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Coon A, Setzen G, Musah RA. Mass Spectrometric Interrogation of Earwax: Toward the Detection of Ménière's Disease. ACS Omega 2023; 8:27010-27023. [PMID: 37546591 PMCID: PMC10399190 DOI: 10.1021/acsomega.3c01943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 08/08/2023]
Abstract
Many diseases remain difficult to identify because the occurrence of characteristic biomarkers within traditional matrices such as blood and urine remain unknown. Disease diagnosis could, therefore, benefit from the analysis of readily accessible, non-traditional matrices that have a high chemical content and contain distinguishing biomarkers. One such matrix is cerumen (i.e., earwax), whose chemical complexity can pose challenges when analyzed by conventional methods. A combination of cerumen chemical profiles analyzed by gas chromatography-mass spectrometry (GC-MS) and direct analysis in real time-high-resolution mass spectrometry (DART-HRMS) were investigated to ascertain the possible presence of the rare otolaryngological disorder Ménière's disease. This illness is currently identified via "diagnosis by exclusion" in which the disease is distinguished from others with overlapping symptoms by the process of elimination. GC-MS revealed a chemical profile difference between those with and without a Ménière's disease diagnosis by a visually apparent diminution of the compounds present in the Ménière's disease samples. DART-HRMS revealed that the two classes could be differentiated using three fatty acids: cis-9-hexadecenoic acid, cis-10-heptadecenoic acid, and cis-9-octadecenoic acid. These compounds were subsequently quantified by GC-MS and overall, the amounts of these fatty acids were decreased in Ménière's disease patients. The average levels for non-Ménière's disease samples were 7.89 μg/mg for cis-9-hexadecenoic acid, 0.87 μg/mg for cis-10-heptadecenoic acid, and 4.94 μg/mg for cis-9-octadecenoic acid. The average levels for Ménière's disease samples were 1.70 μg/mg for cis-9-hexadecenoic acid, 0.13 μg/mg for cis-10-heptadecenoic acid, and 2.07 μg/mg for cis-9-octadecenoic acid. The confidence levels for cis-9-hexadecenoic acid, cis-10-heptadecenoic acid, and cis-9-octadecenoic acid were 98.7%, 99.9%, and 95.4%, respectively. The results suggest that assessment of the concentrations of these fatty acids could be a useful clinical tool for the more rapid and accurate detection of Ménière's disease.
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Affiliation(s)
- Allix
Marie Coon
- Department
of Chemistry, University at Albany, State
University of New York, 1400 Washington Avenue, Albany, New York 12222, United States
| | - Gavin Setzen
- Albany
ENT and Allergy Services, 123 Everett Rd, Albany, New York 12205, United States
| | - Rabi Ann Musah
- Department
of Chemistry, University at Albany, State
University of New York, 1400 Washington Avenue, Albany, New York 12222, United States
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Coon A, Dane AJ, Setzen G, Cody RB, Musah RA. Two-Dimensional Gas Chromatographic and Mass Spectrometric Characterization of Lipid-Rich Biological Matrices-Application to Human Cerumen (Earwax). ACS Omega 2022; 7:230-239. [PMID: 35036695 PMCID: PMC8756784 DOI: 10.1021/acsomega.1c04535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Earwax is a readily accessible biological matrix that has the potential to be used in disease diagnostics. However, its semisolid nature and high chemical complexity have hampered efforts to investigate its potential to reveal disease markers. This is because more conventional methods of analysis such as gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry yield unsatisfactory results due to the presence of many nonvolatile and/or coeluting compounds, which in some cases have very similar mass spectrometric profiles. In addition, these routine methods often require the sample to be saponified, which dramatically increases the complexity of the analysis and makes it difficult to determine which compounds are actually present versus those that are produced by saponification. In this study, two-dimensional GC mass spectrometry (GC × GC-MS) was successfully applied for the characterization of the chemical components of earwax from healthy donors using nonpolar (primary) and midpolar (secondary) columns without saponification. Over 35 of the compounds that were identified are reported for the first time to be detected in unsaponified earwax. The resulting GC × GC-MS contour plots revealed visually recognizable compound class clusters of previously reported groups including alkanes, alkenes, fatty acids, esters, triglycerides, and cholesterol esters, as well as cholesterol and squalene. The application of GC × GC-MS revealed results that provide a foundation upon which future studies aimed at comparing healthy donor earwax to that from individuals exhibiting various disease states can be accomplished.
