Publisher: Sage Publications   (Total: 1089 journals)

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Showing 1 - 200 of 1089 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 24)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 51, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 361, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 24, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 8, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 237, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 44)
Advances in Dental Research     Hybrid Journal   (Followers: 9, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 31, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 135, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 11)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 46, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 10)
Affilia     Hybrid Journal   (Followers: 5, SJR: 0.496, CiteScore: 1)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 2)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 67)
Allergy & Rhinology     Open Access   (Followers: 4)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 12, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 11, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 24, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 8)
American Educational Research J.     Hybrid Journal   (Followers: 227, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 19, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 8)
American J. of Evaluation     Hybrid Journal   (Followers: 17, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 34, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 43, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 6, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 12, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 9, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 215, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 33, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 21, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 330, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 14, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 17, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 54, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 48, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 42, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 11)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal  
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 23, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 26, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 22, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 42, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.558, CiteScore: 1)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 9, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 17, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 16, SJR: 0.578, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 29, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 531, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 4)
Australian J. of Education     Hybrid Journal   (Followers: 42, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 339, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 12)
Behavior Modification     Hybrid Journal   (Followers: 12, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 26)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 19, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 52)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Informatics Insights     Open Access   (Followers: 9)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 3, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 27, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 11, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 217, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 27, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 33, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 13, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 8)
Business & Society     Hybrid Journal   (Followers: 13)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 8, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 32, SJR: 2.209, CiteScore: 4)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 6, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 142, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 27, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 1)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 8, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiovascular and Thoracic Open     Open Access  
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 9, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 5, SJR: 0.889, CiteScore: 3)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Transplantation     Open Access   (Followers: 4, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 2)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 35, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 5)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
China Information     Hybrid Journal   (Followers: 7, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 10, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 4)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access  
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 6, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 10, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 1)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 31, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 3)
Clinical Pediatrics     Hybrid Journal   (Followers: 22, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 12, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 76, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 21, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 25, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 1)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 17, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 21, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 9, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 257, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 11, SJR: 0.843, CiteScore: 2)
Competition and Regulation in Network Industries     Full-text available via subscription   (Followers: 8, SJR: 0.143, CiteScore: 0)
Concurrent Engineering     Hybrid Journal   (Followers: 3, SJR: 0.642, CiteScore: 2)
Conflict Management and Peace Science     Hybrid Journal   (Followers: 40, SJR: 2.441, CiteScore: 1)
Contemporary Drug Problems     Full-text available via subscription   (Followers: 3, SJR: 0.609, CiteScore: 2)
Contemporary Education Dialogue     Hybrid Journal   (Followers: 5, SJR: 0.102, CiteScore: 0)
Contemporary Issues in Early Childhood     Full-text available via subscription   (Followers: 8, SJR: 0.766, CiteScore: 1)
Contemporary Review of the Middle East     Full-text available via subscription   (Followers: 12)
Contemporary Sociology : A J. of Reviews     Full-text available via subscription   (Followers: 35, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription   (Followers: 1)
Contexts     Hybrid Journal   (Followers: 6)

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Similar Journals
Journal Cover
Annals of Otology, Rhinology & Laryngology
Journal Prestige (SJR): 0.807
Citation Impact (citeScore): 1
Number of Followers: 17  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-4894 - ISSN (Online) 1943-572X
Published by Sage Publications Homepage  [1089 journals]
  • Occult Metastasis in Laryngeal Squamous Cell Carcinoma: A Systematic
           Review and Meta-Analysis
    • Authors: Daniel D. Sharbel, Mary Abkemeier, Michael W. Groves, William G. Albergotti, J. Kenneth Byrd, Camilo Reyes-Gelves
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:The incidence of occult metastasis (OM) in laryngeal squamous cell carcinoma (SCC) is still widely debated. In this systematic review, we aim to determine the rate of OM in laryngeal SCC, its impact on recurrence, and the role of elective neck dissection (END) in the management of the clinically negative neck.Methods:A systematic review of the English-language literature in Web of Science, PubMed, MEDLINE, and Cochrane Library databases on occult metastasis in laryngeal SCC from 1977 to 2018 was conducted. Studies evaluating occult metastasis (OM) in patients with laryngeal SCC with clinically negative necks undergoing surgery were included. Studies evaluating other head and neck subsites, clinically node positive, and salvage patients were excluded.Results:Twenty-one articles with a total of 5630 patients were included. The overall rate of OM was 20.5% and was 23% and 12.2% in supraglottic and glottic tumors, respectively. The OM rate in T1-T2 tumors was 13% and 25% in T3-T4 tumors. T3-T4 tumors had significantly greater odds of developing OM compared to T1-T2 tumors (Odds Ratio [OR] = 2.61, 95% Confidence Interval [CI] = 1.92-3.55, P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-07-01T10:51:23Z
      DOI: 10.1177/0003489420937744
       
  • The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common
           Pathology
    • Authors: Geoffrey Casazza, Matthew L. Carlson, Clough Shelton, Richard K. Gurgel
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base.Study Design:Retrospective case seriesSetting:Two tertiary care academic centers.Patients:Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017.Interventions:Surgical management of medially-invasive cholesteatomas.Main Outcome Measures:The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed.Results:Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence.Conclusions:The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-30T10:33:05Z
      DOI: 10.1177/0003489420937731
       
  • Allergic Fungal Sinusitis Imitating an Aggressive Skull Base Lesion in the
           Setting of Pembrolizumab Immunotherapy
    • Authors: Natalie A. Krane, Daniel M. Beswick, David Sauer, Kara Detwiller, Maisie Shindo
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor.Methods:A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement.Results:Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient’s symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation.Conclusions:Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-29T01:17:23Z
      DOI: 10.1177/0003489420937728
       
  • Effect of Low-Pressure Drainage Suction on Pharyngocutaneous Fistula After
           Total Laryngectomy
    • Authors: Mojtaba Maleki Delarestaghi, Aslan Ahmadi, Fatemeh Dehghani Firouzabadi, Maryam Roomiani, Mohammad Dehghani Firouzabadi, Zhaleh Faham
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Pharyngocutaneous fistula (PCF) is one of the most severe multifactorial complications following laryngectomy. The current study aimed at determining the effect of a low-pressure vacuum drain on the incidence of PCF after total laryngectomy.Methods:The current randomized clinical trial was conducted on 35 patients undergoing total laryngectomy in Hazrat Rasoul Akram and Firoozgar hospitals in Tehran, Iran. The subjects were divided into the vacuum drain (n = 15) and control (without vacuum drain) (n = 20) groups. The incidence of PCF and the recovery time were recorded.Results:The rate of PCF formation from the stoma and wound edges was significantly lower in the low-pressure vacuum drain group than in the control group (6.7% vs 40%) (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-29T01:16:44Z
      DOI: 10.1177/0003489420934506
       
  • Letter to the Editor Regarding “Caudal Septal Division and Interposition
           Batten Graft: A Novel Technique to Correct Caudal Septal Deviation in
           Septoplasty”
    • Authors: Amir Arvin Sazgar
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-27T05:34:14Z
      DOI: 10.1177/0003489420934826
       
  • COVID-19 and Total Laryngectomy—A Report of Two Cases
    • Authors: Alberto Paderno, Milena Fior, Giulia Berretti, Francesca Del Bon, Alberto Schreiber, Alberto Grammatica, Davide Mattavelli, Alberto Deganello
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To date, no cases have been reported on the effects of COVID-19 in laryngectomees.Case Presentation:We herein presented two clinical cases of laryngectomized patients affected by COVID-19, detailing their clinical course and complications.Discussion:In our experience, permanent tracheostomy did not significantly affect the choice of treatment. However, dedicated devices and repeated tracheal toilettes may be needed to deal with oxygen-therapy-related tracheal crusting.Conclusion:In conclusion, laryngectomees should be considered a vulnerable population that may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways. The role of the ENT specialist is to guide airway management and inform the support-staff regarding specific needs of these patients.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-25T11:54:27Z
      DOI: 10.1177/0003489420935500
       
  • Composite Cartilage-osseous-mucosal Nasoseptal Flap for Reconstruction
           after Near Total Rhinectomy
    • Authors: Karthik S. Shastri, Yufan Lin, Jessica Scordino, Carlos D. Pinheiro-Neto
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Reconstruction of full thickness nasal defects usually requires different donor sites for the external skin envelope, structural elements, and internal nasal lining. In this paper we present a novel single site method for dual inner lining and skeleton repair for full thickness nasal defects with a composite nasoseptal flap and extended pedicle dissection.Methods:A 72-year-old male presented with a T4b melanoma involving the nasal dorsum and left upper lateral cartilage. Following full thickness resection, reconstruction was performed with a nasoseptal flap (NSF) with attached septal cartilage and vomer in conjunction with a paramedian forehead flap. Extended pedicle dissection into the pterygopalatine fossa allowed the NSF to fully cover the defect.Results:The nasal defect was fully corrected. There was no evidence of flap compromise or nasal valve stenosis at 1 month, 2 month, and 1 year follow-up visits.Conclusions:We present here the first successful application of a composite cartilage-osseous-mucosal NSF for multilayered nasal reconstruction. In appropriate patients, this technique may obviate the need for flaps or grafts from extranasal sources, limiting donor site morbidity.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-24T10:27:49Z
      DOI: 10.1177/0003489420935481
       
  • Analysis of Characteristics and Survival of Primary Cutaneous Adenoid
           Cystic Carcinoma of the Head and Neck
    • Authors: Sara Behbahani, David W. Wassef, Roman Povolotskiy, Jessica Pinto, Nia Joseph, Boris Paskhover
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background/Objectives:Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare skin tumor. The head and neck (H&N) is the most common anatomical location. Due to limited published cases, its clinical course and management are not well understood.Methods:The National Cancer Database (NCDB) was queried for all cases of H&N PCACC diagnosed from 2004 to 2016. Kaplan–Meier (KM) and Cox proportional hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes.Results:A total of 201 cases were analyzed. The average age of diagnosis was 57.7 years (± SD 15.8). There was a female predilection (57.7%; P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-22T06:27:40Z
      DOI: 10.1177/0003489420936719
       
  • First Bite Syndrome Following Rhytidectomy: A Case Report
    • Authors: Anne E. Gunter, Charles M. Llewellyn, Paloma B. Perez, Marc H. Hohman, Scott B. Roofe
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:First bite syndrome (FBS) is a known complication of parotid gland resection, parapharyngeal space dissection, and cervical sympathetic chain injury. It can be described as severe cramping or spasms in the parotid region triggered by the first bite of a meal, with the pain lessening during each subsequent bite. Although dissection for a rhytidectomy is in the vicinity of the parotid parenchyma, face-lift is not typically characterized as a procedure that can lead to FBS.Case description:A 53-year-old female underwent a deep plane face-lift to address her goals of improving jowls, nasolabial folds, and cervicomental angle. Intraoperatively, the dissection proceeded without any complications. Initially, her postoperative course was uneventful; 3 weeks after surgery, she noticed pain at the start of mastication that would improve throughout the course of a meal. She elected to proceed with observation. At 6 months after surgery, she began to experience improvement in her symptoms, and shortly thereafter had complete resolution.Discussion:First bite syndrome is a complication associated with deep lobe parotid resection, first described in 1998. The innervation of the parotid gland is complex and includes contributions from the auriculotemporal nerve, the great auricular nerve, and the cervical sympathetic chain. During rhytidectomy, dissection occurs along the parotidomasseteric fascia in order to elevate a flap of the superficial musculoaponeurotic system. Inadvertent injury to the parotid parenchyma can lead to damage to the postganglionic sympathetic fibers innervating the myoepithelial cells. Ultimately, expectant management is the mainstay of treatment and symptoms typically resolve within 6 months to 1 year.Conclusion:First bite syndrome is a complication that can be seen with a variety of facial surgeries. In the case of rhytidectomy, FBS should be considered a potential risk, as dissection into the parenchyma of the parotid gland can result in postoperative autonomic dysfunction.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-22T06:27:39Z
      DOI: 10.1177/0003489420936713
       
  • Head and Neck Injuries from Rock Climbing: A Query of the National
           Electronic Injury Surveillance System
    • Authors: David W. Chou, Rijul Kshirsagar, Jonathan Liang
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:We describe the incidence and characteristics of patients with head and neck injuries from rock climbing who present to United States emergency departments and evaluate predictors of hospitalization.Methods:The National Electronic Injury Surveillance System (NEISS) database was queried for rock climbing injuries to the head, face, mouth, neck, and ear under product code “mountain climbing” from the years 2009 to 2018. Demographics, injury characteristics, and disposition data were reviewed. Data were evaluated using chi-square analysis with Cochran-Mantel-Haenszal odds ratios (ORs).Results:An estimated 5067 patients (from 129 raw NEISS case numbers) suffered head and neck injuries from rock climbing nationally from 2009 to 2018. Concussion/closed head injury was the most common injury (44%), followed by laceration (23%), soft tissue injury (15%), neck strain/sprain (6%), skull fracture (3%), facial fracture (3%), intracranial hemorrhage (3%), cervical spine fracture (2%), unspecified facial trauma (1%), and dental trauma (0.3%). Males more frequently suffered lacerations (OR 1.6), soft tissue injuries (OR 23.3), cervical spine fractures (OR 336.7), intracranial hemorrhage (OR 582.0), and skull fractures (OR 6.2) than females. Compared to shorter falls, falls over 20 ft were more commonly associated with laceration (OR 2.0), soft tissue injury (OR 3.5), facial fracture (OR 7.5), dental trauma (OR 6.6), intracranial hemorrhage (OR 951.8), skull fracture (OR 81.2), and hospitalization (OR 3.8). Injuries associated with hospitalization included facial fracture (OR 23.7), cervical spine fracture (OR 24.6), intracranial hemorrhage (OR 2210.2), and skull fracture (OR 9.8).Conclusions:Concussions and facial lacerations are the most common head and neck injuries from rock climbing. Males more commonly suffer severe injuries. Falls over 20 ft are associated with more severe injuries and an increased likelihood of hospitalization.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-22T06:27:38Z
      DOI: 10.1177/0003489420936710
       
  • Adult Palatopharyngoplasty: Trends in Morbidity and Mortality from the
           NSQIP Database
    • Authors: Christopher Gates, Jad Ramadan, Steven Coutras, Michele Carr
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Describe the postop morbidity of adults undergoing palatopharyngoplasty (PPP).Method:Adults who underwent PPP were studied using ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database (2016-2017) via CPT code 42145. Analyzed outcomes included length of stay (LOS), readmission, reoperation, and postop complications. Predictive variables were age, gender, BMI, comorbidities.Results:A total of 1081 patients (73.7% male, mean age 42.0 years, range 18-79 years) were included. 95 (8.8%) were diabetic, 183 (16.9%) were smokers, 30 (2.8%) had preoperative dyspnea. 328 (30.3%) took medicine for hypertension. Concurrent procedures occurred in 646 (59.76%), 357 (33.02%) had nasal procedures, 320 (29.60%) had tonsil procedures, 66 (6.11%) had tongue procedures. Within 30 days postop, there were two (0.19%) mortalities. Complications included six wound infections, two dehiscences, four with pneumonia, two pulmonary embolisms, three myocardial infarctions, one DVT, three sepsis, one UTI, one who required CPR, and two who were ventilated for>48 hours. Five required reintubation. A total of 41 (3.79%) returned to OR for a related reason, at least 27 (65.90%) for bleeding. LOS ranged from 0 to 15 days, median 1 day. Overall 38 (3.52%) were readmitted for a related reason, 12 (31.58%) for bleeding and three (7.89%) for pain. Using a significance level of 0.002 (Bonferroni correction), LOS varied with presence of any concurrent procedure, BMI, and estimated probability of mortality and morbidity indices; readmission and reoperation had no significantly associated variables.Conclusion:PPP is associated with low frequency but significant morbidity and mortality.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-22T06:27:37Z
      DOI: 10.1177/0003489420936711
       
