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Gulati A, Abdulbaki H, Callander JK, Cai Y, Chang JL. Video-Based Decision Aids Improve Sleep Surgery Decision-Making: A Randomized Controlled Trial. Laryngoscope 2024; 134:2958-2963. [PMID: 37965946 DOI: 10.1002/lary.31156] [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: 07/11/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre-consultation video decision aids on patient DC and decision readiness. METHODS Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]-100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high-conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. RESULTS Twenty-five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post-visit improvements in DC scores (post-consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision-making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High-conflict patients (n = 5) who reviewed pre-visit videos (intervention sub-group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high-conflict control patients. CONCLUSIONS Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision-making process. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2958-2963, 2024.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Hasan Abdulbaki
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
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Callander JK, Chang JL. Treatment of the Nose for Patients with Sleep Apnea. Otolaryngol Clin North Am 2024; 57:491-500. [PMID: 38072728 DOI: 10.1016/j.otc.2023.11.002] [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] [Indexed: 04/30/2024]
Abstract
Nasal obstruction is common in patients with obstructive sleep apnea (OSA) and may variably impact symptoms and severity of OSA. It is associated with decreased continuous positive airway pressure (CPAP) compliance, and both medical and surgical management of nasal obstruction have resulted in increased CPAP adherence. Treatment of OSA with comorbid rhinitis via topical nasal steroids demonstrates a beneficial impact on daytime sleepiness. Isolated nasal surgery has been shown to result in decreased daytime sleepiness and snoring, with minimal effect on OSA severity.
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Affiliation(s)
- Jacquelyn K Callander
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, CA, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, CA, USA.
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Bhat A, Gulati A, Ryan WR, Chang JL. Comparison of Chronic Sialadenitis Symptom Burden in Patients With Sialolithiasis Versus Stenosis Before and After Sialendoscopy. Otolaryngol Head Neck Surg 2024. [PMID: 38639292 DOI: 10.1002/ohn.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/01/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To define symptomatology and responses to treatment in chronic sialadenitis from sialolithiasis versus duct stenosis and establish a minimal clinically significant difference (MCID) in the validated Obstructive Salivary Problem Impact Test (SPIT). STUDY DESIGN Prospective, cohort. SETTING Tertiary-care center. METHODS Patients completed the SPIT questionnaire at presentation and 3 to 6 months after surgery. SPIT scores and domains were compared between patients with symptomatic sialolithiasis and those with stenosis of a major salivary gland. RESULTS Seventy-nine patients completed the SPIT, including 43 (54%) with sialolithiasis and 36 (46%) with stenosis. Stenosis patients displayed greater baseline scores compared to sialolithiasis patients (45.4 ± 19.9 vs 33.3 ± 18.5, P < .013). Frequency and severity of gland swelling and pain (21.9 ± 8.9 vs 17.1 ± 9.6, P = .02) and functional/psychosocial impact subscores were greater in the stenosis versus sialolithiasis groups (18.0 ± 10.9 vs 11.3 ± 9.4, P < .01). For 43 patients who underwent surgical intervention, SPIT scores improved at 3 to 6 months postoperatively in all domains (-18.6 ± 19.4, P < .01). Degree of improvement did not differ between sialolithiasis versus stenosis groups (-22.0 ± 20.9 vs -13.3 ± 15.8, P = .13). The MCID in SPIT score was found to be -13 points. A postoperative SPIT score of less than 10 suggested symptom resolution. CONCLUSION When compared to sialolithiasis, chronic salivary obstruction from stenosis is associated with greater baseline SPIT scores, indicating poorer sialadenitis-related quality of life due to greater symptom frequency and functional impact. Based on SPIT survey outcomes, a score decrease of 13 points or SPIT score <10 represent significant symptom improvement.
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Affiliation(s)
- Amrita Bhat
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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Callander JK, Kandahari N, Strohl MP, Cheung SW, Chang JL. Laryngeal Hyposensitivity in Obstructive Sleep Apnea. Laryngoscope 2024. [PMID: 38554047 DOI: 10.1002/lary.31415] [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: 12/21/2023] [Revised: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Impaired laryngopharyngeal sensation has been implicated in obstructive sleep apnea (OSA) and may play an important pathophysiological role. We evaluated sensory function in OSA by examining the laryngeal adductor reflex (LAR) response rate and temporal profile to tactile stimulation. METHODS Laryngeal sensation testing was performed in awake adults with and without diagnosed OSA by stimulating the medial aryepiglottic fold or arytenoid using 30-mm 5-0 and 4-0 nylon Cheung-Bearelly monofilaments. Video analysis by two independent reviewers evaluated for the presence of the LAR in response to satisfactory stimuli and LAR latency to vocal fold adduction. RESULTS Twenty-six OSA and 12 control subjects were tested with 270 satisfactory stimuli. The mean full LAR response rate to 4-0 stimulation was 38.3% in OSA vs 86.9% in control subjects (p <0.001) and to 5-0 stimulation was 27% in OSA vs 63.9% in control subjects (p <0.001). The mean LAR latency to vocal fold closure in OSA was 123.7 ms (SD 35.8) vs 156.4 ms (SD 44.3) in control (p = 0.04) subjects. OSA LAR latency was positively correlated with the apnea-hypopnea index (r = 0.30; p = 0.008). CONCLUSION The OSA group exhibited reduced LAR response rates and shortened LAR latency, where latency was correlated with disease severity. Laryngeal hyposensitivity was affirmed and changes to LAR sensorimotor temporal dynamics were revealed. These pathophysiological alterations to the LAR may be accounted for by decreased somatosensory receptor sensitivity, increased sympathetic tone, and reorganized brain stem function in OSA. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Nazineen Kandahari
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Madeleine P Strohl
- Department of Otolaryngology Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky, U.S.A
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
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Cai Y, Zheng YJ, Cheng CM, Strohl KP, Mason AE, Chang JL. Impact of Hypoglossal Nerve Stimulation on Consumer Sleep Technology Metrics and Patient Symptoms. Laryngoscope 2024. [PMID: 38516821 DOI: 10.1002/lary.31398] [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: 01/03/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is usually assessed at discrete and infrequent timepoints. Wearable consumer sleep technologies (CST) may allow for more granular and longitudinal assessments of OSA therapy responses and OSA-related symptoms. METHODS In this case series, we enrolled hypoglossal nerve stimulator (HGNS) patients who had an effective treatment response for an 8-week study using a wearable CST. Participants started with "HGNS-on," were randomized to turn off HGNS therapy during either week 4 or 5 ("HGNS-off"), followed by a return to therapy, "HGNS-resume." Participants completed validated symptom questionnaires assessing sleepiness, insomnia symptoms, functional status, and overall sleep health (Satisfaction, Alertness, Timing, Efficiency, and Duration, SATED) each week. CST metrics and survey scores were compared between HGNS treatment phases. Associations between CST metrics and survey scores were assessed. RESULTS Seven participants with a total of 304 nights of CST data showed no statistically significant changes in total sleep time (TST), wake time after sleep onset, or sleep efficiency (SE) across the study periods. During HGNS-off, survey scores indicated significantly worsened OSA-related symptom scores. Two participants had significantly higher heart rate variability (HRV) during HGNS-off (by 3.3 and 6.3 ms) when compared to HGNS active therapy periods. Amongst CST metrics, SATED scores correlated with TST (r = 0.434, p < 0.0001), HRV (r = -0.486, p < 0.0001), and SE (r = 0.320, = 0.0014). In addition, FOSQ-10 scores correlated with average HR during sleep (r = -0.489, p < 0.001). CONCLUSION A 1-week HGNS therapy withdrawal period impacted OSA-related sleep symptoms. Sleep-related metrics measured by a wearable CST correlated with symptom scores indicating potental value in the use of CSTs for longitudinal sleep-tracking in OSA patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Yixuan James Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Chloe M Cheng
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Ashley E Mason
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, California, U.S.A
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, U.S.A
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Dhanda Patil R, Ishman SL, Chang JL, Thaler E, Suurna MV. In response to Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry. Laryngoscope 2024. [PMID: 38511429 DOI: 10.1002/lary.31412] [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: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
- Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
| | - Stacey L Ishman
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jolie L Chang
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Healthcare System, San Francisco, California, U.S.A
| | - Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, U.S.A
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Zheng YJ, Cai Y, Ifeagwu KC, Chang JL. Snoring Patterns During Hypoglossal Nerve Stimulation Therapy Up-Titration. Laryngoscope 2024; 134:987-992. [PMID: 37334840 DOI: 10.1002/lary.30815] [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: 11/10/2022] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
Longitudinal snoring changes can be captured using a mobile phone application. During hypoglossal nerve stimulator (HNS) therapy up-titration, increasing stimulation voltage was associated with reduced snoring frequency and intensity in this case series of six patients. Laryngoscope, 134:987-992, 2024.