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Affiliation(s)
- Allix
M. Coon
- Department
of Chemistry, State University of New York
at Albany, 1400 Washington
Avenue, Albany, New York 12222, United States
| | - A. John Dane
- JEOL
USA Inc., 11 Dearborn Rd, Peabody, Massachusetts 01960, United States
| | - Gavin Setzen
- Albany
ENT and Allergy Services, 123 Everett Rd, Albany, New York 12205, United
States
| | - Robert B. Cody
- JEOL
USA Inc., 11 Dearborn Rd, Peabody, Massachusetts 01960, United States
| | - Rabi A. Musah
- Department
of Chemistry, State University of New York
at Albany, 1400 Washington
Avenue, Albany, New York 12222, United States
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3
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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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4
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Setzen M, Svider PF, Setzen S, Setzen G, Eloy JA, Johnson AP. The novel corona virus and rhinology: Impact on practice patterns and future directions. Am J Otolaryngol 2020; 41:102569. [PMID: 32683188 PMCID: PMC7263239 DOI: 10.1016/j.amjoto.2020.102569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
Objectives To evaluate the impact of the novel coronavirus pandemic on practice patterns, clinical behavior, personal health, and emotional/psychological concerns of rhinologists. Methods A 15-question survey was sent out to the American Rhinologic Society's (ARS) membership to determine the impact of COVID-19 during the crisis. Demographic factors and practice patterns were collected and evaluated. Results There were 224 total respondents out of 835 ARS members queried (26.8% response rate). Study queries were sent in April 2020. Notably, 17.8% reported illness in themselves or their staff and 74.4% noted a psychological/emotional impact. A plurality of rhinologists noted their practice volume and in-office procedure volume has become 20.0% and 0.0% of their prior volumes, respectively. In addition, 96.2% were noted to be using telemedicine in our subspecialty. Conclusion In addition to severely impacting volume and the perception of future decreases in patients and revenue, the COVID-19 pandemic has had a physical and emotional impact on rhinologists in ways that need to be further studied. These data include significantly novel and objective information. The COVID-19 crisis also reveals the important role of telemedicine in rhinology. Guidelines regarding personal protective equipment for in-office visits, nasal endoscopy, and other in-office and operating room procedures would be particularly helpful as future waves are expected.
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Whitehead MT, Cardenas AM, Corey AS, Policeni B, Burns J, Chakraborty S, Crowley RW, Jabbour P, Ledbetter LN, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shih RY, Subramaniam RM, Utukuri PS, Bykowski J. ACR Appropriateness Criteria® Headache. J Am Coll Radiol 2020; 16:S364-S377. [PMID: 31685104 DOI: 10.1016/j.jacr.2019.05.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/20/2022]
Abstract
Headache is one of the most common human afflictions. In most cases, headaches are benign and idiopathic, and resolve spontaneously or with minor therapeutic measures. Imaging is not required for many types of headaches. However, patients presenting with headaches in the setting of "red flags" such as head trauma, cancer, immunocompromised state, pregnancy, patients 50 years or older, related to activity or position, or with a corresponding neurological deficit, may benefit from CT, MRI, or noninvasive vascular imaging to identify a treatable cause. This publication addresses the initial imaging strategies for headaches associated with the following features: severe and sudden onset, optic disc edema, "red flags," migraine or tension-type, trigeminal autonomic origin, and chronic headaches with and without new or progressive features. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Amanda S Corey
- Panel Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Bruno Policeni
- Panel Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - R Webster Crowley
- Rush University Medical Center, Chicago, Illinois, Neurosurgery expert
| | - Pascal Jabbour
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, Neurosurgery expert
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, American Academy of Neurology
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York, American Academy of Otolaryngology-Head and Neck Surgery
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, University of California San Diego Health Center, San Diego, California
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6
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Harrill WC, Setzen G, Farquhar D, Pillsbury HC. Contemporary analysis of otolaryngic allergy. Laryngoscope 2019; 130:283-289. [PMID: 30982993 DOI: 10.1002/lary.28002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Investigate the current trends in otolaryngic allergy (OA). STUDY DESIGN Cross-sectional survey. METHODS Survey of active AAOA membership. RESULTS Response rate was 27.3%. Regional response distribution rates were proportional to the AAOA membership distribution within the United States (R2 = 0.95; P < 0.001), with no significant regional response bias demonstrated (P = 0.428). Self-reported duration to OA competency was 5.8 years. Physicians reporting OA competency were more likely to be board-certified (P < 0.001) and have AAOA fellowship status (P < 0.001). The AAOA was reported to be the most valuable educational resource toward achieving OA competency, with residency training being least valuable (P < 0.001). 91.5% of respondents' practices offered OA services. Subcutaneous injections predominated at twice the utilization of sublingual immunotherapy. Allergy immunotherapy tablets were rarely utilized. Home allergy shots were offered by 45.2% of respondents. In-office immunotherapy vial compounding was preferred (95.8%) to third-party vendors. 94% of AAOA respondents identified patient compliance to be an issue within OA. Non-inhalant allergy service integration included food allergy (63.5%), asthma (44.9%), allergic fungal sinusitis (43.8%), penicillin allergy (18%), stinging insect allergy (12.6%), and aspirin desensitization (3.9%). CONCLUSION Reported duration to OA competency after residency was surprisingly long. Further investigation of current and future educational/clinical training is warranted given clinical integration reported for OA. Otolaryngology is in the unique position to develop a comprehensive sino-allergy evidence-based strategy integrating the extensive diagnostic and medical treatment arms alongside the surgical expertise of the specialty within a clinical sino-allergy home concept. LEVEL OF EVIDENCE 5 Laryngoscope, 130:283-289, 2020.