  • Reducing ER Visits and Readmissions after Head and Neck Surgery Through a
           Phone-based Quality Improvement Program
    • Authors: Mitali Shah, Jennifer Douglas, Ryan Carey, Manvav Daftari, Teresa Smink, Allison Paisley, Steven Cannady, Jason Newman, Karthik Rajasekaran
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Evaluate the impact of a patient phone calls and virtual wound checks within 72 hours of discharge on reducing emergency room (ER) visits and readmissions.Methods:Single arm trial with comparison to historical control data of patients undergoing multi subsite head and neck cancer operations or laryngectomy between July 2017 and June 2018 at a tertiary academic medical center. Patients were contacted within 72 hours of hospital discharge. As a supplement to the call, patients were given the opportunity to video conference with and/or send pictures to the provider with additional questions via a designated wound care phone.Results:Ninety-one patients met inclusion criteria, of whom 83 (91.2%) were contacted. Six patients (7%) were readmitted, of whom three had not been able to be reached. The patients who had been unable to be contacted were readmitted for dysphagia (2), and a urinary tract infection (1). The contacted patients were advised to go the ER during the call for concerns for postoperative bleeding (2) and gastrointestinal bleeding (1). Twenty-five patients (30%) utilized the wound care phone. 18 patients (21.7%) reported that the phone call survey prevented them from going to the ER. When compared to the prior year, there was as statistically significant decrease in ER visits (P < .05), and no change in readmissions.Conclusions:Implementation of a phone call in the early postoperative period has the potential to decrease unnecessary ER visits and enhance patient satisfaction. This may decrease strain on the health care system and improve patient care.Level of Evidence:Level 4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-22T06:27:36Z
      DOI: 10.1177/0003489420937044
       
  • Transoral Endoscopic Vestibular Thyroglossal Duct Cyst Excision
    • Authors: Marisa A. Ryan, Jonathon O. Russell, Desi P. Schoo, Patrick A. Upchurch, Jonathan M. Walsh
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Thyroglossal duct cysts (TGDCs) are relatively common congenital midline neck masses that are treated with surgical excision. Traditionally these are removed along with any associated tract and the central portion of the hyoid bone through an anterior neck incision. Some patients with TGDCs want to avoid an external neck scar.Methods:We describe the details of a transoral endoscopic vestibular excision of a TGDC and the associated hyoid bone in an adolescent patient.Results:This novel approach was successful and there were no complications.Conclusion:We propose that cervical TGDCs can be safely and completely removed with this approach in appropriately selected patients while avoiding a neck scar.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-20T06:19:40Z
      DOI: 10.1177/0003489420936712
       
  • Ipsilateral Cochlear Implantation in the Presence of Observed and
           Irradiated Vestibular Schwannomas
    • Authors: Matthew J. Urban, Dennis M. Moore, Keri Kwarta, John Leonetti, Rebecca Rajasekhar, Michael B. Gluth, R. Mark Wiet
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Historically, eventual loss of cochlear nerve function has limited patients with neurofibromatosis type 2 (NF2) to auditory brainstem implants (ABI), which in general are less effective than modern cochlear implants (CI). Our objective is to evaluate hearing outcomes following ipsilateral cochlear implantation in patients with NF2 and irradiated vestibular schwannomas (VS), and sporadic VS that have been irradiated or observed.Methods:Multi-center retrospective analysis of ipsilateral cochlear implantation in the presence of observed and irradiated VS. MESH search in NCBI PubMed database between 1992 and 2019 for reported cases of cochlear implantation with unresected vestibular schwannoma.Results:Seven patients underwent ipsilateral cochlear implantation in the presence of observed or irradiated vestibular schwannomas. Four patients had sporadic tumors with severe-profound contralateral hearing loss caused by presbycusis/hereditary sensorineural hearing loss, and three patients with NF2 lost contralateral hearing after prior surgical resection. Prior to implantation, one VS was observed without growth for a period of 7 years and the others were treated with radiotherapy. Mean post-operative sentence score was 63.9% (range 48-91) at an average of 28 (range 2-84) months follow up. All patients in this cohort obtained open set speech perception. While analysis of the literature is limited by heterogenous data reporting, 85% of implants with observed schwannomas achieved some open set perception, and 67% of patients previously radiated schwannomas. Furthermore, blending literature outcomes for post implantation sentence testing in quiet without lip-reading show 59.0 ± 35% for patients with CI and observed tumors and 55.7 ± 35% for patients with radiated tumors, with both groups ranging 0 to 100%.Conclusion:This retrospective series and literature review highlight that hearing outcomes with CI for VS patients are superior to those achieved with ABI. However, important considerations including imaging, delayed hearing loss, and observation time cannot be ignored in this population.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-18T10:42:10Z
      DOI: 10.1177/0003489420935482
       
  • The Effect of Ibuprofen Dosing Interval on Post-Tonsillectomy Outcomes in
           Children: A Quality Improvement Study
    • Authors: Grayson Mast, Krysta Henderson, Michele M. Carr
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:In this Quality Improvement (QI project) it was hypothesized that an increase in dosing intervals for postoperative analgesia when alternating Ibuprofen and Acetaminophen would reduce post-tonsillectomy hemorrhage (PTH) rates for those undergoing tonsillectomies with or without adenoidectomy, while maintaining the standard of postoperative analgesia and reducing visits to the Emergency Room (ER) for reasons other than PTH. Data was collected from 353 children. Utilizing run chart analysis, it was determined that patients experiencing the 4-hour dosing interval had lower rates of PTH, fewer ER visits, and no increase in postoperative phone calls from caregivers.Patients and Methods:Patients were treated with standing Acetaminophen 15 mg/kg q6h and Ibuprofen 10 mg/kg q6h for postoperative analgesia from July of 2017 until January of 2018. Starting January of 2018 through November of 2018, the dosage interval was lengthened 1 hour. Data relating to PTH, ER visits for reasons other than bleeding, and phone calls from caregivers was collected.Results:Run charts were used to assess outcomes regarding PTH, postoperative visits to the ER for reasons other than PTH, and phone calls from caregivers. Our results suggest that a standing protocol of alternating Acetaminophen and Ibuprofen given every 4 hours improves the post-tonsillectomy hemorrhage rate without increasing ER visits or calls about pain.Conclusions:This data shows promise in reducing PTH and ER visits with a longer dose interval when alternating Acetaminophen and Ibuprofen for postoperative analgesia in tonsillectomy patients. A randomized clinical trial should be carried out to further validate these claims.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-17T06:55:27Z
      DOI: 10.1177/0003489420934843
       
  • Oral Cavity Cancer Outcomes in Remote, Betel Nut-Endemic Pacific Islands
    • Authors: Ajay M. Narayanan, Andrey F. Finegersh, Mary P. Chang, Ryan K. Orosco, William J. Moss
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Oral cavity carcinomas individually are the fifth-leading cause of overall cancer mortality in the Northern Mariana Islands, which is likely a representative statistic for many other betel-nut-endemic Pacific islands. Factors associated with survival have been minimally evaluated in this region. The purpose of this study is to further characterize oral cavity carcinoma outcomes and associated prognostic factors in the United States commonwealth of the Northern Mariana Islands (CNMI).Methods:A single-institution retrospective review was undertaken for 81 patients diagnosed with head and neck cancers at the CNMI’s only regional hospital complex from 2005 to 2019. A subset of patients diagnosed with oral cavity carcinoma was further evaluated for survival outcomes. Cox proportional hazard regressions were performed to evaluate for variables associated with survival.Results:A majority of patients had cancer of the oral cavity (64/81, 79%). Fifty-five of these patients had sufficient data for review. The average age at the time of diagnosis was 48 and over half were diagnosed with stage IV disease (29/55, 53%). Five-year overall survival (OS) was 49.5% (95% CI, 33.3-63.7%). Factors associated with worse OS were lymph node metastases at presentation (P = .031), higher overall stage (III or IV vs I or II, P = .016), and higher T-stage (III or IV vs I or II, P = .027). Those who used betel nut were diagnosed at a significantly younger age than those who did not (47.2 vs 55.4, P = .001).Conclusions:The head and neck cancer burden in the CNMI is dominated by betel nut related oral cavity disease that is characterized by delayed presentations in younger patients and decreased OS. Future studies are indicated to improve health literacy as well as to investigate the potential for screening programs.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-17T06:54:07Z
      DOI: 10.1177/0003489420934846
       
  • Expiratory Muscle Strength Training in patients After Total Laryngectomy;
           A Feasibility Pilot Study
    • Authors: Klaske E. van Sluis, Anne F. Kornman, Wim G. Groen, Prof. Michiel W.M. van den Brekel, Lisette van der Molen, Bari Hoffman-Ruddy, Martijn M. Stuiver
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Expiratory muscle strength training (EMST) is a threshold based device-driven treatment for improving expiratory pressure. EMST proved to be effective in different patient groups to improve cough function. To date, EMST has not been tested in the total laryngectomy population (TL).Methods:This prospective, randomized case-series study examined feasibility, safety, and compliance of EMST in a group of TL participants and its effects on pulmonary function, physical exertion, fatigue, and vocal functioning. Ten TL participants were included in the study to perform a 4 till 8 weeks of EMST. Objective and subjective outcome measures included manometry, spirometry, cardio pulmonary exercise testing (CPET), voice recordings, and patient reported outcome measures. Group means were reported and estimates of the effect are shown with a 95% confidence interval, using single sample t-tests.Results:Nine participants completed the full study protocol. Compliance to the training program was high. All were able to perform the training, although it requires adjustments of the device and skills of the participants. Maximum expiratory pressure (MEP) and vocal functioning in loudness improved over time. After EMST no changes were seen in other objective and subjective outcomes.Conclusions:EMST appears to be feasible and safe after total laryngectomy. MEP improved over time but no improvement in the clinically relevant outcome measures were seen in this sample of relatively fit participants. Further investigation of the training in a larger group of participants who report specifically pulmonary complaints is recommended to investigate if the increase in MEP results in clinical benefits.Level of Evidence:4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-12T08:14:52Z
      DOI: 10.1177/0003489420931889
       
  • Outcomes of Paradoxical Vocal Cord Motion Diagnosed in Childhood
    • Authors: Betel Yibrehu, Bianca Georgakopoulos, Pamela A. Mudd, Md Sohel Rana, Nancy M. Bauman
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To explore long-term patient reported outcome (PRO) measures of pediatric paradoxical vocal cord motion (PVCM) including ease of diagnosis, management, symptom duration and effect on quality of life.Methods:All children>8 years of age diagnosed with PVCM at a tertiary pediatric hospital between 2006 and 2017 were invited to complete a survey addressing study objectives.Results:21/47 eligible participants could be contacted and 18/21 (86%) participated. 78% were female with a mean age at diagnosis of 11.6 and 15.0 years at survey completion. Common PVCM symptoms reported were dyspnea (89%), globus sensation (56%), and stridor (50%). The median time to diagnosis was 3 months (IQR 2-5 months). Nearly all reported being misdiagnosed with another condition, usually asthma, until being correctly diagnosed usually by an otolaryngologist. Participants reported undergoing 3.7 diagnostic studies (range 0-8); pulmonary function testing was most common. Of numerous treatments acknowledged, breathing exercises were common (89%) but only reported helpful by 56%. Use of biofeedback was recalled in 1/3 of subjects but reported helpful in only 14% of them. Anti-reflux, allergy, anticholinergics, inhalers and steroids were each used in>50%, but rarely reported effective. PVCM was reportedly a significant stressor when initially diagnosed but despite 2/3 of participants still reporting ongoing PVCM symptoms, the perceived stress significantly decreased over time (Z = 3.26, P = 0.001).Conclusions:This first PVCM PRO study endorses that diagnosis is often delayed and prescribed treatments often viewed as ineffective. While biofeedback and breathing exercises may be critical for short-term control of PVCM episodes, lifestyle changes and stress reduction are likely necessary for long-term management. Increased awareness and improvements in management are needed for this condition.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-12T08:12:23Z
      DOI: 10.1177/0003489420931894
       
  • Does Nasal Surgery Affect Voice Outcomes' A Systematic Review with
           Meta-Analyses
    • Authors: Christopher C Xiao, Friederike S. Luetzenberg, Nancy Jiang, Jonathan Liang
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Changes in airflow dynamics after nasal surgery may have implications on voice quality. Multiple studies have evaluated the impact of nasal surgery on voice using heterogeneous outcome measures. We aim to systematically review the impact of nasal surgery on voice quality.Methods:Our study design was a systematic review with meta-analyses. A literature search of PubMed, Ovid, Cochrane from 1997 to 2017 was performed. Inclusion criteria included English language studies containing original data on nasal surgery and voice. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Meta-analysis was completed on quantitative voice measurements.Results:Of 463 identified, 19 studies with 692 patients fulfilled eligibility. Nasal surgeries performed included endoscopic sinus surgery (11/20), septoplasty (11/20), rhinoplasty (2/20), and turbinate reduction (2/20). Voice outcomes measured included nasalance (8/20), fundamental frequency (11/20), jitter (10/20), shimmer (10/20), harmonic to noise ratio (HRN) (8/20), formants (5/20), and voice handicap index (VHI) (4/20). Voice examinations were assessed preoperatively and 1 to 30 months postoperatively. Meta-analysis revealed statistically significant changes in nasalance, (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-11T01:47:39Z
      DOI: 10.1177/0003489420933290
       
  • Utility of Second-Look Endoscopy with Debridement After Pediatric
           Functional Endoscopic Sinus Surgery in Patients with Cystic Fibrosis
    • Authors: Zachary M. Helmen, Ryan E. Little, Thomas Robey
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED.Methods:Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions.Results:Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively (P value .33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively (P value .01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively).Conclusion:The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-10T06:09:51Z
      DOI: 10.1177/0003489420922865
       
  • Response to the Letter to the Editor by Zhengcai Lou, MD Regarding
           “Outcomes of Adopting Endoscopic Tympanoplasty in an Academic Teaching
           Hospital”
    • Authors: Bin Li, Stephen Asche, Robert Yang, Bevan Yueh, Manuela Fina
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-10T06:07:11Z
      DOI: 10.1177/0003489420928990
       
  • Use of a Cervicofacial Flap in Closing Large Defects Following Wide Local
           Excision of Complicated Preauricular Lesions
    • Authors: Kenneth Akakpo, Kaylee Luck, Robert H. Chun
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Purpose:To describe innovative surgical technique for closure of large defect following complicated preauricular cyst excision secondary to prior failed excision attempts, infections, and drainage procedures. Preauricular cysts must be widely excised including any fistulous tracts in order to reduce recurrence rates; however, the resultant large local excision poses cosmetic challenges.Methods:Retrospective chart review of 3 patient cases who underwent excision of recurrent preauricular lesions involving cervical parotid flap closure. All three cases demonstrate complicated preauricular congenital cysts which were infected and had prior drainage, excision attempts, or sclerotherapy. A cervicoparotid flap was used to close all defects cosmetically with no facial nerve weakness and without distortion to the oral commissure or lateral canthus.Results/conclusions:There is a high recurrence rate seen with wide local congenital cyst excisions that have been previously excised, infected, and drained; as well as, cosmetically unfavorable outcomes utilizing traditional repair. Utilizing our closure technique which involves reconstructive local regional flap with cervicoparotid approach our 3 patients have had no reoccurance of cyst or infection. Our approach also maximizes cosmetic outcomes, with reduced scar visibility. Pre and postoperative photos will be shown.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-10T06:06:31Z
      DOI: 10.1177/0003489420932605
       
  • Hypopharyngeal Squamous Cell Carcinoma in Sisters with LMNA Associated
           Familial Partial Lipodystrophy: A Case Report and Review of the Literature
           
    • Authors: Stephanie J. Youssef, Robert J. Macielak, Lisa A. Schimmenti, Kyriakos Chatzopoulos, Daniel L. Price
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:LMNA-associated familial partial lipodystrophy (FPLD) is a rare autosomal dominant A-type laminopathy characterized by variable loss and redistribution of subcutaneous adipose tissue, dyslipidemia, and insulin resistance. Though A-type lamins play a key role in nuclear membrane structure and regulation of cell proliferation, an association between cancer and LMNA-associated FPLD has not been reported.Methods and Results:This report outlines the case of two biological sisters with LMNA-associated FPLD who developed hypopharyngeal squamous cell carcinoma in the absence of any other risk factors for head and neck cancer.Conclusion:These observations prompt further investigation into the potential role of A-type lamins in the development and progression of head and neck cancers.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-10T06:02:51Z
      DOI: 10.1177/0003489420933645
       
  • Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia
           Rates Following Injection Laryngoplasty
    • Authors: Jason H. Barnes, Diana M. Orbelo, Michael F. Armstrong, Semirra L. Bayan, Christine M. Lohse, Dale C. Ekbom
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Recurrent laryngeal nerve injury is a potential complication of cardiothoracic surgery and cause of unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is an intervention offered to patients with UVFP to alleviate symptoms including dysphagia, dysphonia and weak cough. There is no definitive evidence that IL prevents pneumonia. In this study, we compare rates of pneumonia in patients with UVFP secondary to cardiothoracic surgery who did or did not undergo IL.Methods:A retrospective chart review identified patients diagnosed with UVFP by an otolaryngologist using flexible laryngoscopy following cardiothoracic surgery from January 1, 2008 to December 31, 2017. Each subject was grouped by IL status and assessed for subsequent pneumonia within 6 months of their diagnosis of UVFP. The association of IL with pneumonia was evaluated using Cox proportional hazards regression.Results:Of 92 patients who met inclusion criteria, 35 (38%) underwent IL and 57 (62%) did not. Twenty patients developed pneumonia, four who had undergone IL and 16 who had not; 12 patients developed aspiration pneumonia including two having undergone IL and 10 who had not. Those who had IL were less likely to develop total pneumonia compared to those who had not (HR = 0.33, P = .045). The protective effect of IL was not as clearly sustained when measuring for aspiration pneumonia, specifically (HR = 0.34; P = .10).Discussion:Injection laryngoplasty may reduce the risk of pneumonia in patients with UVFP secondary to cardiothoracic surgery; however, further research is needed to quantify the potential protective nature of IL in this patient population.Level of evidence:3 (A retrospective cohort study)
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-08T08:03:42Z
      DOI: 10.1177/0003489420933650
       
  • Reflux Sign Assessment; Statistical Issue on Reliability to Avoid
           Misinterpretation
    • Authors: Siamak Sabour
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-06T11:40:10Z
      DOI: 10.1177/0003489420931892
       
  • Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants
    • Authors: Jason E. Cohn, Sammy Othman, Michael Toscano, Tom Shokri, Jason D. Bloom, Seth Zwillenberg
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures.Methods:A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher’s exact test, where appropriate, while continuous variables were compared using Mann–Whitney U testing.Results:During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this cohort was 47.6 ± 20.2 years with the majority identifying as African–American (53.7%) and male (67.2%). Otolaryngologists were significantly more likely to assess pre-operative nasal obstruction (100%) compared to plastic surgeons (24.1%) (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-06T11:39:50Z
      DOI: 10.1177/0003489420931562
       
  • Fluoroscopic Swallowing Abnormalities in Dysphagic Patients Following
           Anterior Cervical Spine Surgery
    • Authors: Shumon Ian Dhar, Adam M. Wegner, Pope Rodnoi, John C. Wuellner, Omid Benjamin Mehdizadeh, Shih C. Shen, Yuval Nachalon, Nogah Nativ-Zeltzer, Peter C. Belafsky, Eric O. Klineberg
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To evaluate the precise objective fluoroscopic abnormalities in persons with dysphagia following anterior cervical spine surgery (ACSS).Methods:129 patients with dysphagia after ACSS were age and sex matched to 129 healthy controls. All individuals underwent videofluoroscopic swallow study (VFSS). VFSS parameters abstracted included upper esophageal sphincter (UES) opening, penetration aspiration scale (PAS), and pharyngeal constriction ratio (PCR). Other data collected included patient-reported outcome measures of voice and swallowing, number of levels fused, type of plate, vocal fold immobility, time from surgery to VFSS, and revision surgery status.Results:The mean age of the entire cohort was 63 (SD ± 11) years. The mean number of levels fused was 2.2 (±0.9). 11.6% (15/129) were revision surgeries. The mean time from ACSS to VFSS was 58.3 months (±63.2). The majority of patients (72.9%) had anterior cervical discectomy and fusion (ACDF). For persons with dysphagia after ACSS, 7.8% (10/129) had endoscopic evidence of vocal fold immobility. The mean UES opening was 0.84 (±0.23) cm for patients after ACSS and 0.86 (±0.22) cm for controls (P> .0125). Mean PCR was 0.12 (±0.12) for persons after ACSS and 0.08 (±0.08) for controls, indicating significant post-surgical pharyngeal weakness (P < .0125). The median PAS was 1 (IQR 1) for persons after ACSS as well as for controls. For ACSS patients, PCR had a weak correlation with EAT-10 (P < .0125).Conclusion:Chronic swallowing dysfunction after ACSS appears to be secondary to pharyngeal weakness and not diminished UES opening, the presence of aspiration, vocal fold immobility, or ACSS instrumentation factors.Level of Evidence: 3b
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-05T11:10:02Z
      DOI: 10.1177/0003489420929046
       
  • Impact of Acamprosate on Chronic Tinnitus: A Randomized-Controlled Trial
    • Authors: Mohammad Farhadi, Mohammad Mahdi Salem, Alimohamad Asghari, Ahmad Daneshi, Marjan Mirsalehi, Saeid Mahmoudian
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Tinnitus is a common and distressing otologic symptom, with various probable pathophysiologic mechanisms, such as an imbalance between excitatory and inhibitory mechanisms. Acamprosate, generally used to treat alcoholism, is a glutaminergic antagonist and GABA agonist suggested for treating tinnitus. Thus, we aimed to evaluate the efficacy and safety of acamprosate in the treatment of tinnitus.Methods:The current randomized-controlled trial study included 20 subjects with chronic tinnitus. After performing psycho-acoustic, psychometric and electrophysiological evaluations, all studied tinnitus subjects were randomly divided into two groups of acamprosate and placebo. The first group received oral acamprosate (two tablets of 333 mg/d, three times a day), whereas the second group was given placebo treatment (two tablets, three times a day). After the first 30 days, all evaluations were repeated for the studied groups just in the same manner before the study. Subsequently, the final results of each evaluation were compared together with the baseline values.Results:Nine studied subjects randomly received acamprosate, whereas eleven others received a placebo. There was no significant improvement in the psycho-acoustic tests, except a decrease was observed in the pitch match of tinnitus (P = .039). For those subjects who were receiving acamprosate, a significant reduction was observed in tinnitus handicap inventory (P = .006), tinnitus questionnaire scores (P = .007), and the visual analog scores (P = .007) compared to the placebo group. There was a significant reduction in Action Potential latency (P = .048) as well as an increase in the amplitude of distortion product otoacoustic emissions at 4 kHz (P = .048).Conclusions:The study results indicated a subjective relief of tinnitus as well as some degree of the electrophysiological improvement at the level of the cochlear and the distal portion of the auditory nerve among the subjects who received the acamprosate.Clinical trial registration code:IRCT2013121115751N1
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-05T11:09:43Z
      DOI: 10.1177/0003489420930773
       
  • Long-term Outcomes of Clip Coupler Implantation in Patients with
           Unilateral Congenital Aural Atresia
    • Authors: Chunli Zhao, Jinsong Yang, Yujie Liu, Mengdie Gao, Peiwei Chen, Shouqin Zhao
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To evaluate the long-term safety and efficacy of the Clip coupler attached to the stapes head in patients with unilateral congenital aural atresia (CAA).Methods:This single-center retrospective study included 16 Mandarin-speaking patients who had unilateral microtia accompanied by CAA. All patients were divided into two groups: the short-term follow-up group (n = 9) and the long-term follow-up group (n = 7). The floating mass transducer of the Vibrant Soundbridge (VSB) was positioned in the stapes head by the Clip coupler. The safety of the VSB was investigated by comparing preoperative and postoperative bone-conduction (BC) thresholds as well as by complications. The effectiveness was evaluated by functional gain (FG), word recognition score (WRS), speech reception threshold (SRT) and signal-to-noise ratio (SNR).Results:Pre- and post-operative BC thresholds were no different in all patients. And no complications developed. VSB-aided thresholds in the free-field had improved significantly in both short- and long-term follow-up groups. The improvements of WRS were observed in two groups. The monosyllabic VSB-aided WRS in the long-term follow-up group was significantly higher than that in the short-term follow-up group. When speech was from the impaired ear and noise presented to the side of normal ear (SVSBNCL), lower SNRs were found in two groups after VSB implantation. However, there was no statistical difference in aided SNR between the two groups at SVSBNCL status.Conclusions:Our results show that the FMT connected to the stapes head is a secure and useful device for patients with unilateral CHL/MHL, not only in terms of improved hearing thresholds, but also improved speech intelligibility in quiet and noisy environments.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-05T11:09:03Z
      DOI: 10.1177/0003489420924058
       
  • In Reference to Reflux Sign Assessment: Statistical Issue on Reliability
           to Avoid Misinterpretation
    • Authors: Jerome R. Lechien, Sven Saussez, Kathy Huet, Bernard Harmegnies
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-05T11:03:02Z
      DOI: 10.1177/0003489420931489
       
  • Do Medical Students Receive Adequate Otolaryngology Training' A
           Canadian Perspective
    • Authors: Brandon R. Rosvall, Zachary Singer, Kevin Fung, Christopher J. Chin
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Otolaryngology—head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students’ clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions.Methods:Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions.Results:Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions (r = 0.267, P = .012).Conclusion:The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-04T09:04:41Z
      DOI: 10.1177/0003489420932593
       
  • Facial Muscle Activity Patterns in Clarinet Players: A Key to
           Understanding Facial Muscle Physiology and Dysfunction in Musicians
    • Authors: Leonardo Franz, Luciana Travan, Miriam Isola, Gino Marioni, Renzo Pozzo
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Facial muscle activity is crucial to controlling musical performance in wind instrument playing. Facial muscle dysfunctions are common in wind instrument players, dramatically affecting their professional musical activity and potentially leading to disabling symptoms.The aim of this pilot study on a cohort of healthy clarinetists was to use surface electromyography to identify the facial muscle activity patterns involved in stabilizing the mouthpiece, controlling emission and articulation during musical tasks in physiological conditions, also comparing muscle activity between less and more experienced clarinetists (students vs postgraduates/professionals).Methods:Surface electromyographic measures of the sternocleidomastoid, masseter, mentalis, mylohyoid and buccinator muscles were obtained from eight healthy clarinet players (four students and four postgraduates/professionals) performing two standardized musical tasks.Results:Overall, mean IEMG activity was significantly lower for the sternocleidomastoid than for the other muscles (P = .000), and for the mouthpiece-stabilizing muscles (masseter and mentalis) than for those directly involved in controlling emission and articulation (buccinator and mylohyoid muscles) (P = .000).Regardless of the musical task, the mean IEMG values were significantly higher in the students for the masseter (P = .0007), buccinator (P = .0001) and mylohyoid (0.000), while they were significantly higher in the postgraduates/professionals for the mentalis (P = .000). No significant differences emerged between the two groups for the sternocleidomastoid (P = .207).Conclusions:These preliminary data reflect a significantly higher overall facial muscle activity in the less-experienced group, potentially resulting in an overload, whereas the more expert players had more optimized muscle activity patterns.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-03T06:27:14Z
      DOI: 10.1177/0003489420931553
       
  • The Changing Paradigm of Head and Neck Paragangliomas: What Every
           Otolaryngologist Needs to Know
    • Authors: Nathan D. Cass, Melissa A. Schopper, Jonathan A. Lubin, Lauren Fishbein, Samuel P. Gubbels
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Recommendations regarding head and neck paragangliomas (HNPGL) have undergone a fundamental reorientation in the last decade as a result of increased understanding of the genetic and pathophysiologic basis of these disorders.Objective:We aim to provide an overview of HNPGL and recent discoveries regarding their molecular genetics, along with updated recommendations on workup, treatment, and surveillance, and their implications for otolaryngologists treating patients with these disorders.Results:SDHx susceptibility gene mutations, encoding subunits of the enzyme succinate dehydrogenase (SDH), give rise to the Hereditary Pheochromocytoma/Paraganglioma Syndromes. SDHA, SDHB, SDHC, SDHD, and SDHAF2 mutations each result in unique phenotypes with distinct penetrance and risk for variable tumor development as well as metastasis. Genetic and biochemical testing is recommended for every patient with HNPGL. Multifocal disease should be managed in multi-disciplinary fashion. Patients with SDHx mutations require frequent biochemical screening and whole-body imaging, as well as lifelong follow-up with an expert in hereditary pheochromocytoma and paraganglioma syndromes.Conclusion:Otolaryngologists are likely to encounter patients with HNPGL. Keeping abreast of the latest recommendations, especially regarding genetic testing, workup for additional tumors, multi-disciplinary approach to care, and need for lifelong surveillance, will help otolaryngologists appropriately care for these patients.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-03T06:26:34Z
      DOI: 10.1177/0003489420931540
       
  • Pediatric Quality-of-Life Scores Following a Multidisciplinary
           Aerodigestive Team Approach to Manage Chronic Cough
    • Authors: Betel A. Yibrehu, Gina M. Krakovsky, Md Sohel Rana, Dinesh K. Pillai, Sona Sehgal, Maura E. Collins, Meagan L. Gatti, Nancy M. Bauman
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27).Methods:The PC-QOL-27 survey was administered to ADC patients with chronic cough at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months.Results:Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary function tests (PFT’s 9), esophagogastroduodenoscopy (9), and flexible bronchoscopy/lavage (9).Following ADC management, changes in physical, social and psychological domain scores of the PC-QOL-27 each met the threshold for minimal clinical important difference (MCID) indicating a clinically meaningful improvement. Improvements were most notable in the physical domain where post survey scores significantly improved from pre-survey scores (P = .009) regardless of age, gender, ethnicity, history of endoscopy and season.Conclusions:The physical impact of chronic cough in pediatric patients who failed prior management by a single specialist was lessened by an ADC team approach to management.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-03T06:25:14Z
      DOI: 10.1177/0003489420931558
       
  • Applicant-to-Residency Program Communication: Does It Matter'
    • Authors: Roberto N. Solis, Pompeyo R. Quesada, Cheng Ma, Lindsay M. Olinde, Rodney C. Diaz
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To elucidate the frequency and types of pre- and post-interview communication that applicants engage with programs, to garner the perceptions of both applicants and program directors (PDs), and determine if communication influences outcomes.Subjects and Methods:Electronic surveys were distributed to otolaryngology residency applicants, and to PDs of ACGME-accredited otolaryngology programs after the 2018 to 2019 application cycle.Results:93 of 324 applicants (28.7%) and 33 of 106 PDs (31.3%) responded. In the pre-interview period, 58.1% of applicants sent emails of interest, and 41.9% had a mentor initiate communication. In the post-interview period, the majority of applicants (82.8%) sent notes of intent to their number one choice, and 32.3% had a faculty mentor communicate this on their behalf. The majority of PDs (84.8%) were undecided or did not believe that emails of interest influence decisions to offer an interview, whereas 81.8% believed that communication initiated by an applicant’s mentor has an impact on interview offers. No PD agreed that declarations of intent from applicants have an impact on their rank lists, while only 33.3% of PDs believed that a mentor communicating this for an applicant has some impact. Our statistical findings are in agreement with these perceptions as neither applicant-initiated pre-interview (P = .54), mentor-initiated pre-interview (P = .62), applicant-initiated post-interview (P = .11) nor mentor-initiated post-interview (P = .78) communications influenced the number of interviews received or ultimate match outcome.Conclusion:Pre- and post-interview communication practices vary widely among otolaryngology applicants. Applicant-initiated communication has no impact on outcomes, while mentor-initiated communication is perceived to have more benefit, despite not impacting interview or match outcomes in this study.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-02T12:11:40Z
      DOI: 10.1177/0003489420928381
       
  • Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections
           for Glottic Insufficiency
    • Authors: Alice Q. Liu, Joel Singer, Terry Lee, Amanda Hu
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To assess voice outcomes using the novel technique of in-office laryngeal electromyography-guided vocal fold injections (LEVFI) with hyaluronic acid to treat glottal insufficiency. Secondary objectives included determining the complication/completion rates and if any factors were associated with improved voice outcomes.Methods:Retrospective review of patients who received their first LEVFI from August 2017 to December 2018. Three- and six-month voice outcomes were assessed. Outcomes included voice handicap index-10 (VHI-10), maximum phonation time (MPT), perceptual analysis of voice (GRBAS), fundamental frequency, and stroboscopy.Results:Of the 121 eligible patients (55.4% male, age 63.7 years), 94 (77.7%) had complete 3-month data and 59 (48.8%) had complete 6-month data. VHI-10 was significantly improved from 25.7 ± 7.5 to 20.9 ± 10.9 at 3 months (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-02T12:11:00Z
      DOI: 10.1177/0003489420931556
       
