSs) was the primary outcome measure. Systematic review was performed to identify all cases of CI after HNXRT. A meta-analysis was performed to assess SDS change. RESULTS The retrospective cohort review identified 12 patients who underwent CI after HNXRT. One patient with HN cancer (HNC) and one with central nervous system pathology (CNSP) received bilateral implants. Six had HNC, three had CNSP, and one had Langerhans cell histiocytosis. Eleven had abnormal findings during CI. There were no postoperative complications. Twenty articles with an additional 97 patients were suitable for systematic review inclusion. Of the 109 patients, 67 (61.5%) had HNC and 18 (16.5%) had CNSP. Abnormal intraoperative findings were common (30.3%), most frequently in the mastoid (66.7%). Postoperative complications, including wound dehiscence and infection with some requiring explantation, occurred in 10.1% of patients. Sixty-six patients were included in the meta-analysis. All demonstrated SDS improvement (mean increase, 56.2%). CONCLUSION Patients with prior HNXRT benefit from CI. Paying careful attention to surgical planning and technique, postoperative care, and patient expectations is imperative, as complications are not uncommon.
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Affiliation(s)
- Jumah G. Ahmad
- Department of Otorhinolaryngology – Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benjamin D. Lovin
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lovin BD, Page JC, Appelbaum EN, Gorelik D, Lin KF, Vrabec JT. Isolated Fracture of the Malleus: An Overlooked Cause of Conductive Hearing Loss? Laryngoscope 2024; 134:1032-1041. [PMID: 37584374 DOI: 10.1002/lary.30962] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide suggestions for management. DATA SOURCES PubMed, Embase, Cochrane Library. REVIEW METHODS Retrospective cohort study was performed on 12 patients with isolated malleus fractures. History, physical exam, pre- and post-treatment audiograms, and imaging were obtained. Systematic review of the literature was performed. RESULTS Including the cases herein, 58 isolated malleus fractures were identified, the majority of which were published in the 21st century. Mean time to presentation after injury was 34.4 months. Most common etiology was external auditory canal (EAC) manipulation. Physical exam and imaging did not identify any abnormality at presentation in 16% and 21% of cases, respectively. The majority of fractures involved the manubrium. Air-bone gap (ABG) at initial presentation ranged from 16 to 26 dB, and was greater at higher frequencies. Thirty-six cases underwent surgery. ABG improvement was greater at all frequencies for those who underwent surgery. Final ABG was significantly less than initial ABG at nearly every frequency for those who underwent surgery (p < 0.05), while not at any frequency for those who were observed. CONCLUSIONS Isolated malleus fractures may occur more often than historical data suggests, and are perhaps underdiagnosed. Abrupt removal of a finger from the EAC with pain and hearing loss is nearly pathognomonic. Conductive hearing loss with ABG greater at higher frequencies is most often observed. Observation is unlikely to produce spontaneous improvements in hearing, while surgery demonstrates reliable decreases in ABG. Laryngoscope, 134:1032-1041, 2024.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Joshua Cody Page
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Kenny F Lin
- Houston Methodist ENT Specialists, Houston, Texas, USA
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Lovin BD, Page JC, Vrabec JT. Imaging of Alternobaric Facial Palsy: An Etiologic Hypothesis. Ann Otol Rhinol Laryngol 2023; 132:1059-1067. [PMID: 36278328 DOI: 10.1177/00034894221127499] [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: 07/20/2023]
Abstract