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Affiliation(s)
- Willard C Harrill
- Carolina Ear, Nose & Throat/Sinus and Allergy Center, PA, Hickory, North Carolina, U.S.A.,Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Douglas Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
| | - Harold C Pillsbury
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
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Tekes A, Palasis S, Durand DJ, Pruthi S, Booth TN, Desai NK, Jones JY, Kadom N, Lam HFS, Milla SS, Mirsky DM, Partap S, Robertson RL, Ryan ME, Saigal G, Setzen G, Soares BP, Trout AT, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Sinusitis-Child. J Am Coll Radiol 2018; 15:S403-S412. [DOI: 10.1016/j.jacr.2018.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022]
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8
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Kennedy TA, Corey AS, Policeni B, Agarwal V, Burns J, Harvey HB, Hoang J, Hunt CH, Juliano AF, Mack W, Moonis G, Murad GJ, Pannell JS, Parsons MS, Powers WJ, Schroeder JW, Setzen G, Whitehead MT, Bykowski J. ACR Appropriateness Criteria® Orbits Vision and Visual Loss. J Am Coll Radiol 2018; 15:S116-S131. [PMID: 29724415 DOI: 10.1016/j.jacr.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/22/2023]
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Farrell MB, Lally M, Merrill N, Pizzutiello R, Setzen G, Choi JY. Effect of Facility IAC-Accreditation on CT Dose Awareness and Reduction. Radiol Technol 2017; 88:472-480. [PMID: 28500090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/08/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess characteristics of computed tomography (CT) facilities accredited by the Intersocietal Accreditation Commission (IAC) and evaluate the perceived effect of accreditation on CT radiation dose awareness and reduction. METHODS IAC-accredited CT facilities were sent a survey in April 2016, which included 20 questions categorized into 5 groups: equipment and facility (7), patient safety/practice (5), protocols (2), dose reduction practice (3), and quality improvement (3). RESULTS The response rate was 20.7% (N = 607). A majority of facilities (80%) reported that radiation dose was adjusted based on patient size. Before undergoing accreditation, 79% of facilities reported annual review of CT protocols and radiation exposure. Following accreditation, that number increased to 93%. A majority (77%) of respondents indicated that the accreditation process, along with the IAC Standards and Guidelines, increased awareness of radiation exposure; in addition, 36% indicated that radiation doses were lower after undertaking accreditation. DISCUSSION This study demonstrated that most IAC-accredited facilities followed recommended radiation safety practices by adjusting radiation dose based on patient size, reviewing protocols annually, and participating in quality improvement activities that focus on patient radiation exposure. CONCLUSION IAC-accredited facilities reported that the accreditation process had a positive effect on radiation dose awareness and reduced dose associated with CT examinations.
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Farrell MB, Zhao A, Heller G, Setzen G. Do ENT outpatient computed tomography facilities perceive accreditation as valuable? Ear Nose Throat J 2016; 95:364-367. [PMID: 27657312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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Contrera KJ, Ishii LE, Setzen G, Berkowitz SA. Accountable Care Organizations and Otolaryngology. Otolaryngol Head Neck Surg 2015; 153:170-4. [PMID: 26044787 DOI: 10.1177/0194599815587509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 02/26/2015] [Accepted: 04/28/2015] [Indexed: 11/17/2022]
Abstract
Accountable care organizations represent a shift in health care delivery while providing a significant potential for improved quality and coordination of care across multiple settings. Otolaryngologists have an opportunity to become leaders in this expanding arena. However, the field of otolaryngology-head and neck surgery currently lacks many of the tools necessary to implement value-based care, including performance measurement, electronic health infrastructure, and data management. These resources will become increasingly important for surgical specialists to be active participants in population health. This article reviews the fundamental issues that otolaryngologists should consider when pursuing new roles in accountable care organizations.
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Affiliation(s)
- Kevin J Contrera
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gavin Setzen
- Albany ENT & Allergy Services PC and Albany Medical College, Albany, New York, USA
| | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University, and Accountable Care, Office of Johns Hopkins Physicians, Baltimore, Maryland, USA
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Batra PS, Setzen M, Li Y, Han JK, Setzen G. Computed tomography imaging practice patterns in adult chronic rhinosinusitis: survey of the American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society membership. Int Forum Allergy Rhinol 2015; 5:506-12. [PMID: 25907412 DOI: 10.1002/alr.21483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 09/07/2014] [Revised: 12/08/2014] [Accepted: 12/16/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of this study was to assess the current practice patterns of computed tomography (CT) imaging for diagnosis and management of adult chronic rhinosinusitis (CRS). METHODS A 29-item, electronic, Web-based physician survey was disseminated to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and American Rhinologic Society (ARS) membership from November 2012 to January 2013. RESULTS A total of 331 otolaryngologists completed the survey. Seventy-five percent of respondents did not obtain confirmatory CT imaging prior to initiating medical therapy for CRS. A typical diagnostic scan was considered to be a 3-mm coronal CT with or without 3-mm axial images for 50.6% of participants. On average, the respondents obtained 1 (58.8%) or 2 (36.6%) CT scans prior to proceeding with sinus surgery. CT scanning was most commonly performed in a hospital radiology department (76.4%), followed by a free-standing imaging center (44.5%). An in-office CT scanner was owned by 24.5% of the respondents, mostly commonly a cone beam CT (74.0%) scanner. Most respondents (87.1%) did not experience problems with carriers denying ability to image or reimbursing for scans. Overall, 68.4% of the respondents were unaware of the dosage of radiation delivered by the scanner used for CT acquisition. CONCLUSION This survey provides a snapshot of the current utility of CT imaging in the management paradigm for CRS. Given that most are unaware of the delivered radiation dose, this clearly represents an important area of improvement in the knowledge gap.
