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Benito DA, Shaver TB, Cox R, Strum DP, Mehta V, Shim T, Chillakuru Y, Badger C, Joshi AS. Cost-analysis of in-office versus operating room sialendoscopy: Comparison of cost burden and outcomes. Am J Otolaryngol 2022; 43:103424. [PMID: 35339773 DOI: 10.1016/j.amjoto.2022.103424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Office-based procedures in otolaryngology are increasingly utilized to increase efficiency, reduce cost, and eliminate risks associated with surgery. Gland-preserving surgical management of sialadenitis and sialolithiasis are often performed in the operating room, although many surgeons are moving this practice to clinic. We aim to determine the difference in patient charges and perioperative outcomes for salivary gland procedures performed in the clinic versus the OR. METHODS Retrospective series of patients presenting with sialolithiasis, acute or chronic sialadenitis, and stricture between 2010 and 2019. Demographics, perioperative variables, setting, and charge data were collected. RESULTS 528 patients underwent operative intervention (n = 427 office, n = 101 OR). Cohort demographics were comparable. Sialolithiasis was the most common presenting diagnosis in both cohorts. Both cohorts had similar rates of complete (p = 0.09) and partial (p = 0.97) response to treatment. A higher percentage of patients in the OR group reported no improvement (21.4 vs 12.2%, p = 0.034). Overall complications were similar (p = 0.582). Mean charges were statistically greater in the OR ($5560.35 OR vs $1298.33 office, p < 0.001). Operative time was significantly reduced in the office group (21.8 min vs 60.85 min, p < 0.001). CONCLUSIONS Appropriately selected patients can be successfully treated in outpatient clinic without compromising patient safety or quality while significantly reducing the financial burden to patients and the healthcare system.
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Chalif EJ, Murray RD, Mozaffari K, Chillakuru YR, Shim T, Monfared A, Sherman JH. Malignant Pineal Parenchymal Tumors in Adults: A National Cancer Database Analysis. Neurosurgery 2022; 90:807-815. [DOI: 10.1227/neu.0000000000001915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/19/2021] [Indexed: 12/15/2022] Open
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Chillakuru YR, Gerhard EF, Shim T, Selesnick SH, Lustig LR, Krouse JH, Hanna EY, Smith TL, Fisher EW, Kerschner JE, Monfared A. Impact of COVID-19 on Otolaryngology Literature. Laryngoscope 2021; 132:1364-1373. [PMID: 34622965 PMCID: PMC8662213 DOI: 10.1002/lary.29902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
Objectives/Hypothesis To understand the effect of the COVID‐19 pandemic on the volume, quality, and impact of otolaryngology publications. Study Design Retrospective analysis. Methods Fifteen of the top peer‐reviewed otolaryngology journals were queried on PubMed for COVID and non‐COVID‐related articles from April 1, 2020 to March 31, 2021 (pandemic period) and pre‐COVID articles from the year prior. Information on total number of submissions and rate of acceptance were collected from seven top‐ranked journals. Results Our PubMed query returned 759 COVID articles, 4,885 non‐COVID articles, and 4,200 pre‐COVID articles, corresponding to a 34% increase in otolaryngology publications during the pandemic period. Meta‐analysis/reviews and miscellaneous publication types made up a larger portion of COVID publications than that of non‐COVID and pre‐COVID publications. Compared to pre‐COVID articles, citations per article 120 days after publication and Altmetric Attention Score were higher in both COVID articles (citations/article: 2.75 ± 0.45, P < .001; Altmetric Attention Score: 2.05 ± 0.60, P = .001) and non‐COVID articles (citations/article: 0.03 ± 0.01, P = .002; Altmetric Attention Score: 0.67 ± 0.28, P = .016). COVID manuscripts were associated with a 1.65 times higher acceptance rate compared to non‐COVID articles (P < .001). Conclusions COVID‐19 was associated with an increase in volume, citations, and attention for both COVID and non‐COVID articles compared to pre‐COVID articles. However, COVID articles were associated with lower evidence levels than non‐COVID and pre‐COVID articles. Level of Evidence 3 Laryngoscope, 132:1364–1373, 2022
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Affiliation(s)
- Yeshwant R Chillakuru
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A
| | - Eleanor F Gerhard
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A
| | - Timothy Shim
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A
| | - Samuel H Selesnick
- Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Lawrence R Lustig
- Department of Otolaryngology - Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
| | - John H Krouse
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, U.S.A
