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Azem O, King K, Joshi NP, Tajudeen B, Escobedo P, Bhayani M, Al-Khudari S, Stenson KM, Jelinek M, Papagiannopoulos P, Fidler MJ. Evaluation of Sentinel Lymph Node Drainage Patterns in Early-Stage Oral Cavity Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e564. [PMID: 37785729 DOI: 10.1016/j.ijrobp.2023.06.1887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Surgery is the mainstay for squamous cell carcinoma of the oral cavity (OSCC), which includes an elective neck dissection. To limit morbidity of neck dissection, sentinel lymph biopsy (SLNB) has been introduced to identify patients at risk for nodal metastasis. While the data has thoroughly examined the relationship between SLNB in patients with unilateral lymph node drainage, little information exists on the rate of bilateral lymph node drainage patterns in lateralized OSCC. This study sought to examine the incidence of bilateral lymph node drainage patterns using sentinel node mapping in early stage OSCC. MATERIALS/METHODS This retrospective review of the electronic medical records at Rush University Medical Center focused on patients who underwent a SLNB based on CPT codes 38724, 38900, 38542, and 38510. From this cohort, we limited our analysis to patients with primary clinical T1 or T2 OSCC. Primary outcome was the rate of bilateral nodal drainage on sentinel node mapping based on the SPECT-CT. RESULTS A total of 54 patients were diagnosed with clinical T1/T2N0 OSCC and underwent a SLNB with SPECT-CT. (1) From the cohort of 54, 15 patients (27.78%) had bilateral sentinel lymph node drainage on SPECT-CT, while 39 patients (72.22%) had unilateral sentinel lymph node drainage. (2) Eleven patients (73.3%) from the bilateral drainage cohort completed appropriate SLN mapping with bilateral nodal assessments. (3) Four patients who had SPECT-CT evidence of bilateral drainage completed unilateral nodal assessment alone. (4) Of the patients with bilateral nodal assessment, 1 (9.1%) patient had a positive sentinel node on the ipsilateral side, 2 (18.2%) were found to have a positive sentinel node in the contralateral neck. (5) Overall, 3 patients (20%) had local-regional recurrence in the bilateral sentinel lymph drainage cohort. CONCLUSION Management of early-stage OSCC has evolved to include SLN mapping and biopsy. Our results found that contralateral drainage occurs in 18% of our patients with 2 patients having positive sentinel node in the contralateral neck. Therefore, the rate of contralateral drainage is not clinically insignificant and this result furthers the importance of lymphatic mapping in the early-stage OSCC treatment algorithm.
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Affiliation(s)
- O Azem
- Rush University Medical Center, Chicago, Illinois, OH
| | - K King
- Rush University Medical Center, Chicago, IL
| | - N P Joshi
- Rush University Medical Center, Chicago, IL
| | - B Tajudeen
- Rush University Medical Center, Chicago, IL
| | | | - M Bhayani
- Rush University Medical Center, Chicago, IL
| | | | | | - M Jelinek
- Rush University Medical Center, Chicago, IL
| | | | - M J Fidler
- Rush University Medical Center, Chicago, IL
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2
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Jauregui E, Batra P, Tajudeen B, Papagiannopoulos P, Mahdavinia M. Asthma outcomes with biologic medications for patients with asthma and concurrent chronic rhinosinusitis. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.492] [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: 02/05/2023]
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3
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King K, Rauch R, Roy S, Tatebe K, Tajudeen B, Papagiannopoulos P, Batra P, Bhayani M, Al-Khudari S, Stenson K, Jelinek M, Fidler M, Joshi N. Impact of Routine Surveillance Imaging with Recurrence in Sinonasal Malignancies. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1340] [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: 10/31/2022]
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4
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Foster KJ, Jauregui E, Tajudeen B, Bishehsari F, Mahdavinia M. Smell loss is a prognostic factor for lower severity of coronavirus disease 2019. Ann Allergy Asthma Immunol 2020; 125:481-483. [PMID: 32717301 PMCID: PMC7380219 DOI: 10.1016/j.anai.2020.07.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Katharine J Foster
- Division of Allergy and Immunology, Department of Internal Medicine Rush University Medical Center, Chicago, Illinois
| | - Emilio Jauregui
- Division of Allergy and Immunology, Department of Internal Medicine Rush University Medical Center, Chicago, Illinois; College of Medicine, University of Illinois, Chicago, Illinois
| | - Bobby Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical center, Chicago, Illinois
| | - Faraz Bishehsari
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Section of Gastroenterology, Rush Medical College, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Division of Allergy and Immunology, Department of Internal Medicine Rush University Medical Center, Chicago, Illinois.