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Affiliation(s)
- Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | | | - Yan Li
- Bioinformatics, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Joseph K Han
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
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13
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Navaie M, Sharghi LH, Cho-Reyes S, Keefe MA, Howie BA, Setzen G. Diagnostic Approach, Treatment, and Outcomes of Cervical Sympathetic Chain Schwannomas. Otolaryngol Head Neck Surg 2014; 151:899-908. [DOI: 10.1177/0194599814549550] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective This review examined the diagnostic approach, surgical treatment, and outcomes of cervical sympathetic chain schwannomas (CSCS) to guide clinical decision making. Data Sources Medline, EMBASE, and Cochrane databases. Review Methods A literature review from 1998 to 2013 identified 156 articles of which 51 representing 89 CSCS cases were evaluated in detail. Demographic, clinical, and outcomes data were extracted by 2 independent reviewers with high interrater reliability (κ = .79). Cases were mostly international (82%), predominantly from Asia (50%) and Europe (27%). Conclusions On average, patients were 42.6 years old (SD = 13.3) and had a neck mass ranging between 2 to 4 cm (52.7%) or >4 cm (43.2%). Nearly 70% of cases were asymptomatic at presentation. Presurgical diagnosis relied on CT (63.4%), MRI (59.8%), or both (19.5%), supplemented by cytology (33.7%), which was nearly always inconclusive (96.7%). US-treated cases were significantly more likely to receive presurgical MRI than internationally treated cases but less likely to have cytology ( P < .05). Presurgical diagnosis was challenging, with only 11% confirmatory accuracy postsurgically. Irrespective of mass size, extracapsular resection (ie, complete resection with nerve sacrifice) was the most frequently (87.6%) performed surgical procedure. Common postsurgical adverse events included Horner’s syndrome (91.1%), first bite syndrome (21.1%), or both (15.7%), with higher prevalence when mass size was >4 cm. Adverse events persisted in 82.3% of cases at an average 30.0 months (SD = 30.1) follow-up time. Implications for Practice Given the typical CSCS patient is young and asymptomatic and the likelihood of persistent morbidity is high with standard surgical approaches, less invasive treatment options warrant consideration.
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Affiliation(s)
- Maryam Navaie
- Advance Health Solutions LLC, Boston, Massachusetts, USA
| | | | | | | | | | - Gavin Setzen
- Albany ENT & Allergy Services PC, Albany, New York, USA
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14
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Setzen G, Keefe MA, Sharghi LH, Cho-Reyes S, Howie BA, Navaie M. Cervical Sympathetic Chain Schwannomas: A Global Systematic Review Provides Insight on Diagnosis, Treatment, and Outcomes. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a68] [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: Systematically evaluate the diagnosis, treatment, and outcomes of globally published cases of cervical sympathetic chain schwannomas (CSCS) to guide clinical decision making. Methods: Using Medline, EMBASE, and Cochrane databases, 89 CSCS case reports/series were identified from 1997 to 2013. Most cases were treated internationally (82%), predominantly in Asia (50%) and Europe (27%). Demographic, clinical, and outcomes data were extracted by 2 independent reviewers with high interrater reliability (k = 0.79). P < .05 denoted statistical significance. Results: On average, patients were 42.6 years old (SD = 13.3) and had a 2 to 4-cm (52.7%) or >4-cm (43.2%) neck mass. Nearly 70% of cases were asymptomatic. Presurgical diagnosis relied heavily on computed tomography (63.4%), magnetic resonance imaging (MRI; 59.8%), or both (20%), supplemented by cytology (47.6%). US-treated cases were significantly more likely to receive pre-surgical MRI than internationally treated cases, but less likely to have cytology or histopathology ( P < .05). Presurgical diagnosis accuracy was only 11% as confirmed postsurgically. Extracapsular (complete) resection was more commonly performed than intracapsular resection (87.6%), irrespective of mass size and treatment country. Postsurgical adverse events (AEs) were more common with the extracapsular approach and when mass size was >4 cm. Reported AEs included Horner’s syndrome (89.9%), First Bite syndrome (21.1%), or both (15.7%). AEs persisted in 81.1% of cases, with 28.8 months (SD = 27.1) average follow-up time. Conclusions: Given the typical CSCS patient is young and asymptomatic, presurgical diagnostic accuracy is very low, and the likelihood of persistent postsurgical morbidity is high with aggressive extracapsular surgery, less invasive approaches to differentially manage CSCS are warranted.
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Lee KJ, Das S, Dillon JT, Nielsen DR, Setzen G. The Role of Otolaryngologists in the Accountable Care Organization: Pros and Cons. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a7] [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
Program Description: There are many questions about the role of otolaryngologists in an Affordable Care Organization (ACO). Our team of experts from private practice to academia, from administration to technology, will engage the audience. We will incorporate content that focuses on patient care, quality improvement, and access. We will welcome questions and advice from the audience. Educational Objectives: (1) Make an informed decision whether to join or not to join an ACO. (2) Recognize the pros and cons to such a decision. (3) Manage the risk involved in this decision.
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Navaie M, Sharghi LA, Keefe MA, Howie BA, Cho-Reyes S, Setzen G. Differential diagnosis challenges, treatment patterns, and adverse outcomes for a rare head and neck neoplasm: A global systematic review of cervical sympathetic chain schwannomas. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17020] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Michael A. Keefe
- Department of Otolaryngology, Head and Neck Surgery, Sharp Rees-Stealy Medical Group, San Diego, CA
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Platt MP, Setzen G, Grillone GA, Rebeiz EE, Song P, Chong CD, Tunkel DE. Scary Cases 2013. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a31] [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
Program Description: The Scary Cases 2013 miniseminar uses a case-based, interactive approach to education in patient care and limiting risk. Cases presented by well-known experts and community-based clinicians will focus on what could go wrong or has gone wrong in the management of otolaryngology patients. Each expert will present a specific case that was difficult to manage, had unexpected morbidity, or resulted in litigation. Attendees will participate with an audience response system for key decisions during the case. Difficult cases are often great sources of learning. This miniseminar will provide education on how to anticipate and avoid unwanted outcomes. Educational Objectives: 1) Identify pitfalls that may lead to adverse outcomes or put patients at risk. 2) Diagnose certain otolaryngologic conditions that can easily go undetected. 3) Evaluate the management of cases with high potential for malpractice litigation.
