Abstract
Academic Productivity of Otolaryngologists in the Veterans Health Administration Nationwide
Sarah Dermody (presenter); Sonya Malekzadeh, MD; Jessica Maxwell, MD; Jamie R. Litvack, MD, MS
Objectives: To explore factors that influence scholarly productivity of otolaryngologists employed in a non-academic setting.
Methods: In a nationwide cross-sectional analysis, otolaryngologists employed by the Veterans Health Administration in 2016 were identified. H-index, an objective measure of scholarly productivity, was calculated using the Scopus database for each otolaryngologist. Additional variables including years in practice, geographic location, and gender were collected. The data set was stratified by each independent variable for further analysis. Unpaired 2-sample t test was used to compare the mean h-index of males and females. Pearson r test was used to calculate correlation coefficients for h-index and years in practice. One-way analysis of variance was used to compare h-indices by geographic region.
Results: A total of 260 board-certified otolaryngologists were identified as employed by the Veterans Health Administration in 2016. The mean h-index for otolaryngologists in this setting is 9.38. When stratified by gender, the mean h-index for males and females was not significantly different (9.92 vs 7.67, P = .085). H-index was correlated with years in practice (r = 0.32), although it was more highly correlated for women (r = 0.50) than men (r = 0.27). Academic productivity was not significantly different between geographic regions.
Conclusions: H-index is more highly correlated with years in practice for women than for men. These findings are similar to trends identified in academic settings, suggesting that factors outside of clinical pressures of academic institutions influence scholarly productivity.
Adherence to National Inpatient Sample Methodology Guidelines in the Otolaryngology Literature
Zhipeng Zhang, MD (presenter); Michael Chow; Elisabeth Ference, MD; Eric J. Kezirian, MD, MPH
Objectives: To determine the adherence to practice guidelines in the use of the Healthcare Utilization Project National Inpatient Sample (HCUP-NIS) database in otolaryngology literature.
Methods: Otolaryngology publications from 2014 to 2017 utilizing the NIS database were identified and systematically evaluated based on 6 fundamental research practices established by the HCUP-NIS’s user guidelines: (1) interpreting data as hospitalization records rather than unique patients; avoiding (2) state-, (3) hospital-, and (4) physician-level analyses when inappropriate; (5) avoiding the use of nonspecific secondary diagnostic codes to study comorbidities or inpatient complications; and (6) accounting for survey design and sampling weights to extrapolate nationwide estimates.
Results: Of the 58 studies identified, 55 (94.8%) did not adhere to 1 or more fundamental research practices, and 33 (56.9%) did not adhere to 2 or more practices. Forty-three (74.1%) studies interpreted data as patients rather than hospitalization records or admissions. In addition, 39 (67.2%) studies used nonspecific diagnostic codes to assess comorbidities or complications. Mean nonadherence was not significantly correlated with year of publication (one-way analysis of variance, P = .16) or having an author with biostatistical background (P = .06).
Conclusions: Most studies in the otolaryngology literature do not fully adhere to the HCUP-NIS database methodology. Nonadherence rates in the otolaryngology literature are consistent with rates previously identified in the general medical literature.
Adult Pott’s Puffy Tumor as Complication from Frontal Sinusitis Secondary to Dental Sepsis
Daniel Munoz, MD, MSc (presenter); Andres Readi; Pia Michael; Giorgio Pio
Subperiostic abscess, or Pott’s puffy tumor, is a rare complication of frontal sinusitis or frontal sinus trauma. It is very infrequent because of the use of antibiotics, and it usually occurs in children and rarely in adults. It may be associated with severe complications such as subdural empyema and brain abscess, so it is very important to recognize it early so that surgical treatment can be initiated promptly. We present a clinical case of a 35-year-old male patient, who was previously healthy, with a frontal swelling and fever. His computed tomography scan revealed a large subperiostic abscess with destruction of the frontal bone anterior table. Dental sepsis with extension to the maxillary sinus was also evaluated. The combined endoscopic and open bicoronal frontal sinus approach was performed, with good clinical improvement. We also discuss treatment options and present a systematic review of the literature about this entity.
Assessing Efficacy and Radiographic Modifications of the Sinuses following Balloon Sinuplasty Using Computed Tomography Imaging
Vincent F. Honrubia, MD (presenter); William Martin, MD; Jason B. Hensler, MPAS, PA-C; Katrina Zedan, MSPAS, PA-C; Krystal Purdon, MPAS, PA-C; Cameron Crane Arianna Ramirez
Objectives: To evaluate the efficacy of balloon sinuplasty in treating chronic rhinitis and its effects on sinonasal tract conditions. To determine this efficacy by comparing preoperative and 2 weeks’ postoperative computed tomography (CT) scans using multiple measurements of the sinus ostia and inflow tracts.
Methods: A cohort study of 19 patients who underwent balloon sinuplasty in a clinical setting throughout 2017. CT scan of the sinuses and a Sino-Nasal Outcome Test–20 (SNOT-20) questionnaire were taken before and 2 weeks after the procedure. Diameters of the mid, distal, and proximal portions of the sphenoid and frontal ventilation tracts were taken. Diameters of the middle meatus and infundibulum of the maxillary sinuses were also measured. Transverse dimensions of the middle turbinates were taken as well.
Results: CT measurements of sinuses showed, on average, a 0.5-mm-diameter increase of the ostium and inflow tracts after ballooning. Middle meatus showed a larger increase in diameter than that of the infundibulum. Left sphenoid canals also showed greater dilation than that of right sphenoid canals. These differences may be due to sequence of dilation within these regions. Measurements of the middle turbinate decreased by an average of 0.8 mm. SNOT-20 questionnaire scores decreased by 57.5%, substantiating measured dilation of the sinuses and their improved function.
Conclusions: CT measurements of the sinuses showed an overall increase in the diameters of the sinuses treated, allowing for better airflow and resolution of symptoms. Dilation variances call for future analysis of the procedure sequence to create equal dilation among sinuses.
Characterization of Laryngotracheal, Esophageal, and Neck Soft Tissue Injuries in a Combat Trauma Registry
Michael J. Coulter, MD (presenter); Art A. Ambrosio, MD
Introduction: The Tri-service Combat Registry Trauma Registry Expeditionary Medical Encounter Database (CTR EMED) codes and integrates tactical, operational, and clinical data, allowing for studies and analyses of outcomes of service members deployed overseas. Head and neck trauma has more than doubled during Operation Iraqi Freedom/Operation Enduring Freedom when compared with previously reported historical data. Metrics analyzed will include those associated with laryngotracheal, esophageal, and neck soft tissue injury.
Methods: International Classification of Diseases (ICD) 9 and ICD10 codes were used to identify military members who had inhalation or penetrating neck injuries. Those who had injury severity scores less than 16 were excluded.
Results: A total of 111 patients who met the inclusion criteria were analyzed between 2001 and up to the present. Based on preliminary analysis, there were 52 inhalation injuries and 61 (55.0%) penetrating neck trauma cases. The average age of patients was 24.3 years (range, 19-39 years). The mechanism of injury involved was improvised explosive devices in 63 cases. Of the 52 with inhalation injuries, 48 underwent bronchoscopy, and the average initial bronchoscopy abbreviated injury score was 2.2. The average total burn surface area was 38%, and the average degree of facial burn was 2.1. Of the 61 patients with penetrating neck trauma, 26 were dead on arrival. Twenty-one were able to be intubated orotracheally. Nineteen underwent tracheostomy, and 21 underwent neck exploration. Eight required vascular surgical intervention. P values were less than .5.