OBJECTIVE To report a case of alternobaric facial palsy (AFP) with a hyperpneumatized temporal bone and to review the relevant literature in order to propose a new facet of AFP pathogenesis. METHODS A patient with a hyperpneumatized temporal bone was found to have recurrent episodes of facial palsy associated with air travel. Systematic review of PubMed, Cochrane Library, and Embase characterized all articles related to transient facial palsy associated with altitude changes or diving with a focus on demographics and imaging findings. RESULTS A 25 year-old male was referred for recurrent facial palsy associated with commercial air travel. Imaging demonstrated a hyperpneumatized and well-aerated temporal bone. Total air cell volume was calculated to be 8.59 cc on the affected side. A systematic review of the literature identified 49 cases of AFP. Mean age was 34 years old and 80% were male. Twelve cases had imaging of the temporal bone for evaluation, of which 85% demonstrated at least 1 area of hyperpneumatization. Hyperpneumatization was most frequently encountered in the mastoid, zygomatic root, and inferior petrous apex. CONCLUSION Hyperpneumatization of the temporal bone is critical to AFP etiology as it predicts higher middle ear pressure, if atmospheric pressure changes cannot be equilibrated, via reduced efficacy of normal tympanic membrane pressure buffering. This hypothesis helps to better account for the rarity of the condition and male preponderance.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joshua Cody Page
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
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Lovin BD, Wilkinson AJ, Qing Y, Hernandez M, Nader ME, Raza S, DeMonte F, Gidley PW. The Effect of Metformin on Vestibular Schwannoma Growth: A Systematic Review and Meta-analysis. Laryngoscope 2023; 133:2066-2072. [PMID: 36744870 PMCID: PMC10404300 DOI: 10.1002/lary.30601] [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: 10/28/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To systematically review and evaluate metformin's potential impact on vestibular schwannoma (VS) growth. DATA SOURCES PubMed, Cochrane Library, and Embase. REVIEW METHODS A retrospective cohort study was performed on sporadic VS patients undergoing initial observation who had at least two magnetic resonance imaging studies. Patients were stratified by metformin use during the observation period. Primary endpoint was VS growth, defined as at least a 2 mm increase in diameter. Survival free of tumor growth was evaluated between groups. Systematic review and meta-analysis were performed to produce a pooled odds ratio [OR]. Study heterogeneity was assessed and post-hoc power analysis was performed. RESULTS A total of 123 patients were included, of which 17% were taking metformin. Median patient age was 56.6 years (range, 25.1-84.5). There were no statistically significant differences between the groups. Survival analysis did not demonstrate a statistically significant difference in time to VS growth between groups (hazard ratio = 0.61, 95% confidence interval [CI] = 0.29-1.29). Furthermore, logistic regression analysis did not demonstrate a statistically significant difference between groups in the odds of VS growth (OR = 0.46, 95% CI = 0.17-1.27). Systematic review identified 3 studies. Meta-analysis suggested that metformin reduces the odds of developing VS growth (pooled OR = 0.45, 95% CI = 0.29-0.71). Studies demonstrated low between-study heterogeneity. Power analysis demonstrated a sample size of 220 patients with equal randomization would be required to prospectively identify a true difference with 80% power. CONCLUSIONS Metformin use may reduce the odds of VS growth. A randomized trial would be ideal to identify an unbiased estimate of metformin's effect on VS growth. Laryngoscope, 133:2066-2072, 2023.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alex J Wilkinson
- McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Yun Qing
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shaan Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hernandez BO, Nagatsuka M, Wright SC, Marcellino AJ, Lovin BD, Walker FO, Madden LL. Hemodynamic Changes Associated With Transcervical Laryngeal Injection of Botulinum Toxin. J Voice 2023; 37:452-455. [PMID: 33541763 PMCID: PMC8325702 DOI: 10.1016/j.jvoice.2021.01.003] [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: 08/31/2020] [Revised: 01/01/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure. METHODS One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance. RESULTS Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, P < 0.0001), systolic blood pressure and diastolic blood pressure (7.0 ± 9.5 mm Hg, P < 0.0001; 8.7 ± 14.7 mm Hg, P < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes. CONCLUSIONS Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.
