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Rubinstein BJ, Vazifedan T, Baldassari CM. Secondhand Smoke Exposure Measured in Urinary Cotinine Levels and Severity of Pediatric Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2024; 150:226-232. [PMID: 38329735 PMCID: PMC10853874 DOI: 10.1001/jamaoto.2023.4409] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/23/2023] [Indexed: 02/09/2024]
Abstract
Importance Exposure to secondhand smoke has been associated with numerous health problems in children, including obstructive sleep apnea. Secondhand smoke exposure may be a risk factor for increased pediatric sleep apnea severity. Objectives To assess the association of secondhand smoke exposure (SHSe), quantified by urinary cotinine levels, with severity of obstructive sleep apnea (OSA) in children. Design, Setting, and Participants This was a prospective cohort trial including pediatric patients from 3 to 16 years of age with sleep-disordered breathing who underwent a polysomnogram at a tertiary-level children's hospital in the US in either March 2014 to October 2016 or March 2020 to March 2021. Urine specimens were analyzed for cotinine, an important metabolite of nicotine. Each child's caregiver completed a validated SHSe questionnaire. Data were analyzed from February to June 2023. Exposure OSA and secondhand smoke. Main Outcome and Measures SHSe and severity of pediatric OSA, quantified by urinary cotinine levels and obstructive apnea hypopnea index (AHI) scores. Secondary outcomes were association of urinary cotinine levels with nadir oxygen saturation, sleep-related quality of life measured by the OSA-18 questionnaire, and caregiver-reported smoking habits (collected through a questionnaire). Results The study included 116 patients with a median (IQR) age of 6 (5-9) years, among whom 51 (45%) had obesity. The median (IQR) AHI was 3.0 (1.2-8.0), with 28 children (30.0%) having severe disease (AHI >10). Thirty-four children (29.0%) were found to have a positive result for urine cotinine screening, with a mean (SD) level of 11.7 (9.4) ng/mL. The percentage of children with SHSe was less than anticipated. There was no association identified between urinary cotinine levels and either AHI (ρ = -0.04; 95% CI, -0.22 to 0.15) or nadir oxygen saturation (ρ = -0.07; 95% CI, -0.26 to 0.11). Furthermore, SHSe was not associated with the presence of severe OSA (odds ratio, 0.70; 95% CI, 0.26 to 1.90). Children whose caregivers reported indoor SHSe were more likely to have a detectable urinary cotinine level (odds ratio, 20.3; 95% CI, 6.67 to 61.8). Conclusions and Relevance This cohort study did not identify any clinically meaningful association between SHSe, quantified by urinary cotinine level, and pediatric OSA severity. Future research with a larger number of children with SHSe is needed to confirm these findings and determine whether SHSe affects OSA treatment outcomes in children.
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Affiliation(s)
- Benjamin J. Rubinstein
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk
| | - Turaj Vazifedan
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk
- Division of Sleep Medicine, Children’s Hospital of the King's Daughters, Norfolk, Virginia
- Deputy Editor, JAMA Otolaryngology–Head & Neck Surgery
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Walker KN, Carlson KJ, Rubinstein BJ, Sinacori JT, Mark JR. Tracheoesophageal Fistula as a Complication of Prolonged Ventilation in COVID-19: Description of Reconstruction and Review of the Literature. Ear Nose Throat J 2023:1455613231189907. [PMID: 37534592 DOI: 10.1177/01455613231189907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Infection with COVID-19 pneumonia may necessitate intubation and mechanical ventilation. Viral inflammation and pressure necrosis may lead to scarring, stenosis, and in severe cases, fistula formation. Nonmalignant tracheoesophageal fistulas (TEF) represent a surgical challenge and may necessitate locoregional tissue transfer and tracheal resection to prevent recurrence and maintain airway patency. We present a case of TEF in a 63-year-old female secondary to prolonged mechanical ventilation in the setting of COVID pneumonia, detailing the clinical findings and surgical repair. Primary closure of the esophageal defect with pectoralis major muscle flap onlay and tracheal resection, with median sternotomy for access, provided successful intervention, allowing for subsequent tracheostomy decannulation and return to a complete oral diet. This case offers further evidence of the increased risk of airway complications in COVID-19 infection and provides otolaryngologists with an example of a rare surgical approach useful in management.