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Affiliation(s)
- Yixuan James Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Kene-Chukwu Ifeagwu
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
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Dhanda Patil R, Ishman SL, Chang JL, Thaler E, Suurna MV. Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry. Laryngoscope 2024; 134:471-479. [PMID: 37560883 DOI: 10.1002/lary.30933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/19/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE We aimed to determine the preoperative prevalence of insomnia in the Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) and to examine serial sleep-related data longitudinally, in particular the Insomnia Severity Index (ISI), to compare outcomes between patients with no/subthreshold insomnia (ISI < 15) and moderate/severe insomnia (ISI ≥ 15) at baseline. METHODS We analyzed observational data from ADHERE between March 2020 and September 2022. Baseline demographic and mental health (MH) data, apnea hypopnea index (AHI), ISI, and ESS (Epworth Sleepiness Scale) were recorded. At post-titration (PT) and final visits, AHI, ISI, ESS and nightly usage were compared between baseline ISI < 15 and ISI ≥ 15 subgroups. RESULTS A baseline ISI was obtained in 928 patients (62% with ISI ≥ 15). Of the 578 and 141 patients reaching the 12- and 24-month time periods to complete PT and final visits, 292 (50.5%) and 91 (64.5%) completed the ISI, respectively. Baseline MH conditions were higher with ISI ≥ 15 than ISI < 15 (p < 0.001). AHI reduction and adherence did not differ between patients with baseline ISI ≥ 15 and ISI < 15. Patients with ISI ≥ 15 experienced greater improvement in ESS than ISI < 15 at post-titration and final visits (p = 0.014, 0.025). All patients had improved nocturnal, daytime, and overall ISI scores at follow-up visits (p < 0.001), especially for those with baseline ISI ≥ 15 compared with ISI < 15 (p < 0.05). CONCLUSION HGNS therapy efficacy and adherence were similar between ISI severity subgroups at follow-up visits. Insomnia and sleepiness scores improved in all patients with HGNS therapy and to a greater degree in patients with baseline moderate/severe insomnia. LEVEL OF EVIDENCE 4 Laryngoscope, 134:471-479, 2024.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- Department of Community and Population Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jolie L Chang
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
- Surgical Services, San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA
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Standiford TC, Eltawil Y, Durr ML, Pletcher SD, Chang JL. Leadership Training Curriculum for Otolaryngology-Head and Neck Surgery Residents: A Scoping Review. Otolaryngol Head Neck Surg 2023; 169:1436-1444. [PMID: 37555241 DOI: 10.1002/ohn.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Otolaryngologists take on various leadership roles throughout their daily practice, but specific training focused on leadership development during otolaryngology-head and neck surgery (OHNS) residency is not well-defined. This project explores the current state of leadership curricula for OHNS residents. DATA SOURCES Google Scholar, Embase, PubMed, and MedEdPORTAL. REVIEW METHODS A scoping review was performed on English-language, full-text, peer-reviewed articles that describe leadership curricula for OHNS residents. Investigators reviewed curriculum settings, content, delivery methods, and assessment; curriculum effectiveness was evaluated using Kirkpatrick effectiveness scores and article quality was assessed using the Best Evidence in Medical Education (BEME) index. CONCLUSION Three thousand four hundred sixteen articles met search criteria, 198 articles were included for full-text review, and 4 articles met inclusion criteria. Curriculum content and delivery methods were diverse. Curriculum cadence ranged from 2-day immersion trainings to year-long longitudinal programs. Only one of the included studies utilized a needs assessment to inform curriculum development. Two articles achieved Kirkpatrick effectiveness scores of 2, indicating changes in the attitudes or perceptions among participants and a quality measure of 3, indicating clear conclusions drawn from the results. IMPLICATIONS FOR PRACTICE The current state of leadership training in OHNS residency is limited and nonuniform. These data align with descriptions of leadership training in other surgical residencies which are reported as heterogenous and lacking in effectiveness. This review highlights the need for standardized leadership training for OHNS residents. The high-quality leadership development initiatives within graduate medical education are reviewed to inform future directions for effective curriculum development and assessment.
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Affiliation(s)
- Taylor C Standiford
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, California, USA
| | - Yasmin Eltawil
- San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Megan L Durr
- Department of Otolaryngology-Head & Neck Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head & Neck Surgery, Division of Sleep Surgery and General Otolaryngology, University of California, San Francisco, California, USA
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [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: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Callander JK, Plonowska-Hirschfeld K, Gulati A, Chang JL, Ryan WR. Symptom Outcomes After Sialendoscopy-Assisted Salivary Duct Surgery: A Prospective 6-Year Study. Laryngoscope 2023; 133:792-800. [PMID: 35848880 DOI: 10.1002/lary.30294] [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: 01/14/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective is to evaluate the long-term impact of sialendoscopic-assisted salivary duct surgery (SASDS) on sialadenitis symptoms using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire. METHODS The COSS questionnaire, which scores symptoms on a 0-100 scale, was administered prospectively to adult patients pre-operatively, 1-year, and 6-years post-operatively. We examined COSS scores and categories representing complete (<10), partial (10-25), and no (>25) resolution of symptoms with attention to factors significantly associated with incomplete resolution (≥10). RESULTS Approximately 6-years after SASDS, 111 patients reported scores for 128 symptomatic glands (72 with sialolithiasis, 56 without sialolithiasis). For glands with sialolithiasis, the median COSS score pre-SASDS was 27.5 (interquartile range [IQR]: 13.5-43), which was significantly reduced to 1.0 (IQR: 0-5.5) at 1-year and 1.5 (IQR 0-5) at 6-years postoperatively. Glands without sialolithiasis had a median COSS score of 40.5 (IQR: 23-52.5) preoperatively, that significantly reduced to 13.5 (IQR 5-21) at 1-year and 14 (IQR 6.5-25.5) at 6-years post-operatively. There was no significant difference in scores from 1- to 6-years. Intraoperative presence of sialolith, absence of stenosis, stenosis in the distal duct, and submandibular gland involvement were significant predictors of complete resolution of symptoms at 6-years. CONCLUSION Approximately 6-years after SASDS for sialadenitis, the majority of patients have durable symptom improvement. The sialolithiasis group had higher rates of complete resolution compared to the non-sialolithiasis group. Presence of ductal stenosis on sialendoscopy, non-distal stenoses, and parotid gland involvement were risk factors for persistent long-term sialadenitis symptoms. Laryngoscope, 133:792-800, 2023.
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Affiliation(s)
- Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Karolina Plonowska-Hirschfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Division of General Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Salivary Gland Center, University of California San Francisco, San Francisco, California, U.S.A
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, U.S.A
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Salivary Gland Center, University of California San Francisco, San Francisco, California, U.S.A
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12
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Gulati A, Cognetti DM, Cohen DS, Ogden MA, Schaitkin BM, Walvekar RR, Ryan WR, Chang JL. An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT). Laryngoscope 2023; 133:539-546. [PMID: 35694724 DOI: 10.1002/lary.30244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis-associated symptoms. METHODS We analyzed COSS responses via exploratory factor analysis (EFA) to identify essential symptom domains and reduce overlap in questions. Sialadenitis patients evaluated the significance of index symptoms identified from the literature review. Expert physicians rated symptom relevance in clinical assessment. An updated questionnaire (SPIT) was piloted with both patient and expert interviews to optimize structure and readability. The SPIT was assessed for internal consistency, construct validity, and test-retest stability. RESULTS EFA of 310 COSS responses demonstrated 3 main symptom domains (functional impact, pain, swelling) that explained 58.4% of response variance. Results were not statistically different when collapsing from 11 to 5 question response options. Experts (n = 5) ranked gland swelling, mealtime pain, and foul taste as most clinically important, while patients (n = 12) ranked swelling, non-mealtime pain, and difficulty eating as most bothersome. Most patients experienced sialadenitis-related functional or psychosocial impairment. Following interviews for question refinement, a 25-question survey was finalized. SPIT responses from 50 sialadenitis patients demonstrated internal consistency (Cronbach's alpha = 0.96), 14-day stability (p < 0.001), and agreement with Oral Health Impact Profile-14 scores (p < 0.0001). CONCLUSIONS We developed the SPIT instrument to improve usability and content validity in chronic sialadenitis evaluation. The psychometric assessment demonstrated high construct validity and test-retest reliability. Further work will assess longitudinal changes with treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 133:539-546, 2023.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - David S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Southern California Permanente Medical Group, Harbor City, California, USA
| | - M Allison Ogden
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Barry M Schaitkin
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rohan R Walvekar
- Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Veterans Affairs Medical Center, Surgery Service, San Francisco, California, USA
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13