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Affiliation(s)
- Brian O Hernandez
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Moeko Nagatsuka
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen Carter Wright
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amanda J Marcellino
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Benjamin D Lovin
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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You P, Lovin BD, Patel AJ, Hosek KE, Peng A, Sweeney AD. Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients. Otolaryngol Head Neck Surg 2023; 168:814-820. [PMID: 35414323 DOI: 10.1177/01945998221093529] [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: 01/31/2022] [Accepted: 03/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present the surgical and quality of life (QOL) outcomes of patients who underwent blind sac closure of the external auditory canal (EAC) via a modified Rambo approach. STUDY DESIGN Retrospective case review. SETTING Tertiary academic referral center. METHODS All patients who underwent EAC closure with a modified Rambo approach between 2015 and 2021 were evaluated. Complication rates, QOL estimations from a validated survey, and subjective cosmetic reports were analyzed. RESULTS Thirty-five ears were closed in 31 patients. The most common indication for surgery was related to cochlear implantation and cochlear malformation or cholesteatoma (31.4%). No case involved an immediate complication requiring revision surgery, and 4 ears (11.4%) were suspected of having cholesteatoma within the surgical cavity at a mean 28.6-month follow-up. Adults (≥18 years) had significantly higher QOL scores than children in the medical resource subscale of the Chronic Ear Survey (P < .01), and patients undergoing concurrent EAC closure and skull base tumor removal scored higher than others (P = .04). Females reported higher cosmetic scores than males (P = .04). QOL and cosmetic scores compared favorably to previously published data involving the management of otologic disease. CONCLUSIONS Ear canal closure can be a useful technique for select adult and pediatric patients. Patient and surgeon concerns regarding QOL and cosmesis in ear canal closure should be explored prior to employing this surgical technique, though the present data suggest that the modified Rambo approach to closure is generally associated with reasonable outcomes in both areas.
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Affiliation(s)
- Peng You
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Akash J Patel
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Kathleen E Hosek
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Angela Peng
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Lovin BD, Sweeney AD, Chapel AC, Alfonso K, Govil N, Liu YCC. Effects of Age on Delayed Facial Palsy After Otologic Surgery: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2022; 131:1092-1101. [PMID: 34706584 DOI: 10.1177/00034894211053966] [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: 12/31/2022]
Abstract
OBJECTIVES To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis. METHODS Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature. RESULTS Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days. CONCLUSIONS The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered. LEVEL OF EVIDENCE IIa.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kristan Alfonso
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandini Govil
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yi-Chun Carol Liu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA
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Gadot R, Anand A, Lovin BD, Sweeney AD, Patel AJ. Predicting surgical decision-making in vestibular schwannoma using tree-based machine learning. Neurosurg Focus 2022; 52:E8. [DOI: 10.3171/2022.1.focus21708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Vestibular schwannomas (VSs) are the most common neoplasm of the cerebellopontine angle in adults. Though these lesions are generally slow growing, their growth patterns and associated symptoms can be unpredictable, which may complicate the decision to pursue conservative management versus active intervention. Additionally, surgical decision-making can be controversial because of limited high-quality evidence and multiple quality-of-life considerations. Machine learning (ML) is a powerful tool that utilizes data sets to essentialize multidimensional clinical processes. In this study, the authors trained multiple tree-based ML algorithms to predict the decision for active treatment versus MRI surveillance of VS in a single institutional cohort. In doing so, they sought to assess which preoperative variables carried the most weight in driving the decision for intervention and could be used to guide future surgical decision-making through an evidence-based approach.
METHODS
The authors reviewed the records of patients who had undergone evaluation by neurosurgery and otolaryngology with subsequent active treatment (resection or radiation) for unilateral VS in the period from 2009 to 2021, as well as those of patients who had been evaluated for VS and were managed conservatively throughout 2021. Clinical presentation, radiographic data, and management plans were abstracted from each patient record from the time of first evaluation until the last follow-up or surgery. Each encounter with the patient was treated as an instance involving a management decision that depended on demographics, symptoms, and tumor profile. Decision tree and random forest classifiers were trained and tested to predict the decision for treatment versus imaging surveillance on the basis of unseen data using an 80/20 pseudorandom split. Predictor variables were tuned to maximize performance based on lowest Gini impurity indices. Model performance was optimized using fivefold cross-validation.
RESULTS
One hundred twenty-four patients with 198 rendered decisions concerning management were included in the study. In the decision tree analysis, only a maximum tumor dimension threshold of 1.6 cm and progressive symptoms were required to predict the decision for treatment with 85% accuracy. Optimizing maximum dimension thresholds and including age at presentation boosted accuracy to 88%. Random forest analysis (n = 500 trees) predicted the decision for treatment with 80% accuracy. Factors with the highest variable importance based on multiple measures of importance, including mean minimal conditional depth and largest Gini impurity reduction, were maximum tumor dimension, age at presentation, Koos grade, and progressive symptoms at presentation.