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Affiliation(s)
- Kendra N Walker
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kevin J Carlson
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - John T Sinacori
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jonathan R Mark
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
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Pu SF, Boyle JV, Rubinstein BJ, Bak MJ, Brooke Hooper A, Mark JR. Video-Based Tracheostomy Care Education for Medical Students. OTO Open 2022; 6:2473974X221134267. [PMID: 36329804 PMCID: PMC9623382 DOI: 10.1177/2473974x221134267] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Tracheostomy is a common procedure that requires management by a multidisciplinary team of health care providers across a range of surgical and nonsurgical specialties. Nonsurgical health care providers have demonstrated a lack of knowledge and confidence in tracheostomy care, which improve with tracheostomy education programs. However, tracheostomy care is rarely included in preresidency medical education. The purpose of this study is to evaluate the effectiveness of a tracheostomy care video on third-year medical students' knowledge of and confidence in performing tracheostomy care. Methods Prior to beginning clinical rotations, third-year medical students completed a 10-question tracheostomy care knowledge test (100 points total) and 11-question confidence survey (110 points total). After watching an 18-minute teaching video on tracheostomy care, students repeated the knowledge test and confidence survey. Results An overall 147 medical students completed the educational module. After they watched the tracheostomy education video, their average score on the knowledge test improved from 57.8 to 88.9 out of 100 (P < .0001), and their average rating in confidence improved from 12.7 to 49.1 out of 110 (P < .0001). Students rated the helpfulness of the video a 7.4 out of 10. Discussion Medical students' knowledge of tracheostomy care and confidence in caring for patients with tracheostomies improved after watching the video. Tracheostomy education should be included in early medical education so that future physicians of various specialties can better care for this patient population. Implications for Practice Internet-published videos are an accessible educational resource with great potential application to various topics within otolaryngology, including tracheostomy care.
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Affiliation(s)
- Serena F. Pu
- Eastern Virginia Medical School,
Norfolk, Virginia, USA
- Serena F. Pu, Department of Otolaryngology,
Eastern Virginia Medical School, 600 Gresham Dr, Suite 1100, Norfolk, VA 23507,
USA.
| | - John V. Boyle
- Department of Otolaryngology, Eastern
Virginia Medical School, Norfolk, Virginia, USA
| | | | - Matthew J. Bak
- Department of Otolaryngology, Eastern
Virginia Medical School, Norfolk, Virginia, USA
| | - A. Brooke Hooper
- Department of Internal Medicine,
Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jonathan R. Mark
- Department of Otolaryngology, Eastern
Virginia Medical School, Norfolk, Virginia, USA
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Kenerson MC, Hughes JD, Sanchez AE, DePerrior S, Rubinstein BJ, Dobratz EJ. Outcomes of Two-Stage Interpolated Flaps Versus Single-Stage Techniques for Reconstruction of Intermediate Nasal Defects. Facial Plast Surg Aesthet Med 2020; 23:383-388. [PMID: 33372836 DOI: 10.1089/fpsam.2020.0405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This study compares the results of patients undergoing reconstruction of intermediate nasal defects, measuring 1.5-2.5 cm, with single-staged techniques as opposed to the traditionally recommended staged interpolated flap reconstruction. Design: This is a retrospective review of patients who underwent reconstruction of a nasal defect by a single surgeon between 2010 and 2016. Methods: Postoperative results including revision surgery, treating persistent edema with Kenalog (triamcinolone acetonide), and perioperative complications were analyzed. Aesthetic outcomes were analyzed by a panel of experts and nonexperts, and compared using a 5-point Likert scale. Results: In total, 51 single-stage and 26 two-stage patients underwent evaluation, and of these, 40 single-stage and 15 two-stage patients underwent panel analysis of aesthetic outcomes. The odds of requiring a revision procedure were 6.69 times higher and odds of using Kenalog postoperatively were 29.67 times higher in the two-stage group than in the single-stage group. Aesthetic scores were consistently better for the single-stage group for both panels. Conclusion: Patients undergoing single-stage techniques for reconstruction of intermediate nasal defects showed improved appearance and reduced number of additional procedures relative to patients undergoing two-stage techniques with short-term follow-up.