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Setzen G, Ferguson BJ, Han JK, Rhee JS, Cornelius RS, Froum SJ, Gillman GS, Houser SM, Krakovitz PR, Monfared A, Palmer JN, Rosbe KW, Setzen M, Patel MM. Clinical Consensus Statement. Otolaryngol Head Neck Surg 2012; 147:808-16. [DOI: 10.1177/0194599812463848] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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
Objective To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease. Subjects and Methods A modified Delphi method was used to refine expert opinion and reach consensus by the panel. Results After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy. The statements that reached consensus were grouped into 4 categories: pediatric sinusitis, medical management, surgical planning, and complication of sinusitis or sinonasal tumor. The panel unanimously agreed with 13 of the 33 statements. In addition, at least 75% of the panel strongly agreed with 14 of 33 statements across all of the categories. Conclusions For children, careful consideration should be taken when performing CT imaging but is needed in the setting of treatment failures and complications, either of the pathological process itself or as a result of iatrogenic (surgical) complications. For adults, imaging is necessary in surgical planning, for treatment of medical and surgical complications, and in all aspects of the complete management of patients with sinonasal and skull base pathology.
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Affiliation(s)
- Gavin Setzen
- Albany ENT & Allergy Services, Albany, New York, USA
| | | | - Joseph K. Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - John S. Rhee
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Grant S. Gillman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Ashkan Monfared
- George Washington University School of Medicine, Washington, DC, USA
| | - James N. Palmer
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristina W. Rosbe
- University of California, San Francisco, San Francisco, California, USA
| | - Michael Setzen
- Michael Setzen Otolaryngology PC, Great Neck, New York, USA
| | - Milesh M. Patel
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown CA, Brandt C, Deakins K, Hartnick C, Merati A. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 2012; 148:6-20. [PMID: 22990518 DOI: 10.1177/0194599812460376] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This clinical consensus statement (CCS) aims to improve care for pediatric and adult patients with a tracheostomy tube. Approaches to tracheostomy care are currently inconsistent among clinicians and between different institutions. The goal is to reduce variations in practice when managing patients with a tracheostomy to minimize complications. METHODS A formal literature search was conducted to identify evidence gaps and refine the scope of this consensus statement. The modified Delphi method was used to refine expert opinion and facilitate a consensus position. Panel members were asked to complete 2 scale-based surveys addressing different aspects of pediatric and adult tracheostomy care. Each survey was followed by a conference call during which results were presented and statements discussed. RESULTS The panel achieved consensus on 77 statements; another 39 were dropped because of lack of consensus. Consensus was reached on statements that address initial tracheostomy tube change, management of emergencies and complications, prerequisites for decannulation, management of tube cuffs and communication devices, and specific patient and caregiver education needs. CONCLUSION The consensus panel agreed on statements that address the continuum of care, from initial tube management to complications in children and adults with a tracheostomy. The panel also highlighted areas where consensus could not be reached and where more research is needed. This consensus statement should be used by physicians, nurses, and other stakeholders caring for patients with a tracheostomy.
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Affiliation(s)
- Ron B Mitchell
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas 75207, USA.
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Setzen G, Rhee JS, Ferguson BJ, Han J. Clinical Consensus Statement: Appropriate Use of Computed Tomography for Paranasal Sinus Disease. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415818a77] [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
Program Description: The miniseminar will consist of a lively panel discussion on the newly developed AAO-HNS clinical consensus statement (CS) on the appropriate use of computed tomography (CT) for paranasal sinus disease. There is increasing scrutiny by government, health policy makers, and third-party payers, regarding issues of radiation safety and appropriate utilization with CT imaging. Unlike clinical practice guidelines that could encompass other disciplines, CSs produced by the AAO-HNS are focused on the specialty of otolaryngology-head and neck surgery. Because clinical evidence is lacking, the terms “evidence-based,” and “guideline” should not be used in the context of CSs. Nonetheless, the development panel has conducted a systematic review to ensure that the best available evidence is identified to support decisions, even if this evidence is limited to case series or previously published consensus documents. Educational Objectives: 1) Learn about the systematic review that was conducted to identify the best available evidence to support decisions on the appropriate use computed tomography (CT) for paranasal sinus disease. 2) Understand when it is most appropriate to use CT for paranasal sinus disease.