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Edward W Fisher
- Birmingham Heartlands Hospital, Birmingham, United Kingdom.,Good Hope Hospital, Sutton Coldfield, United Kingdom
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ashkan Monfared
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A
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Shim T, Zalzal H, Kumar N, Tercyak S, Whitehead MT, Reilly B, Preciado D. Round window anatomy predicts ease of cochlear implantation in children. Int J Pediatr Otorhinolaryngol 2021; 149:110852. [PMID: 34311167 DOI: 10.1016/j.ijporl.2021.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aim to evaluate the utility of the Round Window Angle (RWA) as a predictor of difficulty and operative time in cochlear implantation. METHODS A retrospective study of pediatric patients that underwent cochlear implantation and CT temporal bone imaging from January 2008 to November 2019. Correlation, univariate, and multivariate analysis were conducted. RESULTS 347 implantations met inclusion criteria. We found a difference in RWA for difficult (median: 101°, n = 5) and non-difficult (median: 74, n = 317) implantations (p < 0.0001). There was also a difference in RWA in patients with round windows visualized intra-operatively (p < 0.0197). When controlling for age and intraoperative round window visualization, logistic regression showed RWA was significantly associated with difficult insertion (OR: 1.687; p = 0.0246). Further, there was positive correlation between RWA and operative time (r = 0.1779, p = 0.0013) with patients with acute RWAs having shorter operative times (mean 115.7 ± 32.1 min) than those with obtuse RWA (mean 183.5 ± 97.0 min) (p = 0.0035). When accounting for surgeon and patient age, multivariate linear regression showed round window visualization (β = 3.456, p = 0.0006) and obtuse RWA (β = 6.172, p < 0.0001) was associated with an increase in operative time. CONCLUSION Further research is needed to identify difficult cochlear implantations to increase the success and reduce risks associated with the surgery. Our study reports the possibility that an obtuse RWA both significantly increases difficulty and time of operation due to decreased round window visualization.
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Affiliation(s)
- Timothy Shim
- Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Habib Zalzal
- Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Nankee Kumar
- Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Samuel Tercyak
- Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Matthew T Whitehead
- Division of Pediatric Radiology, Children's National Health System, Washington, DC, USA
| | - Brian Reilly
- Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Diego Preciado
- Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA.
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Shim T, Chillakuru Y, Moncada P, Kim S, Sabetrasekh P, Sparks A, Mulcahy CF, Monfared A. Sensorineural Hearing Loss and Tinnitus Characteristics in Patients With Idiopathic Intracranial Hypertension. Otol Neurotol 2021; 42:1323-1328. [PMID: 34172653 DOI: 10.1097/mao.0000000000003213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize patterns of sensorineural hearing loss (SNHL) and tinnitus in patients with idiopathic intracranial hypertension (IIH). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adult patients diagnosed with IIH via lumbar puncture (LP) between 2010 and 2020 who had available audiograms. The study included a total of 40 patients; 33 women, and 7 men with a median age of 43. INTERVENTIONS Diagnostic LP and audiogram. MAIN OUTCOME MEASURES Otologic symptoms, ophthalmologic signs, hearing thresholds, cerebrospinal fluid opening pressures. RESULTS The most commonly reported symptoms were tinnitus in 28 (70%, 23 pulsatile and 5 tonal), aural fullness in 11 (28%), and vertigo in 10 (25%). Twenty-nine patients had ophthalmologic examinations and 18 had evidence of papilledema. Twenty-five (63%) patients had hearing loss in at least one ear at one frequency range. Patients presented with both unilateral and bilateral hearing loss across low, middle, and high frequency ranges. No significant association was observed between hearing loss threshold and LP opening pressure except for 250 Hz in the left ear. After stratification by tinnitus group (pulsatile, tonal, and no tinnitus), no significant difference was found between mean hearing loss threshold at different frequencies. In addition, no significant mean age difference was identified in patients within each tinnitus group. CONCLUSIONS There was no classic pattern or presentation for hearing loss in our IIH patients. They developed sudden, unilateral, or bilateral SNHL in low, middle, or high frequency range. The degree of hearing loss did not correlate with CSF opening pressure.