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Gulati A, Kidane J, Chang JL. Patient Reported Outcome Measures for Salivary Function: A Systematic Review. Laryngoscope 2023. [PMID: 36606658 DOI: 10.1002/lary.30550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/12/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE A number of patient-reported outcome measures (PROMs) assess quality of life and symptom severity in patients with salivary gland dysfunction, but many vary in the extent of validation and domain types addressed. We identified PROMs validated to measure salivary gland function and analyzed key properties. DATA SOURCES PubMed, Web of Science, Embase, PsycInfo, and CINAHL. REVIEW METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Validated instruments with >1 item to assess salivary gland-related symptoms were included. PROMs were evaluated for developmental methodology, structure, validity, and reliability using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. RESULTS A total of 2059 abstracts were retrieved, and 133 full-text articles were reviewed. Sixteen PROMs assessing xerostomia (n = 7), sialadenitis (n = 4), Sjogren's syndrome (n = 2), Parkinson's-associated sialorrhea (n = 2), and oral systemic sclerosis (n = 1) were identified. Most (n = 15) were developed de novo, one was adapted from a pre-existing questionnaire. Eleven PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and 10 included test-retest data. Regarding content validity, four PROMs were developed with both patient and physician input, but none were rated as "adequate." All included comparisons against other questionnaires (n = 7), salivary flow rate (n = 9), and/or healthy controls (n = 3). The most rigorously developed PROM, the Xerostomia Inventory, was rated adequate in 6 out of 7 domains. CONCLUSIONS Several PROMs evaluate salivary function. The abilties of these PROMs to meet design and validation standards were variable, with notable limitations in content validity for all tools. New and updated PROMs assessing obstructive and inflammatory salivary symptoms should utilize patient and provider input. LEVEL OF EVIDENCE N/A Laryngoscope, 2023.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Joseph Kidane
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.,Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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14
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Chang JL, Huwyler C, Yoshida N, Henderson Sabes J, Cheung SW. A Smartphone Application and Education Program for Hearing Health Promotion in High School Teenagers. Laryngoscope 2022. [PMID: 36169307 DOI: 10.1002/lary.30411] [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: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess knowledge retention after video-based hearing health education and measure headphone listening behavior change using a novel smartphone application. METHODS In this prospective longitudinal study, students participated in video-based hearing health education and hearing screening sessions. Hearing health knowledge was assessed in students and parents after 6 weeks. A novel smartphone application was created to measure daily noise exposure based on volume settings with headphone use and to display the National Institute for Occupational Safety and Health (NIOSH) noise doses with alerts for cumulative daily doses nearing the maximum. RESULTS Seventy-six teenage students and parents participated. Eighty three percent of participants identified as a racial or ethnic minority and 66% were of low-income socioeconomic status. Hearing health knowledge was retained in students 6 weeks after education and parents' knowledge improved from baseline. The smartphone app was installed on 12 student phones, and 25% of days monitored exhibited noise doses that exceeded the NIOSH maximum. App use for at least 10 days by nine students showed a significant reduction in average daily noise dose and time spent at the highest volume settings during the second-half of app use. CONCLUSIONS Video-based hearing health education with knowledge question reinforcement was associated with knowledge retention in students and improved parental attitudes and knowledge about hearing conservation. A smartphone app with a real-time display of headphone cumulative noise exposure dose identified at-risk students. The integration of hearing health education, hearing screening, and digital health tools has promised to promote positive behavior changes for long-term hearing conservation. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.,Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Camille Huwyler
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | | | - Jennifer Henderson Sabes
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.,Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
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Abstract
Objectives To characterize the treatment goals and values of adult patients with
obstructive sleep apnea (OSA). Study Design Mixed methods design based on semistructured interviews followed by
cross-sectional surveys. Setting Academic medical center and integrated managed care consortium. Methods Phase 1 involved qualitative analysis of focus groups and interviews to
define treatment goal categories. Phase 2 included analysis of
cross-sectional surveys on most important treatment goals from patients with
OSA presenting to sleep surgery clinic. Positive airway pressure (PAP) use,
Epworth Sleepiness Scale score, and apnea-hypopnea index were obtained to
determine influences on goal choices. Results During focus groups and interviews, treatment goal themes identified included
improving sleep quality, reducing daytime sleepiness, snoring sound
reduction, and health risk reduction. In phase 2, 536 patients were
surveyed, and they reported the primary treatment goals of health risk
reduction (35%), sleep quality improvement (28%), daytime sleepiness
improvement (21%), and snoring sound reduction (16%). The primary treatment
goal was associated with age (P < .0001), excessive
daytime sleepiness (Epworth Sleepiness Scale score >10,
P < .0001), PAP use status (P <
.0001), and OSA severity (apnea-hypopnea index, P <
.0001). Severity of OSA was associated with increasing proportion of
patients choosing health risk reduction as the main treatment goal
(P < .05). Conclusions Adult OSA treatment goal choices vary with age, symptoms, PAP history, and
OSA severity. Understanding patient-specific goals is the essential first
step in the shared decision-making process when choosing surgical or
nonsurgical treatments. Ultimately, goal-focused discussions ensure
alignment of priorities and definitions of success between the patient and
the provider.
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Affiliation(s)
- Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Priyanka Tripuraneni
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Erika M Stephens
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Dang-Khoa Nguyen
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA
| | - Megan L Durr
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA
| | - Jolie L Chang
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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16
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Strohl MP, David AP, Dwyer CD, Rosen CA, Young VN, Chang JL, Cheung SW. Aesthesiometer-Based Testing for Laryngopharyngeal Hyposensitivity. Laryngoscope 2021; 132:163-168. [PMID: 34289117 DOI: 10.1002/lary.29761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a method for threshold estimation of the laryngeal adductor reflex (LAR) response using Cheung-Bearelly monofilaments. STUDY DESIGN Cross-sectional. METHODS Twenty-two healthy adults (12 men, 10 women) were tested for LAR response outcome using 30 mm 5-0 and 4-0 nylon monofilaments. Tactile stimuli were delivered to the aryepiglottic (AE) fold and medial pyriform sinus (MPS). Dichotomous classifier features and performance (area under the curve (AUC)), the LAR response outcome agreement and disagreement matrix, and test-retest reliability were examined. From those data, a test protocol that would minimize patient burden to estimate the LAR triggering threshold was formulated. RESULTS Classifier performance of 5-0 monofilament stimulation of the AE fold (sensitivity = 0.63, specificity = 0.63, PPV = 0.74, NPV = 0.25) and MPS (sensitivity = 0.45, specificity = 0.77, PPV = 0.74, NPV = 0.23,) was slightly below that of 4-0 monofilament stimulation of the AE fold (sensitivity = 0.82, specificity = 0.50, PPV = 0.82, NPV = 0.50) and MPS (sensitivity = 0.84, specificity = 0.64, PPV = 0.90, NPV = 0.56), based on AUC. LAR response outcome agreement for 5-0 and 4-0 stimulations was high (93%) for 5-0 positive response, but low (29%) for 5-0 negative response. Aesthesiometer test-retest reliability for LAR response outcome was excellent (Cronbach's alpha = 0.97). CONCLUSIONS Threshold estimation of the LAR response may be operationalized by adopting a decision tree protocol. For negative LAR response to initial 5-0 monofilament stimulation and positive response to subsequent 4-0 monofilament stimulation, the higher threshold is confirmed. Positive LAR response to 5-0 or 4-0 monofilament stimulation is expected in over 90% of asymptomatic adults. Negative LAR response to 4-0 monofilament stimulation identifies patients at risk for laryngopharyngeal hyposensitivity. LEVEL OF EVIDENCE 3b Laryngoscope, 2021.
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Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Abel P David
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher D Dwyer
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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17
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Strohl MP, Chang JL, Dwyer CD, Young VN, Rosen CA, Cheung SW. Laryngeal Adductor Reflex Movement Latency Following Tactile Stimulation. Otolaryngol Head Neck Surg 2021; 166:720-726. [PMID: 34253075 DOI: 10.1177/01945998211025517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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
OBJECTIVE To measure the latency of laryngeal adductor reflex (LAR) motion onset at 2 laryngopharyngeal subsites using calibrated aesthesiometers. STUDY DESIGN Cross-sectional. SETTING Academic institution. METHODS Twenty-one asymptomatic, healthy subjects (11 male, 10 female) underwent laryngopharyngeal sensory testing with tactile stimuli delivered to the aryepiglottic fold and medial pyriform sinus using 30-mm Cheung-Bearelly monofilaments (4-0 and 5-0 nylon sutures) via channeled flexible laryngoscope. The LAR onset latency, defined as the first visual detection of ipsilateral vocal fold adduction following tactile stimulation, was measured with frame-by-frame analysis of video recordings. RESULTS The overall mean LAR latency across both subsites and stimulation forces was 176.6 (95% CI, 170.3-183.0) ms, without significant difference between subsites or forces. The critical value for LAR response latency prolongation at the .01 significance level was 244 ms. At 30 frames/s video capture resolution, LAR response latency ≥8 frame intervals would indicate abnormal prolongation. CONCLUSION Aesthesiometer-triggered LAR latency appears to be invariant over an 8.7-dB force range and between the aryepiglottic fold and medial pyriform sinus subsites in controls. Laryngeal adductor reflex latency incongruences between stimulation forces or laryngopharyngeal subsites may serve as pathophysiological features to dissect mechanisms of upper aerodigestive tract disorders. LEVEL OF EVIDENCE Level 3B.