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22
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Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144:S1-30. [PMID: 21493257 DOI: 10.1177/0194599810389949] [Citation(s) in RCA: 664] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530,000 procedures performed annually in children younger than 15 years. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Depending on the context in which it is used, it may indicate tonsillectomy with adenoidectomy, especially in relation to sleep-disordered breathing. This guideline provides evidence-based recommendations on the preoperative, intraoperative, and postoperative care and management of children 1 to 18 years old under consideration for tonsillectomy. In addition, this guideline is intended for all clinicians in any setting who interact with children 1 to 18 years of age who may be candidates for tonsillectomy. PURPOSE The primary purpose of this guideline is to provide clinicians with evidence-based guidance in identifying children who are the best candidates for tonsillectomy. Secondary objectives are to optimize the perioperative management of children undergoing tonsillectomy, emphasize the need for evaluation and intervention in special populations, improve counseling and education of families of children who are considering tonsillectomy for their child, highlight the management options for patients with modifying factors, and reduce inappropriate or unnecessary variations in care. RESULTS The panel made a strong recommendation that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. The panel made a strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy. The panel made recommendations for (1) watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years; (2) assessing the child with recurrent throat infection who does not meet criteria in statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess; (3) asking caregivers of children with sleep-disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems; (4) counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing; (5) counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management; (6) advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain; and (7) clinicians who perform tonsillectomy should determine their rate of primary and secondary posttonsillectomy hemorrhage at least annually. The panel offered options to recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A β-hemolytic streptococcus.
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Affiliation(s)
- Reginald F Baugh
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
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Chennupati SK, Govindaraj S, Setzen G, Chiu AG. Adult Burkitt lymphoma originating in the sphenoid sinus: case report and review of the literature. Ear Nose Throat J 2009; 88:E07. [PMID: 19623516] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Burkitt lymphoma is a high-grade B-cell non-Hodgkin lymphoma. The endemic form of this malignancy occurs primarily in children aged 5 to 7 years, and it presents with jaw and facial bone involvement. The sporadic form affects older children (mean age: 12.2 yr) and often manifests as an abdominal mass; it rarely involves the head and neck. The presence of any type of lymphoma in the paranasal sinuses is rare. We report a case of Burkitt lymphoma that originated in the sphenoid sinus in a 66-year-old white woman. The patient presented with hypoesthesia in the left V1 and V2 distributions and frequent left-sided headaches. Imaging revealed that the destructive lesion had spread into the cavernous sinus and infratemporal fossa. Repeat imaging showed progression of the lesion in just 1 month. An endoscopic sphenoidotomy was performed to obtain a tissue specimen, and a diagnosis of sporadic Burkitt lymphoma was established on the basis of its clinical, morphologic, and immunohistochemical characteristics. The patient underwent chemotherapy and radiation. Short-term follow-up imaging showed that the lesion had disappeared, and the patient remained disease-free at 3 years of follow-up. This case is one of the few reported cases of true adult Burkitt lymphoma originating in the sphenoid sinus. We discuss the rapid progression of the disease and the considerable amount of invasion that can occur with minimal symptoms.
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Affiliation(s)
- Sri Kiran Chennupati
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA
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Shah UK, Smith GM, Devaiah A, Setzen G, Roth M, Reilly JS. Corporate-physician relationships: A need for education. Otolaryngol Head Neck Surg 2009; 140:283-7. [DOI: 10.1016/j.otohns.2008.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 10/23/2008] [Indexed: 10/21/2022]
Abstract
Knowledge is lacking among Otolaryngologist–Head and Neck Surgeons (ORL-HNS) regarding basic ethical situations in corporate-provider relationships. A pilot educational program demonstrates the need and potential for improvement by structured intervention. “At risk” areas specifically identified regard acceptable gifts, and payments for meetings and travel. Recommendations are made to educate otolaryngologists in standards for compliant behavior in corporate-physician relationships. Further work to formalize and tailor education to the needs of ORL-HNS is warranted, including continued education through the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF). A checklist is provided here as a first step in enabling more compliant behavior as surgeons engage in corporate relationships.
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Affiliation(s)
- Udayan K. Shah
- Division of Otolaryngology and Department of Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE
- Department of Otolaryngology–Head and Neck Surgery Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Gina M. Smith
- Ballard, Spahr, Andrews & Ingersoll, LLP, and National Judicial College, Philadelphia, PA
| | - Anand Devaiah
- Department of Otolaryngology Corporate Partner Program, Boston Medical Center and the Departments of Otolaryngology–Head and Neck Surgery and Neurological Surgery, Boston University School of Medicine, Boston, MA
| | - Gavin Setzen
- Albany ENT and Allergy Services, PC, and Albany Medical College, Albany, NY
| | - Maurice Roth
- Department of Otolaryngology–Head and Neck Surgery Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
- Drexel College of Medicine, Philadelphia, PA
| | - James S. Reilly
- Division of Otolaryngology and Department of Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE
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25
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Roth M, Shah UK, Smith GM, Mann E, Setzen G. Walking the Line: Staying Clean in Physician-Industry Relationships. Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
OBJECTIVES To present an unusual case of actinomycosis abscess of the thyroid gland as well as review the history, etiology, pathogenicity and treatment of actinomycosis infections of the head and neck. STUDY DESIGN Case study. METHODS A report of a 39 year-old female status post tooth extraction that developed an actinomycosis abscess of the thyroid. RESULTS After a thyroid actinomycosis abscess was suggested by physical exam, ultrasound, CT scan and needle aspiration, an otolaryngology consult was obtained. The patient successfully was managed with thyroidectomy and intravenous ceftriaxone. CONCLUSIONS Although Actinomycosis soft tissue infections of the head and neck are relatively uncommon, the head and neck surgeon must include it in the differential diagnosis when clinical presentation raises suspicion. Early biopsy is necessary for appropriate identification of the organism with the appearance of sulfur granules lending a clue to the diagnosis. Debridement and/or excision are often necessary for antibiotics to be used successfully. Antimicrobial therapy should be used for six to twelve months to completely eradicate the disease and prevent recurrence.