  • Factors Affecting Post-Anesthesia Care Unit Length of Stay in Pediatric
           Patients after an Adenotonsillectomy
    • Authors: Dhivyaa Anandan, Shilin Zhao, Amy S. Whigham
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:(1) To identify clinical factors and perioperative practices that correlate with longer length of stay (LOS) in the post-anesthesia care unit (PACU) after adenotonsillectomy (T&A) in pediatric populations.(2) To understand the relationship between family presence and PACU LOS for pediatric patients after T&A.Methods:Pediatric patients (ages 3-17) who underwent T&A between February 2016 and December 2016 were retrospectively reviewed. Factors assessed for impact on PACU LOS included BMI, preoperative medications, intraoperative medications/narcotics, postoperative medications/narcotics, method of postoperative medication administration, and family presence in the PACU. Kruskal–Wallis and Spearman tests were used to assess correlations. Statistical significance was set a priori at P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-02T12:10:40Z
      DOI: 10.1177/0003489420931557
       
  • Sinonasal Squamous Cell Carcinoma Presentation and Outcome: A National
           Perspective
    • Authors: Zaid Al-Qurayshi, Ryan Smith, Jarrett E. Walsh
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:examine presentation and outcomes of sinonasal squamous cell carcinoma (SCC).Methods:A retrospective study utilizing the National Cancer Database, 2004 to 2015. The study population included adult patients diagnosed with primary sinonasal SCC.Results:A total of 537 patients were included. The mean age of the study population was 62.6 ± 12.7 years. The median follow-up time was 35.6 months (interquartile range: 8.6-55.9). The histological variants identified are: (i) 66.7% keratinizing SCC, (ii) 21.6% non-keratinizing SCC, (iii) 8.0% papillary SCC, and (iv) 3.7% spindle cell carcinoma. Stage at presentation was: (i) 33.3% T1-2, N0, (ii) 31.8% T3-4a, N0, (iii) 13.8% T1-4a, N+, (iv) 17.0% T4b,N0-3, (v) 4.1% M1. Human papilloma virus (HPV) status was available for 96 patients and tested positive in 24 (25.0%) patients. By histological variants, 5-year survival was lowest for spindle cell carcinoma (40.0%), and highest for papillary SCC (70.1%). HPV negative tumors had a 5-year survival of 26.4%, while HPV positive tumors had a 5-year survival of 57.1% (P = .99).Conclusions:Sinonasal SCC could present at advanced stages in two-thirds of the population and exhibit a variety of histological subtypes. Like other sites of head and neck, HPV positive tumors are associated with a favorable prognosis. Endoscopic approach is comparable to open approach in terms of post-surgical margins.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-06-01T06:00:53Z
      DOI: 10.1177/0003489420929048
       
  • Surgical Intervention for Laryngomalacia: Age-Related Differences in
           Postoperative Sequelae
    • Authors: Vijay A. Patel, David Adkins, Jad Ramadan, Adrian Williamson, Michele M. Carr
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM).Methods:A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-29T09:57:31Z
      DOI: 10.1177/0003489420922862
       
  • The Clinical Significance of IGF-1R and Relationship with Epstein–Barr
           Virus Markers: LMP1 and EBERs in Tunisian Patients with Nasopharyngeal
           Carcinoma
    • Authors: Nehla Mokni Baizig, Ben Ayoub Wided, Olfa El Amine, Said Gritli, Michele ElMay
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Tunisia is in the endemic area of nasopharyngeal carcinoma. Epstein–Barr virus (EBV) based assays have been commonly used as standard markers for screening and monitoring the disease. So, it is very important to find novel factors for the early diagnostic and prognostic evaluation of this cancer. The aim of the study was to evaluate the expression of IGF-1R (Insulin Growth Factor Receptor 1), LMP 1 (Latent Membrane Protein 1) and EBERs (EBV encoded RNAs) in order to determine their correlation with clinicopathologic parameters and survival rates in patients with nasopharyngeal carcinoma (NPC). We also looked for the relationship between these biomarkers.Methods:IGF-1R and LMP1 expression was performed by means of immunohistochemical method and EBERs were detected using in situ hybridization of paraffin embedded tumor tissues of 94 patients with nasopharyngeal carcinoma and 45 non-cancerous nasopharyngeal mucosa samples.Results:Our findings demonstrated that IGF-1R was over expressed in 47.87% of NPC patients and only in 2.22% of controls. Positive LMP1 expression was detected in 56.38% of NPC patients and all NPC patients were positive for the EBV-encoded RNAs staining. A statistically significant positive correlation was observed between IGF-1R expression and the tumor size (P < .001). Kaplan–Meier survival curves showed that NPC patients with a strong IGF-1R expression level have shorter median and 5-year Overall Survival than those with weak expression rates (100.15 vs 102.68 months, P = .08). In addition, median and 5-year Disease-Free Survival was significantly lower in the LMP1 positive NPC patients than in the LMP1 negative ones (53.38 vs 93.37 months, P = .03). Moreover, LMP1 expression correlated strongly with IGF-1R expression (P = .018). The relationship between these two biomarkers could influence patient survival.Conclusion:IGF1-R and LMP1 could be valuable prognostic markers in Tunisian NPC patients.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-29T09:53:48Z
      DOI: 10.1177/0003489420929362
       
  • Use of Steroid-Eluting Stents after Endoscopic Repair of Choanal Atresia:
           A Case Series with Review
    • Authors: Lyndy J. Wilcox, Matthew M. Smith, Alessandro de Alarcon, Madison Epperson, Hayley Born, Catherine K. Hart
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective(s):To describe a single institution’s experience with the use of steroid-eluting stents after endoscopic transnasal repair of choanal atresia.Methods:A case series with review of children who underwent choanal atresia repair at a tertiary children’s hospital from June 2017 to January 2018 was performed. Those who had a mometasone drug-eluting stent (Propel® Mini, Intersect ENT Inc., Palo Alto, CA) placed after primary or secondary choanal atresia repair at our institution were included. The primary outcome measure was need for revision surgery due to stenosis. Postoperative regimens, duration of stenting, and need for return to the operating room (OR) were also assessed.Results:Five patients with a median age of 22 months at the time of repair met inclusion criteria. Two (40%) had bilateral atresia and 3 (60%) had confirmed CHARGE syndrome. A total of 6 mometasone drug-eluting stents were used in the 5 cases. Three patients were reassessed at least once in the OR; however, the majority (57.1%) of postoperative evaluations were able to be performed in the office or bedside setting. The first and last evaluations occurred a mean of 14 and 124 days after surgery, respectively. There were no instances of restenosis, repeat surgical interventions, or stent-related complications noted.Conclusion:Placement of a mometasone drug-eluting stent is a promising method to improve postoperative results and management of choanal atresia repair by limiting the need for repeat anesthetics and OR procedures, as well as the complications of traditional stents.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-29T09:52:37Z
      DOI: 10.1177/0003489420928374
       
  • Factors Associated with Failure of Botulinum Toxin Injection in Adductor
           Spasmodic Dysphonia
    • Authors: Kevin Zhao, Martial Guillaud, Amanda Hu
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Electromyography (EMG) Guided botulinum toxin (BTX) injection is considered first-line treatment for adductor spasmodic dysphonia (SD). Failure rate can range between 6% and 29%. Study objective was to determine which factors were associated with failure.Methods:This was a retrospective review conducted at a tertiary, academic center. Adductor SD patients presenting for BTX injections from August 2017 to October 2018 were eligible. Age, gender, Voice Handicap Index (VHI-10), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), number of injections, disease duration, unilateral/bilateral injection, right/left injection, dose quantity, body mass index (BMI), professional voice user, employment, psychiatric comorbidity, breathiness, and dysphagia were investigated. Outcomes included failure as defined by the patient and dosage change. Univariate and multivariate statistical analysis was conducted.Results:Sixty seven out of 564 injections (12%) were categorized as failure by 131 patients. In multivariate analysis, dosage change was associated with shorter duration of good effect (P < .001), BTX dose (P = .016), breathiness (P < .001), bilateral injection (P = .024), dysphagia (P = .012) and professional voice user (P = .021). Failure was associated with first injection with a new physician (P < .001), professional voice user P < .001) and lack of breathiness (P = .003). Failure rate was not associated with age, gender, VHI-10, CAPE-V, disease duration, left/right injection, dose quantity, BMI, psychiatric comorbidity, and dysphagia.Conclusion:Failure rate was 12% and associated with patients’ first injection with a physician, professional voice user, and lack of breathiness. Dosage change occurred in 29% of injections and was associated with injection side effects, bilateral injections, BTX dose, professional voice user, and shorter duration of good effect.Level of evidence: 3
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-29T09:50:50Z
      DOI: 10.1177/0003489420928373
       
  • Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index
           (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques
    • Authors: Andrea Nacci, Luca Bastiani, Maria Rosaria Barillari, Jerome R. Lechien, Massimo Martinelli, Nicola De Bortoli, Stefano Berrettini, Bruno Fattori
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To investigate the psychometric properties of the reflux symptom index (RSI) as short screening approach for the diagnostic of laryngopharyngeal reflux (LPR) in patients with confirmed diagnosed regarding the 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH).Methods:From January 2017 to December 2018, 56 patients with LPR symptoms and 71 healthy individuals (control group) were prospectively enrolled. The LPR diagnosis was confirmed through MII-pH results. All subjects (n = 127) fulfilled RSI and the Reflux Finding Score (RFS) was performed through flexible fiberoptic endoscopy. The sensitivity and the specificity of RSI was assessed by ROC (Receiver Operating Characteristic) analysis.Results:A total of 15 LPR patients (26.8%) of the clinical group met MII-pH diagnostic criteria. Among subjects classified as positive for MII- pH diagnoses, RSI and RFS mean scores were respectively 20 (SD ± 10.5) and 7.1 (SD ± 2.5), values not significantly different compared to the negative MII-pH group. The metric analysis of the items led to the realization of a binary recoding of the score. Both versions had similar psychometric properties, α was 0.840 for RSI original version and 0.836 for RSI binary version. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without LPR pathology diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for LPR pathology were ≥ 5 for RSI binary version and ≥ 15 for RSI original version. Both version overestimated LPR prevalence. The original version had more sensitivity and the RSI Binary version had more specificity.Conclusions:It would be necessary to think about modifying the original RSI in order to improve its sensitivity and specificity (RSI binary version, adding or changing some items), or to introduce new scores in order to better frame the probably affected of LPR patient.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-29T09:49:30Z
      DOI: 10.1177/0003489420930034
       
  • Taste and Smell Dysfunction in COVID-19 Patients
    • Authors: José Manuel Abalo-Lojo, Jéssica María Pouso-Diz, Francisco Gonzalez
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-29T09:48:33Z
      DOI: 10.1177/0003489420932617
       
  • Recovery Over Time and Prognostic Factors in Treated Patients with
           Post-Infectious Olfactory Dysfunction: A Retrospective Study
    • Authors: Takao Ogawa, Keigo Nakamura, Sayuri Yamamoto, Ichiro Tojima, Takeshi Shimizu
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:The aims of the present study were to clarify the time-course of olfactory recovery and the prognostic factors in PIOD patients treated with Toki-shakuyaku-san (TSS).Methods:A retrospective cohort study of patients with PIOD was conducted by reviewing patients’ medical records. This study included patients who received TSS or a combination of TSS and zinc sulfate. Olfactory function was examined by T&T olfactometer at each 3-monthly follow-up visit. Patients with normal and mild olfactory dysfunction were excluded. Gender, age, treatment, duration of disease until the first visit and olfactory function scores of the T&T olfactometer at the first visit were analyzed as candidate clinical predictors of recovery.Results:A total of 82 PIOD patients with ages ranging from 16 to 79 years were included. The mean duration of follow-up was 14.5 months (range 3-45 months). The number of patients with olfactory recovery increased for 24 months and the cumulative recovery rate was 77.3%. In about 60% of patients, olfactory recovery occurred within 6 months. Multivariate analysis showed that younger age (
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-27T06:15:19Z
      DOI: 10.1177/0003489420922563
       
  • Herbal Drug EPs 7630 versus Amoxicillin in Patients with Uncomplicated
           Acute Bacterial Rhinosinusitis: A Randomized, Open-Label Study
    • Authors: Aleksandar Perić, Dejan Gaćeša, Aleksandra Barać, Jelena Sotirović, Aneta V. Perić
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Previous investigations suggest the use of extract from the root of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated acute upper airway inflammations, due to its strong antimicrobial and immunomodulatory effect. We aimed to compare clinical efficacy, safety and bactericidal effect of EPs 7630 and amoxicillin monotherapy in treatment of patients with mild to moderate acute bacterial rhinosinusitis (ABRS).Methods:Fifty ABRS patients were divided into two groups by randomization. Group 1 (n = 25) received EPs 7630 tablets, 3 × 20 mg/day per os for 10 days. Group 2 (n = 25) received amoxicillin tablets 3 × 500 mg/day per os, for 10 days. We assessed total symptom score (TSS), individual symptom scores for each symptom (nasal obstruction, rhinorrhea, postnasal drip, facial pain/pressure, loss of the sense of smell), endoscopic findings, including total endoscopic score (TES) and individual endoscopic signs (mucosal edema, mucopurulent secretion), before and after treatment. Samples of discharge taken from the middle meatus of all patients were cultivated for bacteria before and after therapy.Results:Higher absolute improvement after treatment was found for TSS, nasal obstruction, facial pain/pressure, impaired sense of smell, TES, mucosal edema and mucopurulent secretion in EPs 7630 group compared to amoxicillin group (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-27T06:13:39Z
      DOI: 10.1177/0003489420918266
       
  • Intramuscular Corticosteroids for Acute Upper Respiratory Infections
           Affects Healthcare Utilization
    • Authors: Sean M Parsel, Alaa E Mohammed, Daniel Fort, Blair M Barton, Edward D McCoul
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To examine the use of intramuscular corticosteroid (IMCS) injections for treatment of acute upper respiratory infections (URI) and the influence on healthcare utilization.Methods:This retrospective cohort study used patient encounter data from a large multicenter regional health care system between 2013 and 2017. Adult patients diagnosed with acute URI (acute pharyngitis, acute sinusitis, acute otitis media, and URI not otherwise specified) during ambulatory encounters were included. Follow-up encounters for a diagnosis of acute URI within 60 days were identified and patient characteristics, encounter details, and procedure codes were retrieved. Frequency data was used to calculate IMCS injection administration prevalence, utilization trends, and associations with covariates. Follow-up data for return encounters within 60 days for the same diagnosis was examined.Results:Of the 153 848 initial encounters, 34 600 (22.5%) patients received IMCS injection for acute URI. Injection rates varied from 0.85% to 49.1% depending on specialty and practitioner type. Internal medicine, family medicine, urgent care, and otorhinolaryngology clinics most commonly administered IMCS. 3788 patients returned for a second encounter of which 751 (19.8%) received an injection. IMCS injection during the first encounter was associated with increased odds of repeat visit within 60 days (OR: 1.74; 95% CI: 1.61–1.88).Conclusion:IMCS use in the treatment of acute URI is highly prevalent despite lack of evidence for impact and safety. Prevalence is variable across multiple medical and surgical specialties including otorhinolaryngology. Administration of IMCS injection may contribute to the likelihood of a subsequent healthcare visit for the same indication.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-27T04:49:26Z
      DOI: 10.1177/0003489420929717
       