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Affiliation(s)
- Timothy Shim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC
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Shim T, Benito DA, Chillakuru Y, Darwish C, Chalif E, Strum D, Mulcahy CF, Monfared A. Reply to Letter to the Editor regarding "Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004-2016)". Head Neck 2021; 43:4020-4021. [PMID: 34505727 DOI: 10.1002/hed.26866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/02/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Timothy Shim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Daniel A Benito
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Yeshwant Chillakuru
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Christina Darwish
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Eric Chalif
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - David Strum
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Collin F Mulcahy
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Ashkan Monfared
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
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Shim T, Chillakuru Y, Darwish C, Chalif E, Strum D, Benito DA, Mulcahy CF, Monfared A. Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004-2016). Head Neck 2021; 43:3294-3305. [PMID: 34272901 DOI: 10.1002/hed.26817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Head and neck osteosarcoma (HNOS) is a rare primary bone tumor with limited data to guide treatment approaches. METHODS The NCDB was used to identify patients diagnosed with HNOS. Kaplan-Meier and Cox multivariate regression were used to examine the impact of each treatment on overall survival (OS). RESULTS We identified 821 patients diagnosed with HNOS. Utilization of neoadjuvant chemotherapy + surgery increased from zero cases in 2004 to 24% of cases in 2016. Among surgically treated patients, 5-year OS was 55.8% (CI: 51.7-60.1%). No difference was seen in OS between each treatment cohort on multivariate analysis. However, neoadjuvant chemotherapy + surgery + adjuvant chemotherapy had improved 18-month survival compared to surgery alone (95.8% vs. 78.5%, p = 0.031). CONCLUSIONS Our study demonstrated no survival benefit in perioperative chemotherapy or radiation therapy; however, short-term survival improvement in patients receiving both neoadjuvant and adjuvant chemotherapy displays promise and requires further investigation.
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Affiliation(s)
- Timothy Shim
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Yeshwant Chillakuru
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Christina Darwish
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Eric Chalif
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - David Strum
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel A Benito
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Collin F Mulcahy
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Ashkan Monfared
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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Shim T, Chillakuru Y, Darwish C, Sparks A, Kim S, Wiedermann J, Monfared A. High-Fidelity Surgical Middle Ear Simulator: A Pilot Study. Otol Neurotol 2021; 42:e1067-e1071. [PMID: 34172652 DOI: 10.1097/mao.0000000000003202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess a middle ear simulator as a surgical training tool among a cohort of novice trainees. STUDY DESIGN Prospective pilot study. SETTING The George Washington University Hospital (tertiary care academic hospital). PARTICIPANTS Twenty one medical students and physician assistant students completed the protocol. Each student produced four recordings over 10 attempts. The two raters were attending surgeons from the George Washington University Hospital. INTERVENTIONS Stapedotomies performed on a high-fidelity middle ear simulator. Participants were assessed at baseline with a Purdue pegboard test and trained with video and a low fidelity middle ear simulator. MAIN OUTCOME MEASURES Two experts rated recordings on scales based upon a validated objective skills assessment test (OSAT) format. RESULTS Inter-rater reliability was strong across all stapedotomy skills scores and global rating scores. Participants demonstrated statistically significant improvement up to the third recording (seventh attempt), but the scores on the fourth recording (tenth attempt) were not significantly different from the third. One participant failed to improve in score over 10 attempts. Pegboard test performance was not correlated with score improvement. Low-fidelity trial time was significantly correlated to stapedotomy and global rating scores. CONCLUSIONS This pilot study serves as the first investigation of this middle ear simulator amongst a cohort of trainees. A high-fidelity middle ear simulator may serve as a measurement tool to select future surgical trainees, customize training pathways, and assess surgical capacity before graduation.