Conclusions: Further analysis of operational combat registries will improve assessment of laryngotracheal injuries clinically.
Comparison of Taste Function between Taiwanese and Western People
Rong-San Jiang, MD (presenter); Wen-Jiun Lin
Objectives: In this study, we compared the taste function of normal adult Taiwanese with Western people.
Methods: A total of 102 subjects (40 males and 62 females) with normal taste function were recruited, and their taste function was measured by the whole-mouth suprathreshold taste test and the taste quad test. In the whole-mouth test, 5 concentrations of sweet, bitter, sour, and salty solutions were presented to the subject twice. In the taste quad test, the 4 quadrants of the tongue were tested using high concentrations of sweet, bitter, sour, and salty solutions 6 times. The results of these 2 taste tests were compared with those reported in the literature for normal Western people.
Results: The mean scores of the whole-mouth test were 38.6 for males and 38.9 for females. The mean scores of the taste quad test were 75 for males and 78 for females. Gender did not influence taste function, except for intensity ratings in the taste quad test. Similar findings were reported in Western people. In the whole-mouth test, the results of intensity and pleasantness ratings were also consistent with those found in Western people. In the taste quad test, higher correct identification percentage and higher intensity ratings were found on the anterior tongue than the posterior tongue in Western people, but our results did not show that tendency.
Conclusions: We did not find a higher correct identification percentage and larger intensity ratings on the anterior tongue compared with the posterior tongue in Taiwanese as in Western people.
Ear, Nose, and Throat Objective Structured Clinical Examination: How Well Do Primary Care Residents Perform?
Gabriela M. Perez Raffo, MD (presenter); Maria de las Nieves Ganiele; Maria Dolores Arceo; Carlos-Mario Boccio, MD; Eduardo Durante
Objectives: Ear, nose, and throat (ENT) problems are very common in the field of primary care. Numerous studies have reported that primary care physicians feel a lack of satisfaction on their performance and training to diagnose and manage these diseases. Most of these publications based their findings on perceptions. The aim of this study was to evaluate the competence in diagnosis and management of prevalent ENT problems in primary care medical residents through an objective structured clinical examination (OSCE).
Methods: We identified the prevalent ENT problems through a “Delphi” method survey. The experts also agreed on the degree of competence in each problem that they considered appropriate for residents when finishing their training. Based on these outcomes, a 10-station OSCE was designed. Family medicine, internal medicine, and pediatrics residents in their third and fourth year were evaluated.
Results: The total average score obtained was 61.8, with a median of 63.3 (interquartile range [IQR], 54.9-67.8) for all residents evaluated. The family medicine residents’ average was 64.6 with a median of 65.2 (IQR, 60.85-68.2). The general internal residents’ average was 55.8 with a median of 53.3 (IQR, 48-61.3). The pediatric residents’ average was 67.3 with a median of 66.6 (IQR, 63.6-70.3).
Conclusions: This study measured the competence in management of ENT diseases in primary care residents. Areas of opportunity for improvement were detected for the 3 groups. These findings will provide direction and motivation for future learning in knowledge, skills, and abilities.
Educational Exposure to Transgender Patient Care in Otolaryngology Training
Ian T. Nolan (presenter); Vania Rashidi; Christopher S. Crowe, MD; Benjamin B. Massenburg, MD; Shane D. Morrison, MD
Objectives: Gender dysphoria is estimated to occur in more than 1 million people in the United States (US). With decreasing stigma regarding the transgender population, it is likely that more patients will seek medical and surgical gender affirmation as part of their treatment. This study aims to determine the current state of transgender-related education in US otolaryngology training programs and to evaluate trainee perceptions regarding the importance of such training.
Methods: A cross-sectional survey was performed among US otolaryngology training programs. A representative sample of 22 training programs divided within 4 US Census regions completed a 9-question survey between March and May 2017. Respondents were queried regarding demographics, transgender curricular exposure (didactic and/or clinical), and perceived importance of training in transgender patient care.
Results: A total of 285 trainees (69.3% response rate) participated in the survey. Thirty percent of respondents reported education on or direct exposure to transgender care during residency. Among those with experiences in gender-affirming surgery, more than half were exposed to facial (masculinization or feminization) or pitch alteration surgery. Overall, most respondents believed training in gender-affirming surgery is somewhat important.
Conclusions: Less than one-third of otolaryngology trainees are exposed to transgender patient care. Most trainees endorsed the importance of residency training in gender-affirming surgery.
Effect of Lingual Tonsil Hypertrophy Treatment on Obstructive Sleep Apnea and Laryngopharyngeal Reflux: Systematic Review
Christine M. D’Aguillo, MD (presenter); Jose W. Ruiz, MD; Christie McGee; Douglas Nguyen
Objectives: To perform a systematic review of the literature to determine if patients with lingual tonsil hypertrophy (LTH) who undergo lingual tonsillectomy (LT) have improvements in obstructive sleep apnea (OSA) or laryngopharyngeal reflux (LPR) outcomes.
Methods: A systematic review of the literature using PubMed from 1986 to 2017 was conducted. Studies were included if they investigated the treatment of LTH and its effect on OSA and/or LPR outcomes in human populations. The Apnea-Hypopnea Index (AHI) was used as the primary outcome measure for OSA.
Results: Eight articles discussed the effect of LT on OSA outcomes. Among adults, there was a significant reduction in the mean preoperative AHI (30.73; 95% confidence interval [CI], 26.08-35.35) when compared with the mean postoperative AHI (13.4; 95% CI, 9.17-17.63). Children also had a reduction in the mean AHI score after surgery, from 14.29 (95% CI, 9.78-18.8) preoperatively to 6.06 (95% CI, 3.08-9.04) postoperatively. Although most patients experienced improvement, the change in improvement was not similar between adults and children. Overall, 80.1% of patients improved their AHI score to less than 50% of baseline after LT. No articles discussed the effect of LT on LPR outcomes, but all reviewed LPR studies demonstrated a positive correlation between reflux and LTH severity.
Conclusions: Treatment of LTH via LT improves AHI scores both in adult and pediatric OSA patients when other treatment options have been exhausted. LTH is positively correlated with LPR severity, but no data exist for the effects of LT on LPR severity.
Effect of Silencers for Firearms on Hearing Loss: Systematic Review
Camilo D. Fernandez-Salvador, MD (presenter); Jared M. Theler, MD; Philip D. Littlefield, MD; Macario Camacho, MD; Edward T. Chang, MD; Jamie Andrews, MD
Objectives: Noise-induced hearing loss from firearm use is a major cause of hearing disability in the military. According to the Census for the Bureau, the prevalence of severe hearing impairment among veterans was 10.4% in 2010. Hearing protection devices such as earplugs are the primary means of military hearing protection, but they can hinder communication during training/combat. Firearm suppressors (silencers) are capable of reducing 20-35 dB impulse. Despite this benefit, they are rarely used because of purchase restrictions. Advocates urge to ease restrictions, arguing that it will preserve hearing. Critics argue that it would allow criminal use. However, the benefits of silencers within the military outweigh any possibilities of misuse. We investigate whether silencers could supplement/replace earplugs in the military.