  • Voice-Related Quality of Life in Patients with Chronic Rhinosinusitis
    • Authors: Arthur W. Wu, Evan S. Walgama, Michela Borrelli, James Mirocha, Anca M. Barbu, Narine Vardanyan, Arash Shamsian, Stephanie Hopp, Martin L. Hopp
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Chronic rhinosinusitis (CRS) has long been associated with vocal dysfunction. However, studies quantifying the presence of voice dysfunction in CRS patients or the effects of functional endoscopic sinus surgery (FESS) are sparse. The goal of this study was to determine the voice-related quality of life in patients undergoing FESS for CRS using the validated Voice Related Quality of Life Survey (VRQL). We correlated the preoperative VRQL scores to the Sino-Nasal Outcome Test (SNOT-22) scores, and we determined the effect of FESS on postoperative VRQL scores.Methods:Consecutive patients undergoing FESS were preoperatively administered both the VRQL and the SNOT-22 surveys. Spearman (ρ) and Pearson (r) correlation coefficients were calculated. The VRQL was mailed to patients postoperatively between 3 and 6 months. The paired t-test was used to compare pre- and post-FESS scores.Results:A total of 102 patients were enrolled, and 81 patients completed the two surveys. A total of 51 (62.9%) patients had raw VRQL score ≥ 10, signifying presence of significant vocal symptoms. The mean ± standard deviation (SD) raw VRQL score of the entire study population was 12.4 ± 4.6, and the mean SNOT-22 score was 37.8 ± 19.2. The Spearman correlation coefficient between VRQL and the total SNOT-22 score was 0.34 (P =.002), and the Pearson correlation coefficient was 0.36 (P = .001). Both correlations were similar, demonstrating that increasing severity of CRS symptoms correlates with decreasing voice-related quality of life (QOL). Seventy patients completed the postoperative survey for an 86% retention rate. Thirty-six of these patients had abnormal preoperative VRQL scores, and these patients improved significantly after FESS. The mean preoperative versus postoperative raw scores were 15.2 ± 5.6 versus 12.5 ± 4.1, respectively (P = .003).Conclusion:This study demonstrates the increasing presence of vocal complaints with increasing severity of CRS. It also demonstrates that VRQL scores improve after FESS in those patients with preoperative vocal complaints.Level of Evidence:IV
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-27T04:48:07Z
      DOI: 10.1177/0003489420924061
       
  • Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux
    • Authors: Mikayla J. Huestis, Katherine R. Keefe, Chase I. Kahn, Lauren F. Tracy, Jessica R. Levi
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Laryngopharyngeal reflux (LPR) and associated symptoms can be refractory to treatment with acid suppressing medication. We investigated the role and evidence for complementary and alternative medicine (CAM) for LPR in this systematic review.Review Methods:Complementary and alternative treatment was defined in this systematic review as any non-acid suppressing medication, treatment, or therapy. A literature search was performed by two authors in consultation with a medical librarian using controlled vocabulary for “complementary and alternative medicine” and “laryngopharyngeal reflux” in the databases PubMed and EMBASE, with supplemental searches with Google Scholar.Results:Twenty articles were included in this review for the modalities: alginate, diet modification, prokinetics, respiratory retraining, voice therapy, rikkunshito (RKT), hypnotherapy, and sleep positioning. The studies were analyzed for bias based on the Cochrane criteria for RCTs and Methodological Index for non-RCT (MINORS) criteria for all other studies. For each modality a level of evidence was assigned to the current body of evidence using the GRADE approach.Conclusion:There is mixed evidence with a high degree of bias and heterogeneity between studies for the modalities presented in the paper. Based on this review, an anti-reflux diet is recommended for all patients and there is some low-quality evidence to support alkaline water. For patients with predominant vocal symptoms there is evidence that supports voice therapy. There is insufficient evidence to recommend prokinetics at this time. For patients with predominant globus symptoms, alginate, RKT, and relaxation strategies may be used in conjunction with acid suppressing medications for symptom relief.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-25T12:10:20Z
      DOI: 10.1177/0003489420922870
       
  • Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal
           Antrostomy Site Stenosis
    • Authors: Hyo Jun Kim, Ji Ho Choi, Jae Yong Lee
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:This study was performed to evaluate the incidence, timing, and factors contributing to recurrent maxillary sinusitis due to middle meatal antrostomy (MMA) site stenosis after endoscopic sinus surgery (ESS).Methods:The medical records and endoscopic photographs of 288 patients with chronic rhinosinusitis who underwent ESS were evaluated. Patients visited the clinic with similar schedule after ESS; recurrent maxillary sinusitis due to MMA site stenosis was investigated, including in terms of the incidence and timing. The preoperative computed tomography (CT) scans, intraoperative findings, and possible factors contributing to MMA site stenosis were examined.Results:Recurrent maxillary sinusitis due to MMA site stenosis occurred in 10 patients. Most had unilateral sinusitis and stenosis was observed within 6 months postoperatively. All patients had severe inflammation, pus retention, and thick mucosal hypertrophy in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination.Conclusions:MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-22T10:42:19Z
      DOI: 10.1177/0003489420929365
       
  • Comment on “Outcomes of Adopting Endoscopic Tympanoplasty in an Academic
           Teaching Hospital”
    • Authors: Zhengcai Lou
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-22T10:38:51Z
      DOI: 10.1177/0003489420929364
       
  • Response to Letter to the Editor: Fat Injection Pharyngoplasty for
           Velopharyngeal Insufficiency Management
    • Authors: Kevin J. Contrera, William S. Tierney, Paul C. Bryson
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-22T10:37:59Z
      DOI: 10.1177/0003489420922826
       
  • Perioperative Analgesia for Patients Undergoing Thyroidectomy and
           Parathyroidectomy: An Evidence-Based Review
    • Authors: Brandon K. Nguyen, James Stathakios, Daniel Quan, Jessica Pinto, Hosheng Lin, Anna A. Pashkova, Peter F. Svider
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To perform an evidence-based systematic review evaluating perioperative analgesia, including opioid alternatives, used for patients undergoing thyroidectomy and parathyroidectomy.Methods:A comprehensive literature search from 1997 to January 2018 of Pubmed, Cochrane, and EmBase libraries was performed for studies reporting analgesic administration following thyroid or parathyroid surgery. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were evaluated for level of evidence and given a Jadad score to assess for risk of bias. Outcomes gathered included postoperative pain scores, time to rescue analgesia, rescue analgesic consumption, and adverse events.Results:Thirty-eight randomized controlled trials met inclusion criteria. The GRADE criteria determined the overall evidence to be moderate-high. Studies utilizing NSAIDs reported reduced requirements for rescue analgesics. Acetaminophen studies presented with conflicting data on effectiveness. Gabapentinoid studies demonstrated lower pain scores and an increased time to rescue analgesic. Local anesthetics were effective at decreasing Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) pain scores while also reducing rescue analgesic consumption. Ketamine was shown to increased postoperative nausea and vomiting. NSAIDs and local anesthetic studies had an aggregate grade of evidence A, while all others had grade B evidence.Conclusion:There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens.Level of Evidence:NA
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-21T02:00:38Z
      DOI: 10.1177/0003489420919134
       
  • Sensitivity of High-Resolution Computed Tomography in Otosclerosis
           Patients undergoing Primary Stapedotomy
    • Authors: Anne K. Maxwell, Mohamed Hosameldeen Shokry, Adam Master, William H. Slattery
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To determine the incidence of abnormal otospongiotic or otosclerotic findings on high-resolution computed tomography (HRCT) as read by local radiologists in patients with surgically-confirmed otosclerosis.Study design:Retrospective chart review.Setting:Tertiary-referral private otology-neurotology practice.Patients:Adults (>18 years old) with surgically-confirmed otosclerosis between 2012 and 2017 with a HRCT performed preoperatively.Intervention:Preoperative HRCT then stapedotomy.Main outcome measures:Positive identification and location of radiographic otosclerosis as reported by the local radiologist. We then correlated the CT with surgical location as documented at time of surgery. Audiometry, demographic data, intraoperative findings, and surgical technique were secondarily reviewed.Results:Of the 708 stapes surgeries were performed during the study time frame. Preoperative HRCT scans were available for 68 primary stapedotomy surgeries performed in 54 patients. Otosclerosis was reported in 20/68 (29.4%). Following a negative report by the local radiologist, a re-review by the surgeon and/or collaborating neuroradiologist confirmed otosclerosis in 12/48 additional cases (25.0%). There was an overall sensitivity of 47.1%. Intraoperatively, cases with negative reads tended to have more limited localization at the ligament (8.7%) or anterior crus (39.1%), compared with positive reads, which demonstrated more extensive involvement, with bipolar foci (30.0%) or diffuse footplate manifestations (20.0%) more common. Acoustic reflexes were characteristically absent.Conclusions:While HRCT may aid in the diagnosis of otosclerosis and rule out concomitant pathology in certain cases of clinical uncertainty or unexplained symptoms, its sensitivity for otosclerosis remains low. HRCT should not be relied upon to diagnose routine fenestral otosclerosis.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-20T12:38:55Z
      DOI: 10.1177/0003489420921420
       
  • Ensuring Adequate Care during Hospitalization for Neck Breathers Including
           Laryngectomees
    • Authors: Itzhak Brook
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-19T11:28:54Z
      DOI: 10.1177/0003489420920324
       
  • Clinical Manifestations of Allergic Rhinitis by Age and Gender: A 12-Year
           Single-Center Study
    • Authors: Seung-No Hong, Jun Yeon Won, Eui-Cheol Nam, Tae Su Kim, Yoon-Jong Ryu, Jea-Woo Kwon, Woo Hyun Lee
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Currently, epidemiological data on allergic rhinitis collected through the skin prick test are scarce. Moreover, the relationship of age and sex to allergic rhinitis is not comprehensively understood. This study aimed to characterize allergic rhinitis and the associated clinical manifestations by age and sex.Methods:We retrospectively investigated data from 2883 patients who visited a single university hospital for rhinitis symptoms between January 2003 and December 2014. Of these 2883 patients, 1964 who underwent a skin prick test with 11 standardized allergen extracts and completed a nasal symptom questionnaire were enrolled. The clinical characteristics of allergen sensitization and nasal symptoms were analyzed by sex and age distribution.Results:The prevalence of allergen sensitization progressively decreased with age after peaking at between 20 and 29 years. The sensitization rate was higher in males than in females (P = .046). The sensitization rate to house dust mites decreased with age, while sensitization to mugwort and ragweed increased. Six allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, mugwort, trees, ragweed, and cats) were sufficient to identify>96% of patients with allergen sensitization. Nasal obstruction tended to decrease with age and was more prevalent in males (P = .002) than in females, while rhinorrhea (P = .007) and itching (P = .013) were more prevalent in females. Total nasal symptom scores did not differ by sex.Conclusions:The clinical characteristics of allergic rhinitis, including allergen-sensitization patterns and related symptoms, varied by age and sex. Six common allergens could be sufficient to generate a cost-effective tool to identify allergic rhinitis.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-19T11:28:15Z
      DOI: 10.1177/0003489420921197
       
  • Implantation of Squamous Cell Carcinoma in a Free Flap Donor Site
    • Authors: Priscilla Pichardo, Nicholas Purdy, Thorsen Haugen
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Introduction:It is well known that malignant cells can be implanted at distant donor sites due to iatrogenic surgical contamination. Only a small number of reports, however, have been published describing this.Case Presentation:We present a case of oral cavity Squamous Cell Carcinoma (SCC) reconstructed with a radial forearm free flap in which SCC developed in the subcutaneous tissues beneath the donor incision site 6 months after surgery.Management:The implanted tumor was excised and the field was subsequently treated with radiation. The patient remains disease-free on follow-up.Discussion:We present the second report of tumor implanted in a free flap donor site. Additionally, we discuss the risks of tumor implantation, review the literature, and make recommendations to avoid this complication.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-18T05:06:51Z
      DOI: 10.1177/0003489420917418
       
  • Feasibility of Early Discharge after Open Hypopharyngeal Surgery for
           Dysphagia
    • Authors: Jena Patel, Joseph Spiegel, Michael C. Topf, Maurits Boon, Colin Huntley
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To determine the rate of surgical complications, unplanned readmission, and functional status after open hypopharyngeal surgery for dysphagia with early return to oral diet and hospital discharge.Methods:Retrospective chart review of patients who underwent open hypopharyngeal surgery for management of dysphagia from March 2013 to June 2018 at a single academic institution. A clear liquid diet is restarted the day of surgery and is advanced to a soft diet on postoperative day one. Univariate and multivariate logistic regression was performed to identify risk factors for postoperative complications and unplanned readmission.Results:Ninety patients met eligibility criteria; 62 patients underwent open cricopharyngeal myotomy, 13 underwent Zenker’s diverticulectomy, 15 had a Zenker’s diverticulopexy. Mean inpatient length of stay was 2.0 ± 2.0 days (range 0-11 days); 57 patients (63.3%) were discharged on the same day as surgery or on postoperative day one. Seven patients (7.8%) had postoperative complications; the most common complication was esophageal leak (n = 6). Six patients (6.7%) had unplanned readmissions within 30 days. Mean time to unplanned readmission was 12 days (range 2-19 days). Open diverticulectomy was associated with an increased risk of unplanned readmission with an OR = 7.63 (95% CI 1.29, 45.45, P = .025). At last follow-up, 70% of patients had an increased functional oral intake by at least one scale score (FOIS) after surgery (mean follow-up 0.8 ± 1.1 years, range 0.02-5.1 years).Conclusion:An early diet and discharge may be safe for patients undergoing open surgery without a mechanical or suture closure of their esophageal mucosa, whereas in those undergoing diverticulectomy, NPO status and a radiological check before resuming drinking and eating are advised.Level of Evidence:4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-14T09:29:45Z
      DOI: 10.1177/0003489420916216
       
  • Fat Injection Pharyngoplasty for Velopharyngeal Insufficiency Management:
           A Call for High-level of Scientific Evidence in Future Research Agenda
    • Authors: Rafael Denadai
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-11T10:06:42Z
      DOI: 10.1177/0003489420921419
       
  • Hemifacial Spasm as a Rare Clinical Presentation of Idiopathic
           Intracranial Hypertension: Case Report and Literature Review
    • Authors: Charles B. Poff, Noga Lipschitz, Gavriel D. Kohlberg, Joseph T. Breen, Ravi N. Samy
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To report a rare case of idiopathic intracranial hypertension (IIH) presenting with hemifacial spasm (HFS) and review the current literature.Methods:Case report and literature review. The patient’s medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using PUBMED.Results:A 43-year-old obese female presented with a 2-year history of left HFS.Electroencephalography and head computed tomography were unremarkable. Magnetic resonance imaging demonstrated bilateral anterior inferior cerebellar artery vascular loops involving the internal auditory canals as well as IIH-associated findings. A lumbar puncture was performed and revealed an elevated opening pressure of 26 cm H20 cerebrospinal fluid. Acetazolamide treatment was then initiated, resulting in complete resolution of the HFS.Conclusion:HFS may be a rare presenting manifestation of IIH, and treatment of IIH may result in improvement of HFS symptoms. This is the first report of IIH presenting with HFS in the absence of headache or visual change. As a result, this is the first report of HFS as a presenting manifestation of IIH in Otolaryngology literature.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-11T10:06:05Z
      DOI: 10.1177/0003489420920319
       
  • Book Review: Ear Surgery Illustrated A Comprehensive Atlas of Otologic
           Microsurgical Techniques
    • Authors: Maja Svrakic
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-11T09:57:04Z
      DOI: 10.1177/0003489420912421
       
  • The Impact of Laryngopharyngeal Reflux on Patient-reported Measures of
           Chronic Rhinosinusitis
    • Authors: Hannah J. Brown, Hannah N. Kuhar, Max A. Plitt, Inna Husain, Pete S. Batra, Bobby A. Tajudeen
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:This study explored the impact of laryngopharyngeal reflux (LPR) on quality-of-life outcomes captured by Sino-Nasal Outcome Test (SNOT-22) and Reflux Symptom Index (RSI) in patients with chronic rhinosinusitis (CRS) and patients with symptoms of LPR.Methods:In a retrospective chart review, SNOT-22 and RSI scores were analyzed in patients seen at a tertiary care center with CRS, LPR, or both CRS and LPR. SNOT-22 items were grouped into sleep, nasal, otologic, and emotional symptom subdomains.Results:A total of 138 patients (36 with CRS alone, 60 with LPR alone, and 42 with both CRS and LPR) were included. Compared to patients with CRS alone, those with CRS and LPR (CRS+LPR) had higher SNOT-22 total (50.54 ± 19.53 vs 35.31 ± 20.20, P < .001), sleep (19.61 ± 9.31 vs 14.42 ± 10.34, P < .022), nasal (17.38 ± 7.49 vs 11.11 ± 8.52, P < .001), otologic subdomains (9.17 ± 5.07 vs 5.53 ± 5.14, P < .002), and RSI (22.06 ± 9.42 vs 10.75 ± 8.43, P < .003). Patients with LPR alone had higher RSI compared to those with CRS (18.48 ± 9.77 vs 10.75 ± 8.43, P < .037). RSI and SNOT-22 scores were positively correlated irrespective of patient group (R = 0.289, P = .003).Conclusion:Compared to patients with CRS or LPR alone, those with CRS+LPR demonstrated higher RSI and total and subdomain SNOT-22 scores. Patients with LPR alone had elevated SNOT-22 despite absent endoscopic evidence of sinusitis.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-11T09:56:04Z
      DOI: 10.1177/0003489420921424
       