CONCLUSIONS
Tree-based ML was used to predict which factors drive the decision for active treatment of VS with 80%–88% accuracy. The most important factors were maximum tumor dimension, age at presentation, Koos grade, and progressive symptoms. These results can assist in surgical decision-making and patient counseling. They also demonstrate the power of ML algorithms in extracting useful insights from limited data sets.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine
| | - Benjamin D. Lovin
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston; and
| | - Alex D. Sweeney
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston; and
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas
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Lovin BD. Diagnostic vestibular pocket guide: Evaluation of dizziness, vertigo, and imbalance. Julie A.Honaker. San Diego, CA: Plural Publishing, 2021, 288 pp. Head Neck 2022. [DOI: 10.1002/hed.26916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lovin BD, Hernandez M, Elms H, Choi JS, Lindquist NR, Moreno AC, Nader ME, Gidley PW. Temporal Bone Osteoradionecrosis: An 18-year, Single-Institution Experience. Laryngoscope 2021; 131:2578-2585. [PMID: 34287898 DOI: 10.1002/lary.29758] [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: 04/05/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes. STUDY DESIGN Retrospective chart review. METHODS Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease. RESULTS TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful. CONCLUSIONS TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Hunter Elms
- Department of Otolaryngology-Head and Neck Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Jonathan S Choi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Nathan R Lindquist
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Amy C Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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Lovin BD, Appelbaum EN, Makoshi L, Whitehead WE, Sweeney AD. Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas. Ann Otol Rhinol Laryngol 2021; 130:1360-1368. [PMID: 33834882 DOI: 10.1177/00034894211007242] [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: 11/16/2022]
Abstract
OBJECTIVES To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae. METHODS A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl's fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl's fissures. RESULTS An 11-year-old female was referred for recurrent meningitis. Imaging demonstrated a fistulous connection between the middle ear and IAC diverticulum via the jugular foramen. Specifically, a Hyrtl's fissure was identified, as well as demineralized bone around the jugular bulb. Obliteration of the fissure was initially performed, and a fistula reformed 4 months later. Multifocal CSF egress in the hypotympanum was identified on re-exploration, and middle ear obliteration with external auditory canal (EAC) overclosure was performed. A systematic review of the literature demonstrated 19 cases of spontaneous congenital perilabyrinthine CSF leaks. In total, 6 cases had multiple sources of CSF leak and 2 had history suggestive of intracranial hypertension. All of these noted cases demonstrated leak recurrence. Middle ear obliteration with EAC overclosure was successful in 4 recalcitrant cases. CONCLUSIONS Repair of spontaneous congenital perilabyrinthine CSF leaks in cases demonstrating multiple sources of egress or signs of intracranial hypertension should be approached with caution. Middle ear obliteration with EAC overclosure may provide the most definitive management option for these patients, particularly if initial attempt at primary repair is unsuccessful.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eric N Appelbaum
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Latifah Makoshi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA
| | | | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
OBJECTIVE To investigate the evolving prevalence of otosclerosis in a large urban population. METHODS A retrospective review of patients in a large, urban, public health system was conducted from January 2010 to August 2019 to identify subjects with otosclerosis. Diagnostic testing included audiometry and computed tomography scans. Sex, age at diagnosis, treatment received, race, ethnicity, and country of birth were analyzed for each subject and compared with all eligible patients in the reference population. RESULTS A total of 134 patients from a reference population of 672,839 were diagnosed with otosclerosis and analyzed. The otosclerosis patients were predominantly Hispanic (73%), of which the majority were foreign born (87%). The average age at onset was 46 years and 59% were women. The overall prevalence of otosclerosis was 20 of 100,000 patients. The crude prevalence of otosclerosis by ethnicity was 43 of 100,000 for Hispanics, 12.6 of 100,000 for Caucasians, and 3 of 100,000 for African Americans. Within the Hispanic population, the prevalence of otosclerosis was 60 of 100,000 for foreign-born individuals and 16 of 100,000 for those born in the USA (odds ratio [OR] = 3.69, [95% confidence interval [CI], 2.02-6.76], p < 0.0001). Prevalence was not significantly different among Caucasians and US-born Hispanics. CONCLUSION Otosclerosis in the studied population was most common among Hispanic patients, though it was strongly influenced by country of birth. The "imported" otosclerosis cases are best explained by environmental influence rather than ethnic susceptibility. This discrepancy is likely due to variance in measles immunization rates among North and Central American countries before 1990.