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Affiliation(s)
- John J Cevera
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center, 35 Hackett Boulevard, Albany, NY 12208, USA
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Abstract
PURPOSE To describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman. METHODS Interventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34. RESULTS The lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up. CONCLUSIONS Originally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.
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Affiliation(s)
- B Yazici
- Department of Ophthalmology, Albany Medical Center, New York, USA
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Abstract
We report the familial occurrence of acinic cell carcinoma involving the parotid gland, the first such report of which we are aware. The familial occurrence of any salivary gland neoplasm is rare. Several reports are present in the literature, including pleomorphic adenoma, Warthin tumor, carcinoma of the submandibular gland, and malignant lymphoepithelial lesion. We report the case of a 35-year-old man who underwent excision of a left parotid gland acinic cell carcinoma. Eight years later, his daughter presented at the age of 16 years with a nontender parotid gland mass that was excised and found also to be acinic cell carcinoma. The histologic features of both neoplasms were typical of acinic cell carcinoma. While this may represent a coincidental event, the possibility that this familial occurrence is a manifestation of common genetic or environmental risk cannot be excluded.
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Affiliation(s)
- P L Depowski
- Department of Pathology, Albany Medical College, NY 12208, USA
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Setzen G, Cacace AT, Eames F, Riback P, Lava N, McFarland DJ, Artino LM, Kerwood JA. Central deafness in a young child with Moyamoya disease: paternal linkage in a Caucasian family: two case reports and a review of the literature. Int J Pediatr Otorhinolaryngol 1999; 48:53-76. [PMID: 10365973 DOI: 10.1016/s0165-5876(99)00004-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A case of 'central deafness' is presented in a 3-year-old male Caucasian child with Moyamoya disease (MMD); a rare, progressive and occlusive cerebrovascular disorder predominantly affecting the carotid artery system. Documentation of normal peripheral auditory function and brainstem pathway integrity is provided by acoustic admittance, otoacoustic emission and brainstem auditory evoked potential measurements. The lack of behavioral response to sound, and absent middle and long latency auditory evoked potentials suggest thalamo-cortical dysfunction. Magnetic resonance imaging showed diffuse ischemic damage in subcortical white matter including areas of the temporal lobes. In addition, there were multiple and focal cortical infarctions in both cerebral hemispheres, focused primarily in the frontal, parietal and temporal areas. Taken together, these structural and functional abnormalities in addition to severely delayed speech and language development are consistent with the diagnosis of central deafness and suggest a disconnection between higher brainstem and cortical auditory areas. The child's father also has MMD, but was diagnosed only recently. The presence of paternal linkage is informative since it rules out x-linked recessive and maternal inheritance. To our knowledge, this represents the first documented case of paternal linkage in MMD with central deafness in a Caucasian child with no apparent Japanese ancestry. Herein, we focus on central auditory dysfunction and consider how lesion-induced changes have contributed to a deficit in basic auditory responsiveness, including a severe disturbance in receptive and expressive auditory-based speech and language skills.
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Affiliation(s)
- G Setzen
- Department of Surgery, Albany Medical College, NY 12208, USA
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McFarland DJ, Cacace AT, Setzen G. Temporal-order discrimination for selected auditory and visual stimulus dimensions. J Speech Lang Hear Res 1998; 41:300-314. [PMID: 9570584 DOI: 10.1044/jslhr.4102.300] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Thresholds for the discrimination of temporal order were determined for selected auditory and visual stimulus dimensions in 10 normal-adult volunteers. Auditory stimuli consisted of binary pure tones varying in frequency or sound pressure level, and visual stimuli consisted of binary geometric forms varying in size, orientation, or color. We determined the effect of psychophysical method and the reliability of performance across stimulus dimensions. Using a single-track adaptive procedure, Experiment 1 showed that temporal-order thresholds (TOTs) varied with stimulus dimension, being lowest for auditory frequency, intermediate for size, orientation, and auditory level, and longest for color. Test performance improved over sessions and the profile of thresholds across stimulus dimensions had a modest reliability. Experiment 2 used a double-interleaved adaptive procedure and TOTs were similarly ordered as in Experiment 1. However, TOTs were significantly lower for initially ascending versus descending tracks. With this method, the reliability of the profile across stimulus dimensions and tracks was relatively low. In Experiment 3, psychometric functions were obtained for each of the stimulus dimensions and thresholds were defined as the interpolated 70.7% correct point. The relative ordering of TOTs was similar to those obtained in the first two experiments. Non-monotonicities were found in some of the psychometric functions, with the most prominent being for the color dimension. A cross-experiment comparison of results demonstrates that TOTs and their reliability are significantly influenced by the psychophysical method. Taken together, these results support the notion that the temporal resolution of ordered stimuli involves perceptual mechanisms specific to a given sensory modality or submodality.
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Affiliation(s)
- D J McFarland
- Wadsworth Center, New York State Health Department, Albany 12201-0509, USA.