  • Geographic Variation in Epistaxis Interventions Among Medicare
           Beneficiaries
    • Authors: Kevin Hur, Ido Badash, Guy Talmor, Elisabeth H Ference, Bozena B Wrobel
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To quantify the utilization of epistaxis procedures in the elderly population and assess whether the geographic variability of these procedures is associated with hypertension and direct oral anticoagulant (DOAC) use.Methods:A cross-sectional study was performed on publicly available Medicare procedure and beneficiary data from 2013 to 2016 for all epistaxis procedures categorized by Common Procedural Terminology (CPT). Epistaxis procedures were analyzed by state, complexity, and provider type. Pearson’s correlation coefficient was calculated.Results:Over 4 years, 2 19 827 epistaxis procedures were performed on Medicare patients, 44.3% of which were categorized as simple (control of nasal hemorrhage: anterior simple or posterior primary). Otolaryngologists performed 92.6% of all epistaxis procedures. The frequency of epistaxis procedures performed by state ranged from 0.99 procedures per 10 000 Medicare beneficiaries (PP10K) in Hawaii to 25.7 PP10K in New Jersey. The percentage of epistaxis interventions categorized as complex (anterior complex, posterior subsequent, with nasal endoscopy, or open procedures) in each state varied from 0% in North Dakota to 72.6% in Hawaii. Epistaxis procedure utilization was weakly correlated with the prevalence of hypertension (R2 = 0.08, P = .04) and higher percentage of DOAC among all anticoagulants prescribed (R2 = 0.08, P = .04) in a state’s Medicare population. Utilization of complex epistaxis interventions was not correlated with the prevalence of hypertension or DOAC use.Conclusions:Otolaryngologists perform the vast majority of epistaxis procedures in the Medicare population. However, practice patterns vary across the United States. Hypertension and DOAC use are weakly associated with the utilization of epistaxis interventions.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-11T09:52:39Z
      DOI: 10.1177/0003489420923380
       
  • How Does Age Impact Presentation and Outcomes in Chronic
           Rhinosinusitis'
    • Authors: Thomas Holmes, Chadi Makary, Aykut A. Unsal, Paul Biddinger, Camilo Reyes-Gelves, Stilianos E. Kountakis
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives/Hypothesis:The presence of eosinophilia and nasal polyps are well-established prognostic indicators of chronic rhinosinusitis (CRS). The importance of demographic background, such as age, as independent variables has not been elucidated while taking these factors into account.Study Design:Respective review.Methods:CRS patients who underwent primary surgical treatment were subdivided based on age (young adults = age 18-39, adults = age 40-64, and elderly = age 65+). Groups were then subdivided based on tissue eosinophilia and nasal polyposis. Sinonasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy scores, and Lund-McKay (LM) CT scores were compared preoperatively, and postoperatively during a 5-year period.Results:A total of 431 CRS patients identified and then subsequently broken down into 63 young adults (YA), 209 adults (A), and 159 elderly (E). There was no statistical difference between tissue eosinophilia and presence of polyps between the groups. All three groups had similar short- and long-term SNOT-22 patterns postoperatively. At presentation, young adults had significantly higher SNOT-22 score (33.2 YA, 25.3 A, 23.5 E, P = .029) and significantly higher rhinologic scores (1.9 YA, 1.3 A, 1.3 E, P = .0012) than the adult and elderly patients. Objective disease severity using LK endoscopy scores were only significantly higher in young adults at 1-year time (P = .0026). There was no statistical difference between the groups in regards to preoperative LM CT scores.Conclusions:Young adults are more likely to present with overall higher subjective SNOT-22 scores over adults and elderly patients, despite similar objective findings in the groups. Short- and long-term postoperative improvement holds across all age groups.Level of Evidence:4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-09T04:53:02Z
      DOI: 10.1177/0003489420919124
       
  • Comparison of Materials Used for 3D-Printing Temporal Bone Models to
           Simulate Surgical Dissection
    • Authors: Alexandra McMillan, Armine Kocharyan, Simone E. Dekker, Elias George Kikano, Anisha Garg, Victoria W. Huang, Nicholas Moon, Malcolm Cooke, Sarah E. Mowry
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods.Background:There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training.Methods:High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS.Results:Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance.Conclusions:PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-04T10:18:47Z
      DOI: 10.1177/0003489420918273
       
  • The Impact of Playing a Musical Instrument on Obstructive Sleep Apnea: A
           Systematic Review
    • Authors: Jurjen C. de Jong, Andrew J. Maroda, Macario Camacho, Philip G. Chen
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Study Objectives:To conduct a systematic review of the medical literature evaluating the effects of playing a musical instrument on obstructive sleep apnea (OSA).Data Sources:Scopus, CINAHL, PubMed, and OVID.Review Methods:Searches were performed through October 22, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.Results:After thorough investigation amidst specific exclusion criteria, four studies were included in the systematic review: one randomized controlled trial and three cross-sectional studies. Polysomnography was used to assess apnea-hypopnea index (AHI) related to obstructive sleep apnea (OSA) in the randomized controlled trial, while the Berlin questionnaire was used to assess high- and low risk OSA in the cross-sectional studies. Various instrument types were mentioned in these studies, largely focusing on wind instruments and subgroups within the wind instrument family.Conclusion:Current literature, although sparse, suggests that playing certain types of wind instruments are associated with either improving patients’ AHI or reducing the risk of developing OSA. Future studies with larger sample sizes utilizing validated diagnostic tools to measure the presence and severity of OSA are necessary to determine the true impact of such interventions. Although more research is needed, sustainable and minimally invasive interventions such as playing a specific type of musical instrument could serve as an accessible, inexpensive, and effective adjunctive treatment for OSA.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-04T10:16:37Z
      DOI: 10.1177/0003489420917407
       
  • Prevalence and Prognostic Value of HPV among Tunisian Patients with
           Laryngeal Cancer and Relationship between DNA HPV and p16, IGF-1R,
           Survivin, p53 Expressions
    • Authors: Mariem Ben Elhadj, Asma Fourati, Olfa El Amine, Aida Goucha, Ahmed El May, Michèle-Veronique El May, Nehla Mokni Baizig
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Tobacco and alcohol are the main etiological factors common to laryngeal cancers. However, the Human Papilloma Virus (HPV) constitutes an alternative risk factor according to several studies. In Tunisia, despite the annual increasing incidence of laryngeal squamous cell carcinoma (LSCC), the prevalence and prognostic significance of HPV have never been explored.In this study, we sought to highlight HPV DNA in 70 biopsies of laryngeal cancer, and to analyze the status of HPV infection in association with p53, p16, survivin, and IGF-1R expressions.Methods:HPV high risk (HPV HR) DNA was detected in tumors by in situ hybridization. However, the expression of p53, p16, survivin and IGF-1R were stained by immunohistochemistry test. The correlations of HPV status with clinicopathological parameters, overall survival, disease-free survival and proteins expressions were statistically evaluated.Results:HPV HR DNA was detected in 39 out of 70 (55.71%) laryngeal tumors. HPV+ patients have a better overall survival (P = .081) and long disease-free-survival (P = .016) with a low rate of recurrence (P = .006) than HPV– patients. No significant correlations were found between HPV HR status and clinicopathological parameters (all P > .005). Moreover, HPV+ tumors were not associated with expression of p53, p16 and survivin. However, HPV HR status correlates with weak to moderate IGF-1R expression (P = .043).Conclusion:The substantial detection of HPV HR in LSCC tumors suggest that this virus plays an important part in laryngeal cancer in Tunisia. It is a good prognostic factor. In addition, HPV infection could act to block the pathway of IGF-1R expression.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-04T01:01:16Z
      DOI: 10.1177/0003489420918280
       
  • Mycosis Fungoides of the True Vocal Folds: A Case Report
    • Authors: Jesse R. Qualliotine, Rohan Ahluwalia, Dmitrios Tzachanis, Parag Sanghvi, Philip A. Weissbrod
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To report a case of laryngeal involvement of mycosis fungoides and its symptomatic treatment with laser-assisted surgical ablation.Methods:Case report and literature review.Results:A 76-year-old woman with longstanding MF previously treated with Brentuximab Vedotin who developed persistent cough and dysphonia. The patient’s laryngeal disease burden was treated with KTP-laser ablation and further reduced with doxorubicin and radiotherapy.Conclusions:Although laryngeal, and especially glottic, involvement is a rare finding, suspicion should be maintained in symptomatic patients with cutaneous mycosis fungoides. This the first reported surgical laser treatment of laryngeal symptoms in this context, which can greatly improve a patient’s quality of life.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-28T06:08:47Z
      DOI: 10.1177/0003489420916213
       
  • Ultrasonic Measurement of Lingual Artery and Its Application for Midline
           Glossectomy
    • Authors: Chun Liu, Jie Qin, Dengxiang Xing, Haibo Lu, Ruiyi Yue, Shuhua Li, Dahai Wu
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To explore the application of lingual artery ultrasound (US) for midline glossectomy in patients with obstructive sleep apnea (OSA).Methods:Lingual artery US was performed in 57 OSA patients (OSA group) and 20 normal persons (control group). The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries were compared between two groups. The correlations between apnea-hypopnea index (AHI), AHI after the nasopharyngeal tube insertion (NPT-AHI), Friedman tongue position (FTP) and all the parameters of lingual arteries were analyzed.Results:Both the depths of the lingual arteries and the distances between the bilateral lingual arteries in the OSA group were larger than those in the control group (P < .01). All the parameters of the lingual arteries in OSA patients were positively correlated with AHI, NPT-AHI and FTP (P < .05). While controlling for body mass index (BMI), all the parameters of the lingual arteries in OSA patients were still correlated with NPT-AHI positively (P ≤ .01).Conclusion:Pre-operative US can show the course of the lingual artery clearly for pre-operative planning. The depth and width of the lingual artery in OSA patients were different from controls. NPT-AHI has high sensitivity in predicting all the parameters of the lingual arteries. FTP is closely correlated with the depth of the lingual arteries.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-22T05:52:38Z
      DOI: 10.1177/0003489420913581
       
  • Hemi-laryngopharyngeal Spasm (HeLPS): Defining a New Clinical Entity
    • Authors: Amanda Hu, Murray Morrison, Christopher R. Honey
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome.Methods:A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017.Results:Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years).Conclusion:The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis.Level of Evidence:4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-21T07:41:16Z
      DOI: 10.1177/0003489420916207
       
  • Book Review: Head and Neck Cancer: Management and Reconstruction
    • Authors: Vikas Mehta
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-04T10:36:34Z
      DOI: 10.1177/0003489420912420
       
  • Endoscopic Cartilage Myringoplasty with Inside Out Elevation of a
           Tympanomeatal Flap for Repairing Anterior Tympanic Membrane Perforations
    • Authors: Zhengcai Lou
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:We evaluated the graft take rate and hearing gain of endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap for repairing an anterior tympanic membrane perforation.Study design:A retrospective case seriesSetting:Tertiary university hospitalMaterials and Methods:The study population consisted of patients with an anterior perforation undergoing endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap. The primary outcome was the graft take rate at 6 months. The secondary outcomes were the air–bone gap (ABG) gain at 3 months and complications.Results:A total of 51 patients with a unilateral anterior marginal perforation were included in this study. The mean operation time was 62.2 ± 8.3 minutes. The graft success rate was 92.2% (47/51) at 6 months. The mean preoperative ABG was 28.07 ± 5.13 dB, while the mean postoperative ABG was 12.24 ± 4.89 dB (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-04T10:35:54Z
      DOI: 10.1177/0003489420915208
       
  • Serum Renin Levels in Sudden Sensorineural Hearing Loss
    • Authors: Muhammet Yıldız, Ahmet Baki̇, Ömer Faruk Özer
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:The aim of this study was to investigate the serum renin levels of patients with idiopathic sudden sensorineural hearing loss (ISSNHL).Material and Methods:Twenty-four patients with ISSNHL and 24 asymptomatic healthy volunteers were included in the study. Subjects underwent pure-tone audiometry and serum renin levels were measured.Results:There were 14 women (mean age:42.35 ± 9.53) and 10 men (mean age:43.8 ± 6.87) in the patient group. There were 14 women (mean age:42.4 ± 4.7) and 10 men (mean age:41.4 ± 4.59) in the control group. ISSNHL was detected on the right side in 13 patients and on the left side in 11 patients. Serum renin levels of the patients and controls were 788.01 ± 327.8 and 282.37 ± 107.73 pg/mL, respectively. The serum renin levels were found to be significantly higher in the patient group compared to the control group (P ≤ .001). There was a statistically significant strong positive correlation between serum renin level and the severity of hearing loss (r = 0.77; P = .001).Conclusion:Serum renin levels of patients with ISSNHL were higher than controls. There was a statistically significant strong positive correlation between serum renin level and the severity of hearing loss.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-04T10:34:14Z
      DOI: 10.1177/0003489420915221
       
  • Examining Referral Patterns between Otolaryngology and Gastroenterology: A
           Window into Potential Inter-Specialty Knowledge Gaps
    • Authors: Adam Haines, Nikita Kohli, Benjamin A. Lerner, Michael Z. Lerner
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:The objective of this study was to examine referral patterns between otolaryngology and gastroenterology in order to delineate areas of clinical overlap, as well as to identify areas that might benefit from improved inter-specialty communication and collaboration.Methods:Montefiore’s Clinical Looking Glass tool was used to define parameters for electronic medical record data extraction from 2015 to 2018. Two cohorts were generated, one representing referrals placed by gastroenterology to otolaryngology and a second representing referrals placed by otolaryngology to gastroenterology. The ICD-10 codes in both cohorts were reviewed and 13 distinct “reason for referral” categories were defined. The rates of referral for each category were then calculated for each of the referral cohorts.Results:Otolaryngology referred to gastroenterology at a greater rate than gastroenterology referred to otolaryngology, despite seeing fewer total patients than gastroenterology. For referrals from gastroenterology to otolaryngology, the three most frequent referral reasons were oral cavity/oropharyngeal pathology (28.3%), dysphagia (28.3%), and gastroesophageal reflux disease/laryngopharyngeal reflux disease (GERD/LPRD) (11.3%). For referrals from otolaryngology to gastroenterology, the three most frequent referral reasons were GERD/LPRD (61.7%), dysphagia (18.6%), and esophageal pathology (5.3%).Conclusions:GERD/LPRD was more frequently referred out by otolaryngology than it was by gastroenterology, suggesting the need for further characterization of the discrepancy in management of a disease commonly treated by both specialties. The discrepant rates of referral for dysphagia also suggest a need to better understand what factors contribute to the differences in management of another clinical condition commonly assessed by both specialties.Level of Evidence:4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-04-04T10:32:54Z
      DOI: 10.1177/0003489420916215
       
  • Facial Paralysis and Communicative Participation: The Importance of Facial
           Symmetry at Rest
    • Authors: Noel F. Ayoub, Mohamed Abdelwahab, Michelle Zhang, Yifei Ma, Sarah Stranberg, Tyler S. Okland, Jon-Paul Pepper
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:There is a paucity of research devoted to understanding the communication restrictions encountered by facial paralysis patients. We aim to explore the relationship between patient-reported restrictions in communicative participation and objective facial paralysis severity using validated scales of facial movement.Methods:We performed a pilot retrospective study using a consecutive series of adult patients with a diagnosis of unilateral facial paralysis. In addition to baseline demographics, subjects were evaluated using the Communicative Item Participation Bank Short Form (CPIB), Electronic Facial Assessment by Computer Evaluation (eFACE), and Sunnybrook Facial Grading System (SFGS).Results:Twenty patients were included, 10 (50%) of whom were female with a mean age of 61 ± 13 years and mean duration of facial paralysis of 53 ± 82 months. The mean CPIB score was 14.6 ± 10.0 (range 0-29) and was comparable to scores of patients with conditions known to cause significant communicative disability. The mean eFACE scores were 67.4 ± 29.2, 44.2 ± 30.1, and 73.8 ± 30.0 for the static, dynamic, and synkinesis domains, respectively, with a composite smile score of 58.5 ± 16.9. After adjusting for age, gender, and duration of facial paralysis, significant moderate correlations were observed between the CPIB and the static eFACE domain (r = –0.51, P = .03) and smile composite score (r = 0.48, P = 0.0049), in addition to between the CPIB and SFGS synkinesis domain (r = 0.48, P = 0.04).Conclusions:Patients with unilateral facial paralysis experience significant limitations in communicative participation. These restrictions demonstrate moderate to strong correlations with objective assessments of facial paralysis and quality of life measures. Communicative participation may be a helpful means of tracking response to treatment.Level of Evidence:IV
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-20T06:19:24Z
      DOI: 10.1177/0003489420912446
       