Methods: We performed a literature search using 5 databases from 1995 through December 2017 following guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Results: The literature shows that silencers offered 50% more noise reduction than earplugs alone. Earplugs are unable to reduce the impulse sound level of common firearms (140 dB). Silencers are able to reduce levels to 140 dB or less in certain weapons.
Conclusions: Compared with earplugs alone, silencers offer superior noise reduction when combined with earplugs. Silencers also offer tactical benefits allowing communication during training/missions. In the military, silencers can reduce hearing impairment, promoting military readiness and decreasing hearing impairment disability compensation.
Ergonomic Advantage of Pistol Grip Endoscope in ENT Practice
Itaru Watanabe, MD (presenter); Makoto Miyamoto; Hideki Nakagawa, MD, PhD; Koichiro Saito, MD, PhD
Objectives: Recent technology developed a flexible nasopharyngeal endoscope with a pistol-shaped grip, which could theoretically achieve less ergonomic stress in physicians compared with conventional endoscopes. The purpose of this study was to assess the ergonomic feasibility of this novel device.
Methods: Ten ear, nose, and throat (ENT) physicians (male, 8; female, 2) including experienced surgeons (n = 4) and young residents (n = 6) volunteered in this project. To assess the ergonomic impact of grip shape, a newly developed pistol grip prototype endoscope (PG; Olympus, Japan) and a conventional ENF-VH endoscope (VH; Olympus) were used. An endoscopic task on a training model to mimic daily ENT practice was repeated 3 times on each endoscope, and surface electromyography (sEMG) was recorded. Bilateral sEMG recording was performed on upper-limb muscles including the flexor pollicis brevis muscle (FPB), flexor carpi ulnaris muscle (FCU), brachioradialis muscle (BR), and biceps brachii muscle (BB). The mean amplitude (MA) of sEMG through the task was calculated on every muscle, and the data were compared between PG and VH.
Results: The total number of MA in 4 muscles was significantly lower (P = .0112) in the grip-side limb of PG compared with VH. Furthermore, significantly low MAs were observed in 3 individual muscles (FPB, P = .0414; BR, P = .0039; BB, P = .0102) in the grip-side limb of PG compared with VH. However, no MA difference was observed between endoscopes in the insertion tube-side limb.
Conclusions: Our study first proved the ergonomic feasibility of pistol-designed grip featured in the novel ENT endoscope.
Expression of VEGFA and NFE2L2 Genes and hsa-miR-17-5p and hsa-miR-612 MicroRNAs in Goiter and Papillary Thyroid Cancer
Joao Armando Padovani Junior, PhD (presenter); Patrícia Matos Biselli-Chicote. PhD; Márcia Maria Urbanin Castanhole-Nunes; Ana Paula Girol, PhD; Eny Maria Goloni-Bertollo, PhD; Leonardo Prado Stuchi
Objectives: To investigate the role of VEGFA and NFE2L2 genes in papillary thyroid cancer (PTC) and colloid goiter.
Methods: Fifteen PTC, 17 colloid goiter samples, their respective adjacent tissues, and 5 normal thyroid tissue samples were analyzed. The quantification of genes and microRNAs was performed by quantitative polymerase chain reaction. VEGFA and Nrf2 proteins were analyzed by enzyme-linked immunosorbent assay and immunohistochemistry, respectively. The TPC-1 cell line was transfected with the hsa-miR-17-5p inhibitor and hsa-miR-612 mimic to evaluate the gene regulation.
Results: VEGFA showed high expression in tumor (P = .0125) and goiter (P < .0001) compared with normal tissue, as did NFE2L2 (tumor, P = .0061; goiter, P = .0009). Hsa-miR-17-5p and hsa-miR-612 showed significantly reduced expression in goiter (P < .0001 and P = .015, respectively) relative to normal tissue. VEGFA protein was overexpressed in tumor (P = .0009) and goiter (P = .039) compared with normal tissue. Nrf2 protein was overexpressed in the cytoplasm of tumor in relation to goiter (P < .0001) and normal tissue (P < .0001). Regarding the nucleus, Nrf2 expression was higher in tumor compared with goiter (P < .0001), and no nuclear staining was observed in normal cells. Inhibition of miR-17-5p resulted in a 73% reduction of NFE2L2 expression.
Conclusions: Differential expression of NFE2L2 and VEGFA in PTC and goiter suggests a crucial role of these genes in thyroid disorders. Hsa-miR-612 and hsa-miR-17-5p possibly participate in the regulation mechanisms that contribute to goiter and PTC development. NFE2L2 gene expression is regulated by hsa-miR-17-5p in PTC.
Extensive Sinonasal and Oropharyngeal Necrosis as a Consequence of Adulterated Cocaine with Mimicry of Antineutrophil Cytoplasmic Antibody-Positive Vasculitis
Adnan S. Hussaini, MD (presenter); Cara Black; Gregory J. Milmoe, MD
Background: Compared with its unadulterated form, contaminated cocaine poses a unique set of otolaryngologic challenges. Levamisole, an increasingly common contaminant, often elicits a positive antineutrophil cytoplasmic antibody (ANCA) titer and produces mimicry to necrotizing systemic vasculitides.
Case Presentation: A 33-year-old man with a history of cocaine abuse presented to the emergency department with a 1-month history of sore throat and nasal obstruction. Initial examination revealed moderate devitalization of his soft palate and oropharynx with nasal endoscopy revealing extensive nasal cavity necrosis. A week after undergoing a partial debridement and initiation of empiric antibiotics, the patient’s condition rapidly progressed with development of nasal bridge deformity, velopalatal insufficiency, pronounced dysphagia, and otalgia. Given that his initial laboratory results suggested ANCA positivity, an extensive rheumatological workup was conducted. Ultimately, given that he maintained normal renal function and was without pulmonary pathology, the diagnosis of systemic vasculitis, namely, granulomatosis with polyangiitis (GPA), was largely excluded, thus implicating levamisole as the causative agent.
Conclusions: Adulterated cocaine has the potential for extensive sinonasal and oropharyngeal tissue destruction, which is more aggressive than that caused by the pure form of the substance. In addition, levamisole has the possibility of eliciting positive ANCA titers—an important consideration when differentiating from rheumatologic entities, such as GPA.
Fibroblast Growth Factor Receptor Regulates Growth and Invasion of Cutaneous Squamous Cell Carcinoma
Saudamini Lele, MD (presenter); Kate W. Ramsey; Alok R. Khandelwal, PhD; Tara Moore-Medlin; John DiGiovanni; Cherie-Ann O. Nathan, MD
Background: Keratinocyte-derived cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer. Increased exposure to solar ultraviolet B (UVB) radiation is the primary etiologic factor for cSCC. Furthermore, in organ transplant patients, there is a 65- to 100-fold increased incidence of cSCC compared with the general population. Thus, novel mechanism-based targeted approaches are needed for both prevention and treatment of aggressive cSCC. Analysis of fibroblast growth factor receptors (FGFRs) revealed an increased mRNA and protein expression in cSCC cells compared with normal human epidermal keratinocytes.