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Affiliation(s)
- Michael C Kenerson
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jacob D Hughes
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Anthony E Sanchez
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Sarah DePerrior
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Benjamin J Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Eric J Dobratz
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Mannino EA, Rubinstein BJ, Dobratz EJ. Facial Artery Musculomucosal Flap for Nasopharyngeal and Oropharyngeal Reconstruction. Facial Plast Surg Aesthet Med 2020; 22:449-455. [DOI: 10.1089/fpsam.2019.0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elizabeth A. Mannino
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Benjamin J. Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Eric J. Dobratz
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Naunheim MR, Goldberg L, Dai JB, Rubinstein BJ, Courey MS. Measuring the impact of dysphonia on quality of life using health state preferences. Laryngoscope 2020; 130:E177-E182. [DOI: 10.1002/lary.28148] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Harvard Medical School Boston Massachusetts U.S.A
| | - Leanne Goldberg
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | - Jennifer B. Dai
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | | | - Mark S. Courey
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
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Naunheim MR, Dai JB, Rubinstein BJ, Goldberg L, Weinberg A, Courey MS. A visual analog scale for patient-reported voice outcomes: The VAS voice. Laryngoscope Investig Otolaryngol 2020; 5:90-95. [PMID: 32128435 PMCID: PMC7042645 DOI: 10.1002/lio2.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Although patient-reported outcome measures (PROMs) can be useful for assessing quality of life, they can be complex and cognitively burdensome. In this study, we prospectively evaluated a simple patient-reported voice assessment measure on a visual analog scale (VAS voice) and compared it with the Voice Handicap Index (VHI-10). STUDY DESIGN Prospective survey. METHODS An abbreviated voice measure was designed by a team of otolaryngologists, speech pathologists, and patients that consisted of four VAS questions related to (a) a global question of voice disturbance, (b) physical function of voice, (c) functional issues, and (d) emotional handicap. All English-speaking patients presenting to an academic laryngology clinic for a voice complaint were included. Internal consistency and validity were assessed with comparison to the VHI-10. RESULTS A total of 209 patients were enrolled. Ninety-two percent of patients reported understanding the survey. The four-item VAS survey was highly correlated with VHI-10 score (Pearson correlation .81, P < .0001), and the Cronbach's alpha between all four VAS questions was .94. Age, gender, and diagnosis were not associated with either the global VAS or VHI-10 tool. CONCLUSION Reducing the complexity of instruments assessing voice-related quality of life is feasible, and the VAS voice correlated with existing measures. Simplified assessments may offer advantages compared to more cumbersome PROMs. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and EarBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | | | | | | - Alan Weinberg
- Icahn School of Medicine at Mount SinaiNew YorkNew York
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Roof SA, Ferrandino RM, Villavisanis DF, Amato MV, Rubinstein BJ, Courey MS, Woo P. Infection Rates After Microlaryngeal and Open Phonosurgery: The Role of Postoperative Antibiotics. Laryngoscope 2019; 130:1128-1131. [PMID: 31424561 DOI: 10.1002/lary.28225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although it is known that the airway has bacterial contamination that seeds the surgical site during microlaryngeal surgery, literature on the use of postoperative antibiotics is lacking. We performed a retrospective analysis of open phonosurgical and phonomicrosurgical cases at a single institution to assess whether use of postoperative antibiotics impacts the incidence of surgical site infections (SSI). METHODS In this retrospective cohort study, we reviewed 228 phonomicrosurgery and 53 open phonosurgery cases performed for benign diseases. Surgeries were performed by two laryngologists between February 2016 and August 2018. The surgeons differ in their postoperative antibiotic regimens: no antibiotics versus a 5- to 7-day postoperative course. Data collected include demographics, medical comorbidities, type of benign laryngeal disease, and surgical procedure. The primary outcome measure was postoperative infection, defined as the patient requiring a new prescription for antibiotics, an extended course of antibiotics, or any mention of infection at follow-up/emergency visits within the first month postoperatively. RESULTS The overall rate of SSI was 3.1% and 0% for phonomicrosurgery and open phonosurgery cases, respectively. For phonomicrosurgery, there was no difference in the rate of SSI for patients who received or did not receive antibiotics perioperatively: 2.9% versus 3.2% (P = 0.99). Similarly, there was no difference in the infection rate for open phonosurgical cases. CONCLUSION Infection rates after endoscopic and open phonosurgery are low. In this study, we found no evidence to suggest a protective effect associated with postoperative use of antibiotics. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1128-1131, 2020.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Rocco M Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | | | - Michael V Amato
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Benjamin J Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Mark S Courey
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
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Abstract
The past 100years have witnessed dramatic shifts in the concept of ideal surgical goals and operative technique in tonsil surgery. Surgeons are reviving a technique of intracapsular tonsillectomy with increasing precision thanks to modern technology. With intracapsular tonsillectomy, pediatric patients recover faster, use less pain medication, and have a lower risk of dehydration and hemorrhage. Various considerations will dictate the adoption of this technology in the coming years. This current review explores concepts and controversies surrounding tonsillectomy with a focus on quality improvement.
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Affiliation(s)
- Benjamin J Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive Suite 1100, Norfolk, Virginia 23507, USA.
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive Suite 1100, Norfolk, Virginia 23507, USA.
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