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LoSavio PS, Patel T, Urban MJ, Tajudeen B, Papagiannopoulos P, Revenaugh PC, Husain I, Batra PS. Management of Upper Airway Bleeding in COVID-19 Patients on Extracorporeal Membrane Oxygenation. Laryngoscope 2020; 130:2558-2560. [PMID: 32470179 PMCID: PMC7283688 DOI: 10.1002/lary.28846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/16/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Phillip S LoSavio
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Tirth Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew J Urban
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter C Revenaugh
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Inna Husain
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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6
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Kuhar HN, Shay A, Revenaugh PC, Stenson K, Tajudeen B, Gattuso P, Al-Khudari S. Abstract B37: Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.aacrahns19-b37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The purpose of the present study was to investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials, promoting the dissemination of cancerous cells from existing tumors to previously unaffected regions of the body.
Methods: Pilot prospective study over a 6-month period (April-August 2018) at Rush University Medical Center of glove and instrument washings from 15 high-risk head and neck cancer resection cases (30 samples total). Each case maintained at least one of the following features in addition to a biopsy-proven diagnosis of squamous cell carcinoma or sarcoma of the head and neck: palliative surgery or salvage surgery, positive initial or final margins, extensive tumor burden, and/or extracapsular extension (ECE). After completion of each ablative procedure, surgical gloves of the primary surgeon and the four main surgical instruments in direct contact with the tumor were placed through washings for cytologic assessment (2 samples per case). Tumor and case characteristics were recorded. Samples were blindly evaluated by a board-certified cytopathologist for cytologic assessment.
Results: 15 patients (11 males, 4 females, average age 65.13 years) undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned additional characteristics were included in the study. 26.7% of cases had ECE, 40.0% of cases had positive final margins, and 46.7% of cases had close final margins. Resected tumor locations included the oral cavity (7 cases), neck (4 cases), parotid gland (2 cases), and skin (2 cases). Malignant cells were isolated on glove washings in 1 case (6.7% of cases). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin contamination were isolated from 93.3% of instrument washings and 93.3% of glove washings. These squamous cells were differentiated from mature cells of the oral cavity by the absence of nuclei.
Conclusions: Malignant squamous cells can be isolated from surgical glove washings. This supports the common practice of changing gloves during major head and neck cancer resections and may have important implications for intraoperative practices. Additional investigation is needed to assess for viability of detected malignant cells.
Citation Format: Hannah N. Kuhar, Aryan Shay, Peter C. Revenaugh, Kerstin Stenson, Bobby Tajudeen, Paolo Gattuso, Samer Al-Khudari. Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B37.
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Affiliation(s)
| | - Aryan Shay
- Rush University Medical Center, Chicago, IL
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7
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Byrne N, Kochanski RB, Tajudeen B, Byrne RW. Symptomatic Primary Tethered Optic Chiasm: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E440-E445. [DOI: 10.1093/ons/opaa093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/14/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Symptomatic tethering of the optic nerves and chiasm is a rare occurrence and has been reported following both surgical and medical treatment of pituitary adenoma. Here we present a case of primary optic chiasm tethering in a patient with empty sella syndrome.
CLINICAL PRESENTATION
The patient was a 61-yr-old female who presented with progressively worsening bitemporal hemianopsia. Magnetic resonance imaging (MRI) brain revealed an empty sella with herniation of the optic chiasm into the sella. The patient underwent an endoscopic, endonasal/trans-sphenoidal approach to the sella, where the optic chiasm was then detethered via lysis of arachnoid adhesions and ultimately buttressed with an abdominal fat graft. Postoperatively, the patient did well with subjective and objective improvements in her visual fields.
CONCLUSION
We report a rare case of primary tethered optic chiasm, which was successfully treated via an endoscopic, endonasal approach with abdominal fat graft harvest.