Objectives: To investigate FGFR receptor as a viable target in prevention and treatment of cSCC.
Methods: cSCC cells were treated with pan-FGFR inhibitor AZD4547, and the effect on cSCC cell traverse, proliferation, migration, and invasion was evaluated. For in vivo tumor growth studies, SCID mice with SCC12A tumor xenografts were treated with AZD4547 (15 mg/kg/bw, twice-weekly oral gavage), and the effect on tumor growth was investigated.
Results: AZD4547 significantly decreased cSCC cell traverse, proliferation, migration, and invasion. AZD4547 significantly downregulated mTORC1 and AKT activation markers, suggesting an important role for the mTOR and AKT pathway in FGFR-mediated effects. To further bolster our in vitro studies, SCID mice with SCC12A tumor xenografts treated with AZD4547 exhibited significantly decreased tumor volume compared with the vehicle treatment group.
Conclusions: These results provide evidence for the role of FGFR as a therapeutic potential in cSCC.
Five-Year Review of Neck Abscesses Managed under General Anesthesia
Thevagi Maruthamutu (presenter); Nadarajah Sanjeevan, MD
Objectives: This study aimed to review our experience in managing head and neck abscesses.
Methods: This is a retrospective study of patients who underwent drainage of head and neck abscess under general anesthesia from 2011 to 2015 at Hospital Universiti Sains Malaysia. Seventy patients were reviewed. Peritonsillar abscesses were excluded.
Results: A total of 70 patients met the criteria, of whom 60% were children. The male/female ratio was 60:40. The main presenting symptom was neck swelling, and the average duration of symptom was 7 days prior to admission. The majority (n = 40) of patients were started on antibiotic prior to admission to a tertiary care facility. Fifty-seven (81.4%) of the patients had no microbial growth, and Klebsiella sp. was isolated in 5.7%. No methicillin-resistant Staphylococcus aureus were isolated. All patients received postoperative antibiotics. Only 8 pediatric patients and 12 (42.9%) adult patients underwent a contrast computer tomography scan. The average total hospital stay was 7 days, and the mean postoperative hospital stay was 3 days. Postoperative average hospital stays for diabetes mellitus (DM) patients was 6 days. Fourteen (50%) of the adult patients had DM. There was no mortality, no serious complications, and no need for repeat surgical intervention. All patients were discharged home with no readmission.
Conclusions: Majority culture yield showed no growth. There is no need for a change of antibiotics based on culture, no mortality, and no morbidity. Early discharge after surgical intervention is a feasible and cost-effective option that should be explored.
Identifying Alarm Questions for Clinically Manifest Dysphagia in Head and Neck Cancer Patients Postoncological Treatment
Johanna Hedström (presenter); Lisa Tuomi, PhD; Caroline Elisabeth Olsson, PhD, RN; Caterina A Finizia, MD
Objectives: Dysphagia is a severe dose-limiting toxicity after oncological treatment for head and neck cancer (HNC). The study objective was to explore the relationships between patient-reported dysphagia symptoms and clinical swallowing function in HNC after modern curative radiotherapy.
Methods: Patients treated in 2007 to 2015 for HNC were assessed for dysphagia posttreatment via telephone interview and videofluoroscopy (VFS). A study-specific categorized symptom score was designed to determine patient-reported dysphagia (DESdC = presence of drinking, eating, swallowing difficulties, coughing when eating/drinking [any combination]; scores of 0 to 4, where 0 = no symptom); the penetration-aspiration scale (PAS) was used to determine swallowing function by VFS. Pearson’s correlation coefficient (Pr) was used to determine the relationships between DESdC and PAS.
Results: At a median of 7 months after treatment, dysphagia according to DESdC was reported by 91% of the patients and according to PAS by 61%. Averaged correlations between DESdC grades 1, 2, 3, and 4 and PAS were 0.16, 0.10, 0.27, and 0.18, respectively. Every second patient reporting DESdC grade 3 showed severe swallowing difficulties according to PAS. Correlations between individual DESdCs were highest for swallowing and eating (Pr = 0.53) and lowest for swallowing and coughing (Pr = 0.11).
Conclusions: If difficulties swallowing and eating as well as coughing when eating/drinking are reported, it is probable that the patient will present with moderate or severe impaired swallowing function according to PAS and thus should be referred for further evaluation.
IncobotulinumtoxinA for Sustained Improvement in Sialorrhea in Parkinson’s Disease, Stroke, and Other Etiologies: Long-term Results from a Phase 3 Study
Andrew Blitzer, MD, DDS (presenter); Andrzej Friedman; Olaf Michel; Birgit Flatau-Baqué; Janos Csikós; Wolfgang Jost, PhD
Objectives: To assess the efficacy and safety of repeated treatment with incobotulinumtoxinA (incoBoNTA) for treating sialorrhea.
Methods: A prospective, randomized, double-blind, placebo-controlled study that included a main period (MP; 16 weeks) with a 48-week extension period (EP). Adults with chronic sialorrhea due to Parkinson’s disease, stroke, or traumatic brain injury received placebo or incoBoNTA (75 U or 100 U) in the MP. Subjects received 75 U or 100 U incoBoNTA in each of the 3 EP cycles and remained blinded to dose group. Outcome measures included unstimulated salivary flow rate (uSFR; co-primary endpoint), Global Impression of Change Scale (GICS; co-primary endpoint), Drooling Severity and Frequency Scale (DSFS), and modified Radboud Oral Motor Inventory in Parkinson’s disease (mROMP) drooling. Adverse events were monitored throughout the study.
Results: Subjects receiving incoBoNTA in both MP and EP showed sustained improvements in uSFR across cycles. In the 75-U group, mean uSFR (g/min) was 0.42 at study baseline (n = 74), and 0.36 (n = 68), 0.28, 0.23, and 0.23 at 4 weeks following injections 1, 2, 3, and 4, respectively. Response was numerically greater in the 100-U group (n = 74): 0.40 at baseline, and 0.27 (n = 72), 0.22, 0.21, and 0.17 at 4 weeks after consecutive injections. Mean GICS, DSFS, and mROMP scores also indicated sustained improvement in both treatment groups. Treatment benefit was also shown for subjects who switched from placebo to incoBoNTA in the EP (n = 32). Safety and tolerability were favorable in the MP and EP.
Conclusions: Repeated treatment with incoBoNTA is safe and effective for treating sialorrhea.
Institutional Review of Intranasal Eustachian Tube Dilation for Eustachian Tube Dysfunction
Christine M. D’Aguillo, MD (presenter); Daniel Lan; Michael E. Hoffer, MD
Objectives: (1) To determine the effectiveness of Eustachian tube balloon dilation (ETBD) for treatment of Eustachian tube dysfunction (ETD). (2) To determine the rate of complications associated with the procedure at our institution. (3) To identify preoperative factors and/or physical examination findings that are associated with success of the procedure.