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Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher D Dwyer
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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18
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Gulati A, Stephens EM, Cai Y, Chang JL. Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations. Laryngoscope 2021; 131:2384-2390. [PMID: 34152601 DOI: 10.1002/lary.29695] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/29/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Numerous therapies exist for adult obstructive sleep apnea (OSA), creating potential for patient decisional conflict (DC) that impacts treatment adherence and post-treatment regret. We evaluated the prevalence of elevated DC in OSA patients presenting for positive airway pressure (PAP) alternative therapies and identified gaps in available resources about OSA therapies. STUDY DESIGN Cross-sectional study. METHODS A cross-sectional study was performed based on questionnaires completed by adult OSA patients presenting to an academic sleep surgery clinic from March to October 2020. Surveys examined sleep symptoms, sleep apnea treatment history, goals of therapy, and the SURE checklist, a validated 4-item DC screening scale. Additional qualitative data about OSA decision tool needs were queried with structured interviews in a smaller subset of patients. RESULTS Among 100 respondents, 60 were open to multiple treatment options, whereas 22 were not interested in surgical treatment. Eighty-one respondents (81%) had elevated DC (SURE score < 4). High DC was not associated with CPAP history, OSA severity, or daytime sleepiness (Epworth Sleepiness Scale score ≥ 10). Elevated DC was related to uncertainty regarding optimal treatment choice in 54% of respondents (n = 54), and lack of knowledge regarding risks and benefits of each treatment option in 71% (n = 71). Common themes identified in 9 interviewed patients suggested helpful resources should ideally compare treatment modalities and educate on surgery details, efficacy, and recovery. CONCLUSIONS The majority of OSA patients presenting to sleep surgery clinics have elevated decisional conflict influenced by limited knowledge about options and the risks and benefits of each therapy. There is a need for decision tools that can reduce decisional conflict and promote equitable knowledge about PAP alternative OSA treatments. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2021.
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Affiliation(s)
- Arushi Gulati
- University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Erika M Stephens
- University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
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Xu MJ, Chang JL. Practical Salivary Ultrasound Imaging Tips and Pearls. Otolaryngol Clin North Am 2021; 54:471-487. [PMID: 34024476 DOI: 10.1016/j.otc.2021.02.008] [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: 10/21/2022]
Abstract
Ultrasound imaging is a valuable and effective clinical tool for salivary gland disorder evaluation and management. Pathologies including salivary duct stenosis, sialolithiasis, neoplasms, and autoimmune disorders have characteristic sonographic features. Maneuvers such as bimanual palpation and oral administration of sialagogues during the ultrasound examination can enhance examination findings. Ultrasound guidance is useful for targeting needle biopsies of neoplasms, ensuring appropriate intraparenchymal gland injections, and augmenting salivary duct instrumentation and intraoperative management.
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Affiliation(s)
- Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter Street Box 0342, San Francisco, CA 94115, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter Street Box 0342, San Francisco, CA 94115, USA.
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20
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Strohl MP, Chang C, Ryan WR, Chang JL. Botulinum toxin for chronic parotid sialadenitis: A case series and systematic review. Laryngoscope Investig Otolaryngol 2021; 6:404-413. [PMID: 34195360 PMCID: PMC8223475 DOI: 10.1002/lio2.558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/31/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate salivary gland chemodenervation with botulinum toxin in chronic parotid sialadenitis. METHODS Patients who underwent parotid gland chemodenervation for chronic sialadenitis due to duct stenosis refractory to siaendoscopy were reviewed (case series). Additionally, a systematic review of the literature on botulinum toxin injection for chronic parotid sialadenitis was performed. Inclusion criteria included studies containing original data on botulinum toxin injections in patients with chronic sialadenitis symptoms. RESULTS Sialadenitis symptoms from 10 patients with 13 affected parotid glands were examined. All had duct stenosis diagnosed on sialendoscopy, refractory sialadenitis symptoms, and received parotid onabotulinum toxin injection(s) (median dose 65U). Of patients with 3-month follow-up, 78% reported significant improvement in symptoms. Mean Chronic Obstructive Sialadenitis Symptoms (COSS) Score improved at 3 months post-injection (47-25.9, P = .039) with significant reduction in gland pain frequency and gland swelling severity. No patients had a facial nerve paralysis or increased xerostomia. With the systematic review, 518 abstracts were reviewed and 11 studies met inclusion criteria and included case series or case reports with a total of 40 patients treated with botulinum toxin for chronic parotitis. Thirty-four out of a total of 35 patients in the studies (97%) reported complete (9, 26%) or partial (25, 71%) improvement in sialadenitis symptoms with minimal complications. CONCLUSION Parotid gland chemodenervation with botulinum toxin is a minimally invasive treatment option for symptomatic chronic sialadenitis refractory to medical treatment or sialendoscopy. Botulinum toxin injections alleviate gland pain and swelling associated with salivary obstruction and provide an alternative to parotidectomy for recurrent sialadenitis.Level of evidence: 4.
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Affiliation(s)
- Madeleine P. Strohl
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Chia‐Fan Chang
- Department of Otorhinolaryngology‐Head and Neck SurgeryTaipei Veterans General Hospital and Faculty of Medicine, School of Medicine, National Yang‐Ming UniversityTaipeiTaiwan
| | - William R. Ryan
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jolie L. Chang
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Cai Y, Zheng YJ, Gulati A, Butrymowicz A, Krauter R, Pletcher SD, Sharon JD, Goldberg AN, Chang JL. Patient Use of Low-cost Digital Videoscopes and Smartphones for Remote Ear and Oropharyngeal Examinations. JAMA Otolaryngol Head Neck Surg 2021; 147:336-342. [PMID: 33475683 DOI: 10.1001/jamaoto.2020.5223] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance During the novel coronavirus disease 2019 pandemic, telehealth has become a vital component of health care delivery. For otolaryngology evaluations, examination of the ear and oropharynx is important but difficult to achieve remotely. Objective To assess the feasibility of patient use of low-cost digital videoscopes and smartphones for examination of the ear and oropharynx. Design, Setting, and Participants A prospective quality improvement study was conducted in an academic adult otolaryngology clinic including 23 patients who presented for an in-person appointment and owned a smartphone device. The study was conducted from July 1 to 15, 2020. Interventions Participants were asked to capture pictures and videos of their ear canals and oropharynx with digital videoscopes and their smartphones under real-time guidance over a telehealth platform. They were then surveyed about their experience. Main Outcomes and Measures The primary outcomes were ratings by health care clinicians and a blinded otolaryngologist reviewer of image acceptability. Secondary outcomes included participant time to image acquisition and willingness to purchase digital videoscopes for telehealth use. Results Of the 23 participants included, 14 were women (61%); mean age was 50 years (range, 21 to 80 years). Of the images obtained using the digital otoscope ear examination, 95% were considered acceptable by the health care clinicians and 91% were considered acceptable by the blinded reviewer; 16 participants (70%) reported that the otoscope was easy to use. The mean time to acquire images for both ears was 114 seconds (95% CI, 84-145 seconds). Twenty-one participants (91%) were willing to pay for a digital otoscope for telehealth use. For the oropharyngeal examination, a greater proportion of smartphone video examinations were considered acceptable by clinicians (63% acceptability) and the blinded reviewer (55%) compared with the digital endoscope (clinicians, 40%; blinded reviewer, 14%). The mean time required for the oropharyngeal examination smartphone video capture was shorter at 35 seconds compared with both the digital endoscope (difference, -27 seconds; 95% CI, -7 to -47 seconds) and smartphone photo capture (difference, -53 seconds; 95% CI, -20 to -87 seconds). Conclusions and Relevance Digital otoscopes and smartphones apparently can facilitate remote head and neck physical examination in telehealth. Digital otoscopes were useful for ear examinations, and smartphone videos appeared to be the most useful for oropharyngeal examinations. Further studies are required to determine specific diagnostic capabilities in various telehealth practice settings.
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Affiliation(s)
- Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | | | - Arushi Gulati
- University of California School of Medicine, San Francisco
| | - Anna Butrymowicz
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Roseanne Krauter
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrew N Goldberg
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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22
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Lyu JH, Fan XS, Shen Q, Wang XX, Zhang YF, Huang WB, Cao YL, Zhou C, Chang JL, Ma W, Zhou XJ, Zhang LH. [Feasibility multi-center study of artificial intelligence assistance in cervical fluid-based cytology diagnosis]. Zhonghua Bing Li Xue Za Zhi 2021; 50:353-357. [PMID: 33831994 DOI: 10.3760/cma.j.cn112151-20201109-00835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To propose a method of cervical cytology screening based on deep convolutional neural network and compare it with the diagnosis of cytologists. Method: The deep segmentation network was used to extract 618 333 regions of interest (ROI) from 5, 516 cytological pathological images. Combined with the experience of physicians, the deep classification network with the ability to analyze ROI was trained. The classification results were used to construct features, and the decision model was used to complete the classification of cytopathological images. Results: The sensitivity and specificity were 89.72%, 58.48%, 33.95% and 95.94% respectively. Among the smears derived from four different preparation methods, this algorithm had the best effect on natural fallout with a sensitivity of 91.10%, specificity of 69.32%, positive predictive rate of 41.41%, and negative predictive rate of 97.03%. Conclusion: Deep convolutional neural network image recognition technology can be applied to cervical cytology screening.