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Affiliation(s)
- Timothy Shim
- Division of Otolaryngology, George Washington University, Washington, DC
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Chillakuru Y, Benito DA, Strum D, Mehta V, Saini P, Shim T, Darwish C, Joshi AS, Thakkar P, Goodman JF. Transoral robotic surgery versus nonrobotic resection of oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:2259-2273. [PMID: 33899949 DOI: 10.1002/hed.26724] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/07/2021] [Accepted: 04/14/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of this study is to evaluate the impact of transoral robotic surgery (TORS) compared to nonrobotic surgery (NRS) on overall survival in oropharyngeal squamous cell carcinoma (OPSCC). We performed a retrospective study of patients with HPV+ and HPV- OPSCC undergoing TORS or NRS with neck dissection using the National Cancer Database from the years 2010-2016. Among patients with OPSCC in our cohort, 3167 (58.1%) patients underwent NRS and 2288 (41.9%) underwent TORS. TORS patients demonstrated better overall survival than NRS patients (HPV+ patients: aHR 0.74, p = 0.02; HPV- patients: aHR 0.58, p < 0.01). Subsite analysis showed TORS was correlated with improved survival in base of tongue (BoT) primaries for both HPV+ (aHR 0.46, p = 0.01) and HPV- (aHR 0.42, p = 0.01) OPSCC. Compared to NRS, TORS is associated with improved overall survival for HPV+ and HPV- OPSCC, as well as greater overall survival for BoT primaries.
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Affiliation(s)
- Yeshwant Chillakuru
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel A Benito
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - David Strum
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Varun Mehta
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Prashant Saini
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Timothy Shim
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Christina Darwish
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Arjun S Joshi
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Punam Thakkar
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Joseph F Goodman
- Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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Kapoor E, Strum D, Shim T, Kim S, Sabetrasekh P, Monfared A. Characterization of Sensorineural Hearing Loss in Adult Patients With Sickle Cell Disease: A Systematic Review and Meta-analysis. Otol Neurotol 2021; 42:30-37. [PMID: 32740554 DOI: 10.1097/mao.0000000000002825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES AND MAIN OUTCOME MEASURES To determine the prevalence of sensorineural hearing loss (SNHL) attributable to sickle cell disease (SCD) in the global adult population and to identify factors contributing to its severity. STUDY DESIGN Systematic Review and Meta-analysis. METHODS We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations over 18 years of age with SCD. RESULTS We identified 138 studies from the initial search, 12 of which met inclusion criteria and were utilized for data analysis. A total of 636 SCD patients and 360 controls were included in the Cochrane Review Manager 5.3 meta-analysis. There was a statistically significant increase in the prevalence of SNHL in adults with SCD compared with the general population with a cumulative risk ratio (RR) of 6.03. CONCLUSIONS This is the first systematic investigation of the relationship between SCD and SNHL in adult patients across the globe. SNHL is more prevalent in patients with SCD, specifically those of the HbSS genotype, than the general population likely due to the pathophysiology of the disease and its effects on labyrinthine microvasculature. The increased prevalence of SNHL in the adult SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of adult SCD patients.
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Affiliation(s)
- Elina Kapoor
- Division of Otolaryngology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Abstract
IMPORTANCE Adequate sampling of the nasopharynx is crucial to performing accurate SARS-CoV-2 (COVID) testing. Formalized education of nasal anatomy may improve provider testing technique and reduce false-negative test results. OBJECTIVE To assess the effect of nasal anatomy education on medical providers' comfort level and knowledge base in performing accurate SARS-CoV-2 (COVID) testing. STUDY DESIGN Pre-post survey. SETTINGS Tertiary care academic hospital. PARTICIPANTS 17 nurses performing COVID testing were enrolled. INTERVENTION An educational session on COVID nasopharyngeal testing technique and nasal anatomy was presented by an otolaryngologist. MAIN OUTCOMES AND MEASURES A pre-session survey assessed providers' prior nasal testing training and COVID testing challenges. Provider comfort level with COVID testing was surveyed pre-and post-session. A 6-question nasal anatomy test was administered pre- and post-session. RESULTS 16 out of 17 nurses performed fewer than 10 COVID tests prior to the educational session (94%). Reported challenges with COVID testing included patient discomfort (79.6%), inability to pass the test swab (23.5%) and nasal bleeding (11.8%). The number of providers comfortable with independently performing COVID testing increased from pre- to post-session (5 and 14, p = 0.013). The average number of correct responses to the 6-question nasal anatomy test increased following the session (3.2 ± 1.2 to 5.1 ± 1.1, p = 0.003). Specifically, the number of providers able to localize the nasopharynx increased from 8 providers pre-session to 14 providers post-session (p = 0.04). CONCLUSION Early implementation of nasal anatomy and nasopharyngeal swab technique education can help improve provider comfort and knowledge in performing accurate COVID testing.