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Abstract
We compared the tissue response to a nonabsorbable monofilamented suture made of expanded polytetrafluoroethylene (ePTFE), which has recently been introduced for use in plastic surgery, with the response to 10 other commercially available absorbable sutures and nonabsorbable monofilamented and multifilamented sutures. The sutures were used to secure a patch of ePTFE implanted in the dorsum of adult New Zealand White rabbits. At 30, 60, and 120 days after implantation, the tissue response to the sutures was assessed with respect to the number of foreign-body giant cells present, the thickness of the fibrous capsule that developed, and the general inflammatory response (n = 4 for each suture for each time period). Analysis of variance revealed that specific suture type was significantly associated with foreign-body giant cell count and fibrous capsule thickness. Tevdek had a significantly higher value for mean number of foreign-body giant cells. Silk and Tevdek had significantly thicker fibrous capsules, and ePTFE suture had a significantly thinner capsule. Absorbable sutures and nonabsorbable multifilamented sutures evoked a more extensive tissue response than monofilamented sutures; the differences between nonabsorbable monofilamented and nonabsorbable multifilamented sutures were significant for capsule thickness. In general, suture made of ePTFE produced a minimal tissue response. It should be a good choice for use in facial plastic surgery, in which excellent functional and aesthetic results are critical.
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Affiliation(s)
- G Setzen
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center, N.Y., USA
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Ingle RR, Setzen G, Koltai PJ, Monte D, Pastore J, Jennings TA. p53 protein expression in benign lesions of the upper respiratory tract. Arch Otolaryngol Head Neck Surg 1997; 123:297-300. [PMID: 9076236 DOI: 10.1001/archotol.1997.01900030071009] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE p53 is a tumor suppressor gene that is lost or mutated in most forms of human malignancy. There are, however, very few studies evaluating p53 expression in normal epithelium or benign lesions. DESIGN We screened for p53 protein expression in a variety of benign epithelial lesions of upper respiratory tract using monoclonal antibody DO-1 on paraffin-embedded material. SUBJECTS We studied a total of 109 cases: 16 cases of juvenile and 36 cases of adult laryngeal papillomatosis, 10 cases each of laryngeal nodules and laryngeal polyps, 17 cases of inverted papilloma, and 20 cases of nasal polyps. RESULTS Nuclear immunoreactivity for p53 protein was demonstrated in 14 (88%) of 16 cases of juvenile laryngeal papillomatosis, 33 (92%) of 36 cases of adult laryngeal papillomatosis, 4 (40%) of 10 cases of laryngeal nodules, 8 (80%) of 10 cases of laryngeal polyps, 7 (41%) of 17 cases of inverted papilloma, and 2 (10%) of 20 cases of nasal polyps. These results pertained only to the basal epithelial layer in all cases of laryngeal nodules, laryngeal polyps, and nasal polyps. Intermediate layer cells were also positive for p53 in the majority of the cases of both juvenile (69%) and adult (75%) laryngeal papillomatosis and in a minority of the cases of inverted papilloma (18%). CONCLUSIONS Overexpression of p53 protein is commonly demonstrable in benign epithelial lesions of the upper respiratory tract. This observation suggests that p53 protein accumulation may occur in the absence of mutation of the p53 gene and may correlate with epithelial proliferative activity.
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Affiliation(s)
- R R Ingle
- Department of Pathology, Albany Medical College, NY, USA
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Williams EF, Setzen G, Mulvaney MJ. Modified Bernard-Burow cheek advancement and cross-lip flap for total lip reconstruction. Arch Otolaryngol Head Neck Surg 1996; 122:1253-8. [PMID: 8906062 DOI: 10.1001/archotol.1996.01890230097017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Subtotal lip reconstruction can be performed using local flaps such as the cross-lip flap or fan flap. Total lip reconstructive efforts usually are suboptimal in providing an adequate oral sphincter, an acceptable aesthetic result, or both. For total upper, lower, or extensive combined soft-tissue defects that include both lips, traditional methods of reconstruction include the use of regional flaps. More contemporary reconstructive efforts emphasize staged reconstruction with local tissue flaps using "like" tissue in a sequential fashion to achieve a successful outcome. We describe the reconstruction of total upper, lower, or extensive combined defects and report on 7 cases using a 2-staged method of reconstruction based on the modifications of the Bernard-Burow and Abbe flaps. The principle of esthetic units an intact modiolus and oral sphincter are emphasized to ensure excellent aesthetic and functional results.
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Affiliation(s)
- E F Williams
- Division of Otolaryngology, Albany Medical College, NY, USA
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Abstract
Ketoralac is an injectable nonsteroidal antiinflammatory drug (NSAID) widely used in both out-patient and in-patient settings. Side effects such as acute renal failure, hyperkalemia, gastritis, gastrointestinal bleeding, and asthmatic exacerbation, although rare, have been previously reported. We report the case of a 20-year-old female with polyarteritis nodosa (PAN) who developed bilateral sensorineural hearing loss 25 minutes after receiving 30 mg of intravenous ketoralac. The patient denied any previous medication sensitivities, and was taking oral methotrexate and prednisone at the time of emergency department admission. Both PAN and methotrexate have been independently demonstrated to cause sensorineural hearing loss. We postulate that the patient's hearing loss was the result of ketoralac's direct and indirect ototoxic effects that were potentiated as a result of her underlying illness and medications. We recommend the cautious use of ketorolac in patients with underlying illnesses where NSAID-induced ototoxicity could result in adverse otologic consequences.
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Affiliation(s)
- K C Schaab
- Albany Medical College, Department of Emergency Medicine, NY 12208, USA
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Ismail MH, Hodkinson HJ, Setzen G, Sofianos C, Hale MJ. Gastric mucormycosis. Trop Gastroenterol 1990; 11:103-5. [PMID: 2219440] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of gastric mucormycosis proven on culture and histologic examination and successfully treated with resectional surgery and Amphotericin B is described.
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Affiliation(s)
- M H Ismail
- Department of Medicine, Baragwanath Hospital, Johannesburg, South Africa
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