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Affiliation(s)
- Jonathan S Choi
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine
| | - Alex D Sweeney
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine
| | - Ibrahim Alava
- Department of Otorhinolaryngology, University of Texas Medical School at Houston
| | - Benjamin D Lovin
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine
| | - Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine
| | - Eric N Appelbaum
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine
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14
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Choi JS, Yu J, Lovin BD, Chapel AC, Patel AJ, Gallagher KK. Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database. Skull Base Surg 2020; 83:76-81. [DOI: 10.1055/s-0040-1716676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Abstract
Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database.
Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients.
Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing.
Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.
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Affiliation(s)
- Jonathan S. Choi
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Justin Yu
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Benjamin D. Lovin
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Alyssa C. Chapel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Akash J. Patel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - K. Kelly Gallagher
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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15
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Lindquist NR, Stapp M, Choi JS, Lovin BD, Sweeney AD. Cochlear implantation after traumatic brain injury without otic capsule fracture: A case report and literature review. Am J Otolaryngol 2020; 41:102512. [PMID: 32471775 DOI: 10.1016/j.amjoto.2020.102512] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to report a case of cochlear implantation (CI) for a patient with an otic capsule-sparing traumatic brain injury (TBI) and to review the relevant literature. METHODS A patient with history of TBI received a CI for bilateral profound hearing loss. A systematic review of the literature was performed to identify and compare similar cases. RESULTS A 36-year-old male with a history of hearing loss from right acute labyrinthitis was referred for bilateral profound sensorineural hearing loss (SNHL) after a fall with associated injury to the central auditory nervous system (CANS) including the brainstem. On the right, behavioral acoustic threshold measurements were in the profound range with absent OAEs. On the left, testing revealed no measurable behavioral acoustic thresholds and variable physiologic measures. A right unilateral cochlear implant was performed with most recent follow-up demonstrating speech awareness thresholds of 25 dB HL with excellent detection of all 6 Ling sounds. However, the patient also continues to suffer from other neurologic sequelae related to his TBI, which challenge his ability to demonstrate objective and subjective benefit. A systematic review of the literature demonstrates variable outcomes for patients with TBI and SNHL. CONCLUSIONS Patients with profound SNHL and TBI present a distinct rehabilitative challenge for clinicians. CI may provide meaningful benefit in this population, though care should be taken in patient selection and counseling.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Michaela Stapp
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan S Choi
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Benjamin D Lovin
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Otolaryngology, Texas Children's Hospital, Houston, TX, USA.
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16
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Lovin BD, Clinger JD. Bone wax-induced recurrent frontal sinusitis after skull base surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:120-121. [PMID: 32446646 DOI: 10.1016/j.anorl.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 10/24/2022]
Affiliation(s)
- B D Lovin
- Department of Otolaryngology, Baylor College of Medicine, 1, Baylor Plaza, Houston, TX, 77030, USA.