Methods: This is a retrospective chart review of patients undergoing ETBD at the University of Miami Hospital between January 1, 2012, and December 31, 2017. Pre- and postoperative history and physical examination findings, as well as pre- and postoperative tympanograms and audiograms, were collected. The primary outcome measures were subjective improvement in symptoms as scored by the modified Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and change in tympanometry. Secondary outcome measures include ability to autoinsufflate, resolution of tinnitus, and improvement of audiogram. Preoperative factors associated with improved outcomes will be analyzed with linear regression.
Results: Data for adult patients with ETD who underwent ETBD between 2012 and 2017 were collected. Pre- and postoperative modified ETDQ-7 scores, physical examination findings, tympanograms, and postoperative complications were recorded. In general, we found the procedure to be successful; however, this success rate was affected by specific preoperative history and physical examination findings. There were minimal complications.
Conclusions: ETBD is a safe and effective procedure to treat ETD in adults. In our review, certain preoperative signs were associated with improved outcomes.
Is Early Tracheostomy a Better Choice for Critically Ill Patients Who Required Mechanical Ventilation for More than 10 Days?
Hirotomo Dochi, MD (presenter); Takashi Tsubuku, MD; Yasushi Furuta, MD, PhD
Objectives: To investigate the effect of the timing of tracheostomy in critically ill patients who required prolonged mechanical ventilation of more than 10 days.
Methods: In this retrospective, single-tertiary referral center study, we included 198 patients requiring mechanical ventilation for more than 10 days and admission into the intensive care unit/emergent care unit between January 2011 and August 2016. The patients who underwent tracheostomy before day 10 from intubation were defined as the early tracheostomy (ET) group. We compared 60-day ventilation withdrawal rate and 60-day mortality rate between the ET and non-ET group using Kaplan-Meier, log-rank test, and multivariate regression analyses.
Results: The ET group had significantly reduced mechanical ventilation withdrawal dependence in log-rank test (P = .021). After adjusting for other covariates, “early tracheostomy” remained a significant factor for a higher chance of mechanical ventilation withdrawal (adjusted hazard ratio [aHR] 1.61, 95% confidence interval [CI], 1.06-2.38, P = .027). ET, however, was not associated with improved 60-day survival (aHR 1.46, 95% CI 0.58-3.66, P = .42).
Conclusions: For critically ill patients who required mechanical ventilation for more than 10 days, performing tracheostomy within 10 days was independently associated with shortening the duration of mechanical ventilation. Sixty-day mortality was not associated with the timing of tracheostomy.
Modeling Olfactory Neurogenesis and Differentiation In Vitro
Stefania Goncalves, MD (presenter); Bradley J. Goldstein, MD, PhD
Background: Olfactory losses are common and remain a therapeutic challenge. Pathophysiology often involves problems with maintenance or regeneration of the olfactory neuron population. Mechanisms controlling neurodifferentiation may provide therapeutic targets for anosmia. We sought to develop an approach to monitor olfactory neuron production and biochemical maturation in culture to facilitate mechanistic studies.
Objectives: To test a novel approach for monitoring olfactory neurogenesis in a culture model.
Methods: A mouse genetic and culture approach to target a reporter (tdTomato) and genetic calcium sensor (GCaMP) specifically to mature olfactory neurons (in a Cre-dependent system) was used. Mice were euthanized 10 days after experimentally induced olfactory lesion, followed by isolation of olfactory tissue and purification of neuronal progenitor cells for culture. Cultures were incubated for up to 2 months, with serial observations.
Results: We generated OMP-Cre;LSL-tdTomato-IRES-GCaMP5 mice. Histologic examination was performed, confirming reporter fluorescence in mature olfactory neurons. Long-term cultures produced initial islands of undifferentiated tdTomato(–) progenitor cells. After several weeks, process-bearing cells became tdTomato(+), indicative of neuronal maturation. Expression of the GCaMP calcium sensor was also verified.
Conclusions: Our approach permits live tracking of olfactory neuronal differentiation from progenitor cells in vitro, permitting potential drug screening.
Novel Approach to a Tortuous Frontal Sinus
Vincent F. Honrubia, MD (presenter); Jason B. Hensler, MPAS, PA-C; Katrina D. Zedan, MSPAS, PA-C; Krystal A. Purdon, MPAS, PA-C; Josephine Novak, MS
Objectives: To highlight the presentation and management of an atypical angulation of the frontal sinus during a balloon sinuplasty procedure. To demonstrate the novel use of a 0° straight balloon guide instead of a traditionally curved balloon guide to access the frontal sinus.
Methods: This is a retrospective case review that follows the treatment of a patient presenting with rhinitis symptoms of chronic facial pain, postnasal drainage, intermittent fevers, and disrupted nasal airflow. The patient underwent the balloon sinuplasty procedure in December 2016 in a clinical setting. During the procedure, initial attempts to reach the right frontal sinus with the curved balloon guide proved unsuccessful. The angulation of the frontal sinus ostium did not allow for the curved balloon guide to penetrate the ostium. A 0° straight balloon guide was then used to substitute the curved balloon and successfully penetrated the frontal ostium.
Results: Manipulation of the 0° straight balloon guide into the frontal recess successfully accessed the frontal ostium for subsequent dilation.
Conclusions: In this case, a curved balloon guide was insufficient in reaching the right frontal ostium due to the unusual angulation of the ostium in the frontal recess. Instead, the 0° straight balloon guide could properly reach and successfully dilate the frontal ostium.
Novel Imaging of the Eustachian Tube: Can We Predict Who Will Respond Well to Balloon Dilation?
Amelia Clark, MD (presenter); David Keschner, MD
Objectives: Eustachian tube (ET) dysfunction is one of the most common issues seen in a general ear, nose, and throat practice, and the advent of balloon dilation of the ET has provided a welcome treatment option for many patients. However, predicting who will respond well to balloon dilation remains a challenge. Much of this challenge is rooted in the difficulty with appropriately visualizing and measuring the ET, which runs in an oblique plain not typically addressed on standard computed tomography (CT) reformats. This study seeks to evaluate a novel imaging technique to allow for accurate assessment of the ET and may provide an avenue to predict which patients will benefit most from balloon dilation procedures.
Methods: This retrospective review studies a novel CT-reformatting technique for preoperative CT scans of patients undergoing balloon dilation of the ET.
Results: The ETs were measured using a novel CT scan reformat for 12 patients. Using specific anatomic landmarks described in this study, the entire length of the ET in its oblique plane can be measured from its bony orifice in the middle ear to its termination in the nasopharynx in a standardized manner.
Conclusions: This study describes a novel CT reformatting protocol to better visualize and measure the length of ET. This imaging protocol may provide a useful tool for the otolaryngologist in counseling patients with ET dysfunction and predicting those who may experience better outcomes after balloon dilation.
Novel Training Simulator for Placement of Tympanostomy Tubes Utilizing 3D Printing
Matthew Cooper, MD (presenter); Tawfiq R. Khoury, MD; Liana Puscas, MD
Objectives: The objective of this study is to develop and test a new myringotomy tube placement simulator.