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Affiliation(s)
- Nika Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Bobby Tajudeen
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Brown H, Tajudeen B, Kuhar H, Batra P, Gattuso P, Mahdavinia M. Defining the allergic endotype of CRS by structured histopathology, IgE, and clinical variables. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.083] [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: 11/27/2022]
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9
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Yan L, Blanco J, Reddy V, Al-Khudari S, Tajudeen B, Gattuso P. Clinicopathological features of papillary thyroid microcarcinoma with a diameter less than or equal to 5 mm. Am J Otolaryngol 2019; 40:560-563. [PMID: 31103218 DOI: 10.1016/j.amjoto.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/08/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE This retrospective study was conducted to assess the epidemiological, clinical and histologic characteristics of incidentally identified and presurgically diagnosed papillary thyroid microcarcinomas less than or equal to 5 mm in size (small PTMC). MATERIALS AND METHODS Cases from October 2003 to February 2018 were retrieved from pathology databases, and their clinicopathological features were reviewed. RESULTS There were a total of 182 cases of small PTMCs, 141 women and 41 men. The mean age at diagnosis was 53.5. Most of the small PTMCs were not detected on clinical examination and workup and were diagnosed incidentally during pathologic examination. 21.4% of small PTMCs showed multifocality, with 21 cases of unilateral multifocal lesions and 18 cases with bilateral multifocal tumors. Small PTMCs were most often follicular variant (51.9%) followed by classic type (47.5%). The average size of follicular variants appeared to be larger than that of the classic type PTMCs (2.84 ± 1.43 mm vs 2.26 ± 1.51 mm, P = 0.01). A total of 66 cases (36.3%) had regional lymph node sampling or selective neck dissection and 15 of these cases identified lymph node metastasis (22.7%). 46.7% of patients with node positive microcarcinomas were male compared with 16% male in group with negative lymph nodes (P = 0.03). CONCLUSIONS Small PTMCs (≤5 mm) are often multifocal and bilateral and histology is commonly both the classical and follicular variant of PTC. While often diagnosed incidentally small PTMC can lead to regional lymph node involvement in a significant portion of cases and evaluation of the regional lymph nodes should be considered in the clinical management of these patients.
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Affiliation(s)
- Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
| | - Jayjay Blanco
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Vijaya Reddy
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Samer Al-Khudari
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - Bobby Tajudeen
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
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10
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Miller C, Shay A, Tajudeen B, Sen N, Fidler M, Stenson K, Gattuso P, Al-Khudari S. Clinical features and outcomes in young adults with oral tongue cancer. Am J Otolaryngol 2019; 40:93-96. [PMID: 30472130 DOI: 10.1016/j.amjoto.2018.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 09/30/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate outcomes and survival in young patients with oral tongue cancer (OTC). METHODS Retrospective chart review of patients aged 18-40 with OTC treated between 2000 and 2016. Tumor characteristics of p16 expression, perineural invasion (PNI), and lymph-vascular invasion (LVI) were evaluated. Recurrence-free (RFS) and overall survival (OS) data were analyzed according to Kaplan-Meier method with univariate analysis. RESULTS A total of 23 patients were identified: 12 with early stage disease (ESD, stage I), and 11 with advanced stage disease (ASD, stage III or IV), (17 men and 6 women). Mean age at presentation was 34.5 years (±5 months) and mean follow-up was 46.6 months. For all patients, 5-year RFS was 62% and OS 66%. RFS for ESD was 73% and ASD 25% (log rank p = 0.011). OS for ESD was 100% and ASD 55% (log rank p = 0.012). 22% indicated tobacco use >5 pack-years and 9% heavy alcohol use. Factors associated with worse OS were neck disease (log rank p = 0.073), positive margins (log rank p = 0.001), and LVI (log rank p = 0.002). Factors associated with worse RFS were chemotherapy or radiation therapy prior to surgery (log rank p = 0.002), neck disease (log rank p = 0.047), positive margins (log rank p = 0.039), and PNI (log rank p = 0.001). Expression of p16 was observed in five cases and was not significantly associated with OS or RFS. CONCLUSION In young patients with OTC, factors associated with worse outcomes are similar to known predictors in older patients. Expression of p16 was not statistically associated with improved OS. OS in patients with ESD was excellent (100%), and significantly worse for ASD.