  • Book Review: Chronic Cough
    • Authors: Alexandra Michalowski, John P. Bent
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-20T06:17:04Z
      DOI: 10.1177/0003489420912419
       
  • A Prospective Randomized Clinical Trial of Combination Therapy with Proton
           Pump Inhibitors and Mucolytics in Patients with Laryngopharyngeal Reflux
    • Authors: Minsuk Chae, Dong Hyuk Jang, Ho Chan Kim, Minsu Kwon
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To identify whether combination therapy with mucolytics and proton pump inhibitors (PPIs) leads to faster and more effective symptomatic relief in patients with laryngopharyngeal reflux (LPR).Methods:Patients diagnosed as LPR with a reflux symptom index (RSI) ≥ 13 and a reflux finding score (RFS) ≥ 7 were enrolled in this prospective study. Patients were randomly allocated to control (PPI only) or experimental (PPI + mucolytics) groups and changes in RSI and RFS values were assessed at 1- and 3-month follow-up.Results:One hundred sixteen patients were randomly allocated into either the control group (n = 59) or the experimental group (n = 57). The RSI and RFS scores significantly decreased in both groups (all P < .001) after 1 month of treatment; however, there was no significant difference in RSI change between groups (P = .223). After 3 months of treatment, there remained no significant difference in RSI change between groups (P = .592).Conclusions:Combination therapy with mucolytics and PPI compared to PPI alone did not lead to faster or more effective symptomatic relief in LPR patients.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-18T02:16:08Z
      DOI: 10.1177/0003489420913592
       
  • Effect of Gender, Age, and Profound Disease on Upper Airway Stimulation
           Outcomes
    • Authors: Jena Patel, Kelly Daniels, Lauren Bogdan, Colin Huntley, Maurits Boon
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To evaluate treatment outcomes of upper airway stimulation (UAS) in obstructive sleep apnea (OSA) patients based on patient age, gender, and preoperative disease severity.Methods:Retrospective chart review of patients undergoing UAS from 2014 to 2018 at a tertiary care center. Data collected included demographic information, implantation records, and pre- and postoperative polysomnography (PSG) results. Profound OSA was defined as AHI>65 and age ≥65 was considered advanced age. The primary outcome measured was initial treatment response, defined as a post-operative AHI 50% reduction from baseline.Results:145 patients underwent UAS at our institution including 98 males and 47 females with a mean age of 61.7 ± 11.5 years, mean BMI of 29.1 ± 3.9 kg/m2, and mean preoperative AHI of 34.1 ± 18.2 events/hour. After surgery, patients had a significantly lower mean AHI of 8.6 ± 15.0 events/hour ( 15) after UAS.Level of Evidence:4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-16T07:32:06Z
      DOI: 10.1177/0003489420911656
       
  • Development and Evaluation of an Objective Tympanic Membrane Visualization
           Assessment Technique
    • Authors: Amir A. Hakimi, Simon P. Lalehzarian, Aaron S. Lalehzarian, Ariel M. Azhdam, Benjamin D. Boodaie, David L. Walner
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To introduce an inexpensive method for objectively evaluating otoscopic visualization of the tympanic membrane wherein learners match what they visualize in standardized patients to tympanic membrane photographs.Methods:Two standardized patients had photographs taken of their tympanic membranes using a commercially-available digital otoscope. First- and third-year medical students were asked to perform an otoscopic examination on each patient using a conventional handheld otoscope and to match what they saw with the correct tympanic membrane image among distractor photographs belonging to other patients. The ability of students to match the standardized patients’ tympanic membrane to the correct photographs was assessed before and after a didactic training session. These measurements were compared between the two cohort groups for construct validity.Results:Fifty-one first-year medical students (with no previous otoscopy experience) and 44 third-year medical students (with otoscopy experience from completing pediatric and family medicine clinical clerkships) were recruited to voluntarily participate in this study. At baseline, a larger percentage of third-year students correctly matched both tympanic membranes compared to first-year students (27% vs 8%, P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-09T05:28:32Z
      DOI: 10.1177/0003489420912438
       
  • Effects of Cardiovascular Health Factors and Personal Listening Behaviors
           on Hearing Sensitivity in College-Aged students
    • Authors: Helaine Alessio, Kathleen Hutchinson Marron, Ian M. Cramer, Michael Hughes, Kendrah Betz, Sarah Stephenson, Sarah Wagner, Theresa Loughridge, Brittany Sproat, Allison L. Bunger
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:This study examined the association between pure tone hearing sensitivity and music listening behaviors among traditional college-aged students and sought to determine factors that mediate hearing sensitivity, including health and fitness levels, gender, and personal listening device (PLD) use.Methods:A convenience sample of college students (N = 182; 133 females, 49 males, mean age = 19.8 ± 1.4 year, average PLD use = 1.52 ± 7.1 hours•day−1) completed hearing assessments, music listening behavior questionnaires, and health and fitness tests.Results:Most students listened to music at safe intensity levels (
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-07T12:16:08Z
      DOI: 10.1177/0003489420909403
       
  • Decision Quality Among Parents Who Are Offered Ventilation Tube Insertion
           for Their Children
    • Authors: Maxwell D. Newby, Habib G. Zalzal, Jad Ramadan, Brian M. Kellermeyer, Michele M. Carr
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:To develop a Decision Quality (DQ) tool to measure parents’ DQ concerning ventilation tube (VT) insertion in their children.Method:Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT.Results:Of 100 parent participants, 83% were mothers and 14% were fathers. 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-04T08:44:23Z
      DOI: 10.1177/0003489420909850
       
  • Decreased Tongue Volume Post Radiation
    • Authors: David Garber, Janine Rotsides, Sara Abu-Ghanem, Ilana Bandler, Amy Smith, Irina Oyfe, Dawn-Marie Swahn, Mari Hagiwara, Milan Amin, Aaron M. Johnson
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To evaluate volume changes within the tongue post chemoradiation therapy (CRT)Study Design:Retrospective reviewSetting:Academic Medical CenterSubjects and Methods:Subjects included 19 patients that received CRT as the primary treatment for tonsillar or hypopharynx squamous cell carcinoma. Tongue volumes were calculated by three raters from thin slice computed tomography images collected before treatment and up to 29 months post-CRT. Body mass index (BMI) was also collected at each time point.Results:Inter-rater reliability was high with an ICC of 0.849 (95% CI = 0.773, 0.905). Linear mixed effects modeling showed a mean decrease of 0.45 cm3 (standard error of the mean [SEM] = 0.11) in tongue volume per month post-CRT (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-04T08:43:50Z
      DOI: 10.1177/0003489420911668
       
  • Middle ear Pathologies in Adults Living with Human Immunodeficiency Virus:
           A Systematic Review
    • Authors: Ben Sebothoma, Katijah Khoza-Shangase
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Introduction:Middle ear pathologies have been linked with HIV. The onset and development of these pathologies in individuals with HIV have not been categorized; and clarity has not been gained regarding whether their presentation is any different in this population when compared to HIV negative control group.Purpose:The aim of this study was to explore and document published evidence reflecting trends in middle ear pathologies in adults living with HIV.Methods:A systematic review of literature from January 1982 to December 2018 was conducted using Medline, CINAHL, PubMed, and Psych Info. Studies that reported the occurrence rate of middle ear pathologies in adults with HIV and published in English were included.Results:Twelve articles met the inclusion criteria. Evidence suggests that the reported occurrence rates of middle ear pathologies ranges from 2.5% to 58% in this population. The variability in assessment measures as well as the different cut-off criteria used in studies seem to have an influence in the findings, with pure tone audiometry identifying more middle ear pathologies in the current review than tympanometry with 226 Hz probe tone and clinical examination. Otitis media, conductive hearing loss, and type B tympanogram were common findings reported in this study. No evidence of an association between the use of antiretroviral therapy (ART) and the rates of middle ear pathologies was found.Conclusion:Although there are very few studies that have reported on middle ear pathologies in adults living with HIV, the available studies have sufficiently established a link between HIV and middle ear disease in this population, and have revealed that the rate of occurrence is influenced by a number of factors. Key amongst these is the type of assessment measure used. Careful analysis of middle ear pathologies in this population through well controlled research designs that include different assessment measures. The use of case-control and longitudinal designs to determine differences between groups and to establish the time of onset and development of middle ear pathologies is required.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-03-04T07:27:10Z
      DOI: 10.1177/0003489420909847
       
  • Pathological Mechanisms of Blast-Induced Cholesteatomas
    • Authors: Zhengcai Lou
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-28T08:48:33Z
      DOI: 10.1177/0003489420909418
       
  • Reply to the Letter to the Editor by Zhengcai Lou, MD regarding
           “Pathological Mechanisms of Blast-induced Cholesteatomas”, Ungar et
           al., Ann Otol Rhinol Laryngol. 2019;128:1147–51
    • Authors: Omer J. Ungar
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-27T06:33:10Z
      DOI: 10.1177/0003489420908859
       
  • Book Review: Review of Handbook of Otolaryngic Allergy
    • Authors: Samia F. Nawaz
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-26T10:13:11Z
      DOI: 10.1177/0003489420903287
       
  • Bitter Taste Perception of the Human Tongue Mediated by Quinine and
           Caffeine Impregnated Taste Strips
    • Authors: David T. Liu, Gerold Besser, Florian Oeller, Christian A. Mueller, Bertold Renner
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Tests for gustatory function have become increasingly important in diagnosis and treatment of patients with taste disorders. While caffeine and quinine hydrochloride solutions have been used for global testing of bitter perception, only quinine has been used to test regional bitter perception by means of taste strips. The aim of the present study was to validate caffeine impregnated taste strips as an alternative to quinine taste strips for assessment of regional bitter perception.Methods:A total of 46 healthy volunteers (mean age/range, 23/19-27 years) were included in this study. Quinine and caffeine impregnated taste strips were pairwise presented at different parts of the tongue. Perceived intensity and hedonic dislike were evaluated using labeled magnitude scales. Additionally, gustatory function was assessed using the taste strips test and overall sense of taste was rated using visual analog scales.Results:Assessment of gustatory function demonstrated scores within the normogeusic range in most included subjects (mean/SD, 13.1/2.5). Notably, equally concentrated quinine and caffeine impregnated taste strips placed on different regions of the tongue did not lead to significant differences in perceived intensity or hedonic dislike, whereas quinine and caffeine impregnated taste strips of different concentrations placed on the same region on the tongue led to significant differences of perceived intensity and hedonic dislike. Furthermore, no correlation was found between self-assessment of gustatory function and taste strips scores.Conclusion:Caffeine seems to be a valid bitter compound for regional testing using taste strips and may be used alternatively to quinine.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-07T06:03:25Z
      DOI: 10.1177/0003489420906187
       
  • Cochlear Implants in Alström Syndrome
    • Authors: Gheller Flavia, Gallo Samanta, Trevisi Patrizia, Caserta Ezio, Dassie Francesca, Maffei Pietro, Bovo Roberto
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Too little is known about hearing loss rehabilitation in patients with Alström syndrome (AS). Benefits of hearing aids (HA) have not been fully documented and only one case treated with a Cochlear Implant (CI) has been described in the proceedings of a conference. Furthermore, comorbidities and risk of complications following surgical intervention may contraindicate Cochlear Implant procedures in these patients.The present case report concerns the first AS patient with CI in the literature.Methods:After reporting a concise description of the audiological profile of patients with AS described in the literature, the case of a 22-year-old woman with genetically confirmed Alström syndrome who underwent a sequential bilateral CI (Bi-CI) rehabilitation is reported. Audiological results before and after cochlear implantation are described.Results:The patient showed an excellent functional outcome with CIs, which enabled her to achieve communicative, social and academic results comparable with her peers, and no complications occurred.Conclusions:AS is not necessarily an absolute contraindication to CI. For many AS patients, a good cognitive function and adequate life expectancy represent a clear indication to prompt and adequate hearing rehabilitation with CIs. The description of this type of clinical cases could in the future also generate indications for a tailored audiological treatment of patients with very specific needs, such as patients with Alström Syndrome.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-05T09:50:46Z
      DOI: 10.1177/0003489420903061
       
  • Letter to the Editor
    • Authors: Erich P Voigt
      First page: 641
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-05-12T04:39:45Z
      DOI: 10.1177/0003489420928366
       
  • The Prognosis of Lateral Cartilage Graft for Double-Layer Tympanic
           Membrane Graft in Type I Tympanoplasty
    • Authors: Zhengcai Lou
      First page: 643
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.

      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-01T07:27:03Z
      DOI: 10.1177/0003489420903062
       
  • The Case of the Missing Nose: Congenital Arhinia Case Presentation and
           Management Recommendations
    • Authors: Andrew K. Fuller, Hilary C. McCrary, M. Elise Graham, Jonathan R. Skirko
      First page: 645
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:To discuss the presentation and management of infants with arhinia or congenital absence of the nose.Methods:This case report describes an infant with arhinia that was diagnosed prenatally. In addition to a discussion of the case, a review of the literature was completed to define appropriate postnatal work-up and management.Results:The patient is a term male infant, diagnosed with arhinia on ultrasound and magnetic resonance imaging (MRI) performed at 21-weeks gestational age. Upon birth, the patient was subsequently intubated, followed by tracheostomy due to complete nasal obstruction. Through a genetics evaluation, the patient was found to be heterozygous for the SMCHD1 gene, with hypomethylation at the D4Z4 locus. Plans for reconstruction will be based on future imaging and the development of any nasal patency, however, the patient’s family plans to utilize a prosthetic nose until the patient is older.Conclusion:Arhinia is a rare condition causing respiratory distress in the neonatal period. While stabilization of the airway is the first priority, further management is not clearly defined given the rarity of the malformation. This case discusses stabilization of the airway with a review of treatment and reconstructive options.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-26T10:14:39Z
      DOI: 10.1177/0003489420909415
       
  • Adult Aortotracheal Fistula as Sequela of Double Aortic Arch Repair in
           Infancy: A Case Report
    • Authors: Andrew B. Rees, Jennifer P. Rodney, Mark R. Gilbert, Clayton A. Kaiser, Alexander H. Gelbard
      First page: 649
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Introduction:Double aortic arch is a rare congenital malformation of the aortic arch that most frequently presents in childhood. Early surgical intervention typically yields excellent outcomes.Objectives:To describe aortotracheal fistula as a rare, yet serious complication of vascular ring and subsequent aortic aneurysm in an adult patient.Methods:Clinical history, as well as radiographic and endoscopic imaging were obtained to describe the development, diagnosis, and clinical course of this patient’s aortotracheal fistula. Additionally, follow up data was obtained to document the healing of this fistula after surgical repair.Results:We describe a case of a 46-year-old male with DiGeorge Syndrome and a double aortic arch, repaired in childhood, which developed into an aortotracheal fistula after tracheostomy placement as an adult.Conclusions:This case demonstrates that dangerous complications of a double aortic arch can persist into adulthood, even after surgical repair in infancy. Each patient’s unique anatomy must be considered when thinking about airway management and prevention of complications of this rare congenital anomaly.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-01T07:25:43Z
      DOI: 10.1177/0003489420904739
       
  • Congenital Midline Cervical Cleft: First Report and Genetic Analysis of
           Two Related Patients
    • Authors: Maheer M. Masood, Piotr Mieczkowski, Ewa P. Malc, Ann Katherine M. Foreman, James P. Evans, J. Madison Clark, Austin S. Rose
      First page: 653
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Congenital midline cervical cleft (CMCC) is a rare congenital anterior neck anatomical anomaly. We present the case of two related patients (grandchild and maternal grandmother) who were both born with a congenital midline cervical cleft along with genetic analysis.Methods:Clinical examination of both patients and surgical excision of the grandchild was performed. Genetic analysis with exome sequencing (ES) was conducted for both patients.Results:Genetic analysis with exome sequencing (ES) revealed apparently novel single nucleotide variants in 66 genes present in both proband and grandmother. Five of these variants are predicted to cause frameshifting in the coding region of the respective genes and truncated proteins (OVGP1, TYW1B, ZAN, SSPO, FOLR3). Two of these genes (TYW1B and SSPO) have homozygous indel mutations in both patients.Conclusions:To our knowledge, this is the first case of two related patients with a congenital midline cervical cleft. The results of our genetic analysis reveal potential relevance to CMCC development.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-07T06:04:58Z
      DOI: 10.1177/0003489420906180
       