Methods: Using a mannequin head, inexpensive office materials, and a 3-dimensional (3D) printed ear (PE), realistic tympanostomy tube models were constructed. These were tested on first- and second-year residents at a tertiary health institution’s otolaryngology boot camp in July 2016. First- and second-year residents from 4 different programs were asked to participate in a survey that gauged each trainee’s postgraduate year (PGY), gender, previous experience with PE tubes, and PE tube independence before practicing on the simulator. After practicing on the simulator, the trainees were asked on a separate survey to rate improvement in technical skills, independence, confidence, and overall quality of the simulator on a standard Likert scale.
Results: Sixteen male (84%) residents and 3 female (16%) residents participated in this simulation. Seven (37%) of the residents were PGY 1, and 12 (63%) were PGY 2. Independence with PE tube placement improved among trainees from 2.4 to 3.6 (mean improvement 1.26, P < .0001). This corresponds to an improvement from limited knowledge of the procedure to needing supervision without technical assistance. Trainees agreed that the simulator helped with technical skills (average 4.5; 95% confidence interval [CI], 4.2-4.8), confidence (average 4.5; 95% CI, 4.2-4.9), and was useful overall (average 4.5; 95% CI, 4.2-4.8).
Conclusions: Our novel simulator is an inexpensive way to acquaint new trainees with the principles of PE tube placement and can improve self-confidence, technical skills, and independence.
Outpatient Otolaryngologic Disease at Mbarara Regional Referral Hospital in Uganda
Doreen Nakku, MBChB (presenter); Victoria Nyaiteera, MD; Mary Jue Xu, MD; Regan W. Bergmark, MD; Paul Firth, MBChB
Objectives: To understand otolaryngologic disease at a sub-Saharan outpatient clinic and identify challenges in collecting and documenting care in resource-constrained environments.
Methods: This retrospective observational study describes outpatient encounters at the otolaryngology clinic at Mbarara Regional Referral Hospital in Uganda, a 350-bed district-level academic referral hospital. Demographic information and diagnoses coded using International Classification of Diseases, 10th Revision (ICD-10), codes were available from January 1, 2014, to September 8, 2016, and from November 28, 2016, to February 28, 2017; loss of a record book led to a gap in this time interval. We present the preliminary analysis of visit patterns.
Results: Over the study period, 10,781 patients were evaluated during 16,299 encounters by 4 otolaryngologists. Their median age was 24.9 years (interquartile range, 33.8), and 50.7% (5,463) of patients were female. The majority of patients (56.1%, 6050 patients) were from the hospital catchment area. The most common diagnoses were otitis media, impacted cerumen, and rhinosinusitis. In patients younger than 5 years, disease of the tonsils and adenoids, foreign bodies, and otitis media were most common. In all other age categories, otitis media and impacted cerumen were most common.
Conclusions: In resource-constrained environments, clinicians evaluate high patient volumes with limited support. Patients travel from distant catchment areas, and otologic disease is interestingly prevalent. This study provides insight into the challenges faced when treating otolaryngologic disease in resource-constrained environments: large patient population, limited staffing, and limited medical record infrastructure.
Population-Based Comparison of Rare Head and Neck Malignant Epithelial Tumor Variants
Aakash M. Shah (presenter); Neel R. Sangal; Monica Azmy; Denny Varughese, MD; Boris Paskhover, MD
Malignant myoepitheliomas (MC) and epithelial-myoepithelial carcinomas (EMC) are rare malignancies that have only recently been identified as distinct subtypes of salivary gland carcinomas. Population-based epidemiologic and clinical data are scarce and would be beneficial. This retrospective study is designed to compare the demographic, clinicopathologic, and survival outcomes of patients (657) from 1973 to 2014 with MC (272) and EMC (385) using the Surveillance, Epidemiology, and End Results database. MC and EMC have similar demographic characteristics of primary site (parotid gland: 57.4% and 70.1%, respectively), average age at diagnosis (60.55 and 62.24 years, respectively), and race (white: 62.5% and 69.6%, respectively). They differ in their most common grade (grade III/IV: 21.7% vs grade II: 22.9%), American Joint Committee on Cancer (AJCC) stage (stage III: 19.1% vs stage I: 22.1%), and sex distribution (male: 50.4% and female: 60%). For MC and EMC, the 5-year disease-specific survival rate (DSS; 82.5% and 93.1%, respectively) improved most significantly with surgical resection without radiation and chemotherapy (0.938 vs 0.762 and 0.965 vs 0.85, respectively). On univariate analysis for MC and EMC, grade I (not significant and P = .038, respectively), AJCC stage I (P < .001 and P < .001, respectively), AJCC T1 (not significant and P = .004, respectively), AJCC N0 (P < .001 and P = .004, respectively), and AJCC M0 (P < .001 and P < .001, respectively) were associated with increased DSS. On Cox regression, grade (P = .002), stage (P = .012), and treatment status (P = .039) were significant predictors of survival. MC and EMC are clinically similar tumors associated with favorable prognoses. We present the first population-based analysis of MC and the largest-to-date population-based analysis of EMC.
Postoperative Complications after Septoplasty Surgery
Phillip S. LoSavio, MD (presenter); Sarah Shearer; Pete S. Batra, MD; Bobby Tajudeen, MD
Objectives: To examine the rates of complications after septoplasty surgery.
Methods: The study is a retrospective chart review of 677 patients who underwent septoplasty from January 2011 through May 2017 at a tertiary care center. Patient charts were reviewed for gender, age, race, smoking status, type of surgery, antibiotic use, nasal splint, and packing use. Follow-up notes were reviewed for mention of any of the primary outcomes: hemorrhage requiring packing, septal hematoma, septal perforation, infection, cerebrospinal fluid (CSF) leak, anosmia, dental anesthesia, structural deformities, ocular complications, or medical complications. Chi-square analysis was performed to test if any of the baseline characteristics were associated with specific outcomes.
Results: Forty-three subjects had a complication (6.4%). The most common complication was hemorrhage (2.2%), followed by medical complications (1.5%), infection (1.2%), septal perforation (1%), septal hematoma (0.6%), tooth anesthesia (0.3%), structural deformity (0.3%), and CSF leak (0.1%). The 1 patient with a CSF leak underwent synchronous functional endoscopic sinus surgery, and this was likely not related to the septal surgery. No patients had anosmia or ocular complications. None of the patient or surgical characteristics was found to be significantly associated with any of the outcomes.
Conclusions: This study is one of the largest reviews of postoperative septoplasty complications we have found. Septoplasty is a common procedure and is demonstrated to have a low complication rate overall (6.4%).
Presentation and Management of a Developmental Bony Dehiscence of the Anterior Medial Recess of the Sphenoid Sinus during Balloon Sinuplasty
Vincent F. Honrubia, MD (presenter); William Martin, MD; Jason B. Hensler, MPAS, PA_C; Katrina Zedan, MSPAS, PA-C; Krystal Purdon, MPAS, PA-C; Arianna Ramirez
Objectives: To analyze presentation and management of a unique complication due to a developmental bony dehiscence of the anterior medial recess of the sphenoid sinus during a balloon sinuplasty procedure.
Methods: A retrospective case review of a balloon sinuplasty procedure performed on a patient with chronic rhinitis in October 2016 in a clinical setting. A 16- × 6-mm balloon dilator was used to dilate the patient’s bilateral frontal, sphenoid, and maxillary sinuses. Upon irrigation of the right sphenoid sinus, there was an immediate expansion of the right septal wall due to the patient’s bony dehiscence of the anterior medial recess of the sphenoid sinus. To resolve this, an incision was made into the septal mucosa to drain the expanded septal wall of the retained saline solution.