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Affiliation(s)
- Courtney Miller
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 550, Chicago, IL 60612, United States of America
| | - Aryan Shay
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 550, Chicago, IL 60612, United States of America
| | - Bobby Tajudeen
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 550, Chicago, IL 60612, United States of America
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, 1653 w congress pkwy, Chicago, IL 60612, United States of America
| | - Mary Fidler
- Department of Medicine, section of Medical Oncology, Rush University Medical Center, 1653 w congress pkwy, Chicago, IL 60612, United States of America
| | - Kerstin Stenson
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 550, Chicago, IL 60612, United States of America
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, 1653 w congress pkwy, Chicago, IL 60612, United States of America
| | - Samer Al-Khudari
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 550, Chicago, IL 60612, United States of America.
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11
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Heilingoetter AL, Tajudeen B, Kuhar HN, Gattuso P, Ghai R, Mahdavinia M, Batra PS. Histopathology in Chronic Rhinosinusitis Varies With Sinus Culture. Am J Rhinol Allergy 2018; 32:112-118. [DOI: 10.1177/1945892418762863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Structured histopathology reporting facilitates better understanding of the underlying pathophysiologic mechanisms of chronic rhinosinusitis. The microbiology of chronic rhinosinusitis has been studied extensively; however, distinct histopathologic changes associated with bacteria isolated in chronic rhinosinusitis are largely unknown. Objective The goal of this study is to better understand the relationship between culturable bacteria and histopathology in chronic rhinosinusitis. Methods A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery in a group of patients with chronic rhinosinusitis refractory to medical therapy. Patients with cystic fibrosis or ciliary dysfunction were excluded. Histology variables included eosinophil count per high-power field, neutrophil infiltrate, basement membrane thickening, subepithelial edema, hyperplastic/papillary changes, mucosal ulceration, squamous metaplasia, fibrosis, fungal elements, Charcot-Leyden crystals, and eosinophil aggregates. Baseline Lund-Mackay score and Sinonasal Outcome Test 22 score were also collected. The association of culture data with the aforementioned variables was assessed. Results A total of 59 chronic rhinosinusitis patients who underwent functional endoscopic sinus surgery were included. Chronic rhinosinusitis patients with Pseudomonas aeruginosa had significantly increased neutrophil infiltrate (71.4% vs. 26.9%, p = 0.048), subepithelial edema (28.6% vs. 3.8%, p = 0.047), and a trend toward increased fungal elements (28.6% vs. 5.8%, p = 0.071). Chronic rhinosinusitis patients with Staphylococcus aureus had significantly more hyperplastic changes (20% vs. 2.3%, p = 0.050) and a trend toward increased squamous metaplasia (33.3% vs. 14.2%, p = 0.069). Conclusion Distinct histopathologic changes were noted based on sinus culture data for S. aureus and P. aeruginosa. These findings may have important implications on the extent of surgical management and prognosis after surgery.
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Affiliation(s)
| | - Bobby Tajudeen
- Department of Otorhinolaryngology—Head and Neck Surgery and Rush
Sinus Program, Rush University Medical Center, Chicago, IL, USA
| | - Hannah N. Kuhar
- Rush Medical College, Rush University Medical Center, Chicago,
IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center,
Chicago, IL, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center,
Chicago, IL, USA
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Allergy/Immunology Section,
Rush University Medical Center, Chicago, IL, USA
| | - Pete S. Batra
- Department of Otorhinolaryngology—Head and Neck Surgery and Rush
Sinus Program, Rush University Medical Center, Chicago, IL, USA
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Parasher A, Workman A, Brooks S, Glicksman J, Douglas J, Tajudeen B, Alexander E, David K, Palmer J, Adappa N, Storm P. Risk Factors for Complications and Long-Term Sequelae in Endoscopic Resection of Pediatric Craniopharyngioma. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arjun Parasher
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alan Workman
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Steven Brooks
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jordan Glicksman
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jennifer Douglas
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Erin Alexander
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kennedy David
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - James Palmer
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nithin Adappa
- University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Phillip Storm