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Affiliation(s)
- Lilun Li
- Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC 20037, United States of America
| | - Timothy Shim
- Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC 20037, United States of America
| | - Philip E Zapanta
- Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC 20037, United States of America.
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Darwish C, Shim T, Sparks AD, Chillakuru Y, Strum D, Benito DA, Monfared A. Pediatric head and neck rhabdomyosarcoma: An analysis of treatment and survival in the United States (1975-2016). Int J Pediatr Otorhinolaryngol 2020; 139:110403. [PMID: 33049553 DOI: 10.1016/j.ijporl.2020.110403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) is the most common soft tissue head and neck sarcoma in children. Stringent analysis of survival data is imperative to optimize treatment. METHODS The National Cancer Database (NCDB, 2004-2016) and the Surveillance, Epidemiology, and End Results Program (SEER, 1975-2016) were queried for patients ages 0-19 with RMS of the head and neck. Survival trends were analyzed using univariable logistic regression and Chi-square pairwise comparisons. Survival by treatment was analyzed using log-rank tests, Kaplan Meier, and multivariable Cox-proportional hazards regression. RESULTS 1147 (63.3% age <10 years, 54.3% male) and 459 (71.4% age <10 years, 53.6% male) patients were identified in NCDB and SEER, respectively. In NCDB, embryonal (n = 625, 54.5%) and alveolar (n = 300, 26.2%) were the most common histology and nonparameningeal/non-orbital (n = 634, 55.3%), followed by parameningeal (n = 303, 26.4%) and orbital (n = 210, 18.3%) the most common location. Five-year overall survival (OS) was 70.3% with lower mortality risk for embryonal histology (adjusted HR [aHR] = 0.69, p = 0.0038). Orbital tumors had greatest survival (5-year OS = 92.4%) of all sites, and their mortality risk was higher with chemotherapy and radiation compared to surgery and radiation (aHR = 6.27, p = 0.0302). SEER analysis showed average increased survival by 4% per year (p < 0.0001), but no significant 5-year OS difference when comparing 1976-1980 and 2006-2010 (p = 0.0843). CONCLUSIONS Major prognostic factors for survival in childhood RMS of the head and neck were embryonal histology, orbital site, extent of disease, and use of SRT for orbital tumors. Larger population studies are required to demonstrate survival differences between treatment modalities for other sites.
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Affiliation(s)
- Christina Darwish
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Timothy Shim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew D Sparks
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Yeshwant Chillakuru
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - David Strum
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel A Benito
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Ashkan Monfared
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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Strum D, Kapoor E, Shim T, Kim S, Sabetrasekh P, Monfared A. Prevalence of Sensorineural Hearing Loss in Pediatric Patients with Sickle Cell Disease: A Meta-analysis. Laryngoscope 2020; 131:1147-1156. [PMID: 33091179 DOI: 10.1002/lary.29199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the prevalence of Sensorineural Hearing Loss (SNHL) attributable to Sickle Cell Disease (SCD) in the global pediatric population and to identify factors contributing to its severity. STUDY DESIGN Meta-analysis. METHODS We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations under 18 years of age with excluding studies analyzing patients on iron chelation therapy, adults, or those without objective audiological analysis. RESULTS We identified 138 initial studies with 17 selected for analysis after applying the exclusion criteria. A total of 1,282 SCD patients and 553 controls were included in the meta-analysis. There was a statistically significant increase in the prevalence of SNHL in children with SCD compared to the general population with a cumulative risk ratio of 3.33. CONCLUSION This is the first systematic investigation of the relationship between SCD and SNHL in pediatric patients across the globe. The increased prevalence of SNHL in the pediatric SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of SCD patients to reduce the social and developmental morbidity of hearing loss at a young age. PROSPERO Registration #: CRD42019132601. Laryngoscope, 131:1147-1156, 2021.