Results: The patient’s initial Sino-Nasal Outcome Test–20 score of 80 was reduced to 5 after treatment. This indicates a significant decrease in original symptoms and that the surgical interventions taken proved successful.
Conclusions: Many possible complications relating to balloon sinuplasty procedure are yet to be seen. Here, a small anatomic anomaly of the right sphenoid sinus into the nasal septum gave way to the increased pressure of the saline irrigation and resulted in expansion of mucosa of the right septal wall. This was immediately rectified with an incision into the septal mucosa to relieve the retained fluid, and there were no further complications observed. Complications due to anatomic variances should be taken into consideration by radiologists when evaluating patients prior to treatment.
Previously Unrecognized Cause of Tapia’s Syndrome
Nicholas W. Pritchard, MD (presenter); Marion B. Ridley, MD
Objectives: To recognize and review the causes of Tapia’s syndrome, and to review management options for this rare condition.
Methods: We present the case of a patient with a previously unreported cause of Tapia’s syndrome—paralysis of cranial nerves X and XII. This report describes the presentation, evaluation, and treatment of the patient who was ultimately found to have a large cervical osteophyte impinging on the cranial nerves as the cause of his symptoms.
Results: The patient underwent injection laryngoplasty and surgical resection of the osteophyte with improvement in his symptoms. After 1 year of follow-up, the patient continues to have clinical improvement in his dysphagia, dysphonia, and cervicalgia.
Conclusions: This report adds a previously unrecognized cause of Tapia’s syndrome. Previous cases have been attributed to intubation trauma, aneurysm, neck abscess drainage, malignancy, or shoulder surgery. In this case, surgical intervention was able to improve the symptoms associated with the syndrome.
Pulsatile Oropharyngeal Mass: Case Report and Review of the Literature
Vyas Prasad, MBBS, MRCS, DLO (presenter); Rebecca L. Heywood, MBChB
Objectives: (1) To present an unusual pulsatile left-sided oropharyngeal mass in a 78-year-old female patient who presented with a history of globus of 1-month's duration, which on contrast computed tomography (CT) imaging was found to be a medialized common carotid artery giving the impression of a pseudotumor. (2) To review the current literature on similar reports of pulsatile masses in adults, their presentation, management (if any), and clinical course.
Methods: Case report and literature review using several medical search engines (e.g., PubMed, EMBASE, Medline Plus). The search terms retropharynx, oropharynx, pulsatile, carotid artery aneurysm, tortuous carotid artery, and aberrant carotid artery were used.
Results: Our patient was found to have medialized common carotid arteries, the left being more so than the right and hence the symptoms and signs lateralized accordingly. A literature search resulted in multiple case reports of aneurysms, pseudoaneurysms, and congenital malformations of the carotid artery system but provided fewer results on medialized or tortuous carotid arteries in the neck.
Conclusions: Aberrations of the cervical common or internal carotid arteries are rare, and hence ear, nose, and throat surgeons should be cautious and mindful of these variations in anatomy prior to undertaking a biopsy or bigger procedures in such cases. Imaging studies such as contrast CT and angiograms should be obtained prior to any surgical intervention.
Restoration of Blurry Vision as a Secondary Effect of Balloon Sinuplasty
Vincent F. Honrubia, MD (presenter); Jason B. Hensler, MPAS, PA_C; Katrina Zedan, MSPAS, PA-C; Krystal Purdon, MPAS, PA-C; Arianna Ramirez
Objectives: To analyze a case in which a patient with lacrimal duct obstruction and Fuchs’s dystrophy experienced unexpected relief of blurred vision symptoms after having a balloon sinuplasty procedure for treatment of chronic sinusitis.
Methods: A 65-year-old patient underwent the balloon sinuplasty procedure in February 2016 in a clinical setting. The patient was previously diagnosed with Fuchs’s dystrophy and a lacrimal duct obstruction. Aside from blurry vision, watery eyes caused by lacrimal duct obstruction was noted as the patient’s most prominent symptom. The patient underwent balloon sinuplasty, a septoplasty, and a turbinate reduction. The frontal, sphenoid, and maxillary sinuses were dilated using a 16- × 6-mm balloon dilator and were rinsed with saline solution. Improvement of sinus functioning was evaluated through pre- and postoperative Sino-Nasal Outcome Test–20 (SNOT-20) scores and patient-reported symptoms.
Results: The patient had a preoperative SNOT-20 score of 28 and a postoperative score of 6, indicating the resolution of symptoms. After the surgery, the patient reported complete resolution of symptoms. At the patient’s 1-month postoperative follow-up, the patient reported dry eyes and resolution of blurry vision
Conclusions: Dilation of the sinuses relieved the sinus cavities of pressure from the sinusitis disease. This had a secondary effect of alleviating pressure on the patient’s lacrimal ducts. The release of pressure served in lessening the blurred vision and amount of tears.
Role of the Personal Statement and Program-Specific Paragraph in Otolaryngology Resident Selection: Program Director’s Perspective
Katelyn O. Stepan, MD (presenter); Elliott D. Kozin, MD; Stacey T. Gray, MD; Rosh K. Sethi, MD; Vivian Kaul, MD; Marita S. Teng, MD
Objectives: As the residency application process becomes increasingly competitive, applicants are continually looking for ways to distinguish themselves. A mandatory program-specific paragraph has been recently added to the otolaryngology residency application. The purpose of our study is to evaluate the utility of the personal statement (PS) and program-specific paragraph from a program director’s (PD) perspective.
Methods: A cross-sectional survey was performed using a 12-question survey emailed to 108 otolaryngology residency PDs.
Results: There was a 44% response rate. Most (60%) rated the PS as “somewhat important,” more so when offering interviews than in final rankings. Most (76%) used PS as a screening tool for interviews. Nearly all (94%) reported having no objective way to score the PS, and the most valued aspect was proper grammar and spelling (60%). Eighty percent of the PDs think that it “rarely” or “never” predicts performance. Many voiced that they did not find the program-specific essay to be particularly useful but that it was also the only place an applicant could share a personal connection to a program. Fifty-four percent did not support the continued use of the program-specific paragraph.
Conclusions: Our study suggests that the PS is largely used in the superficial screening of otolaryngology residency applicants. Most PDs did not believe the newly added program-specific paragraph should be continued in the future. These findings may aid programs and students in understanding the role of the PS and program-specific paragraph in the residency selection process.
Small Cell Carcinoma of the Head and Neck: Ten Years of Experience at a Single Institution
Akihisa Wada (presenter); Yasushi Fujimoto, MD; Mariko Hiramatsu; Takashi Maruo, MD, PhD; Sayaka Yokoi; Michihiko Sone, MD; Naoki Nishio, MD
Objectives: To determine the clinical outcomes in patients with small cell carcinoma of the head and neck (SmCC-HN).
Methods: A retrospective review was performed on the clinical data of 8 patients with SmCC-HN at our hospital between 2007 and 2016. The main outcome measurements were disease stage, patient age, primary tumor site, treatment procedures, adverse events, and estimated survival rates. Overall survival was estimated using the Kaplan-Meier method.