| | - J D Clinger
- Department of Otolaryngology, Wake Forest School of Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA
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Lovin BD, Yu J, Choi JS, Patel AJ, Giannoni CM, Gallagher KK. Outcomes in Pediatric Transsphenoidal Pituitary Surgery Stratified by the Use of Image Guidance: An Analysis of the Kids' Inpatient Database from 1997 to 2016. J Neurol Surg B Skull Base 2020; 82:e45-e50. [PMID: 34306916 DOI: 10.1055/s-0040-1701602] [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: 06/21/2019] [Accepted: 12/24/2019] [Indexed: 10/24/2022] Open
Abstract
Background To evaluate the utilization of image guidance technology for pediatric transsphenoidal pituitary resection (TSPR) and analyze the complication rates, length of stay (LOS), and total cost for such surgeries as function of time and utilization of image guidance. Methods The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) was queried for all cases of TSPR between 1997 and 2016. Factors extracted included patient demographics, use of image guidance, LOS, total cost, and complications, including panhypopituitarism, diabetes insipidus (DI), cerebrospinal fluid (CSF) rhinorrhea, and cranial nerve (CN) III, IV, and VI palsies. Multivariate logistic regression was utilized to determine the odds ratio of developing panhypopituitarism, DI, CSF rhinorrhea, and CN palsies for image-guided versus nonimage-guided cases. A generalized linear model was used to determine the effect of image guidance on inflation-adjusted total cost and LOS. Results A total of 1,297 cases of TSPR were included in the KID over this time period. The majority were female, Caucasian, and older than 15 years. Utilization of image guidance has rapidly increased since 2006. Complication rates were comparable, but when controlling for other factors, the use of image guidance showed a lower risk of postoperative DI ( p = 0.05). The use of image guidance also resulted in a shorter LOS by 2.84 days ( p < 0.001) with no associated increase in total cost ( p = 0.663). Conclusion The use of imaging guidance for pediatric TSPR has precipitously increased in recent years, as it is cost-effective, decreases LOS, and may lead to lower complication rates, such as DI.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Justin Yu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Jonathan S Choi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J Patel
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Carla M Giannoni
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - K Kelly Gallagher
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
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18
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Fitzpatrick TH, Lovin BD, Magister MJ, Waltonen JD, Browne JD, Sullivan CA. Surgical management of Eagle syndrome: A 17-year experience with open and transoral robotic styloidectomy. Am J Otolaryngol 2020; 41:102324. [PMID: 31767138 DOI: 10.1016/j.amjoto.2019.102324] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/25/2019] [Indexed: 11/28/2022]
Abstract
Eagle Syndrome (ES) is a rare disorder that can present with symptoms ranging from globus sensation to otalgia that is attributed to an elongated styloid process and/or calcified stylohyoid ligament. No standardized treatment algorithm exists, and although various surgical approaches have been described, data on the use of transoral robotic surgery (TORS) in this population is limited. To investigate the utility of TORS in the treatment of ES, a retrospective review in 19 ES patients was carried out at a single academic, tertiary medical center between 2000 and 2017. Nineteen patients underwent twenty-one styloid resections: 6 performed via TORS and 15 via transcervical approach. Across all patients, 90% reported some degree of lasting improvement in symptoms while 55% reported significant improvement. When TORS was compared to transcervical resection, there was no difference in the subjective rate of "meaningful" (83 vs. 57%) versus rate of "non-meaningful" symptom improvement (17 vs. 43%) (p = 0.35). There was a trend towards less estimated blood loss (EBL), operative time, and post-operative length of stay (LOS) with TORS versus transcervical cases (9.2 mL vs. 30.0 mL, 98 vs. 156 min, and 0.7 vs. 1.2 days); however, these did not reach statistical significance (p = .11, 0.13, and 0.42, respectively). Three patients experienced complications associated with an open approach, as compared to none with TORS. In select patients, TORS styloidectomy is a reasonable surgical alternative to traditional transoral and transcervical techniques as it provides similar symptom improvement, and reduced length of stay, blood loss, and operative time.
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Affiliation(s)
- Thomas H Fitzpatrick
- Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA.
| | - Benjamin D Lovin
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, One Baylor Plaza, Houston, TX 77030, USA.