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Affiliation(s)
- David Strum
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Elina Kapoor
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Timothy Shim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Sunny Kim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Parisa Sabetrasekh
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Ashkan Monfared
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
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Strum D, Kim S, Shim T, Monfared A. An update on autoimmune inner ear disease: A systematic review of pharmacotherapy. Am J Otolaryngol 2020; 41:102310. [PMID: 31733712 DOI: 10.1016/j.amjoto.2019.102310] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David Strum
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States
| | - Sunny Kim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States
| | - Timothy Shim
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States
| | - Ashkan Monfared
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, 2300 M St NW, 4th floor, Washington, DC 20037, United States.
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Mihara M, Kisu I, Hara H, Iida T, Araki J, Shim T, Narushima M, Yamamoto T, Moriguchi H, Kato Y, Tonsho M, Banno K, Aoki D, Suganuma N, Kagawa N, Takehara Y, Kato O, Koshima I. Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. Hum Reprod 2012; 27:2332-40. [DOI: 10.1093/humrep/des169] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Yap YL, Lim J, Yap-Asedillo C, Ong WC, Cheong EC, Naidu S, Shim T, Yeo M, Leow MPG, Lim TC. The Deep Inferior Epigastric Perforator Flap for Breast Reconstruction: Is this the Ideal Flap for Asian Women? Ann Acad Med Singap 2010. [DOI: 10.47102/annals-acadmedsg.v39n9p680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: This study aims to evaluate the outcome and safety of the deep inferior epigastric perforator (DIEP) flap for breast reconstruction in a group of Southeast Asian women treated in our unit and to identify risk factors for breast reconstruction using the DIEP flap in this population. Materials and Methods: This is a prospective study on 50 consecutive DIEP flap breast reconstructions by a single surgeon in an academic institution between July 1999 and July 2006. Data on patient demographics, diagnosis, procedure type, adjuvant and neoadjuvant treatments, risk factors and complications were prospectively collected and registered in a clinical database. Outcome variables include total flap loss, partial flap loss, fat necrosis and minor complications related to the donor site or flap. Known risk factors are analysed to determine if they affect outcome in terms of complication rate in this group of patients. Results: Total flap loss, partial flap loss and fat necrosis complication rates were 6%, 4% and 10%, respectively. Flap complication rates were comparable to those quoted by previous studies done worldwide. Obesity (BMI >27) is a statistically significant factor associated with development of DIEP flap complications in our population. Conclusion: Breast reconstruction with DIEP flap is a safe and reliable method when used in Southeast Asian women, offering optimal results with less donor-site morbidity. Obesity increases the incidence of flap complication in this group of patients.
Keywords: Abdominal-based free flap, Complication, Microsurgery, Post-mastectomy reconstruction
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Affiliation(s)
- Yan Lin Yap
- National University Hospital of Singapore, Singapore
| | - Jane Lim
- National University Hospital of Singapore, Singapore
| | | | - Wei Chen Ong
- National University Hospital of Singapore, Singapore
| | | | | | - Timothy Shim
- National University Hospital of Singapore, Singapore
| | - Matthew Yeo
- National University Hospital of Singapore, Singapore
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Yap YL, Lim J, Yap-Asedillo C, Ong WC, Cheong EC, Naidu S, Shim T, Yeo M, Leow MPG, Lim TC. The deep inferior epigastric perforator flap for breast reconstruction: Is this the ideal flap for Asian women? Ann Acad Med Singap 2010; 39:680-686. [PMID: 20957302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This study aims to evaluate the outcome and safety of the deep inferior epigastric perforator (DIEP) flap for breast reconstruction in a group of Southeast Asian women treated in our unit and to identify risk factors for breast reconstruction using the DIEP flap in this population. MATERIALS AND METHODS This is a prospective study on 50 consecutive DIEP flap breast reconstructions by a single surgeon in an academic institution between July 1999 and July 2006. Data on patient demographics, diagnosis, procedure type, adjuvant and neoadjuvant treatments, risk factors and complications were prospectively collected and registered in a clinical database. Outcome variables include total flap loss, partial flap loss, fat necrosis and minor complications related to the donor site or flap. Known risk factors are analysed to determine if they affect outcome in terms of complication rate in this group of patients. RESULTS Total flap loss, partial flap loss and fat necrosis complication rates were 6%, 4% and 10%, respectively. Flap complication rates were comparable to those quoted by previous studies done worldwide. Obesity (BMI >27) is a statistically significant factor associated with development of DIEP flap complications in our population. CONCLUSION Breast reconstruction with DIEP flap is a safe and reliable method when used in Southeast Asian women, offering optimal results with less donor -site morbidity. Obesity increases the incidence of flap complication in this group of patients.