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Douglas J, Tajudeen B, Kuan E, Bergsneider M, Wang M, Lee J, Palmer J, Adappa N, Storm P. Outcomes of Pediatric Craniopharyngioma Resections after Open versus Expanded Endonasal Surgical Approach. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jennifer Douglas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Bobby Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Edward Kuan
- Department of Head and Neck Surgery, University of California Los Angeles
| | - Marvin Bergsneider
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Marilene Wang
- Department of Head and Neck Surgery, University of California Los Angeles
| | - John Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - James Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nithin Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Phillip Storm
- Children's Hospital of Philadelphia, Division of Neurosurgery, Philadelphia, Pennsylvania, United States
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14
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Papagiannopoulos P, Lin DM, Al-Khudari S, Rajan K, Reddy S, Gattuso P, Tajudeen B, Batra PS. Utility of intraoperative frozen sections in surgical decision making for acute invasive fungal rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:502-507. [PMID: 28182334 DOI: 10.1002/alr.21918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/30/2016] [Accepted: 11/27/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute invasive fungal rhinosinusitis (AIFRS) represents a fulminant, potentially fatal, disease process in immunocompromised patients. The diagnosis often rests on high index of clinical suspicion, with relative paucity of data on the diagnostic and therapeutic implications of intraoperative frozen sections. METHODS Retrospective review was performed for 18 cases undergoing endoscopic sinus surgery for AIFRS. Reliability of intraoperative frozen section diagnosis was evaluated for all patients using final pathology as the gold standard. RESULTS A total of 66 frozen sections were performed. Diagnostic accuracy of frozen sections illustrated sensitivity of 72.7% (95% confidence interval [CI], 0.57 to 0.85), specificity of 100% (95% CI, 0.85 to 1.00), positive predictive value (PPV) of 100% (95% CI, 0.89 to 1.00), and negative predictive value (NPV) of 64.7% (95% CI, 0.46 to 0.80). There was no statistically significant difference in sensitivity of frozen sections in cases of Mucor and Aspergillus at 68.8%% and 76.2%, respectively (p = 0.61). CONCLUSION This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. Frozen section analysis is an effective tool for guiding intraoperative decision making in patients with AIFRS with a high PPV. A Low NPV underscores the importance of clinical suspicion and intraoperative decision making based on endoscopic findings when negative frozen section results are encountered. Further, frozen section analysis appears to be equally effective in detecting either Mucor or Aspergillus.
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Affiliation(s)
- Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Diana Murro Lin
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Samer Al-Khudari
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Kumar Rajan
- Department of Biostatistics, Rush University Medical Center, Chicago, IL
| | - Swathi Reddy
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Paulo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Bobby Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
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Kim IA, Taylor ZD, Cheng H, Sebastian C, Maccabi A, Garritano J, Tajudeen B, Razfar A, Palma Diaz F, Yeh M, Stafsudd O, Grundfest W, St. John M. Dynamic Optical Contrast Imaging: A Technique to Differentiate Parathyroid Tissue from Surrounding Tissues. Otolaryngol Head Neck Surg 2017; 156:480-483. [DOI: 10.1177/0194599816686294] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The variable location and indistinct features of parathyroid glands can make their intraoperative identification challenging. Currently, there exists no routine use of localization methods during surgery. Dynamic optical contrast imaging (DOCI) leverages a novel realization of temporally dependent measurements of tissue autofluorescence that allows the acquisition of specific tissue properties. A prospective series of patients with primary hyperparathyroidism was examined. Parathyroid lesions and surrounding tissues were collected; fluorescence decay images were acquired via DOCI. Ex vivo samples (81 patients) were processed for histologic assessment. DOCI extracts relative fluorescence decay information in a surgically relevant field of view with a clinically accessible acquisition time <2 minutes. Analysis of DOCI revealed microscopic characterization sufficient for tissue type identification consistent with histology ( P < .05). DOCI is capable of efficiently distinguishing parathyroid tissue from adjacent tissues. Such an intraoperative tool would be transformative, helping surgeons to identify lesions, preserve healthy tissue, and improve patient outcomes.