| | - Marcus J Magister
- Wake Forest University Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Joshua D Waltonen
- Wake Forest University Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - J Dale Browne
- Wake Forest University Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Christopher A Sullivan
- Wake Forest University Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Choi JS, Sansoni ER, Lovin BD, Lindquist NR, Phan J, Mayo LL, Ferrarotto R, Su SY. Abscopal Effect Following Immunotherapy and Combined Stereotactic Body Radiation Therapy in Recurrent Metastatic Head and Neck Squamous Cell Carcinoma: A Report of Two Cases and Literature Review. Ann Otol Rhinol Laryngol 2019; 129:517-522. [PMID: 31875405 DOI: 10.1177/0003489419896602] [Citation(s) in RCA: 14] [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] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We present two patients with recurrent, metastatic head and neck squamous cell carcinoma (R/M HNSCC) after platinum-based chemotherapy and radiotherapy (RT) with complete response via abscopal effect following combined immunotherapy (IT) and stereotactic body radiation therapy (SBRT). We review the literature for patients undergoing combined treatment with IT and RT to identify potential cases of abscopal response. STUDY DESIGN This is a case series with a contemporary review of the literature. METHODS Retrospective chart review identified two patients with potential abscopal responses after IT and RT for R/M HNSCC. The MEDLINE database was queried using the search terms "abscopal AND head and neck squamous cell carcinoma" and "immunotherapy AND stereotactic body radiation therapy." RESULTS Two patients with metastatic HNSCC developed complete responses via a possible abscopal effect following combined SBRT and IT. Interim follow-up of both patients revealed a sustained, complete response. We examine the immunogenic effects of RT and report the first cases of potential abscopal effect for R/M HNSCC. We also review several preclinical studies demonstrating the synergistic efficacy of combined RT and IT with a discussion of possible mechanism. CONCLUSION Observation of abscopal effect with combined IT and RT is currently under investigation through several preclinical studies and trials. To the best of our knowledge, these are the first two reported cases of abscopal effect for patients with HNSCC. We report two patients with R/M HNSCC with sustained, complete response after systemic IT and local RT.
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Affiliation(s)
- Jonathan S Choi
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eugene R Sansoni
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Lovin
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren L Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lovin BD, Gidley PW. Squamous cell carcinoma of the temporal bone: A current review. Laryngoscope Investig Otolaryngol 2019; 4:684-692. [PMID: 31890889 PMCID: PMC6929568 DOI: 10.1002/lio2.330] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 09/12/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The rarity of temporal bone squamous cell carcinoma (TBSCC) precludes a clear understanding of the disease and approach to its management. This review provides general background on the disease and discusses the current and emerging oncologic and rehabilitative management options. DATA SOURCES PubMed literature review. METHODS A review of the current literature was conducted to assess and collate up-to-date information regarding TBSCC management. RESULTS TBSCC is a rare and aggressive disease arising in the ear canal, temporal bone, or extratemporal sites. Prior radiation, chronic ear disease, or habitual ear picking may contribute to primary disease development. Because the symptoms of TBSCC and benign otologic disease are similar, TBSCC diagnosis may be delayed, allowing the tumor time to spread throughout the anatomically intricate temporal bone. The extent of the disease is determined based on imaging and is usually staged with the Pittsburgh Staging System. Temporal bone resection with parotidectomy and neck dissection is the current standard of care. Survival is generally good for early disease and poor for advanced disease, but chemotherapy is emerging as a promising treatment option. Auditory rehabilitation with osseointegrated hearing aids is recommended at initial oncologic resection. CONCLUSIONS The knowledge of and outcomes for TBSCC have improved with time, but because of the aggressive nature of the disease and the anatomic intricacy of the temporal bone, TBSCC treatment is complex and should be delivered by a multidisciplinary team. Inter-institutional collaboration may accelerate research for this rare disease. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Benjamin D. Lovin
- Bobby R. Alford Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexas
| | - Paul W. Gidley
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexas
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Choi JS, Lovin BD. Infections of the ear, nose, throat, and sinuses. By Marlene L.Durand, Daniel G.Deschler. Springer, New York City, NY. 2018. $199.00 US. 404 pp. Head Neck 2019. [DOI: 10.1002/hed.25835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jonathan S. Choi
- Department of OtolaryngologyBaylor College of Medicine Houston Texas
| | - Benjamin D. Lovin
- Department of OtolaryngologyBaylor College of Medicine Houston Texas
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Lovin BD, Gitomer SA, Gallagher KK. Facial Cellulitis and Sinonasal Necrotizing Infection in a Middle-aged Woman. JAMA Otolaryngol Head Neck Surg 2019; 145:576-577. [PMID: 30998828 DOI: 10.1001/jamaoto.2019.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Sarah A Gitomer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - K Kelly Gallagher
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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