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Affiliation(s)
- Yan Lin Yap
- Department of Surgery, National University Hospital of Singapore, Singapore
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Abstract
INTRODUCTION In developed countries, the majority of vesicovaginal fistulas develop after gynaecologic surgery, with abdominal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. Abdominal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair to minimize the surgical morbidity of the transabdominal approach. METHODS A 44-year-old female presented with vesicovaginal fistula after abdominal hysterectomy. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed intially to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in the Trendelenburg position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. RESULTS The operation was uncomplicated. Total operative time was 260 min. Normal diet was resumed on day 1 and patient was discharged on the same day with an indwelling catheter. A cystogram performed 3 weeks post surgery showed resolution of the fistula. CONCLUSIONS Laparoscopic repair of vesicovaginal fistula without opening the bladder and using intracorporeal suturing and omentum interpositioning is feasible in selected patients.
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Affiliation(s)
- Ho Yee Tiong
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
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Sohn H, Kim S, Ryu J, Oh S, Moon D, Oh Y, Shim T, Kim W, Suh C, Lee J. [18F]fluorothymidine (FLT) PET after 3 days of gefitinib treatment and tumor response in non-small cell lung cancer (NSCLC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13031 Background: FLT has been developed as a PET tracer for imaging tumor proliferation. We evaluated whether FLT-PET could predict tumor response only after 3 days of gefitinib treatment. Methods: Nonsmokers with adenocarcinoma of the lung were eligible for this study. FLT-PET was performed at 1 day before and 3 days after the start of gefitinib (250 mg/d) therapy. The maximum standardized uptake value (SUVmax) of the main lung mass was measured, and changes in tumor SUVmax were calculated. After 6 weeks of therapy, response was assessed by chest CT according to WHO criteria. The cutoff value predicting subsequent CT response was obtained by receiver operating characteristic curve analysis. Results: Between Jun. 2005 and Nov. 2005, 22 patients were enrolled. CT response was partial response in 12 (54%), stable disease in 5 (23%), and progressive disease in 5 (23%). As early as 3 days after the initiation of therapy, significant difference in % changes of tumor SUVmax on FLT-PET was observed between responders and nonresponders (−32% v −2.3%, P = .002) ( Table ). When a reduction of tumor SUVmax ≥ 20% was used as a cutoff value for FLT-PET response, CT response could be predicted with positive and negative predictive values of 100% and 83%, respectively. Time to progression was significantly longer in FLT-PET responders than nonresponders (median 5.1 v 1.4 months, P = .011). Conclusions: Using FLT-PET obtained on days 0 and 3 of gefitinib therapy, the response could be early predicted in patients with NSCLC. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- H. Sohn
- Asan Medical Center, Seoul, Republic of Korea
| | - S. Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - J. Ryu
- Asan Medical Center, Seoul, Republic of Korea
| | - S. Oh
- Asan Medical Center, Seoul, Republic of Korea
| | - D. Moon
- Asan Medical Center, Seoul, Republic of Korea
| | - Y. Oh
- Asan Medical Center, Seoul, Republic of Korea
| | - T. Shim
- Asan Medical Center, Seoul, Republic of Korea
| | - W. Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - C. Suh
- Asan Medical Center, Seoul, Republic of Korea
| | - J. Lee
- Asan Medical Center, Seoul, Republic of Korea
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Yoon S, Choi E, Kim S, Suh C, Lee J, Shim T, Kim W, Kim D, Park S, Park C. P-646 A phase III randomized trial of postoperative adjuvant therapy inStage II or IIIA completely resected non-small cell lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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