Results: The patients comprised 6 men and 2 women with a mean age of 69.1 years (range, 47-81 years). The primary tumor sites were the nasal/sinonasal cavity in 5 patients, and the oral cavity, oropharynx, and parotid gland in 1 patient each. Seven of 8 patients had stage IVA or IVB SmCC-HN. Six patients were treated using the combined chemotherapy of etoposide and cisplatin, and radiotherapy for the first treatment, while one patient was treated with palliative radiotherapy, and the remaining patient with surgery followed by radiotherapy. The 1-, 2-, and 3-year overall survival rates were 83.3%, 66.7%, and 33.3%, respectively. Although distant metastasis occurred in 5 patients, only 1 experienced local recurrence and was subsequently rescued via salvage surgery. Five of the 6 patients who underwent chemoradiotherapy had grade 4 neutropenia and grade 3 nonhematological toxicity; thus, the planned chemotherapy could not be completed.
Conclusions: Although chemoradiotherapy was a reasonable treatment for patients with SmCC-HN, further investigation of this regimen is needed because of serious adverse events.
Spontaneous Cervical Lymphocele Resulting from Exertion: Case Reports and Literature Review
Tsung-yen Hsieh, MD (presenter); Raj D. Dedhia, MD; Scott C. Fuller, MD; Tsung-yen Hsieh, MD
Background: Lymphoceles are benign, lymph-filled, endothelium-lined collections that are often seen as postsurgical complications of neck, pelvic, and abdominal surgery or following trauma. They are often detected when they cause local swelling, pain, or compression symptoms. Spontaneous development is rare, especially in the neck, with fewer than 40 cases reported in the literature to date.
Case Presentation: We report a 45-year-old male patient who presented with a left supraclavicular painless mass after lifting weights. Computed tomography (CT) imaging revealed a 4.0- × 4.5- × 3.5-cm cystic mass, and fine-needle aspiration (FNA) yielded milky fluid that rapidly reaccumulated. FNA findings were consistent with lymphocele, which was verified with final pathology. Surgical excision of the mass was successfully completed via a transcervical approach. A review of the literature found only 1 prior case reported of a lymphocele that presented after an episode of physical exertion.
Conclusions: It is important to include lymphocele on the list of differential diagnoses for adult patients presenting with a solitary neck mass, especially in the supraclavicular fossa. Surgical excision is the definitive treatment of lymphoceles. However, based on size, symptoms, and location, the risks and benefits of surgical excision should be carefully considered.
Tissue Necrosis and Fungal Rhinosinusitis Resulting from Intranasal Acetaminophen Use
Lauren A. Umstattd, MD (presenter); Laura M. Dooley, MD
Objectives: To examine a distinct clinical disease characterized by mucosal necrosis, local bony destruction, and saprophytic fungal colonization as a result of intranasal acetaminophen misuse.
Methods: This represents a case series of 2 consecutive patients who presented with rhinosinusitis and a history of isolated intranasal acetaminophen use during 2017 at a tertiary referral center.
Results: Two patients presenting to a single academic tertiary care center were evaluated. Patients presented with clinical complaints of severe nasal and facial pain, congestion, and rhinorrhea following intranasal acetaminophen misuse. Both evidenced signs of superficial nasal debris with underlying mucosal necrosis and fungal colonization. Both patients were treated with surgical debridement(s) and oral antifungal medications. Both performed judicious nasal saline rises and remained abstinent from intranasal drugs.
Conclusions: Intranasal drug use usually leads to sinonasal complications, particularly necrosis of the mucosa, submucosa, and underlying bony landmarks. This clinical entity has been classically defined in patients with a history of intranasal cocaine use and, more recently, with intranasal opioid use. Here, we provide a case series of 2 patients with intranasal acetaminophen use, in whom typical mucosal destruction and fungal invasion ensued. This study highlights a distinct otolaryngologic complication of intranasal drug misuse and the importance of a multidisciplinary approach to management.
Unexpected Additional Ear Foreign Bodies
Andrew J. Lerrick, MD (presenter); Gregory Faughnan
Introduction: During the course of delivering care, information from any source, be it another provider or the patient, may be inaccurate. A patient was referred with a foreign body (FB) in his right ear. In fact, including his hearing aids (HAs), he had a total of 7.
History: A 43-year-old man was referred by the emergency room (ER) with retained cotton in his right ear, causing a slight deterioration in hearing. Two weeks earlier, he had used a Q-tip. The ER physician was hesitant to remove the cotton because of its proximity to the tympanic membrane.
Clinical Findings: Despite his relative youth, he had an HA in his right ear, which he removed to permit extraction of the cotton FB. FB count 1: the cotton was removed from the mid-canal with alligator forceps. FB count 2: a second cotton ball was unexpectedly seen closer to the drum. It was removed using forceps. FB count 3: a tympanostomy tube was next seen, properly situated in the right tympanic membrane. It was not removed during this encounter. FB count 4: the patient reinserted his right HA and proceeded to remove an HA from his left ear. FB count 5: what appeared to be white debris in his left external auditory canal proved to be another piece of cotton. It was removed using forceps. FB count 6: deep into the cotton an extruded tympanostomy tube was identified. The drum appeared intact. The tube was removed using forceps.
FB count: 7
Conclusions: Aside from HAs, reinspection of the ear following removal of the primary FB identified 2 additional FBs, while inspection of the contralateral ear unexpectedly revealed 2 more.
Upper Aerodigestive Involvements of Mucous Membrane Pemphigoid at our Institute: What Otolaryngologists Should Know
Hideo Niwa, MD, PhD (presenter); Hiroyasu Endo, DDS, PhD; Yasuhide Makiyama, MD, PhD
Objectives: Mucous membrane pemphigoid (MMP) is common for the oral cavity and ocular lesion. However, it is rare for the aerodigestive tract. It might be difficult for otolaryngologists to examine it. As MMP is a chronic inflammatory and autoimmune blistering disorder that mostly dominates mucous membranes, it can cause nasal membrane scarring and severe laryngeal membrane stenosis. Consequently, MMP may become life threatening. We show upper aerodigestive involvement cases of MMP at our institute.
Methods: Seven cases of MMP with aerodigestive tract involvement have been examined in our institution since 2010. The age range of these 7 patients (4 women and 3 men) was 36 to 80 years. We observed the upper aerodigestive tract with a conventional endoscope and a narrow band image (NBI) fiberscope.
Results: All patients had aerodigestive tract manifestations such as throat discomfort and nasal obstruction including oral lesions with bullae and erosion. All nasal and laryngeal lesions were examined as erosion, erythema, adhesion, and scarring. Two cases showed adhesion between nasal septum and inferior turbinate. Two cases showed severe scar from aryepiglottic fold to arytenoids. One case showed an atresia-like web above the false vocal cord. NBI confirmed the modification of MMP mucosa.
Conclusions: Aerodigestive tract involvements such as nasal mucosa membrane adhesion and laryngeal scarring may bring about a risk of acute dyspnea and death. As NBI can detect mucous membrane blistering patterns accurately, it is useful to examine and evaluate the exact upper aerodigestive involvements of MMP.