  • Gastropharyngeal Anastomotic Leak in Medullary Thyroid Carcinoma Following
           Initiation of a Tyrosine Kinase Inhibitor: A Case Report of an Unusual
           Side Effect of Cabozantinib
    • Authors: Jaeger Ackerman, Sean Kent, Paul Walker
      First page: 657
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Medullary thyroid carcinoma (MTC) accounts for 1% to 2% of thyroid cancers in the United States. When identified early, total thyroidectomy is most often curative. However, in advanced disease, more aggressive treatment such as laryngectomy and esophagectomy may be indicated. Postsurgical fistula formation and leak is a potential complication in such cases. These fistulas are most likely to occur at the anastomotic site in cases of laryngectomy or esophagectomy. Concomitant chemotherapy and radiation increase this risk. Tyrosine kinase inhibitors (TKI) such as Cabozantinib are used as therapy for metastatic MTC. These drugs have previously been associated with dehiscence of anastomotic sites in the gastrointestinal tract. While previously identified in the bowel, this report represents the first documented case of gastropharyngeal anastomosis leak described in the context of TKI use for head and neck cancer.Case Presentation:We present the case of a 72-year-old male previously diagnosed with MTC. His gastropharyngeal anastomosis status-post laryngopharyngectomy and gastric pull up had been stable for 23 years. Over the past year, he developed back pain and was found to have spinal metastases of MTC. He was subsequently started on Cabozantinib to slow the progression of the disease. Within months of starting this TKI, a bleeding pharyngocutaneous fistula developed at the anastomosis site of the gastric pull up and pharynx. Upon discontinuation of Cabozantinib, the fistula healed with no further complications.Conclusions:To our knowledge, this is the first documented case of gastropharyngeal anastomotic leak related to TKI use. A causal relationship is highly plausible given the previously stable anastomosis and the suspicious advent of complications within months of initiation of this new drug. While previously limited to cases of intraabdominal bowel dehiscence, this report now suggests that wound dehiscence must be considered a known side effect of TKIs throughout the gastrointestinal tract, including the gastropharynx. As such, the risk of anastomotic dehiscence should be discussed with the patient prior to starting a TKI.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-10T10:15:47Z
      DOI: 10.1177/0003489420902161
       
  • Cricoid Chondronecrosis: Case Report and Review of Literature
    • Authors: Mark M. Mims, Andree A. Leclerc, Libby J. Smith
      First page: 662
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Cricoid chondronecrosis is a rare entity that has significant consequences for patients. Reports of its occurrence are scattered in the literature and currently there is no comprehensive review to help guide providers.Methods:A case report from our institution is presented. A review of available literature is then provided with assessment of risk factors, signs and symptoms at presentation, laryngeal exam findings, radiologic findings, and surgical techniques.Results:Twenty-four cases of cricoid chondronecrosis were reviewed from the literature. Patient age ranged from 8 months to 76 years. A history of endotracheal intubation for various reasons was present in all but two cases, and duration of intubation ranged from 6 hours to 28 days. Patients presented with airway compromise in all but two cases—one asymptomatic patient with prior tracheostomy and another with dysphagia after radiation. Dysphonia (n = 6) and dysphagia (n = 3) were less commonly present. Subglottic stenosis (n = 19) was the most common exam finding followed by vocal fold impairment (n = 11). When CT scan findings were reported, fragmentation of the cartilage and/or hypodensity of the central lamina were described in all but one case. Interventions ranged from observation on antibiotics and steroids to surgical therapies including tracheostomy, dilation, and posterior cricoid split, with or without stent placement.Conclusions:Cricoid chondronecrosis is a serious, rare entity that can occur even after a short period of endotracheal intubation. Providers must have a high level of suspicion in patients that present with upper airway dyspnea with a history of prior intubation.Level of evidence:Level 4
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-19T06:18:33Z
      DOI: 10.1177/0003489420904974
       
  • Survival Outcomes and Prognostic Factors of Open Partial Laryngeal
           Surgery: A Thirty Years’ Experience
    • Authors: Oreste Gallo, Angelo Cannavicci, Chiara Bruno, Giandomenico Maggiore, Luca Giovanni Locatello
      First page: 669
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Open partial laryngeal surgery (OPLS) represents a wide array of procedures that can be fitted to treat different types of laryngeal cancer (LC). We would like to present our 30-years’ institutional experience, to analyze survival outcomes and to critically discuss prognostic factors.Methods:We reviewed all cases of OPLS performed at our Institution from 1982 to 2016 for LC. Survival analysis by Kaplan–Meier estimate was performed and prognostic variables by multivariate analysis were identified.Results:Mean follow-up time was 68.3 months, 30-day mortality 0.2%, subsequent functional total laryngectomy (TL) was 1.01%. Over 80% of cases were stage I to II. We had 25 local, 62 regional and eight distant recurrences. Local control was 94.9%, overall survival (OS) was 83.4% and disease-specific survival (DSS) was 87.7%. The two major risk factors significantly associated with the risk of death were cT and cN stage. CONCLUSIONS: We have confirmed that OPLS represents an oncologically sound option in the treatment of LC despite the emergence of non-surgical strategies and new transoral mininvasive techniques. Our results highlight that accurate staging, correct selection of the patient and a strong surgical expertise are of paramount importance in this type of surgery.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-07T06:09:37Z
      DOI: 10.1177/0003489420905616
       
  • Effect of Over the Counter Ibuprofen Dosing after Sinus Surgery for
           Chronic Rhinosinusitis: A Prospective Cohort Pilot Study
    • Authors: Craig Miller, Ian M. Humphreys, Greg E. Davis
      First page: 677
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Introduction:Management of pain following endoscopic sinus surgery (ESS) often involves intermittent use of opioid medications. Given the current opioid crisis, many surgeons aim to minimize opioid prescriptions. However, surgeons often avoid the use of NSAIDs following ESS out of concern for increased bleeding risk. We sought to evaluate the effectiveness and safety of over the counter dosing of ibuprofen on pain and bleeding rates following ESS.Methods:Prospective cohort pilot study of patients undergoing ESS. Patients self-selected either control arm (acetaminophen and PRN oxycodone) or intervention arm (alternating ibuprofen with acetaminophen, and PRN oxycodone). Outcome measures included pain (10-point visual analog scale [VAS]), bleeding rate (10-point VAS), and number of opiate pills consumed.Results:Thirty-nine patients completed the study (15 control and 24 intervention). Overall, patients in the intervention arm reported decreased pain levels at days 1 (−0.9 [95%CI: −2.2, 0.5], 3 (−0.9 [95%CI: −2.3, 0.5]), and 7 (−0.6 [95%CI: −1.8, 0.6]), as well as decreased postoperative bleeding at those same days −0.9 [95%CI: −2.1, 0.4], −0.9 [95%CI: −2.1, 0.4], and −0.7 [95% CI: −1.2, −0.7], compared to controls. Opiate consumption was similar between groups with patients consuming on average four opiate pills (oxycodone 5 mg).Conclusions:Over the counter dosing of ibuprofen along with acetaminophen may yield better pain control after sinus surgery compared to acetaminophen alone. Additionally, there was no significant difference in epistaxis in the ibuprofen cohort compared to the cohort who did not take ibuprofen. Furthermore, this study showed very few opioid pills were consumed after routine ESS regardless of pain regimen prescribed. A larger trial is needed to make definitive statements on safety and efficacy.Level of Evidence:2b
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-07T06:09:17Z
      DOI: 10.1177/0003489420906179
       
  • Melanoma Characteristics in Patients with a History of UV Tanning Bed
           Usage
    • Authors: Kristy Truong, Mohammed Milhem, Nitin A. Pagedar
      First page: 684
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:The purpose of this study was to evaluate the effect of tanning bed use on the behavior of subsequent melanomas.Methods:Cases of invasive cutaneous melanoma who completed a baseline questionnaire within 1 year of biopsy were ascertained using an institutional registry. Patients were categorized into one of two groups: (1) no history of UV tanning bed usage or (2) any history of tanning bed usage. Data analysis looked for group differences on the following variables: TNM staging, mitotic rate, family history of melanoma, and basic demographic variables.Results:Among 141 cases, a higher percentage of women (48.28%) reported tanning bed usage compared to men (26.51%, P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-07T06:10:37Z
      DOI: 10.1177/0003489420904744
       
  • Effect of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy for
           Severe Dysphagia Due to Brainstem Disease
    • Authors: Seiko Shibata, Hitoshi Kagaya, Yasunori Ozeki, Eiichi Saitoh, Yoichiro Aoyagi, Yoshihiro Iwata, Kazuo Sakurai
      First page: 689
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease.Methods:Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up.Results:Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up.Conclusion:Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-10T10:16:27Z
      DOI: 10.1177/0003489420904741
       
  • Using a 4K-3D Exoscope for Upper Airway Stimulation Surgery:
           Proof-of-Concept
    • Authors: Vijay A. Patel, Neerav Goyal
      First page: 695
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Demonstrate the potential of the 4K-3D exoscope during upper airway stimulation surgery (UAS).Methods:A proof-of-concept study was performed to evaluate the feasibility of the exoscope during three consecutive UAS.Results:The exoscope was employed during UAS including cuff electrode and sensing lead placement. Three cases were successfully completed without adverse perioperative event; mean operative time was 200 minutes (range 188-218 minutes) with a successive reduction in operative time.Conclusion:This experience demonstrates the potential viability of the exoscope for UAS; it is a safe, innovative, and effective alternative or adjunct to existing visualization modalities. Notable advantages include improved ergonomics, unobstructed surgical field access, wide depth of field visualization, and short learning curve. Future technological enhancements could allow the exoscope to become a promising next-generation tool in the armamentarium of the contemporary sleep surgeon.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-10T10:13:28Z
      DOI: 10.1177/0003489420905873
       
  • Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary
           Rhinology and Allergy Clinic
    • Authors: Kevin L. Li, Christina H. Fang, Denisa Ferastraoaru, Nadeem A. Akbar, Elina Jerschow, Waleed M. Abuzeid
      First page: 699
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology.Methods:One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics.Results:Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics.Conclusion:Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-15T06:32:34Z
      DOI: 10.1177/0003489420905859
       
  • Follow-Up Adherence Is Associated with Outcomes After Endoscopic Sinus
           Surgery
    • Authors: Sarek A. Shen, Aria Jafari, Jesse R. Qualliotine, Adam S. DeConde
      First page: 707
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Background:Clinical follow-up after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) allows for assessment of the sinonasal cavity, debridement, and tailoring of medical therapies. Frequency and timing of postoperative clinical visits is debated, but the impact of adherence on disease-specific outcomes is not well understood. In this longitudinal study, we assessed the association between follow-up adherence and quality of life (QOL) outcomes in the 12 months after ESS.Methods:A retrospective review of patients undergoing ambulatory ESS for CRS between 11/2016 and 1/2018 was performed. We assessed sociodemographic characteristics, radiographic severity, and QOL utilizing the 22-item sinonasal outcome test (SNOT-22). Patients were categorized as “non-adherent,” “moderately-adherent,” and “fully-adherent” to a 1-, 3- and 5-week postoperative visit schedule.Results:A total of 166 patients met the inclusion criteria. Of these, 55 (33.1%) were fully-adherent, 105 (63.2%) were moderately-adherent, and 6 (3.6%) were non-adherent within the 6 weeks following ESS. In the immediate postoperative period, fully-adherent patients demonstrated worse QOL (SNOT-22: 31.2 ± 23.1 vs 27.5 ± 17.6, P = .047). This cohort also had greater psychological dysfunction at baseline and 12-months (P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-21T06:13:38Z
      DOI: 10.1177/0003489420908291
       
  • Development and Validation of an Assessment Tool for Technical Skills in
           Handheld Otoscopy
    • Authors: Mads J. Guldager, Jacob Melchiors, Steven Arild Wuyts Andersen
      First page: 715
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objective:Handheld otoscopy requires both technical and diagnostic skills, and is often reported to be insufficient after medical training. We aimed to develop and gather validity evidence for an assessment tool for handheld otoscopy using contemporary medical educational standards.Study Design:Educational study.Setting:University/teaching hospital.Subjects and Methods:A structured Delphi methodology was used to develop the assessment tool: nine key opinion leaders (otologists) in undergraduate training of otoscopy iteratively achieved consensus on the content. Next, validity evidence was gathered by the videotaped assessment of two handheld otoscopy performances of 15 medical students (novices) and 11 specialists in otorhinolaryngology using two raters. Standard setting (pass/fail criteria) was explored using the contrasting groups and Angoff methods.Results:The developed Copenhagen Assessment Tool of Handheld Otoscopy Skills (CATHOS) consists 10 items rated using a 5-point Likert scale with descriptive anchors. Validity evidence was collected and structured according to Messick’s framework: for example the CATHOS had excellent discriminative validity (mean difference in performance between novices and experts 20.4 out of 50 points, P 
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-22T11:30:36Z
      DOI: 10.1177/0003489420904734
       
  • The Effect of Sphenopalatine Ganglion Block on the Postoperative Pain in
           Patients Undergoing Septorhinoplasty
    • Authors: Nazan Degirmenci, Abdullah Ozdem, Harun Uysal, Pelin Sen, Erol Senturk, Orhan Ozturan, Ayda Turkoz
      First page: 722
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:This study aimed to evaluate the effect of preoperative sphenopalatine ganglion block (SPBG) on the postoperative pain (POP) in patients undergoing septorhinoplasty (SRP).Methods:A retrospective cohort study was performed. A total of 42 patients that had received septorhinoplasty included in the study. The patients that had received SPBG before the surgery included in the Block group (n:20) and the patients that had not received SPBG before the surgery included in the Control group (n:22). POP was questioned with a numeric rating scale (NRS) at the 30th minute (t1), 1st hour (t2), 4th hour (t3), 12th hour (t4), and 24th hour (t5) and noted. The intraoperative details and the dose of the postoperative rescue analgesics were also noted.Results:The average dose of Paracetamol that was used in the postoperative first 24 hours was 500 mg in the Block group and 1363 mg in the Control group, and the difference was statistically significant (P = .001). The average dose of Tramadol was 0 mg in the Block group and 45 mg in the Control group, and the difference was statistically significant (P = .001). There was a statistically significant difference among the groups with respect to NRS in the first 24 hours postoperatively (P  .05).Conclusions:Preoperative SPGB is an effective option to reduce POP and the need for rescue analgesics for patients undergoing SRP.Clinical trial number:NCT04020393
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-22T11:31:15Z
      DOI: 10.1177/0003489420909417
       
  • Evaluation of Acupuncture’s Efficacy Within Otolaryngology
    • Authors: Chase I. Kahn, Mikayla J. Huestis, Michael B. Cohen, Jessica R. Levi
      First page: 727
      Abstract: Annals of Otology, Rhinology & Laryngology, Ahead of Print.
      Objectives:Acupuncture is a form of Traditional Chinese Medicine that has minimal side effects, is cost-effective, can be easily administered, and may serve as a useful non-pharmaceutical therapy for certain conditions. However, studies and clinical practice guidelines are inconsistent in conclusions and recommendations about acupuncture. This qualitative review addresses the evidence available for acupuncture use in otolaryngology.Methods:A literature review was completed using EMBASE, PubMed, and The Cochrane Collection for conditions within otolaryngology that have used and studied the comparative effects of acupuncture. Thirty studies ultimately fit the inclusion criteria and were used for this qualitative review.Results:Studies included in this review contained a variety of conditions within otolaryngology, including allergic rhinitis, chronic rhinitis, tinnitus, sudden sensorineural hearing loss, post-viral olfactory dysfunction, dysphonia, and tonsillectomies.Conclusion:Given its safety profile, cost, and perceived benefit, recommendations and guidelines supporting acupuncture as an alternative or adjunctive therapy are surfacing for certain conditions such as allergic rhinitis. However, stronger conclusions with specific recommendations are limited by varied methodology between majority of the studies. Additional high-quality randomized control studies with low risk of bias are required to continue to assess the effects of acupuncture in the field of otolaryngology before stronger recommendations can be made on other conditions.
      Citation: Annals of Otology, Rhinology & Laryngology
      PubDate: 2020-02-22T11:31:56Z
      DOI: 10.1177/0003489420908289
       
 
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