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Affiliation(s)
- Irene A. Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Head and Neck Cancer Program, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Zachary D. Taylor
- Head and Neck Cancer Program, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Harrison Cheng
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
| | - Christine Sebastian
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Head and Neck Cancer Program, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Ashkan Maccabi
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
| | - James Garritano
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
| | - Bobby Tajudeen
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Head and Neck Cancer Program, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Ali Razfar
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Head and Neck Cancer Program, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Fernando Palma Diaz
- Department of Pathology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Michael Yeh
- Department of Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Oscar Stafsudd
- Department of Electrical Engineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
| | - Warren Grundfest
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Department of Electrical Engineering, Henry Samueli School of Engineering and Applied Sciences, University of California–Los Angeles, Los Angeles, California, USA
| | - Maie St. John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Head and Neck Cancer Program, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
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Mallen-St Clair J, Arshi A, Tajudeen B, Abemayor E, St John M. Epidemiology and treatment of lacrimal gland tumors: a population-based cohort analysis. JAMA Otolaryngol Head Neck Surg 2015; 140:1110-6. [PMID: 25393577 DOI: 10.1001/jamaoto.2014.2846] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Primary tumors of the lacrimal gland are rare and are associated with substantial morbidity and mortality. The literature regarding these tumors is limited to case series and case reports. OBJECTIVE To examine the incidence, treatment, and overall survival (OS) and disease-specific survival (DSS) of patients with cancer of the lacrimal gland. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with primary tumors of the lacrimal gland from 1973 to 2010. MAIN OUTCOMES AND MEASURES Overall survival and DSS. RESULTS A total of 321 patients with nonlymphoid tumors of the lacrimal gland were identified. The most common histological subtypes were adenoid cystic carcinoma (ACC) (32.1%) and squamous cell carcinoma (SCC) (29.9%). Survival analysis revealed a 5-year OS and DSS for all lacrimal gland tumors of 60% and 75%, respectively. On univariate analysis, low tumor grade (P = .04) and surgical treatment (P < .001) were associated with significantly better OS. For ACC tumors, surgery (P = .009), but not radiotherapy (P = .44), was found to significantly improve OS. For SCC tumors, surgical treatment significantly improved both OS (P < .001) and DSS (P = .004); radiation therapy also significantly improved OS (P = .03). Using a multivariable analysis model, age (hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]; P < .001), surgery (HR, 0.43 [95% CI, 0.25-0.75]; P = .003), and T stage at presentation (HR, 1.18 [95% CI, 1.01-1.37]; P = .03) were found to be independent predictors of OS. For ACC alone, age (HR, 1.04 [95% CI, 1.02-1.06]; P < .001) and surgery (HR, 0.35 [95% CI, 0.13-0.91]; P = .03) were independent predictors of OS. For SCC, age (HR, 1.05 [95% CI, 1.02-1.09]; P = .005), surgical resection (HR, 0.31 [95% CI, 0.12-0.83]; P = .02), and radiation therapy (HR, 0.33 [95% CI, 0.14-0.80]; P = .01) were independent predictors of OS. CONCLUSIONS AND RELEVANCE Our study demonstrates that ACC is the most common malignant epithelial neoplasm of the lacrimal gland. Determinants of survival for tumors of the lacrimal gland include age at diagnosis and surgical therapy. Radiation therapy is associated with improved DSS in SCC but not in ACC.
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Affiliation(s)
- Jon Mallen-St Clair
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Armin Arshi
- medical student at David Geffen School of Medicine at University of California, Los Angeles
| | - Bobby Tajudeen
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Maie St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
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Suh JD, Ramakrishnan VR, Tajudeen B, Reger C, Kennedy DW, Chiu AG. Identification and Treatment of Nontuberculous Mycobacterium Sinusitis. Am J Rhinol Allergy 2011; 25:421-4. [DOI: 10.2500/ajra.2011.25.3677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The purpose of this study was to identify the incidence of atypical Mycobacterium identified by routine sinus cultures and review the recent literature on management. Methods A retrospective case series was performed in a tertiary academic hospital. A retrospective case series of all patients treated with atypical Mycobacterium rhinosinusitis from 2005 to 2010 was performed. Cases were identified from a prospective database of 676 endoscopically guided sinus cultures. Results Eight patients with atypical Mycobacterium sinusitis were identified. There were five women and three men. Median age was 63 years (range, 55–71 years). All patients had prior endoscopic sinus surgery a median of 14 months (range, 0.8–162 months) before a positive culture result. Species identified included Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium avium complex. Chief presenting symptoms were postnasal discharge (88%), followed by decreased smell and taste (63%), and facial pain/pressure (38%). Patients were treated based on sensitivity results with long-term oral antibiotics for at least 2 months based on improvements on endoscopy. Median follow-up for patients in this study after treatment was 1.3 years (range, 0.6–4.6 years). Conclusion In this study, atypical mycobacteria were identified in < 1% of sinus cultures. Prolonged, culture-directed antibiotic therapy remains the mainstay of treatment when there is clinical evidence of infection. Previous endoscopic sinus surgery may represent a risk factor for colonization and subsequent infection. Further research is necessary to determine the optimal treatment duration and management to prevent disease relapse