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Affiliation(s)
- J H Lyu
- Department of pathology, Suzhou Municipal Hospital, Suzhou 215002, China
| | - X S Fan
- Department of Pathology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Q Shen
- Department of Pathology, Jinling Hospital, Nanjing 210002, China
| | - X X Wang
- Department of GCP Center,Jiangsu Province Hospital of TCM, Nanjing 210029, China
| | - Y F Zhang
- Department of Pathology, Jiangsu Province Hospital of TCM, Nanjing 210029, China
| | - W B Huang
- Department of Pathology, the Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Y L Cao
- Jiangsu Yitou Health Technology Company, Nanjing 210000, China
| | - C Zhou
- Medical Technology Company, Nanjing 210000, China
| | - J L Chang
- Medical Technology Company, Nanjing 210000, China
| | - W Ma
- Medical Technology Company, Nanjing 210000, China
| | - X J Zhou
- Department of Pathology, Jinling Hospital, Nanjing 210002, China
| | - L H Zhang
- Department of pathology, Affiliated Zhongda Hospital, Southeast University, Nanjing 210009, China
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Gurrola JG, Chang JL, Roland LT, Loftus PA, Cheung SW. Short-term chemosensory distortions and phantoms in COVID-19. Laryngoscope Investig Otolaryngol 2021; 6:172-176. [PMID: 33821217 PMCID: PMC8014200 DOI: 10.1002/lio2.532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/20/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To identify differentiation features of chemosensory dysfunction in COVID-19 infection and their primary drivers. Study Design Cross-sectional cohort comparison. Methods A national anonymous survey was used to query participants regarding nasal symptoms and chemosensory dysfunction including sensitivity levels, and presence or absence of distortions and phantoms within the 6-week time window surrounding their COVID-19 testing and survey completion. Results Three-hundred and sixty-four respondents who reported COVID-19 positive (COVID+; n = 176) or COVID-19 negative (COVID-; n = 188) test results completed the survey. The COVID+ cohort had higher occurrence rates for: (a) chemosensory sensitivity impairments (67.0% vs 30.3%; P < .01), where the rate of complete loss of smell (anosmia) or taste (ageusia) was higher (35.8% vs 4.8%; P < .01), and (b) chemosensory distortions (39.8% vs 19.1%; P < .01), where the rate of anosmia or ageusia with distortions was also higher in the COVID+ cohort (19.9% vs 2.7%; P < .01). Occurrence rates in the two cohorts were similar for chemosensory phantoms (COVID+ 17.0%, COVID- 18.6%; P = .70) and nasal discharge or stuffiness in the presence of sensitivity impairment (COVID+ 63.6%, COVID- 52.6%; P = .17). Conclusion Chemosensory dysfunction in COVID-19 is associated with higher rates of smell or taste sensitivity impairments and distortions. Higher rates of anosmia and ageusia drive these key findings. Chemosensory phantoms and nasal symptoms in the presence of sensitivity impairment occur at rates that should demand clinical attention, but they do not appear to be specific to COVID-19 positivity. Level of Evidence 2b.
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Affiliation(s)
- José G. Gurrola
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Jolie L. Chang
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lauren T. Roland
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Patricia A. Loftus
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Steven W. Cheung
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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24
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Henderson-Sabes J, Shang Y, Perez PL, Chang JL, Pross SE, Findlay AM, Mizuiri D, Hinkley LB, Nagarajan SS, Cheung SW. Author Correction: Corticostriatal functional connectivity of bothersome tinnitus in single-sided deafness. Sci Rep 2021; 11:3566. [PMID: 33547372 PMCID: PMC7864956 DOI: 10.1038/s41598-021-83101-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Yingying Shang
- University of California, San Francisco, USA.,Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing, China
| | | | | | | | - Anne M Findlay
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Srikantan S Nagarajan
- University of California, San Francisco, USA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
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25
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Loftus PA, Roland LT, Gurrola JG, Cheung SW, Chang JL. Temporal Profile of Olfactory Dysfunction in COVID-19. OTO Open 2020; 4:2473974X20978133. [PMID: 33330830 PMCID: PMC7724426 DOI: 10.1177/2473974x20978133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) is associated with olfactory dysfunction, but the evolution of the olfactory loss and timeline to recovery are largely unknown. This study examines changes in smell sensitivity in COVID-19-positive (COVID+) and COVID-19-negative (COVID-) viral illness during the initial weeks after infection. Study Design Cross-sectional cohort comparison. Setting National anonymous surveys. Methods Survey participants were queried about smell sensitivity and general health status at the time of COVID-19 testing and in the weeks that followed. Results In total, 375 (174 COVID+, 201 COVID-) participants completed the survey and 132 (62 COVID+, 70 COVID-) participants completed the 2-week follow-up survey. Normal smell in the COVID+ cohort was less frequent at the time of testing and at follow up (P < .05). Dynamic changes in smell sensitivity in the COVID+ cohort were more frequent in the initial weeks (P < .001). In those with normosmia at the start of infection, 38% of the COVID+ cohort reported worsening smell compared to only 8% in the COVID- cohort (P < .05). Recovery of overall health was associated with normosmia at the time of infection and improvement of smell sensitivity within weeks of infection. Conclusion The COVID+ cohort showed greater dynamic change in smell sensitivity and a higher rate of persistent olfactory dysfunction in the weeks after infection. Normal smell at the time of COVID-19 infection may still worsen before recovery. Overall health recovery after viral illness is associated with improvement in smell sensitivity and the absence of initial anosmia or hyposmia.
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Affiliation(s)
- Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jose G Gurrola
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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26
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Plonowska KA, Ochoa E, Ryan WR, Chang JL. Sialendoscopy in Chronic Obstructive Sialadenitis Without Sialolithiasis: A Prospective Cohort Study. Otolaryngol Head Neck Surg 2020; 164:595-601. [PMID: 32988282 DOI: 10.1177/0194599820957256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate long-term chronic sialadenitis symptoms in patients without sialolithiasis following sialendoscopy-assisted salivary duct surgery (SASDS) compared to a control group managed conservatively. STUDY DESIGN Prospective cohort study. SETTING Tertiary care center. METHODS Thirty-six patients (52 glands) with chronic sialadenitis without sialolithiasis completed the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire at presentation and at 3-month time intervals thereafter for 1 year. Lower COSS scores represent lower symptom severity. We compared 27 patients who underwent SASDS to 9 control patients who elected conservative management. RESULTS COSS gland-specific scores from 38 SASDS-treated glands (cases) and 14 control glands were similar at baseline. At 6 to 12 months (mean, 8.4 months), the surgically treated group had significantly lower scores and a greater score reduction from baseline compared to controls (mean score change [95% confidence interval] cases: 20.7 points [15.7-25.8]; controls: 11.7 points [4.9-18.4]; P = .04). There was a significant difference in scores between the 2 groups over time (P < .001). A greater proportion (72%) of cases reported partial or complete resolution of overall sialadenitis symptoms at 6 to 12 months compared to the controls (22%, P < .05). CONCLUSION Compared to patients electing for conservative management, patients with sialadenitis without sialolithasis treated with SASDS had improved symptom scores and a greater reduction of symptom severity after 6 months. With SASDS, patients had higher rates of significant overall symptom improvement. In evaluating chronic sialadenitis, assessment at multiple time points is necessary to capture the intermittent and cyclical pattern of obstructive symptoms.
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Affiliation(s)
- Karolina A Plonowska
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Edgar Ochoa
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
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Cai Y, Gulati A, Jiam NT, Wai KC, Shuman EA, Pletcher SD, Durr ML, Chang JL. Evolving Otolaryngology Resident Roles and Concerns at the Peak of the US COVID-19 Pandemic. Head Neck 2020; 42:3712-3719. [PMID: 32926482 DOI: 10.1002/hed.26438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/13/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The roles of US otolaryngology residents have changed in response to the coronavirus disease 2019 (COVID-19) pandemic. As the pandemic peaked in the United States, we characterized resident activities and concerns. METHODS A cross-sectional study of US otolaryngology residents between April 20, 2020 and May 2, 2020. RESULTS A total of 219 residents at 65/118 (55%) institutions responded. Thirty (14%) residents had been redeployed. Residents reported greatest concerns regarding education (P < .00001). Assuming adequate protective equipment, 55% desired active participation in high-risk procedures on COVID-19-positive patients. Redeployed residents had greater concern for burnout and reduced in-hospital well-being (P < .05). Resident satisfaction correlated with comfort communicating concerns to their department (odds ratio [OR] = 4.9, 95% confidence interval [CI] 1.4-17.3, P = .01) and inversely correlated with low perceived meaning in work (OR = 3.1, CI 1.1-9.1, P = .03). CONCLUSION Otolaryngology resident concerns have evolved as the pandemic progressed. Residency programs should prioritize resident education, well-being in redeployed residents, and open communication as they transition toward recovery.
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Affiliation(s)
- Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Arushi Gulati
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Nicole T Jiam
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Katherine C Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Elizabeth A Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Megan L Durr
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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28
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Harris JE, Lai SY, Chang JL. Metabolic, Radiation, and Medication Induced Sialadenitis. Curr Otorhinolaryngol Rep 2020. [DOI: 10.1007/s40136-020-00311-9] [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: 11/25/2022]
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Palmieri DE, Schaitkin BM, Chang JL. Clinical Entities that Mimic Salivary Inflammatory Disease. Curr Otorhinolaryngol Rep 2020. [DOI: 10.1007/s40136-020-00303-9] [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: 11/28/2022]
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Strohl MP, Young VN, Dwyer CD, Bhutada A, Crawford E, Chang JL, Rosen CA, Cheung SW. Novel Adaptation of a Validated Tactile Aesthesiometer to Evaluate Laryngopharyngeal Sensation. Laryngoscope 2020; 131:1324-1331. [PMID: 32735711 DOI: 10.1002/lary.28947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate laryngopharyngeal sensation at specific subsites using a novel adaptation of a buckling force aesthesiometer for delivery of calibrated tactile stimuli. STUDY DESIGN Cross-sectional. METHODS Twenty-two healthy adults (12 men, 10 women) were tested for responses to tactile forces, using 30-mm 6-0, 5-0, and 4-0 nylon monofilaments to map sensation of the aryepiglottic (AE) fold, lateral pyriform sinus (PS), and medial PS bilaterally. The outcome measures were the laryngeal adductor reflex (LAR) and patient reported rating of perceptual strength. RESULTS Rates of triggered LAR response grew monotonically with increasing tactile force at a mean (SD) stimulus duration of 663 (164) msec across all three subsites. The AE fold and medial PS had similar profiles and were the most responsive, while the lateral PS was the least responsive. Low force (6-0) response rate was ≤14% for all subsites. High force (4-0) response rate was 91% for AE fold and medial PS, and 23% for lateral PS. The perceptual strength gradient was in the lateral to medial trajectory. CONCLUSION Normative data for LAR response rates to low, medium, and high stimulation forces will be useful to assess sensory dysfunction in a variety of laryngopharyngeal disorders, including aspiration, dysphagia, chronic cough, and spasmodic dysphonia. In turn, that information will guide the creation of innovative treatments. LAR response profiles to low and high force stimuli will inform the development of screening tools to diagnose laryngopharyngeal hypersensitivity and hyposensitivity conditions. LEVEL OF EVIDENCE 3b Laryngoscope, 131:1324-1331, 2021.
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Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher D Dwyer
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Abhishek Bhutada
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Ethan Crawford
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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Roland LT, Loftus PA, Chang JL. Reply to: Challenges in interpreting the diagnostic performance of symptoms to predict COVID-19 status: the case of anosmia. Int Forum Allergy Rhinol 2020; 10:1116-1117. [PMID: 32583946 PMCID: PMC7361774 DOI: 10.1002/alr.22648] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
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Roland LT, Gurrola JG, Loftus PA, Cheung SW, Chang JL. Smell and taste symptom-based predictive model for COVID-19 diagnosis. Int Forum Allergy Rhinol 2020; 10:832-838. [PMID: 32363809 PMCID: PMC7267242 DOI: 10.1002/alr.22602] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022]
Abstract
Background The presentation of coronavirus 2019 (COVID‐19) overlaps with common influenza symptoms. There is limited data on whether a specific symptom or collection of symptoms may be useful to predict test positivity. Methods An anonymous electronic survey was publicized through social media to query participants with COVID‐19 testing. Respondents were questioned regarding 10 presenting symptoms, demographic information, comorbidities, and COVID‐19 test results. Stepwise logistic regression was used to identify predictors for COVID‐19 positivity. Selected classifiers were assessed for prediction performance using receiver operating characteristic (ROC) curve analysis. Results A total of 145 participants with positive COVID‐19 testing and 157 with negative results were included. Participants had a mean age of 39 years, and 214 (72%) were female. Smell or taste change, fever, and body ache were associated with COVID‐19 positivity, and shortness of breath and sore throat were associated with a negative test result (p < 0.05). A model using all 5 diagnostic symptoms had the highest accuracy with a predictive ability of 82% in discriminating between COVID‐19 results. To maximize sensitivity and maintain fair diagnostic accuracy, a combination of 2 symptoms, change in sense of smell or taste and fever was found to have a sensitivity of 70% and overall discrimination accuracy of 75%. Conclusion Smell or taste change is a strong predictor for a COVID‐19–positive test result. Using the presence of smell or taste change with fever, this parsimonious classifier correctly predicts 75% of COVID‐19 test results. A larger cohort of respondents will be necessary to refine classifier performance.
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Affiliation(s)
- Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Jose G Gurrola
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
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Cai Y, Jiam NT, Wai KC, Shuman EA, Roland LT, Chang JL. Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic. Laryngoscope 2020; 130:2550-2557. [PMID: 32368800 PMCID: PMC7267342 DOI: 10.1002/lary.28733] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/06/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus 2019 (COVID-19) pandemic has had widespread implications on clinical practice at U.S. hospitals. These changes are particularly relevant to otolaryngology-head and neck surgery (OHNS) residents because reports suggest an increased risk of contracting COVID-19 for otolaryngologists. The objectives of this study were to evaluate OHNS residency program practice changes and characterize resident perceptions during the initial phase of the pandemic. STUDY DESIGN A cross-sectional survey of U.S. OHNS residents at 81 programs was conducted between March 23, 2020, and March 29, 2020. RESULTS Eighty-two residents from 51 institutions (63% of invited programs) responded. At the time of survey, 98% of programs had enacted policy changes to minimize COVID-19 spread. These included filtered respirator use for aerosol-generating procedures even in COVID-19-negative patients (85%), decreased resident staffing of surgeries (70%), and reduced frequency of tracheotomy care (61%). The majority of residents (66%) perceived that residents were at higher risk of contracting COVID-19 compared to attendings. Residents were most concerned about protective equipment shortage (93%) and transmitting COVID-19 to patients (90%). The majority of residents (73%) were satisfied with their department's COVID-19 response. Resident satisfaction correlated with comfort level in discussing concerns with attendings (r = 0.72, P < .00001) and inversely correlated with perceptions of increased risk compared to attendings (r = -0.52, P < .00001). CONCLUSION U.S. OHNS residency programs implemented policy changes quickly in response to the COVID-19 pandemic. Sources of resident anxieties demonstrate the importance of open communication and an integrated team approach to facilitate optimal patient and provider care during this unprecedented crisis. LEVEL OF EVIDENCE 4. Laryngoscope, 130:2550-2557, 2020.
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Affiliation(s)
- Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Nicole T Jiam
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Katherine C Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Elizabeth A Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco School of Medicine, San Francisco, California, U.S.A
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Ryan WR, Plonowska KA, Gurman ZR, Aubin-Pouliot A, Chang JL. One-Year symptom outcomes after sialolithiasis treatment with sialendoscopy-assisted salivary duct surgery. Laryngoscope 2018; 129:396-402. [DOI: 10.1002/lary.27398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 11/08/2022]
Affiliation(s)
- William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Salivary Gland Surgery Center; Department of Otolaryngology-Head and Neck Surgery; San Francisco California
| | - Karolina A. Plonowska
- the University of California; San Francisco School of Medicine; San Francisco California
| | - Zev R. Gurman
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco California
| | - Annick Aubin-Pouliot
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco California
| | - Jolie L. Chang
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco California
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Plonowska KA, Gurman ZR, Humphrey A, Chang JL, Ryan WR. One‐year outcomes of sialendoscopic‐assisted salivary duct surgery for sialadenitis without sialolithiasis. Laryngoscope 2018; 129:890-896. [DOI: 10.1002/lary.27433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/03/2018] [Accepted: 06/18/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Karolina A. Plonowska
- University of California, San Francisco School of Medicine San Francisco, San Francisco California U.S.A
| | - Zev R. Gurman
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology–Head and Neck Surgery San Francisco, San Francisco California U.S.A
| | - Amanda Humphrey
- University of California, San Francisco School of Medicine San Francisco, San Francisco California U.S.A
| | - Jolie L. Chang
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology–Head and Neck Surgery San Francisco, San Francisco California U.S.A
| | - William R. Ryan
- the Division of Head and Neck Oncologic and Endocrine Surgery, Salivary Gland Surgery Center, Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco, San Francisco California U.S.A
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Emmerson E, May AJ, Berthoin L, Cruz-Pacheco N, Nathan S, Mattingly AJ, Chang JL, Ryan WR, Tward AD, Knox SM. Salivary glands regenerate after radiation injury through SOX2-mediated secretory cell replacement. EMBO Mol Med 2018; 10:e8051. [PMID: 29335337 PMCID: PMC5840548 DOI: 10.15252/emmm.201708051] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 12/25/2022] Open
Abstract
Salivary gland acinar cells are routinely destroyed during radiation treatment for head and neck cancer that results in a lifetime of hyposalivation and co-morbidities. A potential regenerative strategy for replacing injured tissue is the reactivation of endogenous stem cells by targeted therapeutics. However, the identity of these cells, whether they are capable of regenerating the tissue, and the mechanisms by which they are regulated are unknown. Using in vivo and ex vivo models, in combination with genetic lineage tracing and human tissue, we discover a SOX2+ stem cell population essential to acinar cell maintenance that is capable of replenishing acini after radiation. Furthermore, we show that acinar cell replacement is nerve dependent and that addition of a muscarinic mimetic is sufficient to drive regeneration. Moreover, we show that SOX2 is diminished in irradiated human salivary gland, along with parasympathetic nerves, suggesting that tissue degeneration is due to loss of progenitors and their regulators. Thus, we establish a new paradigm that salivary glands can regenerate after genotoxic shock and do so through a SOX2 nerve-dependent mechanism.
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Affiliation(s)
- Elaine Emmerson
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Alison J May
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Lionel Berthoin
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Noel Cruz-Pacheco
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Sara Nathan
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Aaron J Mattingly
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Jolie L Chang
- Department of Otolaryngology, University of California, San Francisco, CA, USA
| | - William R Ryan
- Department of Otolaryngology, University of California, San Francisco, CA, USA
| | - Aaron D Tward
- Department of Otolaryngology, University of California, San Francisco, CA, USA
| | - Sarah M Knox
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
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Larson AR, Aubin-Pouliot A, Delagnes E, Zheng M, Chang JL, Ryan WR. Surgeon-Performed Ultrasound for Chronic Obstructive Sialadenitis Helps Predict Sialendoscopic Findings and Outcomes. Otolaryngol Head Neck Surg 2017; 157:973-980. [DOI: 10.1177/0194599817728867] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To determine the accuracy of surgeon-performed ultrasound (SP-US) features for predicting intraoperative sialendoscopic findings and to correlate ultrasound features with short-term symptomatic outcomes following sialendoscopy-assisted salivary duct surgery (SASDS). Study Design Case series with chart review. Setting The practices of 2 academic sialendoscopy surgeons. Subjects and Methods Between February 2014 and September 2015, 82 patients with 105 symptomatic glands underwent SASDS, of whom 56 patients (75 glands) met inclusion criteria. SP-US and sialendoscopic findings were reviewed for patients with chronic obstructive sialadenitis who underwent SASDS and who had been prospectively evaluated with the University of California–San Francisco Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire (scored 0-100) administered preoperatively and 3 months postoperatively. Results The positive predictive value (PPV) and negative predictive value (NPV) of SP-US for identifying sialoliths intraoperatively were 94% (33/35) and 91% (39/43), respectively. Of glands with sialoliths on SP-US, 97% (34/35) had complete symptom resolution (COSS ≤10) after SASDS. The PPV and NPV of salivary duct dilation on SP-US for finding a corresponding stenosis on sialendoscopy were 93% (14/15) and 50% (14/28), respectively. Nonsialolith SP-US features with the highest PPV for complete or partial symptom resolution (COSS ≤25) following SASDS included distal duct dilation of all glands (86%; 6/7) and dilation of both distal and proximal parotid ducts (75%; 6/8). Conclusion SP-US has high accuracy for ruling in and ruling out sialoliths, as well as for ruling in but not for necessarily ruling out stenosis presence and location. Ultrasound is helpful in estimating degree of short-term symptom response following SASDS.
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Affiliation(s)
- Andrew R. Larson
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Annick Aubin-Pouliot
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Elise Delagnes
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Melissa Zheng
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Jolie L. Chang
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - William R. Ryan
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
- Salivary Gland Center, Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
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Delagnes EA, Zheng M, Aubin-Pouliot A, Chang JL, Ryan WR. Salivary duct stenosis: Short-term symptom outcomes after sialendoscopy-assisted salivary duct surgery. Laryngoscope 2017; 127:2770-2776. [DOI: 10.1002/lary.26665] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/02/2017] [Accepted: 04/12/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Elise A. Delagnes
- School of Medicine; University of California-San Francisco; San Francisco California U.S.A
| | - Melissa Zheng
- School of Medicine; University of California-San Francisco; San Francisco California U.S.A
| | - Annick Aubin-Pouliot
- Department of Otolaryngology-Head and Neck Surgery, Salivary Gland Surgery Center; University of California-San Francisco; San Francisco California U.S.A
| | - Jolie L. Chang
- Department of Otolaryngology-Head and Neck Surgery, Salivary Gland Surgery Center; University of California-San Francisco; San Francisco California U.S.A
| | - William R. Ryan
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncologic and Endocrine Surgery, Salivary Gland Surgery Center; University of California-San Francisco; San Francisco California U.S.A
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Jáuregui E, Kiringoda R, Ryan WR, Eisele DW, Chang JL. Chronic parotitis with multiple calcifications: Clinical and sialendoscopic findings. Laryngoscope 2016; 127:1565-1570. [PMID: 27861944 DOI: 10.1002/lary.26386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/01/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize clinical, imaging, and sialendoscopy findings in patients with chronic parotitis and multiple parotid calcifications. STUDY DESIGN Retrospective review. METHODS Clinical history, radiographic images and reports, lab tests, and operative reports were reviewed for adult patients with chronic parotitis and multiple parotid calcifications who underwent parotid sialendoscopy. RESULTS Thirteen of 133 (10%) patients undergoing parotid sialendoscopy for chronic sialadenitis had more than one calcification in the region of the parotid gland. Seven patients (54%) were diagnosed with immune-mediated disease from autoimmune parotitis (positive Sjögren's antibodies or antinuclear antibodies) or human immunodeficiency virus (HIV) disease. The six patients (46%) who did not have an immune-mediated disorder had most calcifications located anterior or along the masseter muscle. Eight of 13 patients (61%) had at least one calculus found in the parotid duct on sialendoscopy. Four patients (38%) had multiple punctate calcifications within the parotid gland, all of whom had either autoimmune parotitis or HIV. None of the proximal or punctate parotid calcifications posterior to the masseter were visualized on sialendoscopy. CONCLUSIONS Chronic parotitis in conjunction with multiple parotid calcifications is uncommon and was identified in 10% of our cohort. We contrast two classifications of parotid calcifications: 1) intraductal stones that cause recurrent duct obstruction and are often located within the main parotid duct along or anterior to the masseter and 2) punctate intraparenchymal parotid gland calcifications that are not visualized on sialendoscopy and may represent underlying inflammatory disease. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1565-1570, 2017.
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Affiliation(s)
- Emmanuel Jáuregui
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Ruwan Kiringoda
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
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Delagnes EA, Aubin‐Pouliot A, Zheng M, Chang JL, Ryan WR. Sialadenitis without sialolithiasis: Prospective outcomes after sialendoscopy‐assisted salivary duct surgery. Laryngoscope 2016; 127:1073-1079. [DOI: 10.1002/lary.26308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/25/2016] [Accepted: 08/04/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Elise A. Delagnes
- School of MedicineUniversity of California–San FranciscoSan Francisco California U.S.A
| | - Annick Aubin‐Pouliot
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California–San FranciscoSan Francisco California U.S.A
| | - Melissa Zheng
- School of MedicineUniversity of California–San FranciscoSan Francisco California U.S.A
| | - Jolie L. Chang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California–San FranciscoSan Francisco California U.S.A
| | - William R. Ryan
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncologic and Endocrine SurgeryUniversity of California–San FranciscoSan Francisco California U.S.A
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Pross SE, Chang JL, Glastonbury CM, van Zante A, Soe Win K, Eisele DW. Characteristics of oncocytic lipoadenoma of the submandibular gland: a case report. Acta Oto-Laryngologica Case Reports 2016. [DOI: 10.1080/23772484.2016.1167605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Aubin-Pouliot A, Delagnes EA, Chang JL, Ryan WR. Sialendoscopy-assisted surgery and the chronic obstructive sialadenitis symptoms questionnaire: A prospective study. Laryngoscope 2016; 126:1343-8. [DOI: 10.1002/lary.25759] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Annick Aubin-Pouliot
- Department of Otolaryngology-Head and Neck Surgery; University of California-San Francisco; San Francisco California U.S.A
| | - Elise A. Delagnes
- Salivary Gland Surgery Center; and the School of Medicine; University of California-San Francisco; San Francisco California U.S.A
| | - Jolie L. Chang
- Department of Otolaryngology-Head and Neck Surgery; University of California-San Francisco; San Francisco California U.S.A
| | - William R. Ryan
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncologic and Endocrine Surgery; University of California-San Francisco; San Francisco California U.S.A
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Chang JL, Pross SE, Findlay AM, Mizuiri D, Henderson-Sabes J, Garrett C, Nagarajan SS, Cheung SW. Spatial plasticity of the auditory cortex in single-sided deafness. Laryngoscope 2016; 126:2785-2791. [DOI: 10.1002/lary.25961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Jolie L. Chang
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
| | - Seth E. Pross
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
| | - Anne M. Findlay
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California U.S.A
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California U.S.A
| | - Jennifer Henderson-Sabes
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
| | - Coleman Garrett
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California U.S.A
| | - Srikantan S. Nagarajan
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
- Department of Radiology and Biomedical Imaging; University of California, San Francisco; San Francisco California U.S.A
| | - Steven W. Cheung
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
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Heaton CM, Chang JL, Orloff LA. Prognostic Implications of Lymph Node Yield in Central and Lateral Neck Dissections for Well-Differentiated Papillary Thyroid Carcinoma. Thyroid 2016; 26:434-40. [PMID: 26825749 DOI: 10.1089/thy.2015.0318] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 01/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between lymph node yield (LNY) from central (CND) and lateral (LND) neck dissections and risk of recurrence in patients undergoing primary surgery for well-differentiated papillary thyroid carcinoma (WDPTC). METHODS Clinical data were reviewed from all patients with biopsy-proven WDPTC who underwent primary total thyroidectomy with CND or LND at the authors' institution from 2005 to 2009. Patient demographics and tumor characteristics were obtained, and clinical data with at least five-year follow-up were used. Within the CNDs and LNDs, total number of nodes removed (LNY), total positive nodes removed, and the ratio of positive lymph nodes to LNY were determined. RESULTS One hundred fifty-two patients were included in the study, with average follow-up of 69 months. Of 125 patients who underwent CND, 20 had central neck disease recurrence. The LNY of patients with central neck recurrence was significantly less than those who had no recurrence (2.5 vs. 10.3; p < 0.0001). Of 71 patients who underwent LND, 23 had ipsilateral lateral neck disease recurrence. The LNY of patients with lateral neck recurrence was significantly less than those who did not recur (10.5 vs. 24.6; p < 0.0001). Higher rates of recurrence were associated with smaller LNY in both groups. For both groups, lower LNY remains predictive of recurrence on multivariate analysis controlling for pT stage, pN stage, American Joint Committee on Cancer stage, and radioactive iodine treatment. CONCLUSIONS Higher LNY in CNDs and LNDs is associated with lower rates of papillary thyroid carcinoma recurrence in the central and lateral neck. To minimize the risk of recurrence and the need for secondary therapy with revision surgery and/or radiation, surgeons should perform thorough, compartment-oriented CNDs and LNDs when nodal surgery is undertaken.
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Affiliation(s)
- Chase M Heaton
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco , San Francisco, California
| | - Jolie L Chang
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco , San Francisco, California
| | - Lisa A Orloff
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University , Stanford, California
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Dewyer NA, Kiringoda R, Kram YA, Chang JL, Chang CJ, Cheung SW. Stapedectomy Effects on Tinnitus. Otolaryngol Head Neck Surg 2015; 153:1019-23. [DOI: 10.1177/0194599815591532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/26/2015] [Indexed: 01/16/2023]
Abstract
Objective To relate poststapedectomy change in tinnitus loudness to change in tinnitus severity. Study Design Prospective, within-subjects. Setting A single otology and neurotology subspecialty referral practice. Subjects and Methods Forty-nine subjects undergoing stapedectomy completed the study between January 2012 and October 2013. Tinnitus instruments, audiometric data, and demographic information were collected prior to and 1 and 6 months after surgery. Tinnitus loudness was assessed using an 11-point (0 = none; 5 = conversation level; 10 = jet engine) visual analog scale, and severity was measured using the validated Tinnitus Functional Index. The relationship between change in tinnitus loudness and change in tinnitus severity was evaluated using linear regression and receiver operating characteristic (ROC) analyses. Results A linear regression model of change in tinnitus loudness averaged for both ears on a visual analog scale (ΔVASavg) versus change in Tinnitus Functional Index score (ΔTFI) showed a strong correlation (ΔTFI = 9.35 ×ΔVASavg; R = 0.64; P < .001). An ROC analysis identified ΔVASavg between 1.5 and 2.0 as the optimal threshold for predicting a clinically significant change in tinnitus severity (ΔTFI ≥ 13), with sensitivity and specificity of approximately 0.62 and a positive predictive value (PPV) of 0.64. Conclusion For poststapedectomy patients, a VAS loudness change by 1.5 to 2.0 points averaged for both ears in bilateral tinnitus or ~3 points in unilateral tinnitus has a PPV ~0.64 for a clinically significant change in tinnitus severity.
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Affiliation(s)
- Nicholas A. Dewyer
- Departments of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ruwan Kiringoda
- Departments of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Yoseph A. Kram
- Departments of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jolie L. Chang
- Departments of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C.Y. Joseph Chang
- Otorhinolaryngology–Head and Neck Surgery, University of Texas, Houston Medical School and Texas Ear Center, Houston, Texas, USA
| | - Steven W. Cheung
- Departments of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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Rosbe KW, Milev D, Chang JL. Effectiveness and costs of sialendoscopy in pediatric patients with salivary gland disorders. Laryngoscope 2015; 125:2805-9. [DOI: 10.1002/lary.25384] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 12/17/2022]
Affiliation(s)
| | - Dimiter Milev
- Division of Hospital Medicine; Department of Medicine
| | - Jolie L. Chang
- Otolaryngology/Head and Neck Surgery; University of California; San Francisco, San Francisco California U.S.A
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Huang L, Liu X, Li JL, Chang JL, Liu GC, Yu XF, Zhang WY. Comparative pathogenicity of Coxsackievirus A16 circulating and noncirculating strains in vitro and in a neonatal mouse model. ACTA ACUST UNITED AC 2015; 48:420-6. [PMID: 25831207 PMCID: PMC4445665 DOI: 10.1590/1414-431x20144298] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 12/10/2014] [Indexed: 11/22/2022]
Abstract
An enterovirus 71 (EV71) vaccine for the prevention of hand, foot, and mouth disease (HMFD) is available, but it is not known whether the EV71 vaccine cross-protects against Coxsackievirus (CV) infection. Furthermore, although an inactivated circulating CVA16 Changchun 024 (CC024) strain vaccine candidate is effective in newborn mice, the CC024 strain causes severe lesions in muscle and lung tissues. Therefore, an effective CV vaccine with improved pathogenic safety is needed. The aim of this study was to evaluate the in vivo safety and in vitro replication capability of a noncirculating CVA16 SHZH05 strain. The replication capacity of circulating CVA16 strains CC024, CC045, CC090 and CC163 and the noncirculating SHZH05 strain was evaluated by cytopathic effect in different cell lines. The replication capacity and pathogenicity of the CC024 and SHZH05 strains were also evaluated in a neonatal mouse model. Histopathological and viral load analyses demonstrated that the SHZH05 strain had an in vitro replication capacity comparable to the four CC strains. The CC024, but not the SHZH05 strain, became distributed in a variety of tissues and caused severe lesions and mortality in neonatal mice. The differences in replication capacity and in vivo pathogenicity of the CC024 and SHZH05 strains may result from differences in the nucleotide and amino acid sequences of viral functional polyproteins P1, P2 and P3. Our findings suggest that the noncirculating SHZH05 strain may be a safer CV vaccine candidate than the CC024 strain.
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Affiliation(s)
- L Huang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
| | - X Liu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
| | - J L Li
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
| | - J L Chang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
| | - G C Liu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
| | - X F Yu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
| | - W Y Zhang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, China
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Kiringoda R, Eisele DW, Chang JL. A comparison of parotid imaging characteristics and sialendoscopic findings in obstructive salivary disorders. Laryngoscope 2014; 124:2696-701. [DOI: 10.1002/lary.24787] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/28/2014] [Accepted: 05/22/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ruwan Kiringoda
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco School of Medicine; San Francisco California U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Jolie L. Chang
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco School of Medicine; San Francisco California U.S.A
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49
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Ryan WR, Chang JL, Eisele DW. Surgeon-performed ultrasound and transfacial sialoendoscopy for complete parotid duct stenosis. Laryngoscope 2013; 124:418-20. [DOI: 10.1002/lary.23968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 12/06/2012] [Accepted: 12/11/2012] [Indexed: 11/10/2022]
Affiliation(s)
- William R. Ryan
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
| | - Jolie L. Chang
- Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco; San Francisco California U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
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50
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Chang JL, Kezirian EJ. What are the health risks of untreated snoring without obstructive sleep apnea? Laryngoscope 2013; 123:1321-2. [DOI: 10.1002/lary.23670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Jolie L. Chang
- Department of Otolaryngology, Head and Neck Surgery; University of California; San Francisco; California; U.S.A
| | - Eric J. Kezirian
- Department of Otolaryngology, Head and Neck Surgery; University of California; San Francisco; California; U.S.A
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