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Affiliation(s)
- Jeffrey D. Suh
- Division of Otolaryngology–Head and Neck Surgery, University of California–Los Angeles, School of Medicine, Los Angeles, California
| | - Vijay R. Ramakrishnan
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bobby Tajudeen
- Division of Otolaryngology–Head and Neck Surgery, University of California–Los Angeles, School of Medicine, Los Angeles, California
| | - Christine Reger
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David W. Kennedy
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Chiu
- Division of Otolaryngology–Head and Neck Surgery, University of Arizona, Tucson, Arizona
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Habib MG, Waltzman SB, Tajudeen B, Svirsky MA. Speech production intelligibility of early implanted pediatric cochlear implant users. Int J Pediatr Otorhinolaryngol 2010; 74:855-9. [PMID: 20472308 PMCID: PMC2897907 DOI: 10.1016/j.ijporl.2010.04.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the influence of age, and age-at-implantation, on speech production intelligibility in prelingually deaf pediatric cochlear implant recipients. METHODS Forty prelingually, profoundly deaf children who received cochlear implants between 8 and 40 months of age. Their age at testing ranged between 2.5 and 18 years. Children were recorded repeating the 10 sentences in the Beginner's Intelligibility Test. These recordings were played back to normal-hearing listeners who were unfamiliar with deaf speech and who were instructed to write down what they heard. They also rated each subject for the intelligibility of their speech production on a 5-point rating-scale. The main outcome measures were the percentage of target words correctly transcribed, and the intelligibility ratings, in both cases averaged across 3 normal-hearing listeners. RESULTS The data showed a strong effect of age at testing, with older children being more intelligible. This effect was particularly pronounced for children implanted in the first 24 months of life, all of whom had speech production intelligibility scores of 80% or higher when they were tested at age 5.5 years or older. This was true for only 5 out of 9 children implanted at age 25-36 months. CONCLUSIONS Profoundly deaf children who receive cochlear implants in the first 2 years of life produce highly intelligible speech before the age of 6. This is also true for most, but not all children implanted in their third year.
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Mhatre AN, Tajudeen B, Welt EM, Wartmann C, Long GR, Lalwani AK. Temporary reduction of distortion product otoacoustic emissions (DPOAEs) immediately following auditory brainstem response (ABR). Hear Res 2010; 269:180-5. [PMID: 20600743 DOI: 10.1016/j.heares.2010.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 11/19/2022]
Abstract
The hearing status of an experimental animal is typically assessed in the laboratory setting by the combined use of auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs), carried out in succession, with the former assay preceding the latter. This study reports a cautionary finding that the use of this accepted regimen yields a reduced DPOAE response. When the DPOAEs were performed after ABR testing, transient reduction of the DPOAE amplitudes was observed at all frequencies in both the inbred, C57/B6 and FVB/N, and the outbred, SW mouse strains. DPOAEs were reduced post-ABR in multiple mouse strains which suggests that this finding is not strain-specific but a general consequence of the preceding ABR analysis. The reduction in DPOAE was temporary: when re-tested at one hour, DPOAE amplitudes recovered to pre-ABR levels. In contrast to the ABR's impact on DPOAE response, ABR thresholds were not altered or reduced when preceded immediately by DPOAE measurements. The molecular alterations underlying the ABR-induced transient reduction of DPOAE remain to be determined. To investigate the potential role of reactive oxygen species in post-ABR DPOAE reduction, transgenic mice over-expressing SOD1, the cytoplasmic enzyme critical for removal of superoxide radicals were subjected to the same auditory testing regimen. Similar to their wild type littermates, the SOD1 transgenic mice also demonstrated post-ABR DPOAE reduction, and thus do not support a role for superoxide radicals in transient reduction of DPOAE. While toxic noise exposure is known to negatively impact OAE, transient decrease in DPOAE levels following standard ABR assay has not been previously described. A practical outcome from this study is a recommendation for reversal of the traditional order for carrying out auditory tests, with the OAE measurements preceding ABR assessment, thus ensuring that the DPOAE response is unaffected.
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Affiliation(s)
- Anand N Mhatre
- Department of Otolaryngology, New York University School of Medicine, New York, NY 10